Warming up

(Landing at the scene)

There has been an increase in activity around FOB Salerno. I don’t know if it is due to the transition of troops moving in and out of theatre or improved weather conditions, however, this week was busier than last. Picture # 1 is an amazing picture of a black hawk helicopter landing at an injury scene. I didn’t take it, as I am not allowed to, nor do I particularly want to, go off base or as we call it “outside the wire.” This was actually an incident between American troops and enemy combatants. This stockpile of weapons (picture # 2) demonstrates what our troops are up against. Unfortunately, due to experience and many casualties, most troops that travel outside the wire do so in heavily armored trucks (picture #3). This has greatly helped to reduce injuries sustained from IEDs, etc. Unfortunately again, not ALL troops ride in these vehicles. Some still travel in HUMVEEs which have been reinforced with armor; however, they still don’t offer the same degree of protection.

We spent most of the day taking care of a soldier that was riding in a HUMVEE when it was attacked (picture #4). The body armor usually protects the chest and abdomen from severe injury, however, the head, face, and extremities are often exposed. This soldier suffered terrible burns to his extremities and face. After a quick evaluation in the EMT he was taken immediately to the OR. There treatment continued by warming the patient and starting fluid resuscitation. When the skin is burned, the body loses its ability to regulate temperature control and maintain its fluids. Therefore, these types of injuries usually result in the patient being very cold and dehydrated. Deep burns that go all the way around a limb can cause constriction of the extremity due to swelling. When this occurs an escharotomy is required to restore blood flow (picture #5). Once stabilized he was transferred by helicopter to Bagram; within 24 – 28 hours he will be stateside at the BAMC burn center where they will continue his treatment. Unfortunately, one of the soldiers in his company was killed. As he was transported from the morgue to the helicopter, everyone available on base lined up by the flight line to pay their last respects and give him a “heroes'” goodbye (picture #6)

.(Escharotomy)

(Heroes' goodbye)

The rest of the week remained busy with both elective and emergent cases. The thyroid gland is an organ that regulates the metabolism of the body. It utilizes dietary iodine to make the thyroid hormones. In Afghanistan there is a deficiency of iodine. Because of this some individuals develop markedly enlarged thyroids that cause breathing and swallowing problems. Almost every week we see someone in clinic who is symptomatic from a thyroid goiter. We were able to take out two rather large thyroids this week, one of which was on the mother of an interpreter here at the hospital. I’m glad to say, everyone did very well. Picture # 7 shows just one side of the thyroid we removed. The young man I spoke about last week also recovered to the point of being discharged from the hospital. Dr. D and I posed with him before he left while he showed off his wounds (picture # 8). As the weather warms and as more troops move into the area, life is guaranteed to be busier. Although I enjoy the challenge, I continue to hope that the injuries we treat will be minor and non-life threatening. I leave you with a bumper sticker on one of the Special Forces vehicles (picture # 9). Take care.