Military Physicians Are Not Just Physicians in the Military: Using Leadership Training in Military Graduate Medical Education to Assure Mission Success.

Physicians in the military often take leadership roles much earlier in their career than their civilian counterparts. Military Graduate Medical Education programs must continue to provide relevant leadership training that prepares graduates for their imminent leadership roles. The following article illustrates the experience of a junior Army Medical Corps Officer deployed shortly after residency. His case illustrates how he utilized the tools and lessons learned from the professional development and leadership training in his residency to assure the operational readiness and success of his unit.

Collapse in the Heat - From Overhydration to the Emergency Room - Three Cases of Exercise-Associated Hyponatremia Associated with Exertional Heat Illness.

Exertional heat illness and exercise-associated hyponatremia continue to be a problem in military and recreational events. Symptoms of hyponatremia can be mistaken for heat exhaustion or heat stroke. We describe three cases of symptomatic hyponatremia initially contributed to heat illnesses. The first soldier was a 31-yr-old female who "took a knee" at mile 6 of a 12-mile foot march. She had a core temperature of 100.9°F, a serum sodium level of 129 mmol/L, and drank approximately 4.5 quarts of water in 2 h. The second case was a 27-yr-old female soldier who collapsed at mile 11 of a 12-mile march. Her core temperature was 102.9°F and sodium level was 131 mmol/L. She drank 5 quarts in 2.5 h. The third soldier was a 27-yr-old male who developed nausea and vomiting while conducting an outdoor training event. His core temperature was 98.7°F and sodium level was 125 mmol/L. He drank 6 quarts in 2 h to combat symptoms of heat. All the three cases developed symptomatic hyponatremia by overconsumption of fluids during events lasting less than 3 h. Obtaining point-of-care serum sodium may improve recognition of hyponatremia and guide management for the patient with suspected heat illness and hyponatremia. Depending on severity of symptoms, exercise-associated hyponatremia can be managed by fluid restriction, oral hypertonic broth, or with intravenous 3% saline. Utilizing an ad libitum approach or limiting fluid availability during field or recreational events of up to 3 h may prevent symptomatic hyponatremia while limiting significant dehydration.