Abbreviations and Acronyms

Abbreviations and Acronyms

A CPG: clinical practice guideline

CPK: creatine phosphokinase
ABC: Acinetobacter baumannii-calcoaceticus complex CPNB: continuous peripheral nerve block
ABC: airway, breathing, and circulation CPP: cerebral perfusion pressure
ABC: assessment of blood consumption CPR: cardiopulmonary resuscitation
AC: alternating current CRM: Crew Resource Management
ACCP: American College of Chest Physicians CRRT: continuous renal replacement therapy
ACH: Army community hospital CSH: combat support hospital
ACRM: Anesthesia Crisis Resource Management CSI: cervical spine injury
ACS: abdominal compartment syndrome CT: clotting time
ACS: acute compartment syndrome CT: component therapy
ACTH: adrenocorticotropin CT: computed tomography
AE: aeromedical evacuation CVC: central venous catheter
AECC: Aeromedical Evacuation Co-ordination Centre CVP: central venous pressure
AFRICOM: African Command CVVH: CRRT with a veno-venous technique of hemofiltration
AKI: acute kidney injury CXR: chest x-ray
ALI: acute lung injury
AMEDD C&S: Army Medical Department Center and School D
AMPA: alpha-amino-3-hydroxyl-5-methyl-4-isoxazole-propionate
AMPLE: allergies, medication, pregnancy, last eaten DLEBT: double-lumen endobronchial tube
AMR: advanced medical retrieval DCR: damage control resuscitation
APP: abdominal perfusion pressure DLT: double-lumen endobronchial tube
APRV: airway pressure-release ventilation DMS: Defence Medical Services (United Kingdom)
ARDS: acute respiratory distress syndrome DNBI: disease non-battle-injury
APLS: Advanced Paediatric Life Support DoA: depth of anesthesia
APS: acute pain service DPL: diagnostic peritoneal lavage
APTR: activated partial thromboplastin time ratio DR: disaster relief
ATC: acute trauma coagulopathy DVPRS: Defense and Veterans Pain Rating Scale
ATICE: Adaptation to the Intensive Care Environment (instrument) DVT: deep venous thrombosis
ATLS: Advanced Trauma Life Support
ATN: acute tubular necrosis E
ATP: adenosine triphosphate
EAST: Eastern Association for the Surgery of Trauma
AW2: Army Wounded Warrior Program
ECCN: en-route critical care nurse
B ECG: electrocardiogram
ECMO: extracorporeal membrane oxygenation
BABT: behind-armor blunt trauma ED: emergency department
BAS: battalion aid station EDOCS: expeditionary deployable oxygen concentrator system
BATLS: Battlefield Advanced Trauma Life Support EMT-B: emergency medical technician-basic
BIPAP: biphasic positive airway pressure ventilation EN: enteral nutrition
BK: bradykinin ESBL: extended spectrum β-lactamase
BPF: bronchopleural fistula ESPEN: European Society for Parenteral and Enteral Nutrition
BVM: bag-valve masks ETCO2: elevated end-tidal carbon dioxide
ETT: endotracheal tube
C EUCOM: European Command

<C>ABC: catastrophic hemorrhage, airway, breathing, and circula- F

tion
F: French gauge
CASEVAC: casualty evacuation
FiO2: fraction of inspired oxygen
CASF: contingency aeromedical staging facility
FAST: focused assessment with sonography for trauma
CAT: combat application tourniquet
FFP: fresh frozen plasma
CBF: cerebral blood flow
Fr: French gauge
CBRN: chemical, biological, radiological, or nuclear
FRC: functional residual capacity
CC: combat casualty
FST: forward surgical team
CCAT: critical care air transport
FW: fixed wing
CCAST: critical care air support team
FWB: fresh whole blood
CCPG: Canadian clinical practice guideline
CCR: Canadian C-Spine Rule G
CENTCOM: Central Command
CMRO2: cerebral metabolic rate of oxygen G: gauge
CO: cardiac output Ga: gauge
CONUS: continental United States GABA: γ-aminobutyric acid
COTS: coagulopathy of trauma shock GAWS: Guardian Angel Weapon System
COX: cyclooxygenase GCOs: Clinical Guidelines for Operations
CPAP: continuous level of positive airway pressure GCS: Glasgow coma scale

xxv
Combat Anesthesia: The First 24 Hours
G6PD: glucose-6-phosphate dehydrogenase
H MILS: manual inline stabilization
HA: humanitarian assistance
HbCO: carbon monoxide hemoglobin
HD: hemodialysis
HELLP: hemolysis, elevated liver enzymes, and low platelets
(syndrome)
HEMS: Helicopter Emergency Medical System
HFOV: high-frequency oscillatory ventilation
HFV: high-frequency ventilation
HIV: human immunodeficiency virus
HMAP: high mean arterial pressure
HR: heart rate
I N
IAP: intraabdominal pressure
ICO: infection control officer
ICP: intracranial pressure
ICU: intensive care unit
ID: internal diameter
IED: improvised explosive device
IJV: internal jugular
iLA: interventional lung assistance
ILV: independent lung ventilation
IM: intramuscular
IMV: intermittent mandatory ventilation
IN: intranasal
INR: international normalized ratio
IO: intraosseous
IOP: intraocular pressure
IPPV: intermittent positive-pressure ventilation
IRI: ischemia-reperfusion injury
IRT: immediate response team
ISO: International Organization for Standardization
ISS: injury severity score
IV: intravenous
IVC: inferior vena cava
IVCF: inferior vena cava filter
J
JTTR: Joint Theater Trauma Registry
L PAG: periaqueductal grey
LAST: local anesthetic systemic toxicity
LMA: laryngeal mask airway
LMAP: lower mean arterial pressure
LMWH: low molecular weight heparin
LOP: limb occlusion pressure
LRMC: Landstuhl Regional Medical Center
LSI: life-saving intervention
LTP: long-term potentiation
M PiO2: partial pressure of the inspired oxygen
MAC: minimum alveolar concentration
MAP: mean arterial pressure
MASF: mobile aeromedical staging facilities
MCF: maximum clot firmness
MDCT: multidetector row spiral computed tomography
MDR: multidrug-resistant
MEAC: minimum effective analgesic concentration
MEDCEN: military medical center
MEDCOM: US Army Medical Command
MEDEVAC: medical eva
MERT: medical emergency response team
xxvi
MERT(E): medical emergency response team (enhanced)
MH: malignant hyperthermia
MIST-AT: mechanism of injury, injuries sustained, symptoms and
signs, treatment given–age (adult/child) and time of injury
MHS: Military Health System
MODS: multiorgan dysfunction syndrome
MRAP: mine-resistant ambush-protected
MRI: magnetic resonance imaging
MRSA: methicillin-resistant Staphylococcus aureus
MRSN: Multidrug Resistant Organism Repository and Surveil-
lance Network
MTF: medical treatment facility
MTP: massive transfusion protocol
NAPQI: N-acetyl-p-benzoquinine imine
NASA: National Aeronautics and Space Administration
NBI: nonbattle injury
NEXUS: National Emergency X-Radiography Utilization Study
NGF: nerve growth factor
NGO: nongovernmental organization
NHS: National Health Service (United Kingdom)
NK1: neurokinin-1
NMBA: neuromuscular blocking agent
NMDA: N-methyl-d-aspartate
NMS: neuroleptic malignant syndrome
NS: normal saline
NSAID: nonsteroidal antiinflammatory drugs
O
OEF: Operation Enduring Freedom
OI: oxygenation index
OIF: Operation Iraqi Freedom
OL-ILV: one-lung independent ventilation
OR: operating room
OSCAR: High Frequency OSCillation in ARDS (trial)
OSCILLATE : Oscillation for Acute Respiratory Distress Syn-
drome Treated Early (trial)
OTFC: oral transmucosal fentanyl citrate
P
PACCOM: Pacific Command
PCA: patient-controlled analgesia
PCR: polymerase chain reaction
PD: peritoneal dialysis
PE: pulmonary embolism
PECC: patient evacuation coordination center
PEEP: positive end-expiratory pressure
PetCO2: partial pressure of end-tidal carbon dioxide
PG: propylene glycol
PICU: pediatric intensive care unit
PIS: propofol infusion syndrome
PLT: platelets
PMI: patient movement item
PMRC: patient movement requirement center
PN: parenteral nutrition
PO: per os
POGS: portable oxygen generator system
PP: pulse pressures
PPE: personal protective equipment
Ppl: plateau pressure
PPV: positive pressure ventilation
PRBC: packed red blood cells
 Abbreviations and Acronyms

PRIS: propofol infusion syndrome U

PTSD: posttraumatic stress disorder
UFH: unfractionated heparin
Q UK: United Kingdom
UN: United Nations
QEHB: Queen Elizabeth Hospital Birmingham US: ultrasound
R USAF: US Air Force
USAISR: US Army Institute of Surgical Research
RA: regional anesthesia
RAAS: rennin-angiotensin-aldosterone system v
RAF: Royal Air Force
VA: Veterans Affairs (Department)
RAP: regimental aid post
VAP: ventilator-associated pneumonia
RASS: Richmond Agitation-Sedation Scale
VAS: visual analog scale
RBC: red blood cell
VDC: volts direct current
RCC: red cell concentrate
VGA: volatile gas anesthesia
RCDM: Royal Centre for Defence Medicine
VILI: ventilator-induced lung injury
RCT: randomized controlled trial
VITRIS: Vasopressin in Refractory Traumatic Hemorrhagic Shock
REBOA: resuscitative endovascular balloon of the aorta
(study)
rFVIIa: recombinant factor VIIa
VRE: vancomycin-resistant Escherichia coli
RIFLE: risk, injury, failure, loss, and end-stage disease
VRS: verbal rating score
ROSC: return of spontaneous circulation
Vt: tidal volume
RSI: rapid sequence induction
VTE: venous thromboemoblism
RTD: return-to-duty
RRT: renal replacement therapy w
RSI: rapid-sequence induction
RW: rotary wing WFWB: warm fresh whole blood
WHO: World Health Organization
S WRAIR: Walter Reed Army Institute of Research
SAVe: simplified automated ventilator WWR: Wounded Warrior Regiment
SCCM: Society of Critical Care Medicine
SCD: sequential compression device
SCM: sternocleidomastoid muscle
SCV: subclavian
ScvO2: central venous oxygen saturation
SI: sacroiliac
SIB: self-inflating bag
SIMV/PS: synchronized intermittent mandatory ventilation with
pressure support
SIRS: systemic inflammatory response syndrome
SO: standard operating instruction
SOP: standard operating procedures
SOUTHCOM: Southern Command
STRATEVAC: strategic evacuation
SVC: superior vena cava
SVR: systemic vascular resistance

T
TACEVAC: tactical evacuation
TARGIT: Triservice Research Group Initiative on TIVA
TBI: traumatic brain injury
TBSA: total burned surface area
TCCC: Tactical Combat Casualty Care
TCI: target-controlled infusion
TCRA: traumatic cardiorespiratory arrest
TD: tracheal disruption
TENS: toxic epidermal necrolysis syndrome
TIC: toxic industrial chemicals
TIVA: total intravenous anesthesia
TL-ILV: two-lung independent lung ventilation
TLR4: toll-like receptor 4
TRPV: transient receptor potential vallinoid
TTE: transthoracic echocardiogram
TTP: tactic, technique, or procedure
TRALI: transfusion-related acute lung injury
TrkA: tyrosine kinase A
TSAA: Triservice Anaesthetic Apparatus
TST: tuberculin skin testing

xxvii
Combat Anesthesia: The First 24 Hours

xxviii
 Index

Index
A pediatric trauma patients, 410
ventilation strategies, 111
ABC score. See Assessment of Blood Consumption score Acute thermal injury, 164–165
<C>ABCDE guidelines, 286–287 Acute trauma coagulopathy, 87
Abdominal compartment syndrome, 14–15, 298–299 Acute tubular necrosis, 322
Abdominal injuries Adaptation to the Intensive Care Environment, 361
combat casualties, 8 Adrenal crisis, 335
enteral feeding after surgery, 375–377 Adrenocorticotropin, 200
multimodal analgesia, 207–208, 210 Adult Advanced Life Support algorithm, 553
penetrating, 210 Advanced Life Support algorithm
Acalculous cholecystitis, 343 adult, 553
Acetaminophen, 223–225 pediatric, 554
Acidosis Advanced medical retrieval, 48
combat casualties and, 4 Aeromedical Evacuation Patient Record, 397
damage control resuscitation and, 90 Aeromedical team, deployed, 263
massive transfusion and, 98–99 Aeromedical transport
ACTH. See Adrenocorticotropin capabilities and responsibilities, 394, 396
Acute kidney injury combat casualties and, 5–7
early management of, 14 documentation, 397–398
etiology of, 322 fixed wing operations, 397
incidence of, 322 history of, 392–393
indications for renal support, 322–323 operations, 394–398
management options, 323–324 patient movement concepts, 393–394
medical therapy for, 324 patient movement items, 398
outcomes, 324 patient movement requirement centers, 396
prevention of, 322 preflight patient considerations, 395
“RIFLE” classification, 322–323 research, 398
Acute lung injury resupply items, 398
blast lung, 291 rotary wing operations, 397
critical care, 291–292 tasking, 396–397
infection prevention and control, 292 team composition, 394
management of, 136–137 for tracheal disruption and bronchopleural fistula, 316–317
nutrition, 292 training, 398
pediatric trauma patients, 410 Afghanistan
pulmonary contusion, 291 weight estimation for local national children, 471
sedation, 292 AFOI. See Awake fiberoptic intubation
ventilation strategies, 111, 291–292 Aged. See Elderly populations
Acute pain Air Force pararescue, 47–48
basic concepts, 194 Air Rescue Service, 47
descending modulatory pathways, 196 Air transport. See Aeromedical transport
dorsal horn, 195–196 Airway burns, 516
pain matrix, 196–197 Airway management
pain mechanisms, 194–197 acute management of asthma exacerbation algorithm, 406–407
pain perception in higher centers, 196–197 airway bleeding and, 77–78
pain transmission, 195–196 airway devices, 77–78
peripheral nociceptors, 194 airway equipment, 404–406, 470
role of the glia, 196 anesthetic considerations, 77–79
transient receptor potential vallinoid channel subtypes, 195 blind nasal intubation, 79
WHO pain ladder, 207 cervical spine injuries and, 122–123
Acute pain service critical care, 296
clinical practice guideline, 263–264 direct laryngoscopy, 78
deployed acute pain service responsibilities, 262 equipment for pediatric trauma patients, 404–406
enabling change, 265 evidence for current practice, 76–77
governance, 262 facial distortion and, 77–78
multidisciplinary team, 262–263 facial injury and, 76
pain education, 264 fiberoptic intubation, 79
predeployment training, 264 following chemical, biological, radiological, and nuclear expo-
role 3 facilities, 278–279 sure, 512–516
specialist interest group responsibilities, 262 guidelines and techniques in the deployed setting, 79–80
standard operating instruction, 263–264 intrathoracic airway injuries, 134–135
team rounds and meetings, 265 patient positioning, 77–78
team training, 264 pediatric anesthesia, 470, 473, 477–478
Acute respiratory distress syndrome penetrating airway injury and, 77, 80
critical care, 291 penetrating neck injury and, 76–77
etiology of, 12 pitfalls of, 81
management of, 12, 136–137 rapid sequence induction, 79

xxix
Combat Anesthesia: The First 24 Hours

surgical considerations, 79 extremity, junctional, and pelvic injury surgical procedures,

team considerations, 79 148
Airway trauma, 10 following chemical, biological, radiological, and nuclear expo-
ALI. See Acute lung injury sure, 506–521
α2-Adrenergic agonists, 224–225 head trauma and, 127
AmbIT Military PCA Pump, 231 human factors in, 32–34
American College of Surgeons’ Advanced Trauma Life Support, humanitarian operations, 448–457
555 imaging management, 177
Amniotic fluid embolism, 499 intraosseous access, 67–68
“AMPLE” history, 109 local anesthetics, 224–225, 235–236
Amputations monitoring depth of, 187
bilateral above-knee, 35–37 neuraxial anesthesia, 185
considerations, 150 obstetric, 492–502
rapid sequence induction and, 51 pediatric, 470–482
AMR. See Advanced medical retrieval pediatric trauma patient handoff checklist, 405
Analgesia percutaneous central venous access, 64–67
α2-adrenergic agonists, 224 peripheral venous cutdown, 68
abdominal injuries, 207–208, 210 physics of flow, 64
acetaminophen, 223–224 post-anesthesia care of vascular access devices, 69
advanced techniques, 206–207 regional, 148, 179, 185, 242–244
anticonvulsants, 224 for stable casualties, 184–187
basics of, 206 stages of a complex military anesthetic, 61
compartment syndrome, 208–209 target-controlled infusions, 186–187
complex injuries, 209 thoracic injuries, 139
current military practice, 271–272 total intravenous anesthesia, 186–187
frequency of intravenous and oral analgesic administration, training, 61–62
279 ultrasound imaging and, 179
ideal battlefield analgesic, 268 venous access, 179
inhalational analgesia, 270 volatile gas anesthesia, 185
injuries to local nationals, 209–210 Antenatal care, 496
isolated forearm gunshot wound, 210 Antibiotics
isolated lower limb injury, 207 infection management, 387–388
isolated upper limb injury, 207 sepsis management, 387–388
ketamine, 270–271 Anticoagulation
multimodal applications, 206–210 Factor VIIa effects, 352–353
N-methyl-D-aspartate receptor antagonists, 222–223 hemostatic agents, 17
narcotics, 269 massive transfusion effects, 352–353
nonopioid analgesics, 222–225 prevention of venous thromboembolism, 353–356
nonsteroidal antiinflammatory drugs, 223, 269–270 tranexamic acid effects, 352–353
patient-controlled analgesia, 206, 221–222, 416 Anticonvulsants, 224–225
pediatric patients, 416, 474, 481–482 Antifibrinolytics, 91
penetrating abdominal injuries, 210 Aortic injuries, 136
prehospital medicine, 268–272 Aortocaval compression, 496
simple or single injuries, 207–209 APS. See Acute pain service
thoracic injuries, 140, 208 ARDS. See Acute respiratory distress syndrome
treatment facilities, 209–210 Arterial access, 68–69
Anaphylaxis, 333, 335 Assessment of Blood Consumption score, 97
Anemia Asthma
obstetric considerations, 495 acute management exacerbation algorithm, 406–407
Anesthesia. See also Sedation ATC. See Acute trauma coagulopathy
access to vascular space, 49 Atelectasis, 344
acute lung injury, 292 ATICE. See Adaptation to the Intensive Care Environment
airway management, 77–79 ATLS. See American College of Surgeons’ Advanced Trauma Life
arterial access, 68–69 Support
burn injuries, 169–170 ATN. See Acute tubular necrosis
catheter and cannula sizes, 64 Atrial cannulation, 68
clinical management, 60–61 Atropine overdose, 518
combat casualties and, 17 Awake fiberoptic intubation, 79
conscious sedation, 185–186
considerations for, 35–38 B
for critically injured military patients, 569
damage control philosophy, 61 BABT, 135
decision-making, 60 Back pain. See also Spinal injuries
the deployed military anesthesia system, 61 disc lesions, 252
direct atrial cannulation, 68 etiology of, 248–249, 251
elderly populations, 486–490 facet joint pain, 250, 252
equipment, 528–544 mechanical, 248, 250

xxx
 Index

motions associated with lumbar facet joint strain, 252 pediatric patients, 478
musculature of the back, 250 postoperative care, 170
myofascial pain, 250 procedures outside the operating room, 170–171
nerve root compromise, 253 pulmonary evaluation, 168
nerve root pathology, 249 rule of nines, 422
nonspecific, 248, 250 vascular access, 168
sacroiliac joint pain, 250, 252
spinal stenosis, 253 C
treatment options, 255–256
Base deficit correction, 112 <C>ABCDE guidelines, 286–287
BATLS. See Battlefield Advanced Trauma Life Support Calcium management
Battlefield Advanced Trauma Life Support, 139, 286–287, 555 damage control resuscitation and, 90
Belmont Rapid Infuser FMS 2000, 542–543 massive transfusion and, 97–98
Benzodiazepines, 361 Camp Bastion protocol, 242–244
Bilateral above-knee amputations, 35–37 Canadian C-Spine Rule, 123–124
Biofilms Canadian clinical practice guidelines, 372–373, 375
infection and, 383–384 Cannula cricothyroidotomy, 478
Biological exposure. See Chemical, biological, radiological, and Cannula sizes, 64
nuclear exposure Capnometry, 557
Blast lung, 291 Carbohydrate metabolism
Blind nasal intubation, 79 pain response and, 201
Blister agents, 514 Carbon monoxide poisoning, 519
Blood pressure maintenance, 297 Cardiac arrest resuscitation, 552, 556–557
Blood product administration, 54 Cardiac injuries, 135–136, 178
Bone fractures Cardiac tamponade, 336
fixation of, 114 Cardiogenic shock, 10, 332–333
general anesthesia for internal fixation of fractured femur Cardiorespiratory arrest resuscitation, 556–557
neck, 489 Cardiovascular disease
pelvic, 150–151 elderly populations and, 486–487
Bowel damage control, 300 obstetric considerations, 494–495
Brain injury, traumatic. See Traumatic brain injury Cardiovascular injuries
Braun Perfusor Compact S, 543–544 cardiogenic shock, 10
Braun Perfusor pump, 232, 237 combat casualties and, 8–10
Breathing management hemorrhagic shock, 8–9
critical care, 296–297 neurogenic shock, 10
following chemical, biological, radiological, and nuclear expo- obstructive shock, 10
sure, 516–517 traumatic shock, 8–9
pediatric anesthesia, 473–474, 478–479 Cardiovascular system
Brief Pain Inventory, 215 pain response, 202
Bronchopleural fistula volume status, 289–291
aeromedical evacuation, 316–317 CASEVAC. See Casualty evacuation
diagnosis of, 316 Casualties. See Combat casualties
postoperative care, 316–317 Casualty evacuation, 5–7, 46, 393
preventing further injury, 316–317 Catheter sizes, 64
ventilation considerations, 316–317 Catheter techniques, 547
ventilator settings, 316–317 CATs. See Combat application tourniquets
Buddy-buddy system, 43 Cauda equina syndrome, 253
Burn injuries Caudal anesthesia
acute thermal injury, 164–165 for pediatric patients, 482
airway burns, 516 CBF. See Cerebral blood flow
airway management, 422 CCASTs. See Critical Care Air Support Teams
breathing management, 422–423 CCATs. See Critical Care Air Transport Teams
chemical burns, 518 CCPG. See Canadian clinical practice guidelines
circulatory evaluation, 168, 423 CCR. See Canadian C-Spine Rule
electrical injuries, 171 CCs. See Combat casualties
excision, 166 Central venous access. See Percutaneous central venous access
grafting, 166 Central venous pressure, 111–112
infusions, 168–169 Cerebral blood flow, 125, 127
intraoperative anesthetic management, 169–170 Cerebral metabolic rate of oxygen, 126–127
intravenous fluid resuscitation formulas, 165 Cerebral perfusion pressure, 12–13, 125–126, 365, 417
Lund-Browder charts, 422 Cervical myelopathy, 254
neurologic evaluation, 168 Cervical radiculopathy, 254
nonsurgical care, 165–166 Cervical spine injuries
nonthermal skin diseases, 171 airway management, 122–123
nutritional considerations, 168–169 Canadian C-Spine Rule, 123–124
operating room set-up, 166–167 epidemiology, 122
patient evaluation, 167–169 injury patterns, 122

xxxi
Combat Anesthesia: The First 24 Hours

radiologic assessment, 110, 123–124 abdominal trauma, 8

steroids and, 124 aeromedical transport, 5–7
CGOs. See Clinical Guidelines for Operations anesthesia and, 17
Chemical, biological, radiological, and nuclear exposure cardiovascular injuries, 8–10
airway burns, 516 care under fire, 5
airway issues, 512–516 damage control resuscitation, 7
antidotes, 521 extremity injuries and wounds, 8
biological casualties, 516, 518–519 golden hour concept, 4–7
breathing issues, 516–517 hematologic injuries, 16–17
chemical casualties, 517–518 hepatic injuries, 15–16
circulation issues, 517–518 improvised explosive devices injuries, 4
cyanides, 515–516 lethal triad, 4
decontamination, 508, 510 management at role 2 and 3 facilities, 7–8
direct-acting agents, 516–517 management of stable casualties, 182–188
drug contraindications, hazards, and interactions, 520–521 neurologic injuries, 12–13
emergency response, 506–512 outcomes tracking and research, 276–280
hot-zone treatment, 510–512 physiology of, 4
incident management, 506 pulmonary injuries, 10–12
indirect-acting agents, 517 renal injuries, 13–15
inhalational injuries, 515 roles of care, 5–7
initial investigations for casualties, 508 tactical combat casualty care, 4–5
medical hazardous materials site plan, 507 tactical damage control surgery, 7–8
nerve agents, 513–514, 517–519 tactical field care, 5
neurological issues, 518–520 thoracic trauma, 8
personal protective equipment, 507–508 traumatic brain injuries, 7
pulmonary agents, 514–515 Combat casualty care, 43
“Quick Look” assessment, 507, 509 Combat support hospitals, 97
radiological casualties, 516, 518, 519 Command representation, 263
recognizing incidents, 506–507 Compartment syndrome
riot control agents, 515–516 abdominal compartment syndrome, 14–15, 298–299
triage, 510–512 early management of, 14, 298–299
vesicants, 514 extremity compartment syndrome, 7
Chest compressions, 557 multimodal analgesia, 208–209
Chest trauma risk factors, 7
chest wall trauma, 10–11 Component therapy, 101, 103–104
pediatric patients, 402–403 Computed tomography imaging
Children. See Pediatric trauma cervical spine injuries, 110, 124
Choking agents, 514–515 head trauma, 124–125
Cholecystitis, acalculous, 343 initial trauma assessment, 176–177
Chronic pain Concurrent resuscitation, 49
ascending pain pathways, 247 Conscious sedation, 185–186
back pain, 248–253, 255–256 Continuing Promise mission, 449–450
classification of, 246–248 Continuous peripheral nerve block
definition of, 246–248 benefits of, 235
descending modulation, 247 complications, 235–236
interventional procedures, 256 contraindications, 235
neck pain, 253–256 daily rounding considerations, 237–238
neuropathic pain, 246 drugs, 237
treatment options, 255–256 indications, 235
Circulation management infusion settings, 237
critical care, 297–299 isolated upper limb injuries, 207
following chemical, biological, radiological, and nuclear expo- for multiple extremity injuries, 235
sure, 517–518 nursing guidelines, 238
pediatric trauma, 474, 479 securing the catheter, 237
Clinical Guidelines for Operations, 555 when to initiate, 236–237
Clinical practice guideline Continuous renal replacement therapy, 323
acute pain service, 263–264 COTS. See Coagulopathy of trauma shock
Clonidine, 364 COX. See Cyclooxygenase
CMRO2. See Cerebral metabolic rate of oxygen CPG. See Clinical practice guideline
Coagulopathy CPNB. See Continuous peripheral nerve block
combat casualties and, 4 CPP. See Cerebral perfusion pressure
dilutional, 99 Crew Resource Management, 32–33, 61
Coagulopathy of trauma shock. See also Shock Cricothyroidotomy, 478
Camp Bastion protocol, 242–244 Critical care
determining when to use regional anesthesia, 242 acute lung injury, 291–292
Combat application tourniquets, 145 adequacy of resuscitation, 288–289
Combat casualties admission history, 286

xxxii
 Index

airway management, 296 CT imaging. See Computed tomography imaging

anesthetic considerations for critically injured military pa- CVP. See Central venous pressure
tients, 569 CVVH. See Veno-venous technique of hemofiltration
breathing management, 296–297 Cyanide antidotes, 521
burn injuries, 164–171 Cyanide poisoning, 515–516
circulation management, 297–299 Cyclooxygenase, 223
compartment syndromes, 298–299
drug administration, 300 D
environment considerations, 299–300
ethical issues, 460–467 Damage control resuscitation
fluid administration complications, 297–298 acidosis, 90
gastric protection, 300 antifibrinolytics, 91
gut damage control, 300 calcium management, 90
hematology, 288 damage control surgery, 37–38, 88, 293
hemodynamic considerations, 288–291 end points of, 91–92
imaging, 288, 300 evolution of military trauma care, 86–87
intravascular lines, 300 fluids, 38, 88, 89
maintaining blood pressure, 297 hematologic injuries, 16–17
management plans, 288 hemostatic resuscitation, 88–89
management problems following damage control surgery, 293 hypothermia, 90–91
patient discharge, 293 managing the physiology, 89–91
patient transfer, 300 medical adjuncts, 91
pediatrics, 402–424 pathophysiology, 87
physical examination, 286 permissive hypotension, 54, 88
positioning, 300 point-of-care testing, 89
receiving patients, 286–293 point of wounding, 87
record-keeping, 299–300 potassium management, 90
regional techniques, 300 principles of, 87–89
topical negative pressure dressings, 300 recombinant activated factor VII, 91
traumatic brain injury, 299 at role 2 and 3 facilities, 7
venous thromboembolism prophylaxis, 300 specialist retrieval teams, 88
volume status of cardiovascular system, 289–291 Damage control surgery, 37–38, 88, 293
Critical care, perioperative and interoperative DCR. See Damage control resuscitation
adjuncts in trauma resuscitation, 114–115 Debridement, 150
admission to intensive care unit, 114–115 Decontamination, 508, 510
airway assessment, 108–110 Deep peripheral nerve block, 243–244
the “AMPLE” history, 109 Deep venous thrombosis, 352–355
assessment regime, 108–112 Defence Medical Rehabilitation Centre, 570
base deficit correction, 112 Defense and Veterans Pain Rating Scale, 278
circulation, 111 Deontology, 460
clearance of cervical spine, 110 Deployed aeromedical team, 263
conditions requiring rapid sequence induction of anesthesia, Deployed pain service
110 clinical practice guideline, 263–264
early enteral nutrition, 115 deployed acute pain service responsibilities, 262
early intensive care requirements for the severely injured, 109 enabling change, 265
end points in resuscitation, 113 governance, 262
fluids in trauma resuscitation, 114 multidisciplinary team, 262–263
fracture fixation, 114 pain education, 264
hypotensive resuscitation, 113–114 predeployment training, 264
immediate requirements and decision points in treating the specialist interest group responsibilities, 262
severely injured, 109 standard operating instruction, 263–264
infection care bundles, 115 team rounds and meetings, 265
initial management, 108 team training, 264
inotropic agents, 114 DeVilbiss Oxygen Concentrator, 536
lactate correction, 112 Dexmedetomidine, 362, 364
patient history, 108 Dilutional coagulopathy, 99
vascular volume status, 111–112 Direct atrial cannulation, 68
vasoactive agents, 114 Direct laryngoscopy, 78
ventilation, 110–111 Disaster relief, 448, 449
Critical Care Air Support Teams, 392, 394–398 Disease non-battle-injuries, 182
Critical Care Air Transport Teams, 6–7, 392–398 Distributive shock, 333–335
CRM. See Crew Resource Management DLEBT. See Double-lumen endobronchial tube
CRRT. See Continuous renal replacement therapy DLT. See Double-lumen endobronchial tube
Crystalloids, 88, 89, 114 DNBI. See Disease non-battle-injuries
CSHs. See Combat support hospitals Dorsal horn, 195–196
CSIs. See Cervical spine injuries Double-lumen endobronchial tube, 139–140, 307
CT. See Component therapy Dräger Fabius Tiro M, 532–533

xxxiii
Combat Anesthesia: The First 24 Hours

Dräger Narkomed M, 533–536 pumps, 234

Dräger Vamos, 538 securing the catheter, 233–234
Draw-over systems, 528–532 when to initiate, 233
Drug fever, 342–343 Epidural anesthesia
Dustoff units, 46–47 pediatric patients, 482
DVPRS. See Defense and Veterans Pain Rating Scale Epinephrine, 557
DVT. See Deep venous thrombosis Equipment
airway equipment, 404–406, 470
E anesthesia equipment, 528–544
Belmont Rapid Infuser FMS 2000, 542–543
EAST. See Eastern Association for the Surgery of Trauma guide- Braun Perfusor Compact S, 543–544
lines catheter techniques, 547
Eastern Association for the Surgery of Trauma guidelines, 354 conventional general anesthesia machines, 532–536
ECCNs. See En-route critical care nurses DeVilbiss Oxygen Concentrator, 536
ECGs. See Electrocardiograms Dräger Fabius Tiro M, 532–533
Eclampsia, 498 Dräger Narkomed M, 533–536
ECMO. See Extracorporeal membrane oxygenation draw-over systems, 528–532
Elderly populations electrical nerve stimulator, 546
anesthesia, 488–489 epidural equipment changes, 234
cardiovascular disease, 486–487 expeditionary deployable oxygen concentrator system, 536
considerations for deployed military teams, 489 General Electric Healthcare Datex-Ohmeda S/5 Compact,
general anesthesia for internal fixation of fractured femur 537–538
neck, 489 intravenous infusion equipment, 541–544
medications, 487–488 Level 1 H-1200 Fast Flow Fluid Warmer, 541–542
operational factors, 488, 490 medical ultrasound, 546–547
physiology of old age, 486–487 medication delivery systems, 547–549
preoperative assessment, 486 monitors, 537–538
preoperative clinical investigations, 487 needle design, 547
renal disease, 487 nerve localization, 546–547
respiratory disease, 487 obstetric anesthesia, 493–494
Electrical injuries, 171 oxygen supplies, 536–537
Electrical nerve stimulator, 546 patient-controlled analgesia, 206, 221–222, 230–232, 547–549
Electrocardiograms, 135, 556 pediatric trauma, 404–406, 470
Electrolytes personal protective equipment, 507–508
postoperative maintenance for pediatric trauma patients, 412 portable oxygen generator system, 536–537
En-route critical care nurses, 47–48 specialist equipment for pain management, 546–549
End-tidal CO2 Triservice Anesthetic Apparatus, 528–530
methods for measuring, 53 US anesthesia monitoring, 538
tourniquet effects, 157–158 US draw-over system, 531–532
Endotracheal intubation US ventilators, 539–540
estimation of tube size and length in children, 471 Vela, 539
pediatric trauma patients, 477 ventilators, 538–540
Enteral nutrition ESPEN. See European Society for Parenteral and Enteral Nutrition
after abdominal surgery, 375 Ethical issues
after temporary abdominal closure, 376–377 best interests, 463–464, 465
continuation during repeat operations, 377 culture and autonomy, 465–466
early initiation of, 115 deontology, 460
guidelines for initiating and advancing continuous feeding, before deployment, 466–467
414 dual loyalties, 462–464
immunonutrition, 374–375 in the field hospital, 466
pediatric trauma patients, 414 the “four principles,” 460
postpyloric feeding, 375–376 hypothetical scenarios, 464–465
routes of, 373–374 the law of armed conflict, 461–462
surgical access to the gastrointestinal tract, 376 medical ethics in times of war, 460–462
types of, 374 potential conflict in military critical care, 462–466
Entonox, 496 resource allocation, 462–465
Epidural analgesia reverse triage, 463
benefits of, 233 standards of deployed medical care, 461–462
complications, 233 triage, 462–463
contraindications, 232–233 utilitarianism, 460
daily rounding considerations, 234 European Society for Parenteral and Enteral Nutrition, 372–373,
drugs, 234 375
epidural equipment changes, 234 Evacuation
indications, 232 buddy-buddy system, 43
infusion settings, 234 chain of survival, 42–43
nursing guidelines, 234 combat casualty care, 5–7, 43
obstetric anesthesia, 496–497 evacuation chain, 42–44

xxxiv
 Index

higher levels of care, 43–44 Fluid resuscitation

to higher levels of care, 43–44 complications of administration, 297–298
MEDEVAC, 48–54 damage control resuscitation, 88, 89
medical evacuation assets, 46–48 for multiple injuries, 38
patient evacuation coordination center, 42 trauma resuscitation, 114
self treatment, 43 Focused assessment with sonography for trauma, 97, 176
team medics, 43 Fracture fixation, 114
Expeditionary deployable oxygen concentrator system, 536 Fractures. See Bone fractures
Exposure injuries Fresh frozen plasma, 99, 100, 101, 352–353
pediatric patients, 482 Fresh whole blood
Extracorporeal membrane oxygenation, 309 dilutional coagulopathy and, 99
Extremity compartment syndrome, 7, 15 military use of, 101, 103–104
Extremity injuries FWB. See Fresh whole blood
classification of, 144
combat casualties, 8 G
continuous peripheral nerve block, 235
GABA. See γ-aminobutyric acid
general operative intervention considerations, 147–149
γ-aminobutyric acid, 361, 363
infection control, 147
Gastric protection, 300
limb injury revascularization, 155–160
Gastrointestinal tract
managing reperfusion after tourniquet removal, 155–160
surgical access to, 376
postoperative care, 151–152
GAWS. See Guardian Angel Weapon System
prehospital care, 145–146
General anesthesia
regional anesthesia, 148
conventional general anesthesia machines, 532–536
role 3 care, 146–147
for internal fixation of fractured femur neck, 489
surgical considerations, 149–150
obstetric anesthesia, 497
tourniquet use, 148–149
General Electric Healthcare Datex-Ohmeda S/5 Compact, 537–538
Extubation
Glasgow coma scale, 125, 365, 405, 479–480
pediatric trauma patients, 409
Glial cells, 196
Glucocorticoids, 124
F Golden hour concept, 4–7
Goldman risk factor and score, 486–487
Facet joint pain, 250, 252
Grafts, skin, 166
Facial injuries
Guardian Angel Weapon System, 47
airway management, 76
Gunshot wounds
pediatric patients, 478
multimodal analgesia, 210
Factor VIIa. See Recombinant activated factor VIIa
Gut damage control, 300
FAST. See Focused assessment with sonography for trauma
Femoral vein catheterization, 66 H
Fentanyl, 496
Fetal monitoring, 497 Hazardous materials site plan, 507
Fever Head trauma. See also Traumatic brain injury
acalculous cholecystitis, 343 anesthetic use, 127
atelectasis, 344 assessment of, 124–125
drug fever, 342–343 decreasing cerebral oxygen consumption, 126
empiric therapy, 346 Glasgow coma scale, 125
infectious considerations, 340 imaging, 177–178
malignant hyperthermia, 343–344 intracranial hypertension and, 127
neurogenic fever, 342 management, 125–127
neuroleptic malignant syndrome, 343–344 monitoring, 124–125
noninfectious causes, 341–344 pediatric patients, 417–419
pancreatitis, 343 rapid sequence induction for penetrating injuries, 51
pediatric trauma patients, 419 resuscitation, 127
serotonin syndrome, 344 sedation, 365
treatment of, 346 seizures and, 127
workup of, 344–346 Helicopter Emergency Medical System, 49–50
FFP. See Fresh frozen plasma Hematologic injuries
Fiberoptic intubation, 76, 79 anticoagulation, 17
Fiberoptic laryngoscopes, flexible, 78 damage control resuscitation, 16–17
Fibrinolytics hemostatic agents, 17
massive transfusion and, 101 massive transfusion, 16–17
Flexible fiberoptic laryngoscopes, 78 Hematology
Fluid management critical care patients, 288
for burn injuries, 165 pediatric trauma patients, 419–421
conservative, 308–309 Hemodynamics
mechanical ventilation and, 308–309 pediatric trauma patients, 409–412
pediatric trauma patients, 412–415, 479 Hemorrhage
postnatal care, 501 battlefield and preoperative control, 155

xxxv
Combat Anesthesia: The First 24 Hours

control of catastrophic external hemorrhage, 49 I

massive, 471, 474–477
massive hemorrhage protocol, 498–499 ICP. See Intracranial pressure
obstetric protocol, 498–499 ICUs. See Intensive care units
pediatric anesthesia, 471, 474–477 IED. See Improvised explosive devices
preoperative control, 155 iLA. See Interventional lung assist
tourniquet use, 155–160 Imaging
Hemorrhagic shock, 8–9 anesthesia management, 177
Hemostatic agents, 17 basic radiography, 176
Hemostatic resuscitation, 88–89 cardiac injuries, 178
HEMS. See Helicopter Emergency Medical System cervical spine injuries, 123–124
Hepatic injuries computed tomography, 176–177
liver ischemia reperfusion injury, 16 critical care patients, 288, 300
liver trauma, 15 focused assessment with sonography for trauma, 97, 176
shock liver, 16 future considerations, 179
Hercules helicopters, 47 head injuries, 177–178
HFOV. See High-frequency ocillatory ventilation initial trauma assessment, 176–177
High-frequency ocillatory ventilation, 307–308 interventional radiology, 179
High mean arterial pressure, 113 intraabdominal injuries, 178
HMAP. See High mean arterial pressure musculoskeletal injuries, 179
Hospital ships, 448–449 pelvic injuries, 178
Host nation humanitarian operations, 449–450 thoracic injuries, 178
Hot-zone treatment, 510–512 ultrasound regional anesthesia, 179
Human factors vascular injuries, 178
defense anesthesia and, 32–34 venous access for anesthesia, 179
Human immunodeficiency virus infection Immediate Response Team, 44–46
obstetric considerations, 495 Immune function, 202
Humanitarian operations Immunoglobulin, 386
anesthesia techniques, 455–457 Immunologic complications
austere and resource-limited environments, 455–457 massive transfusion and, 99–100
disaster relief, 448, 449 Immunonutrition, 374–375
hospital ships, 448–449 Impact 754 Eagle Univent, 539–540
host nations, 449–450 Improvised explosive devices. See also specific injuries by name
humanitarian assistance as a primary mission, 448 injuries, 4
humanitarian assistance as an additional mission, 448 Independent lung ventilation, 306–307
intraoperative anesthesia management, 452–454 Infants. See Pediatric trauma
medical personnel, 450 Infection care bundles, 115
mission overview and process, 449 Infection prevention and control
nongovernmental organizations, 449–450 acute lung injury, 292
postoperative care, 454–455, 457 antibiotic guidelines, 387–388
preoperative assessment, 451–452 biofilms and, 383–384
surgical services, 450 chemoprophylaxis, 432–434
Hyperkalemia colonization and infection, 382–383
acute management algorithm, 421 common infectious diseases in theater, 437, 441
damage control resuscitation and, 90 extremity, junctional, and pelvic injuries, 147
massive transfusion and, 98 individual interventions, 434–435
medical therapy for, 324 institutional interventions, 435–436
Hyperthermia, malignant, 343–344 intravascular lines and, 383
Hypocalcemia laboratory support, 386–387
damage control resuscitation and, 90 leishmaniasis, 436–440
massive transfusion and, 97–98 malaria, 436
pediatric patients, 482 multidrug-resistant bacteria, 432–441
Hypomagnesemia, 98 operating room procedures, 147
Hypotension pediatric trauma patients, 419
clinical presentation, 328 sources of infection, 382–384
general diagnostic approach, 329–331 tailoring therapy, 386–388
general principles of management, 329, 331–332 ventilators and, 383
pathophysiology of, 328 wounds, 383
Hypotensive resuscitation, 54, 88 Inferior vena cava filters, 355–356
Hypothermia Infusion pumps, 548–549
combat casualties and, 4 Inhalational analgesia, 270
damage control resuscitation and, 90–91 Inhalational injuries, 515
massive transfusion and, 99 Inotropic agents, 114
pediatric patients, 482 Institute of Surgical Research, 101, 103, 565
Hypovolemia Intensive care units
effect on systolic pressure variation, 289 admission to, 114–115
pediatric trauma patients, 475 hypotension diagnosis and management, 328–336
Hypovolemic shock, 37, 332 infection management, 382–388

xxxvi
 Index

nutritional support, 372–377 regional anesthesia, 148

receiving patients, 286–293 role 3 care, 147
sedation use, 360–366 surgical considerations, 150–151
sepsis management, 382–388 tourniquet use, 148–149
shock diagnosis and management, 328–336
Intermittent positive-pressure ventilation, 557 K
Internal jugular vein catheterization, 65–66
Interoperative critical care Ketamine
adjuncts in trauma resuscitation, 114–115 prehospital analgesia, 270–271
admission to intensive care unit, 114–115 suggested doses for acute pain control, 223
assessment regime, 108–112 suggested doses in acute severe pediatric trauma, 474
base deficit correction, 112 Kidney injury. See Acute kidney injury
circulation, 111
early enteral nutrition, 115 L
early intensive care requirements for the severely injured, 109 Lactate correction, 112
end points in resuscitation, 113 Landstuhl Regional Medical Center
fluids in trauma resuscitation, 114 current capabilities, 562–563
fracture fixation, 114 history of, 562
hypotensive resuscitation, 113–114 specialty services, 563
immediate requirements and decision points in treating the surgical specialties, 563
severely injured, 109 Laryngoscopes, flexible fiberoptic, 78
infection care bundles, 115 Laryngoscopy, 78
initial management, 108 LAST. See Local anesthetic systemic toxicity
inotropic agents, 114 Lead clinicians, 263
lactate correction, 112 Leishmaniasis, 436–440
vascular volume status, 111–112 “LEMON” airway assessment, 408
vasoactive agents, 114 Level 1 H-1200 Fast Flow Fluid Warmer, 541–542
ventilation, 110–111 Ligands, 194
Interventional lung assist, 111 Limb injuries. See Extremity injuries
Interventional radiology, 179 Limb occlusion pressure, 159–160
Intraabdominal injuries, 178 Lipolysis, 201
Intracranial hypertension, 127 Liver injuries, 15–16
Intracranial pressure, 12–13, 125–127, 365, 417–419 Liver ischemia reperfusion injury, 16
Intraosseous vascular access, 67–68, 411, 475 LMAP. See Lower mean arterial pressure
Intrathoracic airway injuries, 134–135 LMWH. See Low-molecular weight heparin
Intravascular lines Local anesthetic systemic toxicity, 235–236
infection prevention, 300, 383 Local anesthetics, 224–225, 235–236
Intravenous infusion equipment, 541–544 Local nationals injuries, 209–210
Intubation Log roll, 49
blind nasal intubation, 79 LOP. See Limb occlusion pressure
cervical spine injuries and, 122–123 Lorazepam, 362–363
confirmation of endotracheal tube position, 52–53 Low-molecular weight heparin, 353–355
drugs used with, 51–52 Lower limb injuries
failed intubation drills, 53 multimodal analgesia, 207
fiberoptic, 79 Lower mean arterial pressure, 113
improving success rate of, 52 LRMC. See Landstuhl Regional Medical Center
initial indications for mechanical ventilation, 406 LTV 1000 Series ICU Ventilator, 540
management algorithm, 408 Lund-Browder charts, 422
methods for measuring end-tidal CO2, 53 Lung injuries, 136–137. See also Pulmonary injuries
pediatric trauma patients, 406, 408
resuscitation guidelines, 557 M
success rates for Medical Emergency Response Teams, 52
Inverse-ratio ventilation, 306 MAAS. See Motor Activity Assessment Scale
IPPV. See Intermittent positive-pressure ventilation Macronutrients
IRT. See Immediate Response Team postoperative maintenance for pediatric trauma patients, 413
Ischemia-reperfusion injury, 9, 16. See also Vascular reperfusion Malaria, 436, 495
IVC. See inferior vena cava filters Malignant hyperthermia, 343–344
Manual inline stabilization, 122–123
J MAP. See Mean arterial pressure
Massive hemorrhage. See Hemorrhage
Joint Theater Trauma Registry, 277 Massive transfusion
JTTR. See Joint Theater Trauma Registry acidosis and, 98–99
Junctional injuries anticoagulation and, 17
classification of, 144–145 complications of, 97–100
general operative intervention considerations, 147–149 considerations during military operations, 100–101
infection control, 147 dilutional coagulopathy and, 99
postoperative care, 151–152 effects of, 352–353
prehospital care, 145–146 example of, 16

xxxvii
Combat Anesthesia: The First 24 Hours
fibrinolytics, 101
hemostatic agents and, 17
hyperkalemia and, 98
hypocalcemia and, 97–98
hypomagnesemia and, 98
hypothermia and, 99
immunologic complications, 99–100
initiation protocols, 96–97
military use of fresh whole blood, 101, 103–104
recombinant factor VIIa, 101
UK operational protocol, 100, 102–103
US military protocol, 100–101, 104
Massive transfusion protocol, 96–97
McGill questionnaire, 215
MDCT. See Multidetector computed tomography
MDR. See Multidrug-resistant bacteria
Mean arterial pressure, 156–157, 417
Mechanical ventilation
acute lung injuries and, 291–292
adjuncts to, 308–309
asymmetrical pulmonary pathologies, 307
for bronchopleural fistula, 316–318
conservative fluid management, 308–309
drugs used with, 51–52
extracorporeal membrane oxygenation, 309
the first 24 hours, 304–310
high-frequency ventilation, 307–308
independent lung ventilation, 306–307
infection issues, 383
inverse-ratio ventilation, 306
mode of, 305–308
monitoring and optimizing ventilation, 304–305
neuromuscular blocking agents, 308
nitric oxide and, 308
pediatric trauma patients, 402–409, 406–409
positive end-expiratory pressure, 305
prehospital procedures, 53
pressure-preset ventilation, 305–306
principles of safe ventilation, 304–305
prone positioning, 308
recruitment maneuvers, 308
resuscitation guidelines, 557
spontaneous ventilation, 306
thoracic injuries and, 140
tidal volume, 304
for tracheal disruption, 316–318
transfer ventilators, 309–310
volume-preset ventilation, 305
MEDCENs. See Military medical centers
MEDEVAC
access to vascular space, 49
capabilities, 47
care during, 48–54
concurrent resuscitation, 49
control of catastrophic external hemorrhage, 49
drugs used with intubation and ventilation, 51–52
en-route care, 46–47
intubation, 52–53
the log roll, 49
patient movement concepts, 393
rapid sequence induction, 49–51
resuscitation, 53–54
thoracostomy, 53
training, 46
ventilation, 53
Medical Emergency Response Team
combat casualty retrieval, 46
composition of, 45
xxxviii
evolution of, 44–45
in-theater training, 45–46
intubation success rates, 52
patient movement concepts, 394
predeployment preparation, 45
Medical evacuation assets
CASEVAC, 4–7, 46, 394
MEDEVAC, 46–54, 393–394
US Air Force pararescue, 47–48
Medical hazardous materials site plan, 507
Medical ultrasound, 546–547
MERT. See Medical Emergency Response Team
MHS. See Military Health System
Midazolam, 361–362
Military Health System, 565
Military hospitals
Landstuhl Regional Medical Center, 562–563
in the United States, 564–566
Military medical activities, 565
Military medical centers, 564–565
Military pain scoring systems, 215–216
Military treatment facilities, 43–44
MILS. See Manual inline stabilization
Minimum alveolar concentration, 481
MODS. See Multiorgan dysfunction syndrome
Monitors, 537–538
Morphine, 496
Motor Activity Assessment Scale, 361
MTFs. See Military treatment facilities
MTP. See Massive transfusion protocol
Multidetector computed tomography, 177
Multidisciplinary trauma team, 34–35
Multidrug-resistant bacteria
antibiotic guidelines, 387
chemoprophylaxis, 432–434
common infectious diseases in theater, 437, 441
individual interventions, 434–435
infection from, 382
institutional interventions, 435–436
leishmaniasis and, 436–440
malaria and, 436
organism surveillance, 434
Multimodal analgesia
advanced techniques, 206–207
basics of, 206
compartment syndrome, 208–209
complex injuries, 209
injuries to local nationals, 209–210
isolated forearm gunshot wound, 210
isolated lower limb injury, 207
isolated upper limb injury, 207
multimodal applications, 207–210
penetrating abdominal injuries, 210
simple or single injuries, 207–209
thoracic injuries, 208
treatment facilities, 209–210
Multiorgan dysfunction syndrome, 112–113, 115
Musculoskeletal injury imaging, 179
Myofascial pain, 250
N
N-methyl-D-aspartate receptor antagonists, 222–223
Narcotics. See also specific drugs by name
prehospital analgesia, 269
NASA. See National Aeronautics and Space Administration
Nasal intubation, blind, 79
National Aeronautics and Space Administration, 32
 Index

National Emergency X-Radiography Utilization Study, 123–124 postoperative pediatric trauma patients, 412–415
National Health Service, 32–33 postpyloric feeding, 375–376
Neck injuries surgical access to the gastrointestinal tract, 376
airway management, 76–77 types of enteral feed preparations, 374
whiplash injuries, 254–255
Neck pain O
cervical myelopathy, 254
cervical radiculopathy, 254 Obstetric anesthesia
occipital neuralgia, 254 anemia and, 495
prevalence of, 253 antenatal care, 496
treatment options, 255–256 cardiac disease and, 494–495
whiplash injuries, 254–255 challenges in the deployed environment, 492–495
Needle design, 547 civilian best practice, 501
Neonatal care, 501 current civilian best practice, 495–501
Nerve agents, 513–514, 517–519 deployed civilian experience, 501
Nerve blocks environmental considerations, 493
needle design, 547 equipment considerations, 493–494
pediatric patients, 481 fetal monitoring, 497
Nerve localization, 546–547 high-risk conditions, 498–500
Nerve stimulator, electrical, 546 human immunodeficiency virus infection and, 495
Neuraxial anesthesia, 185 malaria and, 495
Neuraxial blockade, 355 massive hemorrhage protocol, 498–499
Neurogenic fever, 342 military experience, 501
Neurogenic shock, 10, 335 neonatal care, 501
Neuroleptic malignant syndrome, 343–344 normal labor, 493, 496–497
Neurologic injuries obstetric experience of deployed surgeons, 493
cerebral perfusion pressure, 12–13 operative interventions, 493, 497–498
following chemical, biological, radiological, and nuclear expo- pain relief during labor, 496–497
sure, 518–520 patient information, 495–496
intracranial pressure, 12–13 postnatal care, 501
pediatric patients, 479–480 preexisting indigenous standards of care, 492–493
prophylaxis for severe traumatic brain injury, 13 preexisting pathology in the pregnant patient, 493–495
Neurological systems, 202 resources for the deploying anesthesiologist, 501
Neuromuscular blocking agents, 308 risk factors, 493
Neuropathic pain, 246 sexual violence and, 495
NEXUS. See National Emergency X-Radiography Utilization tocolysis, 498
Study trauma management principles, 499–500
NHS. See National Health Service Obstructive shock, 10, 335–336
Nitric oxide Occipital neuralgia, 254
mechanical ventilation and, 308 OL-ILV. See One-lung independent ventilation
NMDA. See N-methyl-D-aspartate receptor antagonists One-lung independent ventilation, 140
Nociceptor receptors, 194 Operating room procedures
Nongovernmental organizations, 449–450 amputation, 150
Nonopioid analgesics, 222–225 communication, 147
Nonsteroidal antiinflammatory drugs, 223, 225, 269–270 debridement, 150
Nonthermal skin diseases, 171 extremity injuries, 149–150
Novel hybrid resuscitation, 54 general principles for surgical management of battlefield
NSAIDs. See Nonsteroidal antiinflammatory drugs wounds, 149
Nuclear exposure. See Chemical, biological, radiological, and infection control, 147
nuclear exposure junctional injuries, 150–151
Nurses patient positioning, 147
continuous peripheral nerve block guidelines, 238 pelvic injuries, 151
en-route critical care nurses, 47–48 regional anesthesia, 148
epidural analgesia guidelines, 234 set-up for burn injuries, 166–167
pain nurses, 263 tourniquet use, 148–149
patient-controlled analgesia guidelines, 232 vascular surgery, 149–150
ward nurses, 263 Operation Smile, 450
Nutritional support Opioids
acute lung injuries and, 292 adverse events, 222
burn injuries and, 168–169 intravenous administration, 220–222
continuation of enteral nutrition during repeat operations, 377 pain regimen based on injury severity, 221
enteral feeding after abdominal surgery, 375 per os administration, 220
enteral nutrition after temporary abdominal closure, 376–377 side effects, 231
enteral route, 373–377 Orthopedic injuries, 149
immunonutrition, 374–375 Oxygen supplies, 536–537
initiation of, 372–373
nutritional requirements, 372
parenteral route, 373–377

xxxix
Combat Anesthesia: The First 24 Hours

P key hormones released, 200

lipolysis, 201
Packed red blood cells, 97, 99 metabolic responses, 200–202
Pain, acute. See also Acute pain service neurological systems response, 202
basic concepts, 194 patient outcomes, 203
descending modulatory pathways, 196 protein catabolism, 200
dorsal horn, 195–196 psychological responses, 202
measuring pain, 277–278 respiratory response, 202
pain matrix, 196–197 system responses, 202
pain mechanisms, 194–197 water and electrolyte balance, 201–202
pain perception in higher centers, 196–197 Pain scoring
pain transmission, 195–196 difficulties with, 214
peripheral nociceptors, 194 importance of, 214
role of the glia, 196 military scoring systems, 215–216
transient receptor potential vallinoid channel subtypes, 195 scoring effects of pain, 215
WHO pain ladder, 207, 277–278 scoring pain intensity, 215
Pain, chronic when to score pain, 217
ascending pain pathways, 247 Pain service
back pain, 248–253, 255–256 clinical practice guideline, 263–264
classification of, 246–248 deployed acute pain service responsibilities, 262
definition of, 246–248 enabling change, 265
descending modulation, 247 governance, 262
interventional procedures, 256 multidisciplinary team, 262–263
neck pain, 253–256 pain education, 264
neuropathic pain, 246 predeployment training, 264
treatment options, 255–256 specialist interest group responsibilities, 262
Pain management standard operating instruction, 263–264
catheter techniques, 547 team rounds and meetings, 265
communication and, 278 team training, 264
continuous peripheral nerve block, 235–238 Pancreatitis, 343
electrical nerve stimulator, 546 Pararescuemen, 47–48
epidural analgesia, 232–234 Parenteral nutrition
future of pain management on the battlefield, 279–280 immunonutrition, 374–375
history of, 276–277 initiation and advancement of, 414
measuring pain, 277–278 pediatric trauma patients, 414–415
medical ultrasound, 546–547 postpyloric feeding, 375–376
medication delivery systems, 547–549 recommendations for nutrition components, 415
needle design, 547 routes of, 373–374
nerve localization, 546–547 surgical access to the gastrointestinal tract, 376
obstetric anesthesia, 496–497 Patient-controlled analgesia, 547–549
pain management champions, 263 benefits of, 206, 230
patient-controlled analgesia, 206, 221–222, 230–232, 547–549 complications, 230–231
pediatric trauma patients, 415–417 contraindications, 230
postnatal care, 501 indications, 230
roles of care, 278 nursing guidelines, 232
specialist equipment for, 546–549 opioid administration, 221–222
Pain medications pediatric trauma patients, 416
acetaminophen, 223–225 pump settings, 231
adverse events, 222 types of drugs, 230
anticonvulsants, 224 when to initiate, 232
frequency of intravenous and oral analgesic administration, Patient evacuation coordination center, 42
279 Patient movement requirement centers, 396
intravenous administration, 220–222 Patient positioning
local anesthetics, 224–225 airway management, 77–78
N-methyl-D-aspartate receptor antagonists, 222–223 critical care, 300
nonopioid analgesics, 222–225 mechanical ventilation and, 308
nonsteroidal antiinflammatory drugs, 223, 225 operating room procedures, 147
opioids, 220–222 percutaneous central venous access, 65, 66
pain regimen based on injury severity, 221 prone positioning, 308
per os administration, 220 Patient transfer, 300
α2-adrenergic agonists, 224–225 Patient transport. See also Aeromedical transport
Pain nurses, 263 pediatric trauma patients, 423
Pain relief Pave Hawk helicopters, 47–48
carbohydrate metabolism, 201 PCA. See Patient-controlled analgesia
cardiovascular response, 202 PECC. See Patient evacuation coordination center
immune function response, 202 Pediatric Advanced Life Support algorithm, 554
initial stress response, 200 Pediatric trauma

xl
 Index

acute management of asthma exacerbation algorithm, 406–407 anterior posterior compression, 145
acute management of hyperkalemia algorithm, 421 classification of, 145
airway equipment, 404–406, 470 general operative intervention considerations, 147–149
airway management, 477–478 imaging, 178
analgesia, 481–482 infection control, 147
analgesic drug doses, 474 lateral compression, 145
anatomy and physiology, 403, 473–474 management strategy for fractures, 150–151
anesthesia, 470–482 postoperative care, 151–152
anesthesia handoff checklist, 405 prehospital care, 145–146
blood product dosing guidelines, 420 regional anesthesia, 148
breathing management, 478–479 role 3 care, 147
burn care, 421–423 surgical considerations, 151
caudal anesthesia, 482 tourniquet use, 148–149
chest trauma, 402–403 vertical shear, 145
circulation management, 474, 479 Percutaneous central venous access
commonly used analgesics, 416 complications of, 67
disability, 479–482 femoral vein, 66
dosing for commonly used medications, 428 history of, 64–65
dosing for single-injection peripheral nerve block, 481 internal jugular vein, 65–66
emergency resuscitation dosing, 427 patient positioning, 65, 66
enteral feeding, 414 pediatric trauma patients, 412, 427, 475–477
epidural anesthesia, 482 subclavian vein, 65
equipment, 404, 470 tasks to be completed on arrival of patient, 65
estimated blood volumes, 420 techniques, 65, 66
estimation of endotracheal tube size and length in children, ultrasound-guided, 66–67
471 Perioperative critical care
exposure, 482 adjuncts in trauma resuscitation, 114–115
fever, 419 admission to intensive care unit, 114–115
fluid management, 412–415, 479 airway assessment, 108–110
Glasgow coma scale, 405, 479–480 the “AMPLE” history, 109
head trauma, 417–419 assessment regime, 108–112
hematologic issues, 419–421 base deficit correction, 112
hemodynamic principles, 409–412 circulation, 111
infection, 419 clearance of cervical spine, 110
initial ventilator settings, 409 conditions requiring rapid sequence induction of anesthesia,
intraosseous insertion, 411 110
massive hemorrhage, 471, 474–477 early enteral nutrition, 115
mechanical ventilation, 402–409 early intensive care requirements for the severely injured, 109
minimum alveolar concentration, 481 end points in resuscitation, 113
neurologic injuries, 479–480 fluids in trauma resuscitation, 114
normal physiological values for children, 470 fracture fixation, 114
nutritional support, 412–415 hypotensive resuscitation, 113–114
pain management, 415–417 immediate requirements and decision points in treating the
parenteral feeding, 414 severely injured, 109
patient-controlled analgesia, 416 infection care bundles, 115
pediatric parameters, 404 initial management, 108
physiologic considerations, 403, 473–474 inotropic agents, 114
preparation, 470–471 lactate correction, 112
pulmonary support, 402–409 patient history, 108
rapid sequence induction, 420, 477–478 vascular volume status, 111–112
receiving pediatric critical care patients, 402 vasoactive agents, 114
recommended extubation criteria, 409 ventilation, 110–111
refeeding syndrome, 415 Peripheral nerve blocks
resuscitation, 412, 427, 475–477 needle design, 547
sedation management, 415–417, 480 pediatric patients, 481
spinal cord trauma, 417–419 Peripheral nociceptors, 194
thermoregulation, 474 Peripheral venous cutdown, 68
transport principles, 423 Peritoneal dialysis, 325
trauma considerations, 471–473 Permissive hypotension, 54, 88
vascular access, 410–412, 475 Personal protective equipment, 507–508
vasoactive agents, 411 Pethidine, 496
ventilator-associated pneumonia bundle, 410 Pharmacists
ventilatory management techniques, 406–410 acute pain service responsibilities, 263
weight estimation for Afghanistan local national children, 471 Physical examinations, 286
Pedro helicopters, 47 Physiotherapists, 263
PEEP. See Positive end-expiratory pressure PIS. See Propofol infusion syndrome
Pelvic injuries PMRCs. See Patient movement requirement centers

xli
Combat Anesthesia: The First 24 Hours

Pneumonia R
ventilator-associated pneumonia bundle, 410
Pneumothorax, 67 RAAS. See Rennin-angiotensin-aldosterone system
Point-of-care testing, 89 Radiologic assessment. See also Imaging
Portable oxygen generator system, 536–537 cervical spine injuries, 123–124
Positioning. See Patient positioning Radiological exposure. See Chemical, biological, radiological, and
Positive end-expiratory pressure, 111, 292, 305–306 nuclear exposure
Postnatal care, 501 RAP. See Regimental aid posts
Postoperative care Rapid sequence induction
burn injuries, 170 airway management, 79, 122–123
extremity injuries, 151–152 care during MEDEVAC, 49–51
junctional injuries, 151–152 indications for, 50–51
pediatric trauma patients, 412–415 medications commonly used for, 420
pelvic injuries, 151–152 pediatric trauma patients, 420, 477–478
Postpyloric feeding, 375–376 risks during MEDEVAC flight, 50
Posttraumatic stress disorder RASS. See Richmond Agitation-Sedation Scale
pain response, 202 RBCs. See Red blood cells
Potassium management RCC. See Red cell concentrate
damage control resuscitation and, 90 RCDM. See Royal Centre for Defence Medicine
massive transfusion and, 98 Recombinant activated factor VIIa
PRBCs. See Packed red blood cells damage control resuscitation and, 91
Preeclampsia, 498 effects of, 352–353
Prehospital medicine massive transfusion and, 101
analgesia, 268–272 Record-keeping, 299–300
care during MEDEVAC, 48–54 Recruitment maneuvers, 308
considerations for the future, 54 Red blood cells, 98
evacuation chain, 42–44 Red cell concentrate, 100
extremity, junctional, and pelvic injuries, 145–146 Refeeding syndrome, 415
Medical Emergency Response Team, 44–46 Regimental aid posts, 43
medical evacuation assets, 46–48 Regional anesthesia
prehospital resuscitation guidelines, 555–556 Camp Bastion protocol, 242–244
Pressure-preset ventilation, 305–306 continuum of risk, 243
PRIS. See Propofol infusion syndrome determining when to use, 242
Project HOPE, 450 for extremity, junctional, and pelvic injury surgical procedures,
Prone positioning, 308 148
Propaq, 538 obstetric anesthesia, 497
Propofol, 362–364 pediatric patients, 480–481
Propofol infusion syndrome, 126, 363–364 potential benefits of, 242
Protein catabolism, 200 for stable casualties, 185
PTSD. See Posttraumatic stress disorder ultrasound imaging and, 179
Pulmonary agents, 514–515 venous access, 179
Pulmonary embolism, 335 Remifentanil, 496
Pulmonary injuries. See also Respiratory disease Renal disease
acute respiratory distress syndrome, 12 elderly populations and, 487
airway trauma, 10 Renal failure
chest wall trauma, 10–11 etiology of, 322
lung injuries, 136–137 incidence of, 322
pediatric trauma patients, 402–409 Indications for renal support, 322–323
pulmonary contusion, 291 management options, 323–324
pulmonary trauma, 10–11 outcomes, 324
prevention of, 322
Q “RIFLE” classification, 322–323
Renal injuries
Q fever, 341, 437, 441 abdominal compartment syndrome, 14–15
QEHB. See Queen Elizabeth Hospital Birmingham acute kidney injury, 14, 322–324
Queen Elizabeth Hospital Birmingham compartment syndrome, 14
anesthetic considerations for critically injured military pa- extremity compartment syndrome, 15
tients, 569 renal replacement therapy, 15
clinical and anesthetic considerations for patients admitted to “RIFLE” criteria for acute renal failure, 15
the military trauma ward, 569 risk factors for acute renal failure, 13
coordinating clinical care, 569–570 Renal replacement therapy, 15, 322–325
essential requirements for receiving casualties at Role 4, 568 Renal support
external relationships, 570 constructing a field-expedient peritoneal dialysis system, 325
operating room activity, 570 etiology of injuries, 322
patient admissions and disposition, 568–569 history of, 322
“Quick Look” assessment, 507, 509 incidence of injuries, 322
indications for, 322–323

xlii
 Index

management options, 323–324 Sedation. See also Anesthesia

modes of, 324 acute lung injury, 292
outcomes, 324 benzodiazepines, 361
prevention of acute kidney injury and renal failure, 322 conscious sedation, 185–186
Rennin-angiotensin-aldosterone system, 290–291 daily interruption of sedation, 365–366
Reperfusion. See also Vascular reperfusion dexmedetomidine, 362, 364
ischemia-reperfusion injury, 9, 16 head injuries, 365
Respiratory disease. See also Pulmonary injuries pediatric trauma patients, 415–417, 480
elderly populations and, 487 pharmacology of sedatives, 362
Goldman risk factor and score, 486–487 propofol, 362–364
Respiratory system restraints and, 366
pain response, 202 sedation scales, 360
Restraints sedatives, 361–364, 417
sedation and, 366 Seizures
Resuscitation. See also Damage control resuscitation head trauma and, 127
adequacy of resuscitation, 288–289 Sepsis
areas of controversy, 557 antibiotic guidelines, 387–388
blood product administration, 53–54 diagnosis of, 333
capnometry as a guide to resuscitation, 557 goal-directed therapy, 334
cardiac arrest guidelines, 552 immunoglobulin doses, 386
chest compressions, 557 laboratory support, 386–387
concurrent, 49 patient management, 333, 384
end points, 113 the resuscitation bundle, 384–385
epinephrine, 557 the sepsis management bundle, 385–386
evidence for military traumatic cardiorespiratory arrest, supportive therapy, 385
556–557 tailoring therapy, 386–388
guidelines, 552–558 Sequential compression device, 354
head trauma, 127 Serotonin syndrome, 344
hypotensive resuscitation, 54 Sexual violence, 495
ideal goals of, 113 Shock
intubation, 557 adrenal crisis, 335
novel hybrid resuscitation, 54 anaphylaxis, 333, 335
obstetric algorithm, 500 cardiac tamponade, 336
pediatric emergency resuscitation dosing, 427 cardiogenic shock, 332–333
pediatric trauma patients, 412, 427, 475–477 categories of, 328–329
prehospital resuscitation guidelines, 555–556 clinical presentation, 328
the resuscitation bundle, 384–385 coagulopathy of trauma shock, 242–244
trauma resuscitation guidelines, 552–555 combat casualties and, 8–10
vasopressors, 557 distributive shock, 333–335
ventilation, 557 hypovolemic shock, 37, 332
Return of spontaneous circulation, 556–557 management of, 332–336
Richmond Agitation-Sedation Scale, 292, 360–361 neurogenic shock, 335
“RIFLE” criteria, 15, 322–323 obstructive shock, 335–336
Riot control agents, 515–516 pathophysiology of, 328
Roles of care pulmonary embolism, 335
acute pain services at role 3 facilities, 278–279 sepsis, 333–334
burn casualties at role 3 facilities, 164–171 traumatic shock, 8–9
for combat casualties, 5–7 Shock liver, 16
combat casualty management at role 2 and 3 facilities, 7–8 SIRS. See Systemic inflammatory response syndrome
damage control resuscitation at role 2 and 3 facilities, 7 Situational awareness
essential requirements for receiving casualties at Role 4, 568 trauma teams and, 34
extremity injury management at role 3 facilities, 146–147 Skin diseases, nonthermal, 171
junctional injury management at role 3 facilities, 147 Skin grafts, 166
pelvic injury management at role 3 facilities, 147 Society of Critical Care Medicine, 360, 365
Royal Air Force Sodium maintenance, 412–413
Critical Care Air Support Teams, 392 SOI. See Standard operating instruction
Royal Centre for Defence Medicine, 568 SOP. See Standard operating procedures
RRT. See Renal replacement therapy Specialist retrieval teams, 88
RSI. See Rapid sequence induction Spinal-epidural analgesia, 497
Rule of nines, 422 Spinal injuries. See also Back pain
airway management, 122–123
S Canadian C-Spine Rule, 123–124
CT imaging, 110
Sacroiliac joint pain, 250, 252 epidemiology, 122
SCCM. See Society of Critical Care Medicine injury patterns, 122
SCD. See Sequential compression device pediatric patients, 417–419
Scoring pain. See Pain scoring radiologic assessment, 110, 123–124

xliii
Combat Anesthesia: The First 24 Hours

steroids and, 124 Thoracotomy, 137–138, 556

Spinal stenosis, 250, 253 Thromboembolic disease
Spontaneous ventilation, 306 chemical prophylaxis, 354–355
Stable casualties Factor VIIa effects, 352–353
choosing anesthetic technique, 184–187 inferior vena cava filters, 355–356
classification of, 182 massive transfusion effects, 352–353
common operations, 183–184 mechanical prophylaxis, 354
conscious sedation, 185–186 neuraxial blockade, 355
monitoring depth of anesthesia, 187 pathophysiology of venous thromboembolism, 352–353
neuraxial anesthesia, 185 prevalence of venous thromboembolism, 353
perioperative considerations, 184 prevention of venous thromboembolism, 353–356
population at risk, 182–183 prophylaxis, 300
regional anesthesia, 185 tranexamic acid effects, 352–353
special considerations, 183 Tidal volume, 304
total intravenous anesthesia, 186–187 TIVA. See Total intravenous anesthesia
volatile gas anesthesia, 185 TL-ILV. See Two-lung independent ventilation
Standard operating instruction Tocolysis, 498
acute pain service, 263–264 Topical negative pressure dressings, 300
Standard operating procedures TOSC. See Return of spontaneous circulation
trauma teams and, 33–34 Total intravenous anesthesia, 186–187
Steroids Tourniquets
spinal injury use, 124 cardiovascular effects, 156–157
Strategic evacuation, 394, 397 combat application tourniquet, 145
STRATEVAC. See Strategic evacuation complications association with, 148
Subclavian vein catheterization, 65 extremity injuries and, 148–149
Superficial peripheral nerve block, 244 junctional injuries and, 148–149
Supraglottic airways, 78 managing reperfusion after removal, 155–160
Surgical principles, 149. See also Operating room procedures metabolic effects, 159
Surviving Sepsis Campaign, 333, 384 neurologic effects, 158
SVR. See Systemic vascular resistance pelvic injuries and, 148–149
Systemic inflammatory response syndrome, 115 physiologic effects, 156–160
Systemic vascular resistance, 156–157 respiratory effects, 157
safety of, 159–160
T tourniquet pain, 158–159
Tracheal disruption
TACEVAC. See Tactical evacuation aeromedical evacuation, 316–317
Tactic, technique, or procedure calls, 47 diagnosis of, 316
Tactical Combat Casualty Care, 4–5, 48, 271 postoperative care, 316–317
Tactical damage control surgery, 7–8 preventing further injury, 316–317
Tactical evacuation, 394, 397 ventilation considerations, 316–317
TAP block. See Transversus abdominis plane block ventilator settings, 316–317
Target-controlled infusions, 186–187 Tracheostomy, 478
TBI. See Traumatic brain injury TRALI. See Transfusion-related acute lung injury
TCCC. See Tactical Combat Casualty Care Tranexamic acid, 352–353
TCI. See Target-controlled infusions Transfer ventilators, 309–310
TCRA. See Traumatic cardiorespiratory arrest Transfers, patient, 300
Team medics, 43 Transfusion, massive. See Massive transfusion
Thermal injury, acute, 164–165 Transfusion-related acute lung injury, 100
Thermoregulation Transient receptor potential vallinoid, 194–195
pediatric trauma patients, 474 Transport, patient. See also Aeromedical transport
Thoracic injuries pediatric trauma patients, 423
analgesia principles, 140 Transversus abdominis plane block, 207–108
anesthesia principles, 139 Trauma shock
aortic injuries, 136 coagulopathy of trauma shock, 242–244
blunt injuries, 135 Trauma team
cardiac injuries, 135–136 communication, 33
combat casualties, 8 considerations for, 35–38
imaging, 178 crew resource management, 33–34
intrathoracic airway injuries, 134–135 familiarization with environment and equipment, 34
lung injuries, 136–137 leadership and followership, 34
multimodal analgesia, 208 multidisciplinary trauma team, 34–35
operative intervention, 137–139 roles of, 36
pathophysiology, 134–137 situational awareness, 34
penetrating injuries, 134 training, 35
practical conduct of anesthesia, 139–140 use of standard operating procedures, 33–34
ventilation strategies, 140 Traumatic brain injury
Thoracostomy, 53 anesthetic use, 127

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 Index

assessment of, 124–125 pediatric trauma patients, 410–412, 475

critical care, 299 percutaneous central venous access, 64–67
decreasing cerebral oxygen consumption, 126 peripheral venous cutdown, 68
Glasgow coma scale, 125 physics of flow, 64
intracranial hypertension and, 127 post-anesthesia care of vascular access devices, 69
management, 125–127 Vascular injuries
monitoring, 124–125 imaging, 178
neuroprotective measures, 13 surgical considerations, 149–150
prophylaxis for, 13 Vascular reperfusion, 155–160
resuscitation, 127 Vasoactive agents, 114, 411
seizures and, 127 Vasopressors, 557
tactical damage control surgery, 7 Vela ventilators, 539
Traumatic cardiorespiratory arrest, 552, 556–557 Veno-venous technique of hemofiltration, 323–324
Traumatic shock, 8–9 Venous thromboembolism
Triage chemical prophylaxis, 354–355
ethical issues, 462–463 factor VIIa effects, 352–353
following chemical, biological, radiological, and nuclear expo- inferior vena cava filters, 355–356
sure, 510–512 massive transfusion effects, 352–353
Triservice Anesthetic Apparatus, 528–530 mechanical prophylaxis, 354
TRPV. See Transient receptor potential vallinoid neuraxial blockade, 355
TTPs. See Tactic, technique, or procedure calls pathophysiology of, 352–353
Tuberculin skin testing, 437 prevalence of, 353
Two-lung independent ventilation, 140 prevention of, 353–356
prophylaxis, 300
U tranexamic acid effects, 352–353
Ventilation, mechanical
UFH. See Unfractionated heparin
acute lung injuries and, 291–292
Ultrasound, medical, 546–547
adjuncts to, 308–309
Unfractionated heparin, 353–355
asymmetrical pulmonary pathologies, 307
United Kingdom
for bronchopleural fistula, 316–318
buddy-buddy system, 43
conservative fluid management, 308–309
Defence Medical Services, 32
drugs used with, 51–52
massive transfusion operational protocol, 100, 102–103
extracorporeal membrane oxygenation, 309
Medical Emergency Response Team, 44–46
the first 24 hours, 304–310
Queen Elizabeth Hospital Birmingham, 568–571
high-frequency ventilation, 307–308
team medics, 43
independent lung ventilation, 306–307
United Kingdom Defence Medical Services
infection issues, 383
pain scoring systems, 215–216
inverse-ratio ventilation, 306
United States
mode of, 305–308
combat casualty care, 43
monitoring and optimizing ventilation, 304–305
massive transfusion military protocol, 100–101, 104
neuromuscular blocking agents, 308
medical evacuation assets, 46–48
nitric oxide and, 308
military anesthesiologists, 32
pediatric trauma patients, 406–410
military hospitals, 564–566
positive end-expiratory pressure, 305
Upper limb injuries
prehospital procedures, 53
multimodal analgesia, 207
pressure-preset ventilation, 305–306
US Air Force
principles of safe ventilation, 304–305
Critical Care Air Transport Teams, 6–7, 392
prone positioning, 308
pararescue, 47–48
recruitment maneuvers, 308
US anesthesia monitoring, 538
resuscitation guidelines, 557
US Army’s Institute of Surgical Research, 101, 103, 565
spontaneous ventilation, 306
US draw-over system, 531–532
thoracic injuries and, 140
US ventilators, 539–540
tidal volume, 304
USAF, Form 3899, Aeromedical Evacuation Patient Record, 397
for tracheal disruption, 316–318
USAISR. See US Army’s Institute of Surgical Research
transfer ventilators, 309–310
USNS Comfort, 448–449, 450, 452, 454
volume-preset ventilation, 305
USNS Mercy, 448, 452
Ventilator-associated pneumonia, 383
Utilitarianism, 460
Ventilators, 538–540
V Vesicants, 514
Veterans Affairs Medical Centers, 565–566
VAP. See Ventilator-assiciated pneumonia Video laryngoscopy, 78
Vascular access Virchow triad, 352
access to vascular space, 49 Visual analogue pain scale, 215
arterial access, 68–69 Volatile gas anesthesia, 185
catheter and cannula sizes, 64 Volume-preset ventilation, 305
direct atrial cannulation, 68 VTE. See Venous thromboembolism
intraosseous access, 67–68

xlv
Combat Anesthesia: The First 24 Hours

W
Walter Reed Army Institute of Research, 437–440
Ward nurses, 263
Water/electrolyte balance, 201–202
Whiplash injuries, 254–255
World Health Organization
pain ladder, 207, 277–278
surgical checklist, 33
WRAIR. See Walter Reed Army Institute of Research

Z
Zygopaphyseal joint pain, 250

xlvi
 Index

MERT Head Out Again by Tony Green, acrylic on paper, 2009.

Art: Courtesy of Tony Green.

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Combat Anesthesia: The First 24 Hours

xlviii