Request for information on military medicine/physician education

Recently, a medical resident asked me whether a certain medical finding in a patient might be related to a prior blast/IED injury ("Could it be a delayed response in the skin"?)

I am not in the military and I've never practiced medicine in that environment. (I note as veterans are rotating back into civilian life, many physicians as faced with similar scenarios.)

What resources are available to civilian physicians interested in improving skills? WRT the medical resident's question, I did find a book called Military Dermatology on Amazon. I'll keep searching, of course. Other online or book resources?

Thanks!

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Originally Posted by Madhu

Recently, a medical resident asked me whether a certain medical finding in a patient might be related to a prior blast/IED injury ("Could it be a delayed response in the skin"?)

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I’m not a medical professional, but one possibility is that neurotrauma has lead to endocrine dysfunction manifesting in a skin condition. There are, of course, many other possibilities.

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Originally Posted by Madhu

What resources are available to civilian physicians interested in improving skills? WRT the medical resident's question, I did find a book called Military Dermatology on Amazon. I'll keep searching, of course. Other online or book resources?

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Try the Borden Institute's/Walter Reed's Blast Injury: Translating Research Into Operational Medicine.

You can also go through the issues of The Journal of Special Operations Medicine; they've published several articles on blast injuries over the past few years.

This item arrived from the Royal British Legion:

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Research centre to combat devastating effects of roadside bombs at Imperial College London.

Gaining a better understanding of the injuries caused by roadside bombs and improving both treatment and the means of protection are key aims of a new £8 million research centre launched today. Designing 'intelligent' combat boots to deflect the impact of a roadside bomb and diagnosing damage more quickly in the injured to reduce future medical problems are two potential benefits.

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Link:http://www.britishlegion.org.uk/abou...injury-studies

The CDC among others has also joined the fight

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Expect an “upside-down” triage

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Very helpful. Educational links which I will explore more fully when I have time.

I was thinking something along the lines of the following:

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Veterans from the first Gulf War with embedded shrapnel have stronger skin reactions to metal allergy than those without shrapnel, according to the first study of cutaneous reactivity to traumatically implanted metals.
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Dr. Marianna Shvartsbeyn and her colleagues patch tested 40 Gulf War I veterans to an extensive number of metal allergens and found that, overall, 25% were reactive to zinc and 12.5% to manganese.

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http://www.skinandallergynews.com/sp...bcc0c3506.html



Brief and initial reaction based on what I already know and what I've learned from a quick skimming of certain materials:


1. Prior sites of skin trauma (scars) may serve as sites of re-flaring or flaring of chronic inflammatory skin conditions such as psoriasis, sarcoidosis, eczema, etc.

2. TBI may affect portions of the brain involved with touch perception and patients may experience sensations of skin tingling, burning, pain, pruritis ("itching").

a. This may result in skin manipulation by the patient (scratching, etc.)

3. A skin injury may introduce an infectious agent with cutaneous symptoms manifesting at a later date (the following pdf is interesting but I haven't had a chance to go through it fully so I don't know if it relates to this point):

(Returning Veterans From Iraq pdf/slides):
www.sgim.org/userfiles/file/AMHandouts/AM06/handouts/WD04.pdf

4. Patients theoretically may present with metal allergies to shrapnel although I haven't explored that in detail and I don't know the data or studies very well.


I am sure there are more to go on this list. I will update as I find out more.