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Breath-hold diving is a common practice as a part of military dive training. An association between prior lung injury and a propensity for lung barotrauma may have the potential to impact mission readiness for combat divers, Pararescue, Combat Controllers, Army Engineer divers, and various units in Naval Special Warfare and Special Operations. Barotrauma is a common complication of diving, typically occurring at depths greater than 30 m (98.4 ft). Individuals with abnormal lung anatomy or function may be at increased risk of barotrauma at shallower depths than those with healthy lungs, rendering these service members unfit for certain missions. We describe the case of a 25-year-old male, with a remote history of polytrauma and resultant pulmonary pleural adhesions, whose dive training was complicated by lung barotrauma at shallow depths. In missions or training utilizing breath-hold diving, the association with secondary alterations in lung or thoracic anatomy and function may limit which service members can safely participate., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2021. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Portal vein thrombosis is the thrombotic occlusion of the extrahepatic portal system, which can propagate towards the vena caval system. Although rare, it occurs primarily in those with cirrhosis, intra-abdominal infections, malignancy, or hypercoagulable disorders. This report describes the first reported case of a soldier within special operations without identifiable risk factors who was found to have a completely occlusive portal vein thrombosis after approximately 10 days of insidious abdominal pain. This case emphasizes the importance of considering this rare but dangerous pathology among this highly screened and capable special operations population., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2021. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

The 2014 Ebola outbreak in West Africa is the largest in history. Ebola viral disease is a severe and fatal illness characterized by a nonspecific viral syndrome followed by fulminant septic shock and coagulopathy. Despite ongoing efforts directed at experimental treatments and vaccine development, current medical management of Ebola viral disease is largely limited to supportive therapy, thus making early case identification and immediate implementation of appropriate control measures critical. Because a case of Ebola viral disease was confirmed in the United States on September 30, 2014, emergency medicine providers should be knowledgeable about it for a number of reasons: we are being called on to answer questions about Ebola and allay public fears, we are likely to be first to encounter an infected patient, and there are increasing numbers of US emergency physicians working in Africa who risk coming in direct contact with the disease. This article seeks to provide emergency physicians with the essential and up-to-date information required to identify, evaluate, and manage Ebola viral disease and to join global efforts to contain the current outbreak., (Copyright © 2014 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.)

Purpose: This study aimed to determine the prevalence, importance, and types of incidental findings (IF) in non-enhanced CT scans performed for suspected renal colic, based on ACR white papers and other accepted radiographic recommendations., Methods: Retrospective review of 5,383 consecutive finalized reports of nonenhanced CT using renal colic protocol performed on adult patients at 2 emergency departments over a 5.5-year period. IF were defined as those unrelated to symptoms (as opposed to alternate causes of symptoms) and were categorized as "important" if follow-up was recommended based on recently published consensus recommendations. Subsets of reports of those with important IF were blindly re-reviewed to calculate inter-rater variability for presence and categorization of important IF., Results: Important IF were identified in 12.7% (95% confidence interval [CI]: 11.8%-13.6%) of scans. Prevalence of important IF increased with age: important IF in individuals age >80 years were 4 times more common than for those aged 18-30 years: 28.9% (95% CI: 22.4%-36.4%) versus 6.9% (95% CI: 5.5%-8.6%), respectively, P ≤ .05. Women had a higher prevalence of important IF compared with men: 13.4% (95% CI: 12.2%-14.7%) versus 11.9% (95% CI: 10.7%-13.2%), but the difference was not statically significant (P = .09). There was substantial inter-rater agreement (kappa ≥ 0.69) regarding presence and classification of important IFs using published guidelines., Conclusions: Important IF occurred in 12.7% of non-enhanced CT scans performed for suspected renal colic in the emergency department and are more common in older individuals. Prospective studies that use radiographic recommendations to characterize IF and examine the outcome and cost of their workup are encouraged., (Copyright © 2015 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

The use of clinical simulation in graduate level nursing education provides the opportunity for students to learn and apply theoretical practices of nursing care in a safe and controlled environment. It was postulated that laboratory simulation would mimic the stress levels of a real clinical situation as measured by the stress hormone cortisol. The purpose of this study was to determine whether high-fidelity simulation approximates the stress experienced by nurse anesthesia students in the operating room. Participants (n = 21) were recruited from an accredited nurse anesthesia program in the southern U.S. Saliva was collected for 3 days under controlled conditions for baseline data. Next, saliva was collected for 3 days: the day before, the day of, and the day after simulation. The same process was repeated for the first clinical day in the operating room. The participants acted as their own control. There was a significant (p < 0.05) increase in cortisol levels during laboratory simulation as compared to baseline values. Although levels of cortisol were higher during clinical time than baseline, this increase was not significant (p > 0.05), and levels were lower than levels during simulation. Laboratory simulation of patient scenarios raised the stress hormone cortisol level threefold above baseline levels in nurse anesthesia students, while actual clinical experience did not.