Page 138 - JSOM Fall 2025

Study Collaborators ; Steven G. Schauer, LTC, DO, MS ; Nee- Conclusion
1
4
Kofi Mould-Millman, MD, PhD, MSCS 1
It is unlikely that these patient characteristics may contribute
1 University of Colorado School of Medicine, Aurora, CO to early recognition of hypocalcemic trauma patients; how-
2 Colorado School of Public Health, Aurora, CO ever, more research is needed to compare the trauma triage
3 Stellenbosch University, Cape Town, South Africa scores to evaluate their utility in identifying patients at risk for
4 Western Cape Government Health and Wellness, Cape Town, hypocalcemia in trauma.
South Africa

Introduction BEST CASE REPORT
Calcium derangements are common after trauma, with prior Acute Aortic Dissection in a Paratrooper Following
research linking hypocalcemia to mortality. With upcoming Airborne Operation: A Case Report
1
1
studies evaluating empiric calcium supplementation, our re- Sarah Mongold, MD ; Ryan Menges, PA-C ; Ethan Haley,
1
search aims to identify patient characteristics specifically asso- EMT-P ; David Taylor, PA-C 1
ciated with hypocalcemia to target certain trauma populations 1 4/160th SOAR (Abn)
for potential supplementation in resource-limited pre-hospital
settings. Introduction
Aortic dissection is a rare and potentially life-threatening con-
Methods dition that can occur in individuals subjected to high-stress
This study includes a subset of individuals enrolled in the Ep- activities. Airborne operations involve extreme physical forces
idemiology and Outcomes of Prolonged Trauma Care (EpiC) that may increase the risk of aortic injury.
study in South Africa, those with at least one serum ionized
calcium level obtained prior to blood product administration. Methods
Patient characteristics such as sex, injury type (blunt, pene- We report a case of a 37-year-old male paratrooper who sus-
trating, mixed), injury location, initial laboratory values, and tained an acute aortic dissection (Stanford Type A and B) fol-
hemodynamic measurements were evaluated. Several ana- lowing a static line training jump. The patient, an experienced
tomic and physiologic measures of injury severity were also paratrooper, was participating in a routine training exercise.
evaluated. Descriptive and inferential statistics were used to After returning home, he developed chest pain and syncopized
compare groups, and multivariable logistic regression adjusted before presenting to the local emergency department.
for confounders.
Results
Results
Diagnostic imaging revealed a large ascending and descend-
A total of 1,989 subjects met inclusion criteria. The median ini- ing aortic dissection. The patient underwent immediate sur-
tial ionized calcium was 1.14mmol/L (IQR 1.09–1.19mmol/L); gical repair of the ascending portion. The descending portion
27.2% were hypocalcemic (<1.10mmol/L), and 1.0% hyper- was monitored and the patient treated with dual anti- platelet
calcemic (>1.29mmol/L) on presentation. Hypocalcemic indi- therapy. He recovered successfully with no postoperative com-
viduals were older (33.7 vs. 32.2y; p=.005) and had shorter plications. He underwent genetic testing for an underlying
injury-to-vital sign times (2.5 vs. 2.9hr; p=.008) but showed connective tissue disorder.
no significant differences in initial hemodynamics orinjury se-
verity, location, or type. In univariable regression analyses, a Discussion
physiologically based triage severity score was the only trauma
severity score significantly associated with calcium levels (esti- This case highlights the potential risk of aortic dissection in
mate –0.004 [CI –0.007 to –0.001]; p=.004). paratroopers. The physical forces associated with parachute
jumps, including deceleration and barotrauma, may contribute
Discussion to the development of aortic injury. We review the relevant lit-
erature and discuss the implications for the medical screening
There is no apparent relationship between injury type, bodily and management of paratroopers at risk for aortic dissection.
location, or initial individual hemodynamic measurements to
predict hypocalcemia, except a trauma triage severity score Conclusion
in this trauma population. The triage severity score (TEWS)
most associated with hypocalcemia is a composite measure of Acute aortic dissection is a rare but potentially catastrophic
systolic blood pressure, heart rate, SpO , temperature, ambu- injury in paratroopers. This case report serves as a reminder of
2
latory status, and mental status; although each is not individ- the importance of prompt recognition and treatment of aor-
ually correlated with hypocalcemia, the composite measure is. tic emergencies in this population. Further research is needed
In austere medical environments with limited laboratory capa- to elucidate the mechanisms of aortic injury in paratroop-
bilities, empiric calcium supplementation targeted at the most ers and identify patients at increased risk, as well as inform
vulnerable patients could be a low-cost risk-reduction strategy, evidence-based guidelines for their medical evaluation and
if such patients could be identified. management.

PMID: 40986754; DOI: 10.55460/RLWH-J3I8

136 | JSOM Volume 25, Edition 3 / Fall 2025