Front Line Surgery [recurso electrónico] : A Practical Approach / edited by Matthew J. Martin, Alec C. Beekley.

Preface -- Foreword -- Top Ten Combat Trauma Lessons -- Prehospital and Enroute Care -- Combat Triage and Mass Casualty Management -- Initial Management Priorities: Beyond ABCDE -- Damage Control Resuscitation -- To Operate or Image? (Pulling the Trigger) -- Ultrasound in Combat Trauma -- Contamination, Colostomies, and Combat Surgery -- Liver and Spleen Injury Management in Combat (Old School) -- Pancreatic and Duodenal Injuries (Sleep when you can…) -- Operative Management of Renal Injuries -- Major Abdominal Trauma -- To Close or Not to Close: Managing the Open Abdomen -- Choice of Thoracic Incision -- Lung Injuries -- Diagnosis and Management of Penetrating Cardiac Injury -- Thoracic Vascular Injuries—Operative Management in “Enemy” Territory -- Chest Wall and Diaphragm Injury -- Soft Tissue Wounds and Fasciotomies -- Open Fractures -- Mangled Extremities and Amputations -- Peripheral Vascular Injuries -- The Neck -- Genitourinary Injuries (excluding kidney) -- Neurosurgery for Dummies -- Spine Injuries -- Face, Eye, and Ear Injuries -- Burn Care in the Field Hospital -- The Pediatric Patient in Wartime -- The Combat ICU Team -- Postoperative Resuscitation -- Monitoring -- Ventilator Management -- Practical Approach to Combat-related Infections and Antibiotics -- Stabilization and Transfer from the Far Forward Environment -- Humanitarian and Local National Care -- Expectant and End of Life Care in a Combat Zone -- Appendix A. Improvise, Adapt, and Overcome: Field Expedient Methods in a Forward Environment -- Appendix B. Burn Diagrams and Sample Burn Orders -- Appendix C. Resources, References, and Readiness.

Front Line Surgery is designed to provide practical insights for surgeons whose areas of practice demand quick best-outcome based solutions to complex and urgent clinical problems. Both editors are active duty officers and surgeons with multiple tours in Iraq. Each chapter provides detailed instructions and combat/emergency surgical principles with multiple detailed illustrations. While the focus is clearly clinical, the authors also provide clinical pearls in both traditional and non-traditional narrative. Top Ten Combat Trauma Lessons 1. Patients die in the ER, and 2. Patients die in the CT scanner; 3. Therefore, a hypotensive trauma patient belongs in the operating room ASAP. 4. Most blown up or shot patients need blood products, not crystalloid. Avoid trying “hypotensive resuscitation” – it’s for civilian trauma. 5. For mangled extremities and amputations, one code red (4 PRBC + 2 FFP) per extremity, started as soon as they arrive. 6. Patients in extremis will code during rapid sequence intubation, be prepared, and intubate these patients in the OR (not in the ER) whenever possible. 7. This hospital can go from empty to full in a matter of hours; don’t be lulled by the slow periods. 8. The name of the game here is not continuity of care, it is throughput. If the ICU or wards are full, you are mission incapable. 9. MASCALs live or die by proper triage and prioritization – starting at the door and including which x-rays to get, labs, and disposition. 10. No Personal Projects!!! They clog the system, waste resources, and anger others. See #8 above. Reprinted from "The Volume of Experience (January 2008 edition)", a document written and continuously updated by U.S. Army trauma surgeons working at the Ibn Sina Hospital, Baghdad, Iraq.

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