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2004 Emergency War Surgery Handbook

–        488 pages  with diagrams and illustrations. Please see complete description of all the files on this CD below.

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Although called the 3rd US Revision, this edition of Emergency War Surgery (EWS) represents an entirely new Handbook both in style and content. All material is new and revised to reflect lessons learned from ongoing American involvement in Southwest Asia.

“The editors of this edition are to be congratulated for drawing on the experiences of numerous colleagues recently returned from tours of duty in Southwest Asia in order to provide as current a Handbook as possible,” said William Winkenwerder, Jr., MD, Assistant Secretary of Defense for Health Affairs.

The Handbook takes a bulleted manual style in order to optimize its use as a rapid reference. Drafted by subspecialty experts, it was then updated by surgeons returned from yearlong deployments in Iraq and Afghanistan.

Illustrations are featured much more prominently than in the earlier edition.

“This revision of the Emergency War Surgery handbook provides the information needed to save the country’s and military’s most precious resource: our soldiers, sailors, airmen, and marines,” said Kevin C. Kiley, MD (LTG, MC, US Army), The Surgeon General.

A collaborative effort of the Borden Institute and the AMEDD Center & School, this Handbook is the essential tool for the management of forward combat trauma. “Its intent, and the single-minded determination of the contributors, is the retention of lessons learned from recent, as well as past, battlefield surgery,” said Dave E. Lounsbury, MD (COL, MC, US Army), Director of the Borden Institute.

Table of contents:

EDITORIAL & PRODUCTION xvi

EDITORIAL BOARD xvii

CONTRIBUTORS xviii

ACKNOWLEDGMENTS xx

FOREWORD xxi

PREFACE xxiii

PROLOGUE xxvii

Chapter 1: Weapons Effects and Parachute Injuries

Epidemiology 1.1

Mechanism of Injury 1.2

Antipersonnel Landmines 1.6

Small Arms 1.7

Armored Vehicle Crew Casualties 1.9

Unexploded Ordnance 1.13

Parachute Injuries 1.14

Chapter 2: Levels of Medical Care

Level I 2.1

Level II 2.2

Forward Surgical Team (FST) 2.3

Level III 2.6

Level IV 2.9

Level V 2.10

Chapter 3: Triage

Categories 3.2

Special Categories 3.4

Combat Stress 3.4

Triage Decision Making 3.8

Setup, Staffing, and Operation of Triage System 3.10

Chapter 4: Aeromedical Evacuation

Medical Considerations/Requirements 4.2

Medical Evacuation Precedences 4.5

Phone Numbers 4.7

Critical Care Air Transport Teams (CCATT) 4.9

Chapter 5: Airway/Breathing

Initial Management 5.1

Orotracheal Intubation 5.3

Rapid Sequence Intubation (RSI) 5.3

Difficult Airway 5.5

Surgical Cricothyrotomy 5.6

Blind Intubation 5.8

Chapter 6: Hemorrhage Control

Stop the Bleeding 6.1

Tourniquet 6.3

Internal Bleeding 6.5

Hemostatic Agents 6.6

Chapter 7: Shock and Resuscitation

Recognition and Classification 7.1

Control Bleeding 7.2

Controlled Resuscitation 7.4

Transfusion Therapy 7.6

Walking Blood Bank 7.7

Chapter 8: Vascular Access

Subclavian Vein or Internal Jugular Vein 8.1

Greater Saphenous Vein 8.3

Chapter 9: Anesthesia

Induction of General Anesthesia 9.2

Rapid Sequence Intubation 9.3

Chapter 10: Infections

Diagnosis 10.1

Common Microorganisms 10.2

Treatment 10.3

Empiric Coverage 10.5

Soft Tissue Infections 10.6

Intraabdominal Infections 10.7

Pulmonary Infections 10.7

Sepsis 10.8

Dosages 10.11

Chapter 11: Critical Care

Damage Control 11.1

Resuscitation From Shock 11.2

Traumatic Brain Injury 11.3

Pulmonary System and Ventilators 11.5

Cardiovascular System 11.7

Renal System and Electrolytes 11.9

Hematologic System 11.10

Gastrointestinal System and Nutrition 11.10

Immune System and Infections 11.14

Endocrine System 11.14

Musculoskeletal System 11.15

Preparation for Evacuation 11.15

Chapter 12: Damage Control Surgery

Phases 12.1

Chapter 13: Face and Neck Injuries

Airway 13.1

Bleeding 13.2

Fracture Management 13.3

Soft Tissue Injuries 13.9

Penetrating Neck Trauma 13.12

Specific Face and Neck Injuries 13.14

Vertebral Artery 13.15

Internal Carotid Artery 13.15

Internal Jugular Vein 13.15

Trachea 13.16

Esophagus 13.16

Otologic Injury 13.19

Chapter 14: Ocular Injuries

Triage 14.1

Open Globe 14.2

Anterior Segment Injuries 14.3

Cornea Chemical Injuries 14.3

Corneal Abrasions 14.4

Corneal Ulcer and Keratitis 14.5

Foreign Bodies 14.6

Hyphema 14.7

Retrobulbar Hemorrhage 14.7

Lateral Canthotomy 14.8

Orbital Floor (Blowout) Fractures 14.9

Lid Lacerations 14.10

Laser Eye Injuries 14.12

Enucleation 14.13

Chapter 15: Head Injuries

Types 15.1

Classification 15.2

Glasgow Coma Scale 15.5

Management, Medical 15.7

Management, Surgical 15.11

Chapter 16: Thoracic Injuries

Life-Threatening Injuries 16.3

Tube Thoracostomy 16.4

Resuscitative Thoracotomy 16.6

Median Sternotomy 16.9

Specific Injuries:

Vascular 16.11

Heart 16.12

Lung 16.12

Esophagus 16.14

Diaphragm 16.15

Chapter 17: Abdominal Injuries

Indication for Laparotomy 17.2

Diagnostic Adjuncts 17.2

Abdominal Ultrasound 17.3

Diagnostic Peritoneal Lavage 17.7

CT Scan 17.7

Wound Exploration 17.8

Stomach Injuries 17.9

Duodenum Injuries 17.9

Pancreas Injuries 17.10

Liver Injuries 17.11

Spleen Injuries 17.12

Colon Injuries 17.12

Rectum Injuries 17.14

Retroperitoneal Injuries 17.15

Abdominal Closure 17.16

Chapter 18: Genitourinary Tract Injuries

Renal Injuries 18.1

Ureteral Injuries 18.6

Bladder Injuries 18.9

Urethral Injuries 18.10

External Genitalia 18.11

Chapter 19: Gynecologic Trauma and Emergencies

Vulva Injuries 19.1

Vagina Injuries 19.2

Uterus/Cervix Injuries 19.3

Emergent Total Abdominal

Hysterectomy 19.4

Adnexa 19.5

Retroperitoneal Hematoma 19.6

Gynecologic/Obstetric Emergencies 19.7

Vaginal Hemorrhage: Not Pregnant 19.7

Vaginal Hemorrhage: Pregnancy 19.8

Precipitous Vaginal Delivery 19.9

Emergency Cesarean Section 19.11

Neonatal Resuscitation 19.15

Chapter 20: Wounds and Injuries of the Spinal Column and

Cord

Classification 20.1

Pathophysiology 20.2

Transport 20.4

Cervical Spine 20.5

Halo Immobilization 20.6

Thoracic and Lumbar Spine 20.8

Emergent Surgery 20.9

Pharmacologic Treatment 20.9

General Management 20.10

Chapter 21: Pelvic Injuries

Blunt Injuries 21.1

Penetrating Injuries 21.3

Chapter 22: Soft-Tissue Injuries

Presurgical 22.1

Wound Care 22.2

Crush Syndrome 22.6

Compartment Syndrome 22.9

Fasciotomy 22.10

Chapter 23: Extremity Fractures

Introduction 23.1

Transportation Casts 23.4

Shoulder/Humerus 23.8

Elbow/Forearm 23.8

External Fixation 23.10

Skeletal Traction 23.19

Chapter 24: Open-Joint Injuries

Signs 24.1

Treatment 24.2

Joint Infection 24.5

Hip Wounds 24.5

Shoulder Wounds 24.8

Chapter 25: Amputations

Indications 25.1

Technique 25.3

Postoperative Management 25.5

Transportation Casts 25.6

Chapter 26: Injuries to the Hands and Feet

Types of Injuries 26.1

Hand 26.1

Foot 26.5

Chapter 27: Vascular Injuries

Evaluation and Diagnosis 27.1

Management 27.3

Shunt Placement 27.6

Compartment Syndrome 27.8

Chapter 28: Burns

Point of Injury Care 28.1

Escharotomy 28.3

Estimation of Fluid Resuscitation 28.4

Rule of Nines 28.4

Management 28.6

Wound Care 28.7

Extremity Care, Escharotomy 28.9

Electrical Injury 28.10

Chemical Burns 28.11

Grafting: “How I Do It” 28.12

Chapter 29: Environmental Injuries

Cold Injury 29.1

Hypothermia 29.7

Heat Injury 29.11

Altitude Illness 29.22

Chapter 30: Radiological Injuries

Introduction 30.1

Triage 30.2

Decontamination 30.6

Chapter 31: Biological Warfare

Detection, Diagnosis 31.1

Decontamination 31.2

Evacuation Precautions 31.3

Bacterial Agents 31.5

Viral Agents 31.5

Toxins 31.6

Chapter 32: Chemical Injuries

Protection 32.1

Nerve Agents 32.2

Vesicants 32.3

Cyanogens 32.4

Surgical Treatment 32.6

Chapter 33: Pediatric care

Anatomic and Physiologic

Considerations 33.1

Pulmonary 33.2

Cardiovascular 33.2

Burns 33.3

Gastrointestinal 33.3

Hematology 33.4

Renal 33.4

Modified Glasgow Coma Scale 33.5

Rapid Sequence Intubation 33.6

Equipment, Age and Weight

Matched Sizes 33.7

Commonly Used Drugs 33.7

Surgical Management 33.8

Chapter 34: Care of Enemy Prisoners of War/Internees

UN and Geneva Convention 34.1

What Healthcare Providers Should Do 34.2

What Healthcare Providers Should Not Do 34.3

Recusal 34.3

Planning 34.6

Medical Photography 34.9

Security 34.10

Envoi E.1

Appendix 1: Principles of Medical Ethics A1.1

Appendix 2: Glasgow Coma Scale A2.1

Appendix 3: Theater Joint Trauma Record A3.1

Index xxxi

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