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.
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.
