the military medical community within nato and its multinational challenges- dunn
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Clinical Case
• 26 yo male serviceman.• PC. Sore upper limbs and dark urine• Past hx gastric ulcers and on losec 20mg daily.• Did a weights session on the Monday was OK Tuesday , but had very sore and weak
upper limbs, abdominal pain on the Wed with dark urine. Seen by the medic who found he had protein and blood in the urine, was unsure and thought he may have a UTI , gave him analgesia then referred him the next day to clinic.
• Seen by a locum GP who found the arm pain was improving , urine was clear.• Urine dipstick showed protein++ and blood BP 160/75.• He diagnosed rhabdomyolysis and sent the urine to the lab and did AST and ALT, K+
and creat. and sent him home.
• 2 days later I was at the clinic and his results were on my desk• ALT 691 AST 2831 GGT 22 Creat 73 EGR>60 , K= 4.8• Urine protein 1.5g/leuc 26-50 , no RBC.
• I requested a CPK and saw the patient. • He had not used steroids , but had a EAS protein shake prior to the weights session.• Arms were still sore and weak but improved. He still had some abdo pain• BP 150/70, and I thought his liver was tender.
• CPK was 233000iu/l.
He was admitted by the medical team for observation.
• Rhabdomyolysis• Skeletal muscle injury releasing myoglobin, CPK LDH, AST ALT and other
intracellular contents into the plasma.• Potential complications include Hypernatraemia, Hyperkalemia, hyperuricaemia, hypo
or hyper calcaemia, DIC , and renal failure……
• Muscle pain , limited ROM and dark urine post exercise.
Changes in the Age composition of the Army RF
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RF DEPLOYABLE STATUS
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Annual Workplace Injuries
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Lower back InjuriesLower Limb InjuriesOther InjuriesAnnualised Injury Rate Compared to Total RF Strength
• Medical Software• Beware the central server• Resource training , and ongoing training• Must have good user interface to gain credibility (instinctive)
DTP
ABCA• Standards• Publications• Reports.
• TRAC2ES• TCCC
Don’t forget the alcohol !!!
“An asymmetric response to an asymmetric challenge”
COMBAT ATHLETE
Military Clinical Leadership