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Introduction: Exertional heat stroke is a pathology well known to military doctors because it is not uncommon for our soldiers to regularly make intense efforts in difficult training or operational missions. Idiopathic etiology and genetics are by far the most described. We report for the first time a case of exertional heat stroke secondary to amphetamine use in the military environment and here, let’s raise the issue of ethics in the Army. Case Presentation: A young parachutist soldier presented an episode of general convulsions complicating an exertional heat stroke during an 8 km race in battledress and combat boots. After further investigations, laboratory results found amphetamine in the urine. Even if the soldier only allowed branched chain amino acids (BCAAs) supplements, this exertional heat stroke was due to amphetamine use. After a review of the physiopathological effects of amphetamine, we will recall the various means of screening with their limits. Many of our soldiers consume dietary supplements to be able to better endure the constraints to which they are exposed in internship or operations. Conclusions: Doping, willingly or not, is a reality in our Army, even though we still struggle to understand it. Health and command chains must be vigilant to these lines to preserve the health of our military on the one hand and enforce a code of ethics on the other.

A 31-year-old woman presented to the emergency room for symptoms that promptly evoked thyrotoxicosis in a dysthyroid patient. The evolution was quickly unfavorable despite the initial specific management of thyrotoxicosis. The search for a cause for the acute decompensation of her thyroid pathology has led to the diagnosis of acute bacterial meningitis. The treatment of the meningitis has quickly improved the patient's condition. This case illustrates the necessity of looking for an acute underlying cause for thyrotoxicosis to not delay the treatment or risk aggravating the case. This clinical case also illustrates the management of thyrotoxicosis, a known but very rare pathology.

Background In current French military operations, it is not uncommon for the military nurses (MNs) to be required to support soldiers alone in isolated areas. At a time when advanced practice nurses in the civilian sector develop extended skills, we asked MNs about their willingness to be trained in point-of-care ultrasound (POCUS).Methods We conducted a web-based survey from 1 November 2018 to 1 December 2018, including all MNs deployed in the Barkhane operation. The questionnaire, sent by e-mail, aimed to describe the willingness of MNs to be trained in POCUS. Their opinion on the usefulness of this training, the situations and ultrasound targets that seemed most profitable to them were also studied.Results 30 questionnaires out of 34 were completed. On average, MNs had 7.4 years of practice and had already carried out three military operations. Three MNs reported having been trained in POCUS and six had already performed POCUS on the field. 96% of the untrained MNs wanted to be trained. Twenty-nine (96%) MNs felt that there was added value in knowing how to perform POCUS, especially in operations and in isolated posts without a military physician (MP). Focused assessment with sonography for trauma, pleural and urinary tract ultrasound were the targets considered most useful to them, in that order.Conclusion MNs are interested in learning POCUS. A training course before their departure on mission for simple and quick acquisition targets would be easy to implement and probably beneficial for the patient, the MN and the MP.