Page 96 - Journal of Special Operations Medicine - Spring 2016

Category: Nontoxic Patient The authors also wish to thank Dermnet.NZ for the use
With Nonpalpable Petechiae of the basic morphology pictures. Dermnetnz.org is an
Immune thrombocytopenic purpura (ITP) – In this condi- excellent online reference for dermatology.
tion, the patient’s immune system attacks their platelets.
These patients may have petechiae or purpura but gen- Disclaimers
erally look pretty well. The primary concern with this
condition is to ensure it is not associated with a more The views and medical opinion herein represent those of
serious cause such as DIC or TTP. ITP can be caused by the authors. They do not reflect the operation practice
drug reactions, viral infections, pregnancy, or can be id- or views of the Canadian Forces or other organizations.
iopathic. Significant bleeding can occur. In the deployed The cases are provided to be educational and thought
setting, the clinician should search for a precipitating provoking; at no time does the author suggest that the
cause and carefully observe the patient for any deteriora- tactical clinicians exceed the scope of their practice or
tion or bleeding. These patients may require steroids and act against the direction of their medical protocols or
or IV immunoglobulin. They should be evacuated to a recommendations of their medical leadership.
7
higher level of care when it is tactically feasible to do so.
Disclosures
Category: Nontoxic Patient With Palpable Rash
Autoimmune vasculitis – In this category of conditions, The authors have nothing to disclose.
the patient’s immune system attacks the blood vessels.
This is a large and complicated category of autoimmune References
illnesses that can present differently. It can occur from
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-treatment-and-prognosis?source=search_result&search=
she developed some joint pain in her knees. She did not Immune+thrombocytopenia+%28ITP%29+in+adults%3A+
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lesion; the finding was leukocytoclastic vasculitis. The
doxycycline was suspected as the cause. The patient was
treated with steroids and improved over the next 4 weeks. Sgt Banting of the Canadian Forces is a medical technician
with extensive SOF experience who is currently on the Cana-
dian Forces Physician Assistant course.
Acknowledgments
Major Meriano is a practicing emergency physician. He has
The authors gratefully acknowledge Dr Heather Murphy- served in various capacities with the Canadian Forces and Re-
Lavoie for the use of the algorithm. It is highly recom- serves since 2003. Comment and suggestions can be sent to
mended that her article and iOS app be used as a reference. sofclinicalcorner@gmail.com.

80 Journal of Special Operations Medicine Volume 16, Edition 1/Spring 2016