Secondary abdominal compartment syndrome after military wounding.

Intra-abdominal hypertension and abdominal compartment syndrome are increasingly recognised as causes of serious morbidity and mortality in critically injured patients, particularly those with significant burns. Identification of at risk patients, routine monitoring of intra-abdominal pressures and appropriate, early treatment may reduce the incidence and complication rate of abdominal compartment syndrome and so improve outcomes in critically injured personnel. We present the case of an American Marine injured in an explosion while on patrol in Afghanistan, who despite the absence of significant intraabdominal injury, went on to develop abdominal compartment syndrome and required decompressive laparotomy.

Better drug history taking: an assessment of the DRUGS mnemonic.

To improve drug history taking before anaesthesia, we have previously suggested a checklist with the mnemonic DRUGS (Doctor, Recreational, User, Gynaecological, Sensitivities). We have now tested this mnemonic in 1053 patients admitted for surgery, comparing the results with the information obtained in the original clerking. Use of the mnemonic yielded additional information in 621 patients (59%). Drugs which had gone unrecorded in routine clerking were detected in 24% of patients on medication. Of 199 patients with high alcohol intake, this feature had been recorded in only 38 (19%). Unprescribed medicines, being taken by 158, had been noted in only 31 (20%). Of women taking oral contraceptives or hormone replacement therapy, more than two-thirds had not given this information. Sensitivities had been recorded accurately in 100 patients but the mnemonic yielded relevant information in a further 85. On this evidence, use of the simple DRUGS mnemonic improves drug history taking in anaesthetic practice.

Stress fracture of the sternum: an unusual injury?

Stress fracture of the sternum is a rare condition which presents as acute anterior chest pain after repetitive upper-body exercise. Two case reports are presented and it is postulated that this is an often underdiagnosed condition which should be considered in the differential diagnosis of acute chest pain in the athlete. Awareness of the injury together with meticulous clinical examination supported by good quality radiographs or isotope bone scan may lead to an increase in the diagnosis of this injury.

Taking a 'drugs' history.

A simple, anonymous questionnaire was used to examine the depth of drug history taken from patients by a group of junior doctors. The results showed that most who replied restricted their history to prescription medicines and smoking. We feel that this is no longer sufficient and that a drug history should be expanded to include substances such as recreational drugs and over-the-counter preparations. If an allergy is reported, detailed questioning about its nature is also important since the term is often used by patients when a true allergy does in fact not exist. We present a mnemonic which can be used as an aide memoire to the various areas of importance.

The laryngeal mask airway (its potential for the military).

The introduction of the laryngeal mask airway (LMA) in the early 1980s has revolutionised airway management. Clinicians have shown the ease of LMA insertion compared to endotracheal intubation by unskilled personnel. Despite the lack of protection against aspiration of gastric contents, the LMA's ability to maintain the airway and oxygenation warrants its incorporation into military life support protocols and into an integrated respiratory support concept for conventional and NBC operations.