Page 103 - JSOM Summer 2024

they would be used. Furthermore, the epinephrine vials in the Department of the Navy, the Department of Defense, or the
AMAL may be utilized for other emergencies, such as Ad- U.S. Government.
vanced Cardiac Life Support or anaphylaxis.
Copyright statement: I am a military service member of the
U.S. government. This work was prepared as part of my offi-
However, given that there is no ability to measure electrolytes cial duties. Title 17, U.S.C., §105 provides that copyright pro-
and hyperkalemia, adding three-lead cardiac-monitoring ca- tection under this title is not available for any work of the U.S.
pability should be considered. Second, as there is no ability to Government. Title 17, U.S.C., §101 defines a U.S. Government
measure renal function, renally cleared drugs, particularly enox- work as a work prepared by a military Service member or em-
aparin, should be used with caution in patients at risk for acute ployee of the U.S. Government as part of that person’s official
kidney injury. Subcutaneous heparin may be a more versatile duties.
drug for chemical VTE prophylaxis in austere environments
where renal function (beyond UOP) cannot be monitored.
Disclosures
The authors declare no funding or conflicts of interest.
Next, Distributed Maritime Operations is not a future op-
erating concept. It is happening now during current routine Funding
naval operations. As such, having a few nasogastric tubes on No funding was received for this work.
board may be beneficial for decompression of ileus related to
abdominal infections, small bowel obstruction, or for enteral This scenario and the project “Maritime Applications of Pro-
hydration and resuscitation in patients unable to take in fluids longed Casualty Care” were presented at the Special Opera-
by mouth during PCC. Finally, the lack of ultrasound equip- tions Medicine Association 2023 Scientific Assembly on 18
ment and training on smaller naval vessels must be addressed. May 2023 in Raleigh, North Carolina.
Historically, ultrasound capability has not been available be-
cause of limited space and the potential cost of equipment and References
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doi:10.55460/I18B-1ZQM
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Disclaimer 13. Castro R, Kattan E, Ferri G, et al. Effects of capillary refill time-vs.
The views expressed in this article are those of the authors and lactate-targeted fluid resuscitation on regional, microcirculatory
do not necessarily reflect the official policy or position of the and hypoxia-related perfusion parameters in septic shock: a

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