Combat Anesthesia: The First 24 Hours

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.  

Table of Contents

Contributors xiii

Foreword by The Surgeon General  

Prologue xxi

Preface xxiii

Section I. Background Knowledge

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

2. Preparing the Team 31 

3. Military Prehospital Medicine

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

4. Conducting a Complex Trauma Anesthetic 59

5. Vascular Access and Infusion Devices for Combat Anesthesia 63

6. Managing the Airway 75 

7. Damage Control Resuscitation 85

8. Massive Transfusion in the Field 95 

9. Perioperative and Interoperative Critical Care 107

10. Head and Neck Trauma 121

11. Thoracic Injury 133

12. Extremity, Junctional, and Pelvic Trauma 143

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

14. Imaging 175 

. Management of Stable Casualties 181

Section III. Pain Management 191

16. The Physiology of Acute Pain 193

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

18. Multimodal Analgesia for Specific Injury Patterns 205

19. Scoring Pain 213

20. Pain Medications 219 

21. Advanced Pain Management Techniques 229

22. Regional Anesthesia and Coagulopathy of Trauma Shock 241

23. Acute Presentations of Chronic Pain Conditions 245

24. The Deployed Pain Service 261 

25. Prehospital Analgesia 267

26. Combat Trauma Outcomes Tracking and Research 275

Section IV. Field Critical Care: Immediate Postoperative Management, Organ Preservation, and Preparation for Transfer 283

27. Receiving the Critical Care Patient 285

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

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

30. Ventilation for Tracheal Disruption and Bronchopleural Fistula 315

xi 31. Renal Support in Military Operations 321

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

33. Differential Diagnosis and Management of Fever in Trauma 339 

34. Thromboembolic Disease and Management of Anticoagulation in Trauma 351 

35. Intensive Care Unit Sedation in the Trauma Patient 359

36. Nutritional Support in the Intensive Care Unit 371

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

38. Air Transport of the Critical Care Patient 391 

39. Basics of Pediatric Trauma Critical Care Management 401 

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

Section V. Special Circumstances 445

41. Humanitarian Operations and Aid Agency Anesthesia 447

42. Ethical Challenges of Deployed Military Critical Care 459

43. Military Pediatric Anesthesia 469 

44. Anesthesia Considerations in the Elderly Population 485 

45. Obstetric Anesthesia 491 

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

Section VI. Resources and Further Information 525

47. Current Anesthesia Equipment 527xii 48. Specialist Equipment for Pain Management 545

49. Resuscitation Guidelines 551

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

51. The Home Base: Queen Elizabeth Hospital Birmingham and Other Hospitals in the United Kingdom 567 

Abbreviations and Acronyms xxv

Index xxix




This resource has been published for the use of military providers caring for our Service Members injured in combat. Whether the trauma care provider is a physician, nurse, or Combat Medic, the ensuing chapters of this text will serve as a valuable resource.

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