AbbreviAtions and Acronyms · 2020. 4. 27. · EDOCS: expeditionary deployable oxygen concentrator system EMT-B: emergency medical technician-basic EN: enteral nutrition ESBL: extended

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Abbreviations and Acronyms

AbbreviAtions and Acronyms

AABC: Acinetobacter baumannii-calcoaceticus complexABC: airway, breathing, and circulationABC: assessment of blood consumptionAC: alternating currentACCP: American College of Chest PhysiciansACH: Army community hospitalACRM: Anesthesia Crisis Resource Management ACS: abdominal compartment syndromeACS: acute compartment syndromeACTH: adrenocorticotropinAE: aeromedical evacuationAECC: Aeromedical Evacuation Co-ordination CentreAFRICOM: African Command AKI: acute kidney injuryALI: acute lung injuryAMEDD C&S: Army Medical Department Center and SchoolAMPA: alpha-amino-3-hydroxyl-5-methyl-4-isoxazole-propionateAMPLE: allergies, medication, pregnancy, last eatenAMR: advanced medical retrievalAPP: abdominal perfusion pressureAPRV: airway pressure-release ventilationARDS: acute respiratory distress syndromeAPLS: Advanced Paediatric Life SupportAPS: acute pain serviceAPTR: activated partial thromboplastin time ratioATC: acute trauma coagulopathyATICE: Adaptation to the Intensive Care Environment (instrument)ATLS: Advanced Trauma Life Support ATN: acute tubular necrosisATP: adenosine triphosphateAW2: Army Wounded Warrior Program

bBABT: behind-armor blunt traumaBAS: battalion aid stationBATLS: Battlefield Advanced Trauma Life SupportBIPAP: biphasic positive airway pressure ventilationBK: bradykininBPF: bronchopleural fistulaBVM: bag-valve masks

c<C>ABC: catastrophic hemorrhage, airway, breathing, and circula-tionCASEVAC: casualty evacuationCASF: contingency aeromedical staging facilityCAT: combat application tourniquetCBF: cerebral blood flowCBRN: chemical, biological, radiological, or nuclearCC: combat casualtyCCAT: critical care air transportCCAST: critical care air support teamCCPG: Canadian clinical practice guidelineCCR: Canadian C-Spine RuleCENTCOM: Central Command CMRO2: cerebral metabolic rate of oxygenCO: cardiac outputCONUS: continental United StatesCOTS: coagulopathy of trauma shockCOX: cyclooxygenaseCPAP: continuous level of positive airway pressure

CPG: clinical practice guidelineCPK: creatine phosphokinaseCPNB: continuous peripheral nerve blockCPP: cerebral perfusion pressureCPR: cardiopulmonary resuscitation CRM: Crew Resource ManagementCRRT: continuous renal replacement therapyCSH: combat support hospitalCSI: cervical spine injuryCT: clotting timeCT: component therapyCT: computed tomographyCVC: central venous catheterCVP: central venous pressureCVVH: CRRT with a veno-venous technique of hemofiltrationCXR: chest x-ray

DDLEBT: double-lumen endobronchial tubeDCR: damage control resuscitationDLT: double-lumen endobronchial tubeDMS: Defence Medical Services (United Kingdom)DNBI: disease non-battle-injuryDoA: depth of anesthesiaDPL: diagnostic peritoneal lavageDR: disaster reliefDVPRS: Defense and Veterans Pain Rating ScaleDVT: deep venous thrombosis

eEAST: Eastern Association for the Surgery of TraumaECCN: en-route critical care nurseECG: electrocardiogramECMO: extracorporeal membrane oxygenationED: emergency departmentEDOCS: expeditionary deployable oxygen concentrator systemEMT-B: emergency medical technician-basicEN: enteral nutritionESBL: extended spectrum β-lactamaseESPEN: European Society for Parenteral and Enteral NutritionETCO2: elevated end-tidal carbon dioxideETT: endotracheal tubeEUCOM: European Command

FF: French gaugeFiO2: fraction of inspired oxygenFAST: focused assessment with sonography for traumaFFP: fresh frozen plasmaFr: French gaugeFRC: functional residual capacityFST: forward surgical teamFW: fixed wingFWB: fresh whole blood

G G: gaugeGa: gaugeGABA: γ-aminobutyric acidGAWS: Guardian Angel Weapon SystemGCOs: Clinical Guidelines for Operations GCS: Glasgow coma scale

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Combat Anesthesia: The First 24 Hours

G6PD: glucose-6-phosphate dehydrogenase

H

HA: humanitarian assistanceHbCO: carbon monoxide hemoglobinHD: hemodialysisHELLP: hemolysis, elevated liver enzymes, and low platelets

(syndrome)HEMS: Helicopter Emergency Medical SystemHFOV: high-frequency oscillatory ventilationHFV: high-frequency ventilationHIV: human immunodeficiency virusHMAP: high mean arterial pressureHR: heart rate

iIAP: intraabdominal pressureICO: infection control officerICP: intracranial pressureICU: intensive care unitID: internal diameterIED: improvised explosive deviceIJV: internal jugulariLA: interventional lung assistanceILV: independent lung ventilationIM: intramuscularIMV: intermittent mandatory ventilationIN: intranasalINR: international normalized ratioIO: intraosseousIOP: intraocular pressureIPPV: intermittent positive-pressure ventilation IRI: ischemia-reperfusion injuryIRT: immediate response teamISO: International Organization for StandardizationISS: injury severity scoreIV: intravenousIVC: inferior vena cavaIVCF: inferior vena cava filter

JJTTR: Joint Theater Trauma Registry

LLAST: local anesthetic systemic toxicityLMA: laryngeal mask airwayLMAP: lower mean arterial pressureLMWH: low molecular weight heparinLOP: limb occlusion pressureLRMC: Landstuhl Regional Medical Center LSI: life-saving interventionLTP: long-term potentiation

m

MAC: minimum alveolar concentrationMAP: mean arterial pressureMASF: mobile aeromedical staging facilitiesMCF: maximum clot firmnessMDCT: multidetector row spiral computed tomographyMDR: multidrug-resistantMEAC: minimum effective analgesic concentrationMEDCEN: military medical centerMEDCOM: US Army Medical CommandMEDEVAC: medical evaMERT: medical emergency response team

MERT(E): medical emergency response team (enhanced)MH: malignant hyperthermiaMILS: manual inline stabilizationMIST-AT: mechanism of injury, injuries sustained, symptoms and

signs, treatment given–age (adult/child) and time of injuryMHS: Military Health System MODS: multiorgan dysfunction syndromeMRAP: mine-resistant ambush-protectedMRI: magnetic resonance imaging MRSA: methicillin-resistant Staphylococcus aureusMRSN: Multidrug Resistant Organism Repository and Surveil-

lance NetworkMTF: medical treatment facilityMTP: massive transfusion protocol

nNAPQI: N-acetyl-p-benzoquinine imineNASA: National Aeronautics and Space AdministrationNBI: nonbattle injuryNEXUS: National Emergency X-Radiography Utilization StudyNGF: nerve growth factorNGO: nongovernmental organizationNHS: National Health Service (United Kingdom)NK1: neurokinin-1NMBA: neuromuscular blocking agentNMDA: N-methyl-d-aspartateNMS: neuroleptic malignant syndromeNS: normal salineNSAID: nonsteroidal antiinflammatory drugs

oOEF: Operation Enduring FreedomOI: oxygenation indexOIF: Operation Iraqi FreedomOL-ILV: one-lung independent ventilationOR: operating roomOSCAR: High Frequency OSCillation in ARDS (trial)OSCILLATE : Oscillation for Acute Respiratory Distress Syn-

drome Treated Early (trial)OTFC: oral transmucosal fentanyl citrate

PPACCOM: Pacific CommandPAG: periaqueductal greyPCA: patient-controlled analgesiaPCR: polymerase chain reactionPD: peritoneal dialysisPE: pulmonary embolismPECC: patient evacuation coordination centerPEEP: positive end-expiratory pressurePetCO2: partial pressure of end-tidal carbon dioxidePG: propylene glycolPICU: pediatric intensive care unitPiO2: partial pressure of the inspired oxygenPIS: propofol infusion syndromePLT: plateletsPMI: patient movement itemPMRC: patient movement requirement centerPN: parenteral nutritionPO: per osPOGS: portable oxygen generator systemPP: pulse pressuresPPE: personal protective equipmentPpl: plateau pressurePPV: positive pressure ventilationPRBC: packed red blood cells

xxvii

Abbreviations and Acronyms

PRIS: propofol infusion syndromePTSD: posttraumatic stress disorder

QQEHB: Queen Elizabeth Hospital Birmingham

rRA: regional anesthesiaRAAS: rennin-angiotensin-aldosterone systemRAF: Royal Air ForceRAP: regimental aid postRASS: Richmond Agitation-Sedation ScaleRBC: red blood cellRCC: red cell concentrateRCDM: Royal Centre for Defence Medicine RCT: randomized controlled trialREBOA: resuscitative endovascular balloon of the aortarFVIIa: recombinant factor VIIaRIFLE: risk, injury, failure, loss, and end-stage diseaseROSC: return of spontaneous circulation RSI: rapid sequence inductionRTD: return-to-dutyRRT: renal replacement therapyRSI: rapid-sequence induction RW: rotary wing

sSAVe: simplified automated ventilatorSCCM: Society of Critical Care MedicineSCD: sequential compression deviceSCM: sternocleidomastoid muscleSCV: subclavianScvO2: central venous oxygen saturationSI: sacroiliacSIB: self-inflating bagSIMV/PS: synchronized intermittent mandatory ventilation with

pressure supportSIRS: systemic inflammatory response syndromeSO: standard operating instructionSOP: standard operating proceduresSOUTHCOM: Southern CommandSTRATEVAC: strategic evacuationSVC: superior vena cavaSVR: systemic vascular resistance

tTACEVAC: tactical evacuationTARGIT: Triservice Research Group Initiative on TIVATBI: traumatic brain injuryTBSA: total burned surface areaTCCC: Tactical Combat Casualty CareTCI: target-controlled infusionTCRA: traumatic cardiorespiratory arrest TD: tracheal disruptionTENS: toxic epidermal necrolysis syndromeTIC: toxic industrial chemicalsTIVA: total intravenous anesthesiaTL-ILV: two-lung independent lung ventilationTLR4: toll-like receptor 4TRPV: transient receptor potential vallinoidTTE: transthoracic echocardiogramTTP: tactic, technique, or procedureTRALI: transfusion-related acute lung injuryTrkA: tyrosine kinase ATSAA: Triservice Anaesthetic ApparatusTST: tuberculin skin testing

UUFH: unfractionated heparinUK: United KingdomUN: United NationsUS: ultrasoundUSAF: US Air ForceUSAISR: US Army Institute of Surgical Research

vVA: Veterans Affairs (Department)VAP: ventilator-associated pneumoniaVAS: visual analog scaleVDC: volts direct currentVGA: volatile gas anesthesiaVILI: ventilator-induced lung injuryVITRIS: Vasopressin in Refractory Traumatic Hemorrhagic Shock

(study)VRE: vancomycin-resistant Escherichia coliVRS: verbal rating scoreVt: tidal volumeVTE: venous thromboemoblism

wWFWB: warm fresh whole bloodWHO: World Health OrganizationWRAIR: Walter Reed Army Institute of ResearchWWR: Wounded Warrior Regiment

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Combat Anesthesia: The First 24 Hours

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Combat Anesthesia: The First 24 Hours Index

Index A

ABC score. See Assessment of Blood Consumption score<C>ABCDE guidelines, 286–287Abdominal compartment syndrome, 14–15, 298–299Abdominal injuries

combat casualties, 8enteral feeding after surgery, 375–377multimodal analgesia, 207–208, 210penetrating, 210

Acalculous cholecystitis, 343Acetaminophen, 223–225Acidosis

combat casualties and, 4damage control resuscitation and, 90massive transfusion and, 98–99

ACTH. See AdrenocorticotropinAcute kidney injury

early management of, 14etiology of, 322incidence of, 322indications for renal support, 322–323management options, 323–324medical therapy for, 324outcomes, 324prevention of, 322“RIFLE” classification, 322–323

Acute lung injuryblast lung, 291critical care, 291–292infection prevention and control, 292management of, 136–137nutrition, 292pediatric trauma patients, 410pulmonary contusion, 291sedation, 292ventilation strategies, 111, 291–292

Acute painbasic concepts, 194descending modulatory pathways, 196dorsal horn, 195–196pain matrix, 196–197pain mechanisms, 194–197pain perception in higher centers, 196–197pain transmission, 195–196peripheral nociceptors, 194role of the glia, 196transient receptor potential vallinoid channel subtypes, 195WHO pain ladder, 207

Acute pain serviceclinical practice guideline, 263–264deployed acute pain service responsibilities, 262enabling change, 265governance, 262multidisciplinary team, 262–263pain education, 264predeployment training, 264role 3 facilities, 278–279specialist interest group responsibilities, 262standard operating instruction, 263–264team rounds and meetings, 265team training, 264

Acute respiratory distress syndromecritical care, 291etiology of, 12management of, 12, 136–137

pediatric trauma patients, 410ventilation strategies, 111

Acute thermal injury, 164–165Acute trauma coagulopathy, 87Acute tubular necrosis, 322Adaptation to the Intensive Care Environment, 361Adrenal crisis, 335Adrenocorticotropin, 200Adult Advanced Life Support algorithm, 553Advanced Life Support algorithm

adult, 553pediatric, 554

Advanced medical retrieval, 48Aeromedical Evacuation Patient Record, 397Aeromedical team, deployed, 263Aeromedical transport

capabilities and responsibilities, 394, 396combat casualties and, 5–7documentation, 397–398fixed wing operations, 397history of, 392–393operations, 394–398patient movement concepts, 393–394patient movement items, 398patient movement requirement centers, 396preflight patient considerations, 395research, 398resupply items, 398rotary wing operations, 397tasking, 396–397team composition, 394for tracheal disruption and bronchopleural fistula, 316–317training, 398

Afghanistanweight estimation for local national children, 471

AFOI. See Awake fiberoptic intubationAged. See Elderly populationsAir Force pararescue, 47–48Air Rescue Service, 47Air transport. See Aeromedical transportAirway burns, 516Airway management

acute management of asthma exacerbation algorithm, 406–407airway bleeding and, 77–78airway devices, 77–78airway equipment, 404–406, 470anesthetic considerations, 77–79blind nasal intubation, 79cervical spine injuries and, 122–123critical care, 296direct laryngoscopy, 78equipment for pediatric trauma patients, 404–406evidence for current practice, 76–77facial distortion and, 77–78facial injury and, 76fiberoptic intubation, 79following chemical, biological, radiological, and nuclear expo-

sure, 512–516guidelines and techniques in the deployed setting, 79–80intrathoracic airway injuries, 134–135patient positioning, 77–78pediatric anesthesia, 470, 473, 477–478penetrating airway injury and, 77, 80penetrating neck injury and, 76–77pitfalls of, 81rapid sequence induction, 79

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surgical considerations, 79team considerations, 79

Airway trauma, 10ALI. See Acute lung injuryα2-Adrenergic agonists, 224–225AmbIT Military PCA Pump, 231American College of Surgeons’ Advanced Trauma Life Support,

555Amniotic fluid embolism, 499“AMPLE” history, 109Amputations

bilateral above-knee, 35–37considerations, 150rapid sequence induction and, 51

AMR. See Advanced medical retrievalAnalgesia

α2-adrenergic agonists, 224abdominal injuries, 207–208, 210acetaminophen, 223–224advanced techniques, 206–207anticonvulsants, 224basics of, 206compartment syndrome, 208–209complex injuries, 209current military practice, 271–272frequency of intravenous and oral analgesic administration,

279ideal battlefield analgesic, 268inhalational analgesia, 270injuries to local nationals, 209–210isolated forearm gunshot wound, 210isolated lower limb injury, 207isolated upper limb injury, 207ketamine, 270–271multimodal applications, 206–210N-methyl-D-aspartate receptor antagonists, 222–223narcotics, 269nonopioid analgesics, 222–225nonsteroidal antiinflammatory drugs, 223, 269–270patient-controlled analgesia, 206, 221–222, 416pediatric patients, 416, 474, 481–482penetrating abdominal injuries, 210prehospital medicine, 268–272simple or single injuries, 207–209thoracic injuries, 140, 208treatment facilities, 209–210

Anaphylaxis, 333, 335Anemia

obstetric considerations, 495Anesthesia. See also Sedation

access to vascular space, 49acute lung injury, 292airway management, 77–79arterial access, 68–69burn injuries, 169–170catheter and cannula sizes, 64clinical management, 60–61combat casualties and, 17conscious sedation, 185–186considerations for, 35–38for critically injured military patients, 569damage control philosophy, 61decision-making, 60the deployed military anesthesia system, 61direct atrial cannulation, 68elderly populations, 486–490equipment, 528–544

extremity, junctional, and pelvic injury surgical procedures, 148

following chemical, biological, radiological, and nuclear expo-sure, 506–521

head trauma and, 127human factors in, 32–34humanitarian operations, 448–457imaging management, 177intraosseous access, 67–68local anesthetics, 224–225, 235–236monitoring depth of, 187neuraxial anesthesia, 185obstetric, 492–502pediatric, 470–482pediatric trauma patient handoff checklist, 405percutaneous central venous access, 64–67peripheral venous cutdown, 68physics of flow, 64post-anesthesia care of vascular access devices, 69regional, 148, 179, 185, 242–244for stable casualties, 184–187stages of a complex military anesthetic, 61target-controlled infusions, 186–187thoracic injuries, 139total intravenous anesthesia, 186–187training, 61–62ultrasound imaging and, 179venous access, 179volatile gas anesthesia, 185

Antenatal care, 496Antibiotics

infection management, 387–388sepsis management, 387–388

AnticoagulationFactor VIIa effects, 352–353hemostatic agents, 17massive transfusion effects, 352–353prevention of venous thromboembolism, 353–356tranexamic acid effects, 352–353

Anticonvulsants, 224–225Antifibrinolytics, 91Aortic injuries, 136Aortocaval compression, 496APS. See Acute pain serviceARDS. See Acute respiratory distress syndromeArterial access, 68–69Assessment of Blood Consumption score, 97Asthma

acute management exacerbation algorithm, 406–407ATC. See Acute trauma coagulopathyAtelectasis, 344ATICE. See Adaptation to the Intensive Care EnvironmentATLS. See American College of Surgeons’ Advanced Trauma Life

SupportATN. See Acute tubular necrosisAtrial cannulation, 68Atropine overdose, 518Awake fiberoptic intubation, 79

B

BABT, 135Back pain. See also Spinal injuries

disc lesions, 252etiology of, 248–249, 251facet joint pain, 250, 252mechanical, 248, 250

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motions associated with lumbar facet joint strain, 252musculature of the back, 250myofascial pain, 250nerve root compromise, 253nerve root pathology, 249nonspecific, 248, 250sacroiliac joint pain, 250, 252spinal stenosis, 253treatment options, 255–256

Base deficit correction, 112BATLS. See Battlefield Advanced Trauma Life SupportBattlefield Advanced Trauma Life Support, 139, 286–287, 555Belmont Rapid Infuser FMS 2000, 542–543Benzodiazepines, 361Bilateral above-knee amputations, 35–37Biofilms

infection and, 383–384Biological exposure. See Chemical, biological, radiological, and

nuclear exposureBlast lung, 291Blind nasal intubation, 79Blister agents, 514Blood pressure maintenance, 297Blood product administration, 54Bone fractures

fixation of, 114general anesthesia for internal fixation of fractured femur

neck, 489pelvic, 150–151

Bowel damage control, 300Brain injury, traumatic. See Traumatic brain injuryBraun Perfusor Compact S, 543–544Braun Perfusor pump, 232, 237Breathing management

critical care, 296–297following chemical, biological, radiological, and nuclear expo-

sure, 516–517pediatric anesthesia, 473–474, 478–479

Brief Pain Inventory, 215Bronchopleural fistula

aeromedical evacuation, 316–317diagnosis of, 316postoperative care, 316–317preventing further injury, 316–317ventilation considerations, 316–317ventilator settings, 316–317

Buddy-buddy system, 43Burn injuries

acute thermal injury, 164–165airway burns, 516airway management, 422breathing management, 422–423chemical burns, 518circulatory evaluation, 168, 423electrical injuries, 171excision, 166grafting, 166infusions, 168–169intraoperative anesthetic management, 169–170intravenous fluid resuscitation formulas, 165Lund-Browder charts, 422neurologic evaluation, 168nonsurgical care, 165–166nonthermal skin diseases, 171nutritional considerations, 168–169operating room set-up, 166–167patient evaluation, 167–169

pediatric patients, 478postoperative care, 170procedures outside the operating room, 170–171pulmonary evaluation, 168rule of nines, 422vascular access, 168

C

<C>ABCDE guidelines, 286–287Calcium management

damage control resuscitation and, 90massive transfusion and, 97–98

Camp Bastion protocol, 242–244Canadian C-Spine Rule, 123–124Canadian clinical practice guidelines, 372–373, 375Cannula cricothyroidotomy, 478Cannula sizes, 64Capnometry, 557Carbohydrate metabolism

pain response and, 201Carbon monoxide poisoning, 519Cardiac arrest resuscitation, 552, 556–557Cardiac injuries, 135–136, 178Cardiac tamponade, 336Cardiogenic shock, 10, 332–333Cardiorespiratory arrest resuscitation, 556–557Cardiovascular disease

elderly populations and, 486–487obstetric considerations, 494–495

Cardiovascular injuriescardiogenic shock, 10combat casualties and, 8–10hemorrhagic shock, 8–9neurogenic shock, 10obstructive shock, 10traumatic shock, 8–9

Cardiovascular systempain response, 202volume status, 289–291

CASEVAC. See Casualty evacuationCasualties. See Combat casualtiesCasualty evacuation, 5–7, 46, 393Catheter sizes, 64Catheter techniques, 547CATs. See Combat application tourniquetsCauda equina syndrome, 253Caudal anesthesia

for pediatric patients, 482CBF. See Cerebral blood flowCCASTs. See Critical Care Air Support TeamsCCATs. See Critical Care Air Transport TeamsCCPG. See Canadian clinical practice guidelinesCCR. See Canadian C-Spine RuleCCs. See Combat casualtiesCentral venous access. See Percutaneous central venous accessCentral venous pressure, 111–112Cerebral blood flow, 125, 127Cerebral metabolic rate of oxygen, 126–127Cerebral perfusion pressure, 12–13, 125–126, 365, 417Cervical myelopathy, 254Cervical radiculopathy, 254Cervical spine injuries

airway management, 122–123Canadian C-Spine Rule, 123–124epidemiology, 122injury patterns, 122

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radiologic assessment, 110, 123–124steroids and, 124

CGOs. See Clinical Guidelines for OperationsChemical, biological, radiological, and nuclear exposure

airway burns, 516airway issues, 512–516antidotes, 521biological casualties, 516, 518–519breathing issues, 516–517chemical casualties, 517–518circulation issues, 517–518cyanides, 515–516decontamination, 508, 510direct-acting agents, 516–517drug contraindications, hazards, and interactions, 520–521emergency response, 506–512hot-zone treatment, 510–512incident management, 506indirect-acting agents, 517inhalational injuries, 515initial investigations for casualties, 508medical hazardous materials site plan, 507nerve agents, 513–514, 517–519neurological issues, 518–520personal protective equipment, 507–508pulmonary agents, 514–515“Quick Look” assessment, 507, 509radiological casualties, 516, 518, 519recognizing incidents, 506–507riot control agents, 515–516triage, 510–512vesicants, 514

Chest compressions, 557Chest trauma

chest wall trauma, 10–11pediatric patients, 402–403

Children. See Pediatric traumaChoking agents, 514–515Cholecystitis, acalculous, 343Chronic pain

ascending pain pathways, 247back pain, 248–253, 255–256classification of, 246–248definition of, 246–248descending modulation, 247interventional procedures, 256neck pain, 253–256neuropathic pain, 246treatment options, 255–256

Circulation managementcritical care, 297–299following chemical, biological, radiological, and nuclear expo-

sure, 517–518pediatric trauma, 474, 479

Clinical Guidelines for Operations, 555Clinical practice guideline

acute pain service, 263–264Clonidine, 364CMRO2. See Cerebral metabolic rate of oxygenCoagulopathy

combat casualties and, 4dilutional, 99

Coagulopathy of trauma shock. See also ShockCamp Bastion protocol, 242–244determining when to use regional anesthesia, 242

Combat application tourniquets, 145Combat casualties

abdominal trauma, 8aeromedical transport, 5–7anesthesia and, 17cardiovascular injuries, 8–10care under fire, 5damage control resuscitation, 7extremity injuries and wounds, 8golden hour concept, 4–7hematologic injuries, 16–17hepatic injuries, 15–16improvised explosive devices injuries, 4lethal triad, 4management at role 2 and 3 facilities, 7–8management of stable casualties, 182–188neurologic injuries, 12–13outcomes tracking and research, 276–280physiology of, 4pulmonary injuries, 10–12renal injuries, 13–15roles of care, 5–7tactical combat casualty care, 4–5tactical damage control surgery, 7–8tactical field care, 5thoracic trauma, 8traumatic brain injuries, 7

Combat casualty care, 43Combat support hospitals, 97Command representation, 263Compartment syndrome

abdominal compartment syndrome, 14–15, 298–299early management of, 14, 298–299extremity compartment syndrome, 7multimodal analgesia, 208–209risk factors, 7

Component therapy, 101, 103–104Computed tomography imaging

cervical spine injuries, 110, 124head trauma, 124–125initial trauma assessment, 176–177

Concurrent resuscitation, 49Conscious sedation, 185–186Continuing Promise mission, 449–450Continuous peripheral nerve block

benefits of, 235complications, 235–236contraindications, 235daily rounding considerations, 237–238drugs, 237indications, 235infusion settings, 237isolated upper limb injuries, 207for multiple extremity injuries, 235nursing guidelines, 238securing the catheter, 237when to initiate, 236–237

Continuous renal replacement therapy, 323COTS. See Coagulopathy of trauma shockCOX. See CyclooxygenaseCPG. See Clinical practice guidelineCPNB. See Continuous peripheral nerve blockCPP. See Cerebral perfusion pressureCrew Resource Management, 32–33, 61Cricothyroidotomy, 478Critical care

acute lung injury, 291–292adequacy of resuscitation, 288–289admission history, 286

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airway management, 296anesthetic considerations for critically injured military pa-

tients, 569breathing management, 296–297burn injuries, 164–171circulation management, 297–299compartment syndromes, 298–299drug administration, 300environment considerations, 299–300ethical issues, 460–467fluid administration complications, 297–298gastric protection, 300gut damage control, 300hematology, 288hemodynamic considerations, 288–291imaging, 288, 300intravascular lines, 300maintaining blood pressure, 297management plans, 288management problems following damage control surgery, 293patient discharge, 293patient transfer, 300pediatrics, 402–424physical examination, 286positioning, 300receiving patients, 286–293record-keeping, 299–300regional techniques, 300topical negative pressure dressings, 300traumatic brain injury, 299venous thromboembolism prophylaxis, 300volume status of cardiovascular system, 289–291

Critical care, perioperative and interoperativeadjuncts in trauma resuscitation, 114–115admission to intensive care unit, 114–115airway assessment, 108–110the “AMPLE” history, 109assessment regime, 108–112base deficit correction, 112circulation, 111clearance of cervical spine, 110conditions requiring rapid sequence induction of anesthesia,

110early enteral nutrition, 115early intensive care requirements for the severely injured, 109end points in resuscitation, 113fluids in trauma resuscitation, 114fracture fixation, 114hypotensive resuscitation, 113–114immediate requirements and decision points in treating the

severely injured, 109infection care bundles, 115initial management, 108inotropic agents, 114lactate correction, 112patient history, 108vascular volume status, 111–112vasoactive agents, 114ventilation, 110–111

Critical Care Air Support Teams, 392, 394–398Critical Care Air Transport Teams, 6–7, 392–398CRM. See Crew Resource ManagementCRRT. See Continuous renal replacement therapyCrystalloids, 88, 89, 114CSHs. See Combat support hospitalsCSIs. See Cervical spine injuriesCT. See Component therapy

CT imaging. See Computed tomography imagingCVP. See Central venous pressureCVVH. See Veno-venous technique of hemofiltrationCyanide antidotes, 521Cyanide poisoning, 515–516Cyclooxygenase, 223

d

Damage control resuscitationacidosis, 90antifibrinolytics, 91calcium management, 90damage control surgery, 37–38, 88, 293end points of, 91–92evolution of military trauma care, 86–87fluids, 38, 88, 89hematologic injuries, 16–17hemostatic resuscitation, 88–89hypothermia, 90–91managing the physiology, 89–91medical adjuncts, 91pathophysiology, 87permissive hypotension, 54, 88point-of-care testing, 89point of wounding, 87potassium management, 90principles of, 87–89recombinant activated factor VII, 91at role 2 and 3 facilities, 7specialist retrieval teams, 88

Damage control surgery, 37–38, 88, 293DCR. See Damage control resuscitationDebridement, 150Decontamination, 508, 510Deep peripheral nerve block, 243–244Deep venous thrombosis, 352–355Defence Medical Rehabilitation Centre, 570Defense and Veterans Pain Rating Scale, 278Deontology, 460Deployed aeromedical team, 263Deployed pain service

clinical practice guideline, 263–264deployed acute pain service responsibilities, 262enabling change, 265governance, 262multidisciplinary team, 262–263pain education, 264predeployment training, 264specialist interest group responsibilities, 262standard operating instruction, 263–264team rounds and meetings, 265team training, 264

DeVilbiss Oxygen Concentrator, 536Dexmedetomidine, 362, 364Dilutional coagulopathy, 99Direct atrial cannulation, 68Direct laryngoscopy, 78Disaster relief, 448, 449Disease non-battle-injuries, 182Distributive shock, 333–335DLEBT. See Double-lumen endobronchial tubeDLT. See Double-lumen endobronchial tubeDNBI. See Disease non-battle-injuriesDorsal horn, 195–196Double-lumen endobronchial tube, 139–140, 307Dräger Fabius Tiro M, 532–533

xxxiv


Dräger Narkomed M, 533–536Dräger Vamos, 538Draw-over systems, 528–532Drug fever, 342–343Dustoff units, 46–47DVPRS. See Defense and Veterans Pain Rating ScaleDVT. See Deep venous thrombosis

e

EAST. See Eastern Association for the Surgery of Trauma guide-lines

Eastern Association for the Surgery of Trauma guidelines, 354ECCNs. See En-route critical care nursesECGs. See ElectrocardiogramsEclampsia, 498ECMO. See Extracorporeal membrane oxygenationElderly populations

anesthesia, 488–489cardiovascular disease, 486–487considerations for deployed military teams, 489general anesthesia for internal fixation of fractured femur

neck, 489medications, 487–488operational factors, 488, 490physiology of old age, 486–487preoperative assessment, 486preoperative clinical investigations, 487renal disease, 487respiratory disease, 487

Electrical injuries, 171Electrical nerve stimulator, 546Electrocardiograms, 135, 556Electrolytes

postoperative maintenance for pediatric trauma patients, 412En-route critical care nurses, 47–48End-tidal CO2

methods for measuring, 53tourniquet effects, 157–158

Endotracheal intubationestimation of tube size and length in children, 471pediatric trauma patients, 477

Enteral nutritionafter abdominal surgery, 375after temporary abdominal closure, 376–377continuation during repeat operations, 377early initiation of, 115guidelines for initiating and advancing continuous feeding,

414immunonutrition, 374–375pediatric trauma patients, 414postpyloric feeding, 375–376routes of, 373–374surgical access to the gastrointestinal tract, 376types of, 374

Entonox, 496Epidural analgesia

benefits of, 233complications, 233contraindications, 232–233daily rounding considerations, 234drugs, 234epidural equipment changes, 234indications, 232infusion settings, 234nursing guidelines, 234obstetric anesthesia, 496–497

pumps, 234securing the catheter, 233–234when to initiate, 233

Epidural anesthesiapediatric patients, 482

Epinephrine, 557Equipment

airway equipment, 404–406, 470anesthesia equipment, 528–544Belmont Rapid Infuser FMS 2000, 542–543Braun Perfusor Compact S, 543–544catheter techniques, 547conventional general anesthesia machines, 532–536DeVilbiss Oxygen Concentrator, 536Dräger Fabius Tiro M, 532–533Dräger Narkomed M, 533–536draw-over systems, 528–532electrical nerve stimulator, 546epidural equipment changes, 234expeditionary deployable oxygen concentrator system, 536General Electric Healthcare Datex-Ohmeda S/5 Compact,

537–538intravenous infusion equipment, 541–544Level 1 H-1200 Fast Flow Fluid Warmer, 541–542medical ultrasound, 546–547medication delivery systems, 547–549monitors, 537–538needle design, 547nerve localization, 546–547obstetric anesthesia, 493–494oxygen supplies, 536–537patient-controlled analgesia, 206, 221–222, 230–232, 547–549pediatric trauma, 404–406, 470personal protective equipment, 507–508portable oxygen generator system, 536–537specialist equipment for pain management, 546–549Triservice Anesthetic Apparatus, 528–530US anesthesia monitoring, 538US draw-over system, 531–532US ventilators, 539–540Vela, 539ventilators, 538–540

ESPEN. See European Society for Parenteral and Enteral NutritionEthical issues

best interests, 463–464, 465culture and autonomy, 465–466deontology, 460before deployment, 466–467dual loyalties, 462–464in the field hospital, 466the “four principles,” 460hypothetical scenarios, 464–465the law of armed conflict, 461–462medical ethics in times of war, 460–462potential conflict in military critical care, 462–466resource allocation, 462–465reverse triage, 463standards of deployed medical care, 461–462triage, 462–463utilitarianism, 460

European Society for Parenteral and Enteral Nutrition, 372–373, 375

Evacuationbuddy-buddy system, 43chain of survival, 42–43combat casualty care, 5–7, 43evacuation chain, 42–44

xxxv


higher levels of care, 43–44to higher levels of care, 43–44MEDEVAC, 48–54medical evacuation assets, 46–48patient evacuation coordination center, 42self treatment, 43team medics, 43

Expeditionary deployable oxygen concentrator system, 536Exposure injuries

pediatric patients, 482Extracorporeal membrane oxygenation, 309Extremity compartment syndrome, 7, 15Extremity injuries

classification of, 144combat casualties, 8continuous peripheral nerve block, 235general operative intervention considerations, 147–149infection control, 147limb injury revascularization, 155–160managing reperfusion after tourniquet removal, 155–160postoperative care, 151–152prehospital care, 145–146regional anesthesia, 148role 3 care, 146–147surgical considerations, 149–150tourniquet use, 148–149

Extubationpediatric trauma patients, 409

F

Facet joint pain, 250, 252Facial injuries

airway management, 76pediatric patients, 478

Factor VIIa. See Recombinant activated factor VIIaFAST. See Focused assessment with sonography for traumaFemoral vein catheterization, 66Fentanyl, 496Fetal monitoring, 497Fever

acalculous cholecystitis, 343atelectasis, 344drug fever, 342–343empiric therapy, 346infectious considerations, 340malignant hyperthermia, 343–344neurogenic fever, 342neuroleptic malignant syndrome, 343–344noninfectious causes, 341–344pancreatitis, 343pediatric trauma patients, 419serotonin syndrome, 344treatment of, 346workup of, 344–346

FFP. See Fresh frozen plasmaFiberoptic intubation, 76, 79Fiberoptic laryngoscopes, flexible, 78Fibrinolytics

massive transfusion and, 101Flexible fiberoptic laryngoscopes, 78Fluid management

for burn injuries, 165conservative, 308–309mechanical ventilation and, 308–309pediatric trauma patients, 412–415, 479postnatal care, 501

Fluid resuscitationcomplications of administration, 297–298damage control resuscitation, 88, 89for multiple injuries, 38trauma resuscitation, 114

Focused assessment with sonography for trauma, 97, 176Fracture fixation, 114Fractures. See Bone fracturesFresh frozen plasma, 99, 100, 101, 352–353Fresh whole blood

dilutional coagulopathy and, 99military use of, 101, 103–104

FWB. See Fresh whole blood

GGABA. See γ-aminobutyric acidγ-aminobutyric acid, 361, 363Gastric protection, 300Gastrointestinal tract

surgical access to, 376GAWS. See Guardian Angel Weapon SystemGeneral anesthesia

conventional general anesthesia machines, 532–536for internal fixation of fractured femur neck, 489obstetric anesthesia, 497

General Electric Healthcare Datex-Ohmeda S/5 Compact, 537–538Glasgow coma scale, 125, 365, 405, 479–480Glial cells, 196Glucocorticoids, 124Golden hour concept, 4–7Goldman risk factor and score, 486–487Grafts, skin, 166Guardian Angel Weapon System, 47Gunshot wounds

multimodal analgesia, 210Gut damage control, 300

HHazardous materials site plan, 507Head trauma. See also Traumatic brain injury

anesthetic use, 127assessment of, 124–125decreasing cerebral oxygen consumption, 126Glasgow coma scale, 125imaging, 177–178intracranial hypertension and, 127management, 125–127monitoring, 124–125pediatric patients, 417–419rapid sequence induction for penetrating injuries, 51resuscitation, 127sedation, 365seizures and, 127

Helicopter Emergency Medical System, 49–50Hematologic injuries

anticoagulation, 17damage control resuscitation, 16–17hemostatic agents, 17massive transfusion, 16–17

Hematologycritical care patients, 288pediatric trauma patients, 419–421

Hemodynamicspediatric trauma patients, 409–412

Hemorrhagebattlefield and preoperative control, 155

xxxvi


control of catastrophic external hemorrhage, 49massive, 471, 474–477massive hemorrhage protocol, 498–499obstetric protocol, 498–499pediatric anesthesia, 471, 474–477preoperative control, 155tourniquet use, 155–160

Hemorrhagic shock, 8–9Hemostatic agents, 17Hemostatic resuscitation, 88–89HEMS. See Helicopter Emergency Medical SystemHepatic injuries

liver ischemia reperfusion injury, 16liver trauma, 15shock liver, 16

Hercules helicopters, 47HFOV. See High-frequency ocillatory ventilationHigh-frequency ocillatory ventilation, 307–308High mean arterial pressure, 113HMAP. See High mean arterial pressureHospital ships, 448–449Host nation humanitarian operations, 449–450Hot-zone treatment, 510–512Human factors

defense anesthesia and, 32–34Human immunodeficiency virus infection

obstetric considerations, 495Humanitarian operations

anesthesia techniques, 455–457austere and resource-limited environments, 455–457disaster relief, 448, 449hospital ships, 448–449host nations, 449–450humanitarian assistance as a primary mission, 448humanitarian assistance as an additional mission, 448intraoperative anesthesia management, 452–454medical personnel, 450mission overview and process, 449nongovernmental organizations, 449–450postoperative care, 454–455, 457preoperative assessment, 451–452surgical services, 450

Hyperkalemiaacute management algorithm, 421damage control resuscitation and, 90massive transfusion and, 98medical therapy for, 324

Hyperthermia, malignant, 343–344Hypocalcemia

damage control resuscitation and, 90massive transfusion and, 97–98pediatric patients, 482

Hypomagnesemia, 98Hypotension

clinical presentation, 328general diagnostic approach, 329–331general principles of management, 329, 331–332pathophysiology of, 328

Hypotensive resuscitation, 54, 88Hypothermia

combat casualties and, 4damage control resuscitation and, 90–91massive transfusion and, 99pediatric patients, 482

Hypovolemiaeffect on systolic pressure variation, 289pediatric trauma patients, 475

Hypovolemic shock, 37, 332

I

ICP. See Intracranial pressureICUs. See Intensive care unitsIED. See Improvised explosive devicesiLA. See Interventional lung assistImaging

anesthesia management, 177basic radiography, 176cardiac injuries, 178cervical spine injuries, 123–124computed tomography, 176–177critical care patients, 288, 300focused assessment with sonography for trauma, 97, 176future considerations, 179head injuries, 177–178initial trauma assessment, 176–177interventional radiology, 179intraabdominal injuries, 178musculoskeletal injuries, 179pelvic injuries, 178thoracic injuries, 178ultrasound regional anesthesia, 179vascular injuries, 178venous access for anesthesia, 179

Immediate Response Team, 44–46Immune function, 202Immunoglobulin, 386Immunologic complications

massive transfusion and, 99–100Immunonutrition, 374–375Impact 754 Eagle Univent, 539–540Improvised explosive devices. See also specific injuries by name

injuries, 4Independent lung ventilation, 306–307Infants. See Pediatric traumaInfection care bundles, 115Infection prevention and control

acute lung injury, 292antibiotic guidelines, 387–388biofilms and, 383–384chemoprophylaxis, 432–434colonization and infection, 382–383common infectious diseases in theater, 437, 441extremity, junctional, and pelvic injuries, 147individual interventions, 434–435institutional interventions, 435–436intravascular lines and, 383laboratory support, 386–387leishmaniasis, 436–440malaria, 436multidrug-resistant bacteria, 432–441operating room procedures, 147pediatric trauma patients, 419sources of infection, 382–384tailoring therapy, 386–388ventilators and, 383wounds, 383

Inferior vena cava filters, 355–356Infusion pumps, 548–549Inhalational analgesia, 270Inhalational injuries, 515Inotropic agents, 114Institute of Surgical Research, 101, 103, 565Intensive care units

admission to, 114–115hypotension diagnosis and management, 328–336infection management, 382–388

xxxvii


nutritional support, 372–377receiving patients, 286–293sedation use, 360–366sepsis management, 382–388shock diagnosis and management, 328–336

Intermittent positive-pressure ventilation, 557Internal jugular vein catheterization, 65–66Interoperative critical care

adjuncts in trauma resuscitation, 114–115admission to intensive care unit, 114–115assessment regime, 108–112base deficit correction, 112circulation, 111early enteral nutrition, 115early intensive care requirements for the severely injured, 109end points in resuscitation, 113fluids in trauma resuscitation, 114fracture fixation, 114hypotensive resuscitation, 113–114immediate requirements and decision points in treating the

severely injured, 109infection care bundles, 115initial management, 108inotropic agents, 114lactate correction, 112vascular volume status, 111–112vasoactive agents, 114ventilation, 110–111

Interventional lung assist, 111Interventional radiology, 179Intraabdominal injuries, 178Intracranial hypertension, 127Intracranial pressure, 12–13, 125–127, 365, 417–419Intraosseous vascular access, 67–68, 411, 475Intrathoracic airway injuries, 134–135Intravascular lines

infection prevention, 300, 383Intravenous infusion equipment, 541–544Intubation

blind nasal intubation, 79cervical spine injuries and, 122–123confirmation of endotracheal tube position, 52–53drugs used with, 51–52failed intubation drills, 53fiberoptic, 79improving success rate of, 52initial indications for mechanical ventilation, 406management algorithm, 408methods for measuring end-tidal CO2, 53pediatric trauma patients, 406, 408resuscitation guidelines, 557success rates for Medical Emergency Response Teams, 52

Inverse-ratio ventilation, 306IPPV. See Intermittent positive-pressure ventilationIRT. See Immediate Response TeamIschemia-reperfusion injury, 9, 16. See also Vascular reperfusionIVC. See inferior vena cava filters

J

Joint Theater Trauma Registry, 277JTTR. See Joint Theater Trauma RegistryJunctional injuries

classification of, 144–145general operative intervention considerations, 147–149infection control, 147postoperative care, 151–152prehospital care, 145–146

regional anesthesia, 148role 3 care, 147surgical considerations, 150–151tourniquet use, 148–149

KKetamine

prehospital analgesia, 270–271suggested doses for acute pain control, 223suggested doses in acute severe pediatric trauma, 474

Kidney injury. See Acute kidney injury

LLactate correction, 112Landstuhl Regional Medical Center

current capabilities, 562–563history of, 562specialty services, 563surgical specialties, 563

Laryngoscopes, flexible fiberoptic, 78Laryngoscopy, 78LAST. See Local anesthetic systemic toxicityLead clinicians, 263Leishmaniasis, 436–440“LEMON” airway assessment, 408Level 1 H-1200 Fast Flow Fluid Warmer, 541–542Ligands, 194Limb injuries. See Extremity injuriesLimb occlusion pressure, 159–160Lipolysis, 201Liver injuries, 15–16Liver ischemia reperfusion injury, 16LMAP. See Lower mean arterial pressureLMWH. See Low-molecular weight heparinLocal anesthetic systemic toxicity, 235–236Local anesthetics, 224–225, 235–236Local nationals injuries, 209–210Log roll, 49LOP. See Limb occlusion pressureLorazepam, 362–363Low-molecular weight heparin, 353–355Lower limb injuries

multimodal analgesia, 207Lower mean arterial pressure, 113LRMC. See Landstuhl Regional Medical CenterLTV 1000 Series ICU Ventilator, 540Lund-Browder charts, 422Lung injuries, 136–137. See also Pulmonary injuries

MMAAS. See Motor Activity Assessment ScaleMacronutrients

postoperative maintenance for pediatric trauma patients, 413Malaria, 436, 495Malignant hyperthermia, 343–344Manual inline stabilization, 122–123MAP. See Mean arterial pressureMassive hemorrhage. See HemorrhageMassive transfusion

acidosis and, 98–99anticoagulation and, 17complications of, 97–100considerations during military operations, 100–101dilutional coagulopathy and, 99effects of, 352–353example of, 16

xxxviii


fibrinolytics, 101hemostatic agents and, 17hyperkalemia and, 98hypocalcemia and, 97–98hypomagnesemia and, 98hypothermia and, 99immunologic complications, 99–100initiation protocols, 96–97military use of fresh whole blood, 101, 103–104recombinant factor VIIa, 101UK operational protocol, 100, 102–103US military protocol, 100–101, 104

Massive transfusion protocol, 96–97McGill questionnaire, 215MDCT. See Multidetector computed tomographyMDR. See Multidrug-resistant bacteriaMean arterial pressure, 156–157, 417Mechanical ventilation

acute lung injuries and, 291–292adjuncts to, 308–309asymmetrical pulmonary pathologies, 307for bronchopleural fistula, 316–318conservative fluid management, 308–309drugs used with, 51–52extracorporeal membrane oxygenation, 309the first 24 hours, 304–310high-frequency ventilation, 307–308independent lung ventilation, 306–307infection issues, 383inverse-ratio ventilation, 306mode of, 305–308monitoring and optimizing ventilation, 304–305neuromuscular blocking agents, 308nitric oxide and, 308pediatric trauma patients, 402–409, 406–409positive end-expiratory pressure, 305prehospital procedures, 53pressure-preset ventilation, 305–306principles of safe ventilation, 304–305prone positioning, 308recruitment maneuvers, 308resuscitation guidelines, 557spontaneous ventilation, 306thoracic injuries and, 140tidal volume, 304for tracheal disruption, 316–318transfer ventilators, 309–310volume-preset ventilation, 305

MEDCENs. See Military medical centersMEDEVAC

access to vascular space, 49capabilities, 47care during, 48–54concurrent resuscitation, 49control of catastrophic external hemorrhage, 49drugs used with intubation and ventilation, 51–52en-route care, 46–47intubation, 52–53the log roll, 49patient movement concepts, 393rapid sequence induction, 49–51resuscitation, 53–54thoracostomy, 53training, 46ventilation, 53

Medical Emergency Response Teamcombat casualty retrieval, 46composition of, 45

evolution of, 44–45in-theater training, 45–46intubation success rates, 52patient movement concepts, 394predeployment preparation, 45

Medical evacuation assetsCASEVAC, 4–7, 46, 394MEDEVAC, 46–54, 393–394US Air Force pararescue, 47–48

Medical hazardous materials site plan, 507Medical ultrasound, 546–547MERT. See Medical Emergency Response TeamMHS. See Military Health SystemMidazolam, 361–362Military Health System, 565Military hospitals

Landstuhl Regional Medical Center, 562–563in the United States, 564–566

Military medical activities, 565Military medical centers, 564–565Military pain scoring systems, 215–216Military treatment facilities, 43–44MILS. See Manual inline stabilizationMinimum alveolar concentration, 481MODS. See Multiorgan dysfunction syndromeMonitors, 537–538Morphine, 496Motor Activity Assessment Scale, 361MTFs. See Military treatment facilitiesMTP. See Massive transfusion protocolMultidetector computed tomography, 177Multidisciplinary trauma team, 34–35Multidrug-resistant bacteria

antibiotic guidelines, 387chemoprophylaxis, 432–434common infectious diseases in theater, 437, 441individual interventions, 434–435infection from, 382institutional interventions, 435–436leishmaniasis and, 436–440malaria and, 436organism surveillance, 434

Multimodal analgesiaadvanced techniques, 206–207basics of, 206compartment syndrome, 208–209complex injuries, 209injuries to local nationals, 209–210isolated forearm gunshot wound, 210isolated lower limb injury, 207isolated upper limb injury, 207multimodal applications, 207–210penetrating abdominal injuries, 210simple or single injuries, 207–209thoracic injuries, 208treatment facilities, 209–210

Multiorgan dysfunction syndrome, 112–113, 115Musculoskeletal injury imaging, 179Myofascial pain, 250

n

N-methyl-D-aspartate receptor antagonists, 222–223Narcotics. See also specific drugs by name

prehospital analgesia, 269NASA. See National Aeronautics and Space AdministrationNasal intubation, blind, 79National Aeronautics and Space Administration, 32

xxxix


National Emergency X-Radiography Utilization Study, 123–124National Health Service, 32–33Neck injuries

airway management, 76–77whiplash injuries, 254–255

Neck paincervical myelopathy, 254cervical radiculopathy, 254occipital neuralgia, 254prevalence of, 253treatment options, 255–256whiplash injuries, 254–255

Needle design, 547Neonatal care, 501Nerve agents, 513–514, 517–519Nerve blocks

needle design, 547pediatric patients, 481

Nerve localization, 546–547Nerve stimulator, electrical, 546Neuraxial anesthesia, 185Neuraxial blockade, 355Neurogenic fever, 342Neurogenic shock, 10, 335Neuroleptic malignant syndrome, 343–344Neurologic injuries

cerebral perfusion pressure, 12–13following chemical, biological, radiological, and nuclear expo-

sure, 518–520intracranial pressure, 12–13pediatric patients, 479–480prophylaxis for severe traumatic brain injury, 13

Neurological systems, 202Neuromuscular blocking agents, 308Neuropathic pain, 246NEXUS. See National Emergency X-Radiography Utilization

StudyNHS. See National Health ServiceNitric oxide

mechanical ventilation and, 308NMDA. See N-methyl-D-aspartate receptor antagonistsNociceptor receptors, 194Nongovernmental organizations, 449–450Nonopioid analgesics, 222–225Nonsteroidal antiinflammatory drugs, 223, 225, 269–270Nonthermal skin diseases, 171Novel hybrid resuscitation, 54NSAIDs. See Nonsteroidal antiinflammatory drugsNuclear exposure. See Chemical, biological, radiological, and

nuclear exposureNurses

continuous peripheral nerve block guidelines, 238en-route critical care nurses, 47–48epidural analgesia guidelines, 234pain nurses, 263patient-controlled analgesia guidelines, 232ward nurses, 263

Nutritional supportacute lung injuries and, 292burn injuries and, 168–169continuation of enteral nutrition during repeat operations, 377enteral feeding after abdominal surgery, 375enteral nutrition after temporary abdominal closure, 376–377enteral route, 373–377immunonutrition, 374–375initiation of, 372–373nutritional requirements, 372parenteral route, 373–377

postoperative pediatric trauma patients, 412–415postpyloric feeding, 375–376surgical access to the gastrointestinal tract, 376types of enteral feed preparations, 374

O

Obstetric anesthesiaanemia and, 495antenatal care, 496cardiac disease and, 494–495challenges in the deployed environment, 492–495civilian best practice, 501current civilian best practice, 495–501deployed civilian experience, 501environmental considerations, 493equipment considerations, 493–494fetal monitoring, 497high-risk conditions, 498–500human immunodeficiency virus infection and, 495malaria and, 495massive hemorrhage protocol, 498–499military experience, 501neonatal care, 501normal labor, 493, 496–497obstetric experience of deployed surgeons, 493operative interventions, 493, 497–498pain relief during labor, 496–497patient information, 495–496postnatal care, 501preexisting indigenous standards of care, 492–493preexisting pathology in the pregnant patient, 493–495resources for the deploying anesthesiologist, 501risk factors, 493sexual violence and, 495tocolysis, 498trauma management principles, 499–500

Obstructive shock, 10, 335–336Occipital neuralgia, 254OL-ILV. See One-lung independent ventilationOne-lung independent ventilation, 140Operating room procedures

amputation, 150communication, 147debridement, 150extremity injuries, 149–150general principles for surgical management of battlefield

wounds, 149infection control, 147junctional injuries, 150–151patient positioning, 147pelvic injuries, 151regional anesthesia, 148set-up for burn injuries, 166–167tourniquet use, 148–149vascular surgery, 149–150

Operation Smile, 450Opioids

adverse events, 222intravenous administration, 220–222pain regimen based on injury severity, 221per os administration, 220side effects, 231

Orthopedic injuries, 149Oxygen supplies, 536–537

xl


P

Packed red blood cells, 97, 99Pain, acute. See also Acute pain service

basic concepts, 194descending modulatory pathways, 196dorsal horn, 195–196measuring pain, 277–278pain matrix, 196–197pain mechanisms, 194–197pain perception in higher centers, 196–197pain transmission, 195–196peripheral nociceptors, 194role of the glia, 196transient receptor potential vallinoid channel subtypes, 195WHO pain ladder, 207, 277–278

Pain, chronicascending pain pathways, 247back pain, 248–253, 255–256classification of, 246–248definition of, 246–248descending modulation, 247interventional procedures, 256neck pain, 253–256neuropathic pain, 246treatment options, 255–256

Pain managementcatheter techniques, 547communication and, 278continuous peripheral nerve block, 235–238electrical nerve stimulator, 546epidural analgesia, 232–234future of pain management on the battlefield, 279–280history of, 276–277measuring pain, 277–278medical ultrasound, 546–547medication delivery systems, 547–549needle design, 547nerve localization, 546–547obstetric anesthesia, 496–497pain management champions, 263patient-controlled analgesia, 206, 221–222, 230–232, 547–549pediatric trauma patients, 415–417postnatal care, 501roles of care, 278specialist equipment for, 546–549

Pain medicationsacetaminophen, 223–225adverse events, 222anticonvulsants, 224frequency of intravenous and oral analgesic administration,

279intravenous administration, 220–222local anesthetics, 224–225N-methyl-D-aspartate receptor antagonists, 222–223nonopioid analgesics, 222–225nonsteroidal antiinflammatory drugs, 223, 225opioids, 220–222pain regimen based on injury severity, 221per os administration, 220α2-adrenergic agonists, 224–225

Pain nurses, 263Pain relief

carbohydrate metabolism, 201cardiovascular response, 202immune function response, 202initial stress response, 200

key hormones released, 200lipolysis, 201metabolic responses, 200–202neurological systems response, 202patient outcomes, 203protein catabolism, 200psychological responses, 202respiratory response, 202system responses, 202water and electrolyte balance, 201–202

Pain scoringdifficulties with, 214importance of, 214military scoring systems, 215–216scoring effects of pain, 215scoring pain intensity, 215when to score pain, 217

Pain serviceclinical practice guideline, 263–264deployed acute pain service responsibilities, 262enabling change, 265governance, 262multidisciplinary team, 262–263pain education, 264predeployment training, 264specialist interest group responsibilities, 262standard operating instruction, 263–264team rounds and meetings, 265team training, 264

Pancreatitis, 343Pararescuemen, 47–48Parenteral nutrition

immunonutrition, 374–375initiation and advancement of, 414pediatric trauma patients, 414–415postpyloric feeding, 375–376recommendations for nutrition components, 415routes of, 373–374surgical access to the gastrointestinal tract, 376

Patient-controlled analgesia, 547–549benefits of, 206, 230complications, 230–231contraindications, 230indications, 230nursing guidelines, 232opioid administration, 221–222pediatric trauma patients, 416pump settings, 231types of drugs, 230when to initiate, 232

Patient evacuation coordination center, 42Patient movement requirement centers, 396Patient positioning

airway management, 77–78critical care, 300mechanical ventilation and, 308operating room procedures, 147percutaneous central venous access, 65, 66prone positioning, 308

Patient transfer, 300Patient transport. See also Aeromedical transport

pediatric trauma patients, 423Pave Hawk helicopters, 47–48PCA. See Patient-controlled analgesiaPECC. See Patient evacuation coordination centerPediatric Advanced Life Support algorithm, 554Pediatric trauma

xli


acute management of asthma exacerbation algorithm, 406–407acute management of hyperkalemia algorithm, 421airway equipment, 404–406, 470airway management, 477–478analgesia, 481–482analgesic drug doses, 474anatomy and physiology, 403, 473–474anesthesia, 470–482anesthesia handoff checklist, 405blood product dosing guidelines, 420breathing management, 478–479burn care, 421–423caudal anesthesia, 482chest trauma, 402–403circulation management, 474, 479commonly used analgesics, 416disability, 479–482dosing for commonly used medications, 428dosing for single-injection peripheral nerve block, 481emergency resuscitation dosing, 427enteral feeding, 414epidural anesthesia, 482equipment, 404, 470estimated blood volumes, 420estimation of endotracheal tube size and length in children,

471exposure, 482fever, 419fluid management, 412–415, 479Glasgow coma scale, 405, 479–480head trauma, 417–419hematologic issues, 419–421hemodynamic principles, 409–412infection, 419initial ventilator settings, 409intraosseous insertion, 411massive hemorrhage, 471, 474–477mechanical ventilation, 402–409minimum alveolar concentration, 481neurologic injuries, 479–480normal physiological values for children, 470nutritional support, 412–415pain management, 415–417parenteral feeding, 414patient-controlled analgesia, 416pediatric parameters, 404physiologic considerations, 403, 473–474preparation, 470–471pulmonary support, 402–409rapid sequence induction, 420, 477–478receiving pediatric critical care patients, 402recommended extubation criteria, 409refeeding syndrome, 415resuscitation, 412, 427, 475–477sedation management, 415–417, 480spinal cord trauma, 417–419thermoregulation, 474transport principles, 423trauma considerations, 471–473vascular access, 410–412, 475vasoactive agents, 411ventilator-associated pneumonia bundle, 410ventilatory management techniques, 406–410weight estimation for Afghanistan local national children, 471

Pedro helicopters, 47PEEP. See Positive end-expiratory pressurePelvic injuries

anterior posterior compression, 145classification of, 145general operative intervention considerations, 147–149imaging, 178infection control, 147lateral compression, 145management strategy for fractures, 150–151postoperative care, 151–152prehospital care, 145–146regional anesthesia, 148role 3 care, 147surgical considerations, 151tourniquet use, 148–149vertical shear, 145

Percutaneous central venous accesscomplications of, 67femoral vein, 66history of, 64–65internal jugular vein, 65–66patient positioning, 65, 66pediatric trauma patients, 412, 427, 475–477subclavian vein, 65tasks to be completed on arrival of patient, 65techniques, 65, 66ultrasound-guided, 66–67

Perioperative critical careadjuncts in trauma resuscitation, 114–115admission to intensive care unit, 114–115airway assessment, 108–110the “AMPLE” history, 109assessment regime, 108–112base deficit correction, 112circulation, 111clearance of cervical spine, 110conditions requiring rapid sequence induction of anesthesia,

110early enteral nutrition, 115early intensive care requirements for the severely injured, 109end points in resuscitation, 113fluids in trauma resuscitation, 114fracture fixation, 114hypotensive resuscitation, 113–114immediate requirements and decision points in treating the

severely injured, 109infection care bundles, 115initial management, 108inotropic agents, 114lactate correction, 112patient history, 108vascular volume status, 111–112vasoactive agents, 114ventilation, 110–111

Peripheral nerve blocksneedle design, 547pediatric patients, 481

Peripheral nociceptors, 194Peripheral venous cutdown, 68Peritoneal dialysis, 325Permissive hypotension, 54, 88Personal protective equipment, 507–508Pethidine, 496Pharmacists

acute pain service responsibilities, 263Physical examinations, 286Physiotherapists, 263PIS. See Propofol infusion syndromePMRCs. See Patient movement requirement centers

xlii


Pneumoniaventilator-associated pneumonia bundle, 410

Pneumothorax, 67Point-of-care testing, 89Portable oxygen generator system, 536–537Positioning. See Patient positioningPositive end-expiratory pressure, 111, 292, 305–306Postnatal care, 501Postoperative care

burn injuries, 170extremity injuries, 151–152junctional injuries, 151–152pediatric trauma patients, 412–415pelvic injuries, 151–152

Postpyloric feeding, 375–376Posttraumatic stress disorder

pain response, 202Potassium management

damage control resuscitation and, 90massive transfusion and, 98

PRBCs. See Packed red blood cellsPreeclampsia, 498Prehospital medicine

analgesia, 268–272care during MEDEVAC, 48–54considerations for the future, 54evacuation chain, 42–44extremity, junctional, and pelvic injuries, 145–146Medical Emergency Response Team, 44–46medical evacuation assets, 46–48prehospital resuscitation guidelines, 555–556

Pressure-preset ventilation, 305–306PRIS. See Propofol infusion syndromeProject HOPE, 450Prone positioning, 308Propaq, 538Propofol, 362–364Propofol infusion syndrome, 126, 363–364Protein catabolism, 200PTSD. See Posttraumatic stress disorderPulmonary agents, 514–515Pulmonary embolism, 335Pulmonary injuries. See also Respiratory disease

acute respiratory distress syndrome, 12airway trauma, 10chest wall trauma, 10–11lung injuries, 136–137pediatric trauma patients, 402–409pulmonary contusion, 291pulmonary trauma, 10–11

Q

Q fever, 341, 437, 441QEHB. See Queen Elizabeth Hospital BirminghamQueen Elizabeth Hospital Birmingham

anesthetic considerations for critically injured military pa-tients, 569

clinical and anesthetic considerations for patients admitted to the military trauma ward, 569

coordinating clinical care, 569–570essential requirements for receiving casualties at Role 4, 568external relationships, 570operating room activity, 570patient admissions and disposition, 568–569

“Quick Look” assessment, 507, 509

R

RAAS. See Rennin-angiotensin-aldosterone systemRadiologic assessment. See also Imaging

cervical spine injuries, 123–124Radiological exposure. See Chemical, biological, radiological, and

nuclear exposureRAP. See Regimental aid postsRapid sequence induction

airway management, 79, 122–123care during MEDEVAC, 49–51indications for, 50–51medications commonly used for, 420pediatric trauma patients, 420, 477–478risks during MEDEVAC flight, 50

RASS. See Richmond Agitation-Sedation ScaleRBCs. See Red blood cellsRCC. See Red cell concentrateRCDM. See Royal Centre for Defence MedicineRecombinant activated factor VIIa

damage control resuscitation and, 91effects of, 352–353massive transfusion and, 101

Record-keeping, 299–300Recruitment maneuvers, 308Red blood cells, 98Red cell concentrate, 100Refeeding syndrome, 415Regimental aid posts, 43Regional anesthesia

Camp Bastion protocol, 242–244continuum of risk, 243determining when to use, 242for extremity, junctional, and pelvic injury surgical procedures,

148obstetric anesthesia, 497pediatric patients, 480–481potential benefits of, 242for stable casualties, 185ultrasound imaging and, 179venous access, 179

Remifentanil, 496Renal disease

elderly populations and, 487Renal failure

etiology of, 322incidence of, 322Indications for renal support, 322–323management options, 323–324outcomes, 324prevention of, 322“RIFLE” classification, 322–323

Renal injuriesabdominal compartment syndrome, 14–15acute kidney injury, 14, 322–324compartment syndrome, 14extremity compartment syndrome, 15renal replacement therapy, 15“RIFLE” criteria for acute renal failure, 15risk factors for acute renal failure, 13

Renal replacement therapy, 15, 322–325Renal support

constructing a field-expedient peritoneal dialysis system, 325etiology of injuries, 322history of, 322incidence of injuries, 322indications for, 322–323

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management options, 323–324modes of, 324outcomes, 324prevention of acute kidney injury and renal failure, 322

Rennin-angiotensin-aldosterone system, 290–291Reperfusion. See also Vascular reperfusion

ischemia-reperfusion injury, 9, 16Respiratory disease. See also Pulmonary injuries

elderly populations and, 487Goldman risk factor and score, 486–487

Respiratory systempain response, 202

Restraintssedation and, 366

Resuscitation. See also Damage control resuscitationadequacy of resuscitation, 288–289areas of controversy, 557blood product administration, 53–54capnometry as a guide to resuscitation, 557cardiac arrest guidelines, 552chest compressions, 557concurrent, 49end points, 113epinephrine, 557evidence for military traumatic cardiorespiratory arrest,

556–557guidelines, 552–558head trauma, 127hypotensive resuscitation, 54ideal goals of, 113intubation, 557novel hybrid resuscitation, 54obstetric algorithm, 500pediatric emergency resuscitation dosing, 427pediatric trauma patients, 412, 427, 475–477prehospital resuscitation guidelines, 555–556the resuscitation bundle, 384–385trauma resuscitation guidelines, 552–555vasopressors, 557ventilation, 557

Return of spontaneous circulation, 556–557Richmond Agitation-Sedation Scale, 292, 360–361“RIFLE” criteria, 15, 322–323Riot control agents, 515–516Roles of care

acute pain services at role 3 facilities, 278–279burn casualties at role 3 facilities, 164–171for combat casualties, 5–7combat casualty management at role 2 and 3 facilities, 7–8damage control resuscitation at role 2 and 3 facilities, 7essential requirements for receiving casualties at Role 4, 568extremity injury management at role 3 facilities, 146–147junctional injury management at role 3 facilities, 147pelvic injury management at role 3 facilities, 147

Royal Air ForceCritical Care Air Support Teams, 392

Royal Centre for Defence Medicine, 568RRT. See Renal replacement therapyRSI. See Rapid sequence inductionRule of nines, 422

S

Sacroiliac joint pain, 250, 252SCCM. See Society of Critical Care MedicineSCD. See Sequential compression deviceScoring pain. See Pain scoring

Sedation. See also Anesthesiaacute lung injury, 292benzodiazepines, 361conscious sedation, 185–186daily interruption of sedation, 365–366dexmedetomidine, 362, 364head injuries, 365pediatric trauma patients, 415–417, 480pharmacology of sedatives, 362propofol, 362–364restraints and, 366sedation scales, 360sedatives, 361–364, 417

Seizureshead trauma and, 127

Sepsisantibiotic guidelines, 387–388diagnosis of, 333goal-directed therapy, 334immunoglobulin doses, 386laboratory support, 386–387patient management, 333, 384the resuscitation bundle, 384–385the sepsis management bundle, 385–386supportive therapy, 385tailoring therapy, 386–388

Sequential compression device, 354Serotonin syndrome, 344Sexual violence, 495Shock

adrenal crisis, 335anaphylaxis, 333, 335cardiac tamponade, 336cardiogenic shock, 332–333categories of, 328–329clinical presentation, 328coagulopathy of trauma shock, 242–244combat casualties and, 8–10distributive shock, 333–335hypovolemic shock, 37, 332management of, 332–336neurogenic shock, 335obstructive shock, 335–336pathophysiology of, 328pulmonary embolism, 335sepsis, 333–334traumatic shock, 8–9

Shock liver, 16SIRS. See Systemic inflammatory response syndromeSituational awareness

trauma teams and, 34Skin diseases, nonthermal, 171Skin grafts, 166Society of Critical Care Medicine, 360, 365Sodium maintenance, 412–413SOI. See Standard operating instructionSOP. See Standard operating proceduresSpecialist retrieval teams, 88Spinal-epidural analgesia, 497Spinal injuries. See also Back pain

airway management, 122–123Canadian C-Spine Rule, 123–124CT imaging, 110epidemiology, 122injury patterns, 122pediatric patients, 417–419radiologic assessment, 110, 123–124

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steroids and, 124Spinal stenosis, 250, 253Spontaneous ventilation, 306Stable casualties

choosing anesthetic technique, 184–187classification of, 182common operations, 183–184conscious sedation, 185–186monitoring depth of anesthesia, 187neuraxial anesthesia, 185perioperative considerations, 184population at risk, 182–183regional anesthesia, 185special considerations, 183total intravenous anesthesia, 186–187volatile gas anesthesia, 185

Standard operating instructionacute pain service, 263–264

Standard operating procedurestrauma teams and, 33–34

Steroidsspinal injury use, 124

Strategic evacuation, 394, 397STRATEVAC. See Strategic evacuationSubclavian vein catheterization, 65Superficial peripheral nerve block, 244Supraglottic airways, 78Surgical principles, 149. See also Operating room proceduresSurviving Sepsis Campaign, 333, 384SVR. See Systemic vascular resistanceSystemic inflammatory response syndrome, 115Systemic vascular resistance, 156–157

TTACEVAC. See Tactical evacuationTactic, technique, or procedure calls, 47Tactical Combat Casualty Care, 4–5, 48, 271Tactical damage control surgery, 7–8Tactical evacuation, 394, 397TAP block. See Transversus abdominis plane blockTarget-controlled infusions, 186–187TBI. See Traumatic brain injuryTCCC. See Tactical Combat Casualty CareTCI. See Target-controlled infusionsTCRA. See Traumatic cardiorespiratory arrestTeam medics, 43Thermal injury, acute, 164–165Thermoregulation

pediatric trauma patients, 474Thoracic injuries

analgesia principles, 140anesthesia principles, 139aortic injuries, 136blunt injuries, 135cardiac injuries, 135–136combat casualties, 8imaging, 178intrathoracic airway injuries, 134–135lung injuries, 136–137multimodal analgesia, 208operative intervention, 137–139pathophysiology, 134–137penetrating injuries, 134practical conduct of anesthesia, 139–140ventilation strategies, 140

Thoracostomy, 53

Thoracotomy, 137–138, 556Thromboembolic disease

chemical prophylaxis, 354–355Factor VIIa effects, 352–353inferior vena cava filters, 355–356massive transfusion effects, 352–353mechanical prophylaxis, 354neuraxial blockade, 355pathophysiology of venous thromboembolism, 352–353prevalence of venous thromboembolism, 353prevention of venous thromboembolism, 353–356prophylaxis, 300tranexamic acid effects, 352–353

Tidal volume, 304TIVA. See Total intravenous anesthesiaTL-ILV. See Two-lung independent ventilationTocolysis, 498Topical negative pressure dressings, 300TOSC. See Return of spontaneous circulationTotal intravenous anesthesia, 186–187Tourniquets

cardiovascular effects, 156–157combat application tourniquet, 145complications association with, 148extremity injuries and, 148–149junctional injuries and, 148–149managing reperfusion after removal, 155–160metabolic effects, 159neurologic effects, 158pelvic injuries and, 148–149physiologic effects, 156–160respiratory effects, 157safety of, 159–160tourniquet pain, 158–159

Tracheal disruptionaeromedical evacuation, 316–317diagnosis of, 316postoperative care, 316–317preventing further injury, 316–317ventilation considerations, 316–317ventilator settings, 316–317

Tracheostomy, 478TRALI. See Transfusion-related acute lung injuryTranexamic acid, 352–353Transfer ventilators, 309–310Transfers, patient, 300Transfusion, massive. See Massive transfusionTransfusion-related acute lung injury, 100Transient receptor potential vallinoid, 194–195Transport, patient. See also Aeromedical transport

pediatric trauma patients, 423Transversus abdominis plane block, 207–108Trauma shock

coagulopathy of trauma shock, 242–244Trauma team

communication, 33considerations for, 35–38crew resource management, 33–34familiarization with environment and equipment, 34leadership and followership, 34multidisciplinary trauma team, 34–35roles of, 36situational awareness, 34training, 35use of standard operating procedures, 33–34

Traumatic brain injuryanesthetic use, 127

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assessment of, 124–125critical care, 299decreasing cerebral oxygen consumption, 126Glasgow coma scale, 125intracranial hypertension and, 127management, 125–127monitoring, 124–125neuroprotective measures, 13prophylaxis for, 13resuscitation, 127seizures and, 127tactical damage control surgery, 7

Traumatic cardiorespiratory arrest, 552, 556–557Traumatic shock, 8–9Triage

ethical issues, 462–463following chemical, biological, radiological, and nuclear expo-

sure, 510–512Triservice Anesthetic Apparatus, 528–530TRPV. See Transient receptor potential vallinoidTTPs. See Tactic, technique, or procedure callsTuberculin skin testing, 437Two-lung independent ventilation, 140

UUFH. See Unfractionated heparinUltrasound, medical, 546–547Unfractionated heparin, 353–355United Kingdom

buddy-buddy system, 43Defence Medical Services, 32massive transfusion operational protocol, 100, 102–103Medical Emergency Response Team, 44–46Queen Elizabeth Hospital Birmingham, 568–571team medics, 43

United Kingdom Defence Medical Servicespain scoring systems, 215–216United States

combat casualty care, 43massive transfusion military protocol, 100–101, 104medical evacuation assets, 46–48military anesthesiologists, 32military hospitals, 564–566

Upper limb injuriesmultimodal analgesia, 207

US Air ForceCritical Care Air Transport Teams, 6–7, 392pararescue, 47–48

US anesthesia monitoring, 538US Army’s Institute of Surgical Research, 101, 103, 565US draw-over system, 531–532US ventilators, 539–540USAF, Form 3899, Aeromedical Evacuation Patient Record, 397USAISR. See US Army’s Institute of Surgical ResearchUSNS Comfort, 448–449, 450, 452, 454USNS Mercy, 448, 452Utilitarianism, 460

VVAP. See Ventilator-assiciated pneumoniaVascular access

access to vascular space, 49arterial access, 68–69catheter and cannula sizes, 64direct atrial cannulation, 68intraosseous access, 67–68

pediatric trauma patients, 410–412, 475percutaneous central venous access, 64–67peripheral venous cutdown, 68physics of flow, 64post-anesthesia care of vascular access devices, 69

Vascular injuriesimaging, 178surgical considerations, 149–150

Vascular reperfusion, 155–160Vasoactive agents, 114, 411Vasopressors, 557Vela ventilators, 539Veno-venous technique of hemofiltration, 323–324Venous thromboembolism

chemical prophylaxis, 354–355factor VIIa effects, 352–353inferior vena cava filters, 355–356massive transfusion effects, 352–353mechanical prophylaxis, 354neuraxial blockade, 355pathophysiology of, 352–353prevalence of, 353prevention of, 353–356prophylaxis, 300tranexamic acid effects, 352–353

Ventilation, mechanicalacute lung injuries and, 291–292adjuncts to, 308–309asymmetrical pulmonary pathologies, 307for bronchopleural fistula, 316–318conservative fluid management, 308–309drugs used with, 51–52extracorporeal membrane oxygenation, 309the first 24 hours, 304–310high-frequency ventilation, 307–308independent lung ventilation, 306–307infection issues, 383inverse-ratio ventilation, 306mode of, 305–308monitoring and optimizing ventilation, 304–305neuromuscular blocking agents, 308nitric oxide and, 308pediatric trauma patients, 406–410positive end-expiratory pressure, 305prehospital procedures, 53pressure-preset ventilation, 305–306principles of safe ventilation, 304–305prone positioning, 308recruitment maneuvers, 308resuscitation guidelines, 557spontaneous ventilation, 306thoracic injuries and, 140tidal volume, 304for tracheal disruption, 316–318transfer ventilators, 309–310volume-preset ventilation, 305

Ventilator-associated pneumonia, 383Ventilators, 538–540Vesicants, 514Veterans Affairs Medical Centers, 565–566Video laryngoscopy, 78Virchow triad, 352Visual analogue pain scale, 215Volatile gas anesthesia, 185Volume-preset ventilation, 305VTE. See Venous thromboembolism

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WWalter Reed Army Institute of Research, 437–440Ward nurses, 263Water/electrolyte balance, 201–202Whiplash injuries, 254–255World Health Organization

pain ladder, 207, 277–278surgical checklist, 33

WRAIR. See Walter Reed Army Institute of Research

ZZygopaphyseal joint pain, 250

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

Art: Courtesy of Tony Green.

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AbbreviAtions and Acronyms · 2020. 4. 27. · EDOCS: expeditionary deployable oxygen concentrator system EMT-B: emergency medical technician-basic EN: enteral nutrition ESBL: extended

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