Fundamentals of Frontline Surgery

Cover
Half Title
Title Page
Copyright Page
Dedication
Contents
Forewords to Fundamentals of Frontline Surgery
	Reference
Preface
The Editors
List of Contributors
1. The Resource-Limited Environment
	Introduction
	What Makes Conflict or Disaster Surgery Different?
	Echelons and Roles of Medical Support
	Evacuation Chain Between Roles or Echelons of Care
	Humanitarian or Conflict Response Categories
	Laws of Conflict
	Am I Ready for Deployment Within a Resource-Limited Environment?
2. Patterns of Injury
	Contents
	Energy Release Processes
		Bombs
		Projectile Injury
		Knives (and Fragments)
	Blast Effects on the Human Body
		Blast Effects in Vehicles
		Blunt Impact
		Burns
	The Global Overview: Meta-analysis of Blast Injury
		Deliberate Acts
		Domestic Explosions
		Industrial Activity and Explosive Storage
		The Natural World
	The Effect of High-Strain Rate on Biological Materials
		Bone
		Skin
	Conclusion
	Acknowledgements
	Further Reading
3. Damage Control Resuscitation
	Damage Control Resuscitation (DCR) in Resource-Limited Environment
		Permissive Hypotension as a Bridge to Definitive Control
		Haemostatic Resuscitation
		Damage Control Surgery
		Monitoring
	Further Reading
4. No Blood ... What to Do?: Fluid Administration in Austere Environments
	Haemorrhage
	Treatment Options in the Prehospital Arena
		Whole Blood
	Packed Red Blood Cells
	Plasma
	Crystalloids
	Colloids
	Tranexamic Acid
	How Do I Stop Thinking About the Future and Treat the Patient Now?
	Whenever Shock is Diagnosed, Administer Tranexamic Acid (TXA)
	Key Points
	Further Reading
5. Point-of-Care Ultrasound
	Introduction
	Resource Limitation Concern
	Brief Review of Material
	Resource-Limited Environment Pocus
		E-Fast
			How to Perform the Exam
		RUSH (Rapid Ultrasound for Shock)
			Pump Evaluation
			Tank Evaluation
			Pipe Evaluation
		Optic Nerve Sheath Diameter (ONSD)
	Other POCUS Range in the Resource-Limited Environment
	Ten Resource-Limited Environment POCUS Key Points
	Further Reading
6. Thoracic Injury Management
	Introduction
	Left Anterolateral Thoracotomy
	Clamshell Thoracotomy
	Cardiac Injuries
	Hilar Injuries
	Pulmonary Injuries
	Posterior Mediastinal Injuries
		Aortic Control
		Tracheobronchial Injury
		Oesophageal Injury
		Combined Tracheobronchial Injuries
	Clamshell Thoracotomy and Exposure of Arch Vessels
	Closure and Drains
	Anterolateral Thoracotomy
	Clamshell
	Additional Reading
7. Junctional and Extremity Vascular Trauma
	Junctional and Extremity Vascular Trauma
		Epidemiology
		Presentation and Initial Workup
		Pathology
	Considerations for Vascular Surgery in Austere Conditions
		Priorities in the Multiply Injured Patient
		Injury Diagnosis and Imaging
		Surgical Equipment and Supplies
		Orthopaedic Injury
		Vascular Damage Control
		Vein Injury Management
		Fasciotomy
		Postoperative Assessment and Monitoring
	General Vascular Reconstruction Techniques
		Vascular Control
		Injury Exposure
		Thrombectomy and Anticoagulation
		Focal Repairs
		Interposition and Bypass Grafts
		Tissue Coverage
	Common Vascular Exposures and Reconstructions
		Upper Extremity
	Key Points
	Further Reading
8. Trauma Laparotomy and Damage Control Laparotomy
	Introduction
		Who Needs Damage Control Surgery?
		Damage Control Laparotomy
		The Venue
		Patient Position
		The Technique
		The Incision
		Once Inside
		Then What?
		Total Haemorrhage Control
		The Retroperitoneum
		Hollow Viscus Injury
		Other Important Injuries Not to Miss
		At the End of Damage Control Surgery Stage I
	Additional Reading
9. Damage Control for Severe Pelvic Haemorrhage in Trauma
	Introduction
		Pelvic Anatomy and Haemorrhage
		Damage Control for Pelvic Haemorrhage
		Technique of Pelvis-Only Extraperitoneal Pelvic Packing
		Technique of Extraperitoneal Pelvic Packing via the Abdomen
		Other Strategies
	Additional Reading
10. Abdominal Injuries
	Resource Limitation Concerns
	Brief Review of Material
	How to Do It?
		Aortic Control
		Abdominal Compartments
		Liver
		If the Pringle Manoeuvre Controls Bleeding, then This Is a Good Sign. If Not, Then You Have a Hepatic Vein or Retro-Hepatic IVC Injury!
			Liver Suturing (Deep Suture Repair)
			Omental Plugging (Packing)
			Local Haemostatic Agents
			Hepatic Balloon Tamponade
	Spleen
	Mesentery
	Retroperitoneal Haemorrhage
	Major Abdominal Vascular Injuries
	Kidney
	Diaphragm
	Pancreas
	Hollow Viscus Injuries
	Oesophagus
	Gastric Injuries
	Duodenum
	Small Bowel
	Colon and Rectum
	Urinary Tract Injuries
	Ten Key Points
	Further Reading
11. Acute Care Emergency Surgery
	Resource Limitation Concerns
	Acute Appendicitis
		Procedure
	Hernia
		Umbilical and Paraumbilical Hernia Repair
		Inguinal Hernia Repair
	Right Hemicolectomy
		Surgical Considerations
	Left Hemicolectomy
	Stoma Formation
	Perforation of Gastric and Duodenal Ulcers
		Operative Versus Non-operative Management
	Further Reading
12. Frontline Consideration for Paediatric Emergency and Trauma Surgery
	Introduction
	Anatomical Considerations
	Physiological Considerations
	The Initial Assessment
		Airway
		Breathing
		Circulation
		Vascular Access
		Fluid Resuscitation
		Disability
		Exposure
		Imaging
	Assume Every Child Is Sick
		Tranexamic Acid (TXA)
		Massive Transfusion
		In the Operating Room
	Further Reading
13. RLE Orthopaedic Injury Management
	Damage Control Principles
	Resource Limitation Concerns
	Procedures
		Wound Incision
		Wound Excision
		Amputation
		Application of Splints and Casts
	Upper Extremity
	Lower Extremity
		Application of Traction
		Application of Extremity External Fixation
	Upper Extremity
	Lower Extremity
		Application of Pelvic External Fixation
	Key Points
	Further Reading
14. Neurotrauma in the Field: Down Range
	Cranial Trauma
		Introduction
		Considerations
		Common Cases and Treatment
			Blast Injury
			Ballistics
			Closed Head Injuries
	Spinal Trauma
		Introduction
		Military Versus Civilian
		Spinal Column Injury
		Spinal Cord Injury
	Key Points
	Further Reading
15. Management of Ballistic Face and Neck Trauma in an Austere Setting
	Resource Limitation Concerns
	Step-by-Step Procedures
	Exsanguinating Haemorrhage
	Airway Provision
	Step-by-Step Procedure 1: Surgical Cricothyroidotomy
	Cervical Spine Immobilisation
	Management of Facial Haemorrhage
	Step-by-Step Procedure 2: Arresting Facial Bleeding by Nasal and Oral Packing
	Damage Control Surgery for Penetrating Neck Injury
	Investigations of Penetrating Neck Injury
	The Use of Neck Zones
	Zone 1 Injuries
	Zone 2 Injuries
	Zone 3 Injuries
	Surgical Treatment of Penetrating Cervical Vascular Injury
	Step-by-Step Procedure 3: Access to the Common Carotid Artery in Neck Zone II
	Surgical Treatment of Laryngotracheal Injuries
	Surgical Treatment of Oesophageal Injuries
	Soft Tissue Facial Trauma
	Imaging of Facial Fractures
	Stabilisation of Facial Fractures with Maxillary-Mandibular Fixation
	Step-by-Step Procedure 4: Maxillary-Mandibular Stabilisation with IMF Screws
	Internal Fixation of Facial Fractures
	External Fixation of Facial Fractures
	Ten Key Points
	Further Reading
16. Management of Ophthalmic Injuries by the Forward Surgical Team
	Introduction
	Recognise That Ocular Pathology is Present
		History
		Examination
	Inspect the Eyes
		Closed Globe Injury
		Orbital Compartment Syndrome
	Visual Acuity Is Tested as Follows
	Pupils Are Tested as Follows
	Assess Whether the Pathology Requires Time-Critical Management
		Chemical Injury
		Orbital Compartment Syndrome
		Open Globe Injury
		Hyphaemia
		Retinal Detachment and Dialysis
		Closed Globe Injuries After Refractive Surgery
	Understand How to Safely Temporise and Package Serious Ocular Pathology
		Chemical Injury
		Orbital compartment syndrome
		Open Globe Injuries
		Closed Globe Injuries
		Retinal Detachments
		Closed Globe Injuries After Refractive Surgery
	Understand Some of the Issues Around Prolonged Care of Eye Injuries, Including the Effect of Delay and the Risk of Sympathetic Ophthalmia
	Further Reading
17. Resource-Limited Environment Plastic Surgery
	Introduction
		Tissue Response to Injury
		Debridement
		Extension Lines
	Fasciotomy of the Extremities
		Overview
		Resource Limitation Concerns
		Diagnosis
	Surgical Technique
		Leg
		Foot
		Thigh
	Hand
	Dorsal
	Palmar
	Digital
		Forearm
		Arm
	Burns
		Overview
		Resource Limitation Concerns
		Acute Management
	Airway
	Breathing
	Circulation
	Disability
	Exposure
	Fluids
	Adjunctive Measures
	Dressings
	Burn Excision
	Electrical Burns
	Chemical Burns
	Peripheral Cold Injury
		Overview
		Resource Limitation Concerns
		Clinical Presentation
		Assessment
		Management
		Plastic Surgery Reconstructive Elevator
			Principles
			Skin Grafts
				Classification
				Types
			Local Flaps
				Vascularity
				Composition
				Method of Movement
				Procedure and Equipment Details for Local Skin Flaps
	Suggested Reading
18. Acute Acoustic Trauma and Blast-Related Hearing Loss
	Resource Limitation Concerns
		Limitations of Diagnosis
		Limitations of Treatment
		Bone Conducting Hearing Systems
		Knowledge Update (Brief Review of Material)
	Key Concepts
	Further Reading
19. Obstetrics in Limited-Resource Settings
	Introduction
	Haemorrhage
		Management
	Hypertensive disorders
	Sepsis
	Abortion
	Obstructed Labour
	Caesarean Section
		Indications
		Techniques
		Postoperative Care
	Caesarian Section for Breech Delivery
	Types and Definitions
	Key points:
	Further Reading
Index