Page 148 - JSOM Fall 2022

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In Performance Evaluation of the Solo-T and the Combat Hypertonic Saline for Severe Traumatic Brain Injury With
Application Tourniquet in a Perfused Cadaver Model, the au­ Herniation: A Military Prehospital Case Report details the
thors evaluated a 10.2­cm­wide, minimally elastic, adhesive management of a pregnant patient with severe traumatic brain
wrap–based tourniquet (Solo­T or ST) alongside a 3.8­cm­ injury and signs of impending or ongoing herniation. Addi­
wide windlass­based tourniquet (Combat Application Tourni­ tionally, the authors review the pathophysiology and signs of
quet Generation 7, or CAT). herniation, the mechanism of action of hyperosmotic thera­
pies, and the rationale behind the use of hypertonic saline in
the combat setting.
The Present State of Military Physician Leadership: A Lack-
ing Paradigm? (Editorial) discusses the military health system
and suggests (1) Make clinical practice matter, (2) Emphasize
the need for ICTL training for everyone, (3) Perform an evi­
dence­based evaluation of nonmedical training requirements
and eliminate those that have little value, and (4) Build clinical
practice into staffing models for all leadership, administrative,
and operational positions.
LEFT: Combat Application Tourniquet
Generation 7 (CAT), RIGHT: Solo­T (ST).
In the Letter to the Editor, the authors discuss “Casualty
Helicopter Crashes in the Deployed Combat Setting: The De- Evacuation (CASEVAC) Platform Review and Case Series of
partment of Defense Trauma Registry Experience describes US Military Enroute Critical Care Team With Contract Per­
injury patterns associated with military helicopter mishaps, sonnel Recovery Services in an Austere Environment,” by N.
which frequently lead to multiple casualty events with com­ L. Boyer, et al. (Volume 21, Edition 4/Winter 2021).
plex injury patterns. Data specific to this mechanism of injury
in the deployed setting are limited. In Smallpox as a Bioagent: A Refresher and Update for the
SOF Provider (Infectious Diseases), the authors include its
A Review of Acute Kidney Injury (Critical Care Medicine): epidemiology and management with updated FDA­approved
Acute kidney injury (AKI) is a serious, often silent, medical countermeasures.
condition with diverse etiologies and complex pathophysiol­
ogy. We discuss the case of a patient injured in a single vehicle
rollover. Included is a discussion of prevention and supportive
care, with a focus on electrolyte repletion, fluid correction,
minimization of nephrotoxic exposures, and identification
and treatment of the root cause.

The authors of Bilateral Pneumothoraces in a Tandem Para-
chuting Passenger Without Traumatic Impact: A Case Report
explore the forces of the parachute “opening shock” and dis­
cuss options for diagnosis and conservative management of
pneumothorax in the operational context.

Day 7 – First-time vaccinee successful
“take.”

144 | JSOM Volume 22, Edition 3 / Fall 2022