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War Surgery, Field Manual
Hans Husum with Swee Chai Ang and Erik Fosse
Third World Network
ISBN 983-9747-14-12 (hb)
ISBN 983-9747-12-6 (pb)
764 pages
21x27 cm
Price
US$140.00 for First World countries
US$50.00 for Third World countries
Prices are inclusive of postage costs by airmail
War surgery,
Field Manual takes a unique approach to the subject of trauma and war
surgery. Unlike the usual literature written for well-equipped, conventional
armies and Western-style hospitals---thus of limited value to doctors,
and community health workers facing less than ideal conditions in Third
World countries---this manual adopts the standpoint of poor and vulnerable
communities and staff, caught in wars they did not ask for.
In
this ground-breaking work, the authors have set a standard reference for
care under difficult conditions, with the lack of medical facilities and
proper staff. They promote a concept of forward life support and surgery
close to the front line, which draws on the resources and knowledge of
the local community, which improvises with local equipment and materials,
and also includes a complete guide to post-operative, high-energy nutrition
based on local foodstuffs and food-processing traditions. The authors
have distilled in this well-illustrated textbook the knowledge gained
after 15 years of experience with post-Vietnam generation of weapons during
surgery in the Middle East, Afghanistan and South East Asia.
". .
. . a wealth of information on the organization of war medical service
and on approaches to setting up forward clinics . . . . an indispensable
tool for surgeons and medical assistants who find themselves in circumstances
of war . . . . no other manual in existence covers this information with
such depth and clarity."
David Werner, the author of Where There is No Doctor.
"We
have used the procedures recommended in War Surgery, Field Manual in building
a network of mobile forward clinics. Since 1989 our field clinics have
provided limb and life-saving surgery to more than 5,500 war casualties
from the combat grounds in Central and Eastern Afghanistan. With its simple
terminology and clarifying illustrations, the book has proved to be very
useful in training of graduate as well as non-graduate medical staff."
Dr. Assadullah Reha MD, Medical Director
Mujahed Emergency Medical Centre, Jalalabad, Afghanistan.
". .
. . This is something that is not easily obtained from literature, and
this book will be an important contribution to the field . . . . It will
help establish a standard of care for military and non-military health
care providers . . . ."
Prof. John A. Weigelt MD, Vice-Chairman
Department of Surgery, University of Minnesota, USA.
"War
Surgery, Field Manual was extremely well done and represented a nice summary
of the problems. Certainly, it will be of great interest to any military
medical personnel."
Prof. F. William Blaisdell MD, Chairman
Department of Surgery, University of California, USA.
CONTENTS
Foreword-why
this book
How to use the book
Section1:
The war medical organization
1. The
war medical network
Examples
from recent regional wars
Training of medical staff
2. The
forward clinic (FC)
Organization
of forward basic life support (BLS)
The BLS team
Management routines
Organization of the forward clinic (FC)
Standard medical and technical equipment
Light and heavy BLS kits
The one-man mobile FC
Consumption of medical materials
Cleaning and maintenance of instructments
How to improvise
Section2:
Basics of war surgery
3. Physics of the
weapon
Weapon
theory
The wound track
Blast injuries
Mine injuries
Modern arms and ammunition
4. Physiology of the
injury
The
tissue reponse to injury
The body response to injury
5. The
clinical examination
Access
vital functions-pain and anxiety
Access vital functions-airways and breathing
Access vital functions-circulation
Examine the regional injuries
Abdominal and pelvic injury
Head and neck injury
Spinal injury
Fracture and joint injury
Nerve injury
6. Triage-sorting
casulties
The
principles of triage
Triage in mass casulties
7. BLS:
Basic life support and basic life-saving surgery
Fundamentals
of basic life-saving surgery
Free airway
Support the breathing, Chest drainage
Manage circulatory shock
Manage pain and fear
Early carbohydrate nutrition
Procedures of basic life-saving surgery
Prevent heat loss-start early rewarming
Emergency thoracotomy and aortic clamping
Emergency laparotomy
Liver emergencies
Injury to the spleen
Duodenal and stomach emergencies
Pancreatic emergencies
Kidney emergencies
Limb emergencies
Multi-injred burn cases
8. Surgical
technique
Non-traumatic
technique
Choice of incisions
Dissection and retraction
Control of bleeding
Surgery on bone
Sufures and surgical knots
9. Fasciotomy, debridement
and drainage
Plan
your surgery
Fasciotomy - when and how
The debridement in detail
Methods for drainage
Section
3: General procedures
10. Injuries
to arteries and veins
Types
of vascular injury
Primary amputation, ligature or reconstruction?
Exploration
Reconstruction
Complications of vascular surgery
11. Fractures
Types
of fractures
Healing of fractures
Soft tissue flaps
Joint protection
Battlefied management
Plastercraft
The Trueta plaster method
External fixation
Traction
Delayed healing and infested fractures
12. Joint
injuries
Evaluation
of joint function
The soft tissue problem
Fracture through joints
Infected joints
13. Tendon
injuries
Primary
management
Secondary reconstruction
14. Nerve
injuries
Diagnosis
and exploration
Secondary nerve repair
15. Amputations
Evaluation
of extensive limb injuries
Types of emergency amputations
Amputation theory-the elective amputation
Early prosthesis training
16. Wound
closure
Monitor
the wounds
Closure by spontaneous granulation
Delayed primary suture (DPS)
Skin grafts
Skin flaps
17. Injuries
to children and old people
Basic
life support and surgery in children
Basic life support and surgery in old people
18. Emergency
blood transfusion
Reasons
for blood transfusion
Emergency blood tranfusion
Autotransfusion
Complications of blood transfusion
19. Hypothermia and
hyperthermia
Management
of hypothermia
Management of hyperthermia
20. Disease
interfering with surgery
Types
of anemia
Malabsorption and vitamin deficiencies
Schistosomiasis
Ascariasis
Amebiasis
Malaria
Typhoid fever
HIV and AIDS
Section
4: Specific injuries
21. Injury
to the head and neck
Surgical
anatomy
Preparations for surgery
Anesthesia
Scalp injury
Open skull injury
Control bleeding inside the skull
Skull hematoma after closed skull injury
Complications of skull surgery
Management of neck injury
22. Injury
to the spine
Surgical
anatomy
Types of spinal injury
Evacuation
Preparations for surgery
Anesthesia
Open spinal injury
Spinal fractures
Complications of injury and surgery
Rehabilitation after spinal injury
23. Injury
to the face
Surgical
anatomy
Evacuation
Preparations for surgery
Anesthesia
Soft tissue injury
Open fractures
Midface fractures
Upperface fractures
24. Injury to the
eye
Surgical
anatomy. The examination
Preparations for surgery
Anesthesia
Eyelid injury
Penetrating eye injury
Complications of injury and surgery
25. Injury
to the chest
Surgical
anatomy
Types of wartime chest injury
Preparations for surgery
Anesthesia
Chest wall injury
Exploration of the chest-standard thoracotomy
Cardiac injury
Emergency thoracotomy
Complications of injury and surgery
26. Abdominal
injuries in general
Priorities
for surgery
Preparations for surgery
Anesthesia
Abdominal wall injury
The midline incision. The exploration
Methods of control bleeding
Decompression-drainage-closure
Emergency laparotomy
27. Injury
to the intestine
Surgical
anatomy
The general procedure in missile injury
Two-step management in emergencies
Injury to the small intestine
Injury to the colon
Injury to the rectum
Reconstruction after enterostomy
28. Injury
to the liver and biliary tract
Surgical
anatomy
Liver injury
Complications of liver injury and surgery
Injury to the biliary tract
29.
Injury to the stomach and duodenum
Surgical
anatomy
Stomach injury
Injury to the duodenum and promimal jejunum
Emergency procedures
Complications of injury and surgery
30. Injury
to the spleen
Surgical
anatomy
Removal of the speen-splenectomy
Complications of injury and surgery
31.
Injury to the pancreas
Surgical
anatomy
Pancreatic injury
Complications of injury and surgery
32. Injury
to the kidneys
Surgical
anatomy
Injury to the kidney
Injury to the ureter
Complications of injury and surgery
33. Injury to the
urinary bladder and urethra
Surgical
anatomy
Types of injury
Injury to the bladder
Injury to the urethra
Complications of injury and surgery
34.
Injury to the male organs
35. Injury
to the female organs
Surgical
anatomy and physiology
Anesthesia to the pregnant woman
Injury to the pregnant woman
Injury to the non-pregnant woman
Complications of injury and surgery
36. Complications
of abdominal surgery
Post-operative
monitoring
The management of common complications
37. Pelvic
injury
Surgical
anatomy
Preparations for surgery
Anesthesia
Penetrating pelvic injury
Hip joint injury
Exploration of the main arteries
Pelvic fractures
Complications of injury and surgery
38. Upper
limb injury
Preparations
for surgery
Shoulder and arm injury
Surgical anatomy
Exploration of shoulder injury
Shoulder fractures
Extensive shoulder injury
Exploration of arm injury
Open arm fractures
Elbow injury Surgical anatomy
Exploration of shoulder injury
Elbow fractures
Extensive elbow injury
Forearm and hand injury Surgical anatomy
Exploration of forearm and hand injury
Fractures of the forearm and hand
Extensive hand injury
Amputations at the forearm and hand
Complications of injury and surgery
39. Lower
limb injury
Preparations
for surgery
Thigh injury
Surgical anatomy
Fasciotomy and exploration
Fracture management
Crush injuries
Thigh amputations
Injury to the distal thigh and knee Surgical anatomy
Preparations for surgery
Exploration for missile injury
Open joint fractures
Amputations at the knee joint
Lower leg injury
Surgical anatomy
Preparations for surgery
Exploration and fasciotomy
Fracture management
Types of amputation
Complications of limb injury and surgery
40. Burns
Physiology
of burn injury
Examination and classification of burns
Fluid therapy
Nutrition
Triage of wartime burns
Basic life support
Manangement of the burn wound
High voltage electrical burns
Chemical burns
Complications of burns
Section
5: Treatment after surgery
41. Monitoring
and complications after surgery
Monitor
the war wound
Monitor vital functions
Respiratory failure
Ciculatory failure
Renal failure
Coagulation system complications
Multi-organ failure
42. Nutrition after
injury and surgery
Why
enteral feeding-why homemade diets
Metabolic response to injury and surgery
Malnutrition complications surgery
Planning post-operative nutrition
Monitor the nutrition
Enteral feeding
Common foodstuffs and their nutrient value
Food processing and the viscoty problem
Home-made diets for enteral feeding
Common high-energy diets for oral feeding
Field standards of volume and weight
43. Exercises and
physical rehabilitation
Draw
up a rehabilitation program
Respiratory support and exercises
Basic training therapy
Training after limb injury
Ambulation and walking aids
Rehabilitation after head and spinal injury
Rehabilitation of multi-injury patients
44. Microbiology
and infections
What
is bacteria
What is infection
Guidelines for treatment
Septic shock
Bacteria important in surgery
Common infections and common antibiotics
Resistance to antibiotics
Disinfection and sterilization
Section
6 : Field anesthesia
45. Wartime
anesthesia complications
Airway
obstruction
Circulatory collapse
Sympathetic hyperactivity
Side effects of general anesthetics
Side effects of local anesthetics
46. Local anesthesia
Infiltration
anesthesia
Intercostal nerve block, Pleural analgesia
Brachial plexus nerve block
Axillary nerve block
Nerve block of the hand
Femoral nerve block
Nerve block of the foot
Regional intravenous anesthesia
47. Spinal anesthesia
The
anesthetics
The procedure
48.
Intermittent Ketamine anesthesia
Appendices
1.
Management quality control
2. Blood-grouping, cross-matching, and blood-banking
3. Microscopic examination of bacteria. The gram-stain procedure
4. Books recommended for further studies
Acknowledgements
Glossary
Index
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