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Combat Anesthesia: The First 24 Hours

Combat Anesthesia: The First 24 Hours
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This book focuses on anesthesia care during the 24 hours following battle wounds. It is written by British and American physicians who began this collaboration while providing acute care to injured Soldiers of both countries at Camp Bastion and Fort Leatherneck in the Helmand province of Afghanistan. These authors, having deployed throughout Afghanistan and Iraq, address the ways in which care was delivered by U.S. and British trauma teams working together and sharing their competence. This is a story of how these expert physicians organized care and improved in-hospital patient outcomes. The principles presented in this book are also relevant to trauma care in non-military hospitals in the United States, Britain, and beyond.

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Table of Contents

Table of Contents:

Contributors xiii

Foreword by The Surgeon General xix

Prologue xxi

Preface xxiii

Section I. Background Knowledge 1

1. Physiology of Injury and Early Management of Combat Casualties 3

 Diego Vicente, Benjamin K. Potter, and Alexander Stojadinovic

2. Preparing the Team 31

Simon Mercer, Scott Frazer, and darin via

3. Military Prehospital Medicine 41

 Craig D. Pope, Christopher Wright, Jonathan B. Lundy, Giles R. Nordmann, Daniel Gower, Samuel Fricks,

 Larry N. Smith, and Stephen Rush

Section II. Practical Aspects of Anesthesia for Complex Military Trauma 57

4. Conducting a Complex Trauma Anesthetic 59

 Paul Wood, Christopher J. Nagy, Tom Woolley, and Allison A. Cogar

5. Vascular Access and Infusion Devices for Combat Anesthesia 63

 Andrew G. Haldane and Lance R. Hoover

6. Managing the Airway 75

 Simon Mercer and John Breeze

7. Damage Control Resuscitation 85

 Rob Dawes, Rhys Thomas, and Mark Wyldbore

8. Massive Transfusion in the Field 95

 Matthew Roberts, Mark H. Chandler, and W. Jonathan Mayles

9. Perioperative and Interoperative Critical Care 107

 C.L. Park and P.J. Shirley

10. Head and Neck Trauma 121

 Ryan Keneally, Michael Shigemasa, and Arthur R. Mielke

11. Thoracic Injury 133

 Jonathan A. Round, Adrian J. Mellor, and W. Andrew Owens

12. Extremity, Junctional, and Pelvic Trauma 143

 Victoria Pribul, Richard Reed, and Paul Moor

13. Critical Care and Anesthetic Care of Military Burn Casualties at Role 3 Facilities 163

Christopher V. Maani, Michael K. Tiger, and Jacob J. Hansen

14. Imaging 175

 Richard Heames and George Evetts

15. Management of Stable Casualties 181

 Stephen Lewis and S. Jagdish

Section III. Pain Management 191

16. The Physiology of Acute Pain 193

 Guy James Sanders

17. Why Pain Relief Is Important: The Physiological Response 199

 Dan E. Roberts and Dominic Aldington

18. Multimodal Analgesia for Specific Injury Patterns 205

 R. Scott Frazer

19. Scoring Pain 213

 Jemma Looker and Dominic Aldington

20. Pain Medications 219

 Matthew Pena, Michael Kent, Christopher J. Spevak, and Taylor Atchley

21. Advanced Pain Management Techniques 229

 K. Woods and Gregory K. Applegate

22. Regional Anesthesia and Coagulopathy of Trauma Shock 241

 Dan Connor

23. Acute Presentations of Chronic Pain Conditions 245

 Mark Davies and Steven P. Cohen

24. The Deployed Pain Service 261

Michael Ingram

25. Prehospital Analgesia 267

 Michael Lee, Michael Kent, Charlotte Small, C.L. Park, and Claire Sandberg

26. Combat Trauma Outcomes Tracking and Research 275

 Chester “Trip” Buckenmaier III and Kevin T. Galloway

Section IV. Field Critical Care: Immediate Postoperative Management, Organ Preservation, and

Preparation for Transfer 283

27. Receiving the Critical Care Patient 285

 Bryce Randalls

28. Damage Control Philosophy in Critical Care: Patient Management and Organ Support 295

 Robin D. Berry

29. Mechanical Ventilation of the Trauma Patient in the First 24 Hours 303

 Karen Smyth and James J.K. McNicholas

30. Ventilation for Tracheal Disruption and Bronchopleural Fistula 315

Jeffrey A. Mikita and Douglas Powell

31. Renal Support in Military Operations 321

 Ian Nesbitt and Michael K. Almond

32. Diagnosis and Management of Hypotension and Shock in the Intensive Care Unit 327

 Jessica Bunin

33. Differential Diagnosis and Management of Fever in Trauma 339

 Christian Popa

34. Thromboembolic Disease and Management of Anticoagulation in Trauma 351

 Aaron B. Holley

35. Intensive Care Unit Sedation in the Trauma Patient 359

Timothy Jardeleza

36. Nutritional Support in the Intensive Care Unit 371

 Jan O. Jansen, S. Turner, and Andrew McD. Johnston

37. Management of Infection and Sepsis in the Intensive Care Unit 381

 Timothy Scott, Andrew Matheson, and Andrew D. Green

38. Air Transport of the Critical Care Patient 391

 Robert D. Tipping, Sean M. MacDermott, Clinton Davis, and Todd E. Carter

39. Basics of Pediatric Trauma Critical Care Management 401

 Christopher M. Watson and Downing Lu

40. Multidrug-Resistant Organisms and Infection Control Practice in the US Military Medical System 431

 Michael Zapor

Section V. Special Circumstances 445

41. Humanitarian Operations and Aid Agency Anesthesia 447

 Laura L. Roberts, Jeyasankar Jeyanathan, John H. Chiles, and Peter F. Mahoney

42. Ethical Challenges of Deployed Military Critical Care 459

 Deborah Easby, David P. Inwald, and James J.K. McNicholas

43. Military Pediatric Anesthesia 469

 Giles R. Nordmann, Deborah Easby, and H.E.J. Pugh

44. Anesthesia Considerations in the Elderly Population 485

 Paul Wood and Peter F. Mahoney

45. Obstetric Anesthesia 491

 Ben Siggers, Harriet Edgar, Christopher Tebrock, and Harold Gelfand

46. Anesthesia Following Chemical, Biological, Radiological, and Nuclear Exposure 505

 T.C. Nicholson-Roberts, Elspeth J. Hulse, and Scott M. Croll

Section VI. Resources and Further Information 525

47. Current Anesthesia Equipment 527

 R. Scott Frazer and J.C. Wright

48. Specialist Equipment for Pain Management 545

 Michael Ingram, Anthony Plunkett, and Indy Wilkinson

49. Resuscitation Guidelines 551

 Nicholas T. Tarmey and R. Scott Frazer

50. The Home Base: Landstuhl, Germany, and Hospitals in the Continental United States 561

 Craig C. McFarland and Christopher J. Spevak

51. The Home Base: Queen Elizabeth Hospital Birmingham and Other Hospitals in the United

Kingdom 567

 Paul Wood

Abbreviations and Acronyms xxv

Index xxix


This textbook is intended to be educational for military healthcare providers and first responders. The content may also be useful to some civilian healthcare providers, as well.

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