Dirty dust

This is supposed to be a trauma hospital.  We see our share, though thankfully, far less than we used to see here earlier in the war.  People do get sick wherever they are, however, and if they're sick enough, and they are in Iraq, they evenutally find their way here.  I should qualify that statement, as all sick Iraqis obviously don't end up here.  This is meant to say, all US military, any coalition military as per host country (some countries fly their patients home or to other nearby bases), contract workers (depending on where they are injured, and what is their country of origin - American and British contractors all end up coming here), and Iraqi military, police, or civilians who are approved for treatment here on a case by case basis (more on this arbitrary process in a blog tbd).

The sick huddled masses yearning to receive ICU medical treatment include routine pneumonia, heart attack and pyelonephritis patients.  They also include a handful who fall victim to nasty arthropods, an occassional stroke patient - including the 22 yo boy I cared for last night - and a surprisingly high number of pneumonitides.  Some military colleagues of mine published a manuscript describing a series of patients in the New England Journal of Medicine a couple of years ago noting the increased rate of acute eosinophilic pneumonitis among otherwise young, healthy soldiers here in Iraq.  This is a inflammatory reaction which causes lung damage, usually at the prompting of an allergen.  These patients typically increased or started smoking cigarettes in theatre, and developed acute shortness of breath imediately after a dust storm, implying some allergen in the dust, and a baseline lung inflammation due to new or increased smoking.  This shortness of breath came with hypoxia - an inability to deliver oxygen to the tissues - terrible lung inflammation on radiographic studies, often intubation and ventilatory support, and sometime death.  Interestingly, we have seen a handful of these patients here in central Iraq, and a number sent here via helicopter or airplane transport from surrounding areas.  We treat them with steroids - not anabolic steroids, but anti-inflammation steroids - and try to send these patients to a higher level of care as we can.  [This involves the USAF's critical care air transport team CCATT, and I will write more details on this fascinating subculture within military medicine on a later blog].

Perhaps the eons old tradition of the Kafiyah (or Bedouin headdress) has a purpose beyond fashion.  I did not get a camoflauge military-issue Kafiyah, but I may fashion my own for the next dust storm that comes this way.  Maybe I will get one at the Haji-mart!