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Fundamentals of Frontline Surgery
Fundamentals of Frontline Surgery
Edited by Professor Mansoor Khan
Consultant Oesophagogastric, General and Trauma Surgeon, Honorary Clinical Professor of Trauma Surgery, Brighton and Sussex University Hospital, Brighton, UK Surgeon Commander Royal Navy (Retired)
and
Professor David Nott
Professor of Humanitarian Surgery, Imperial College London Consultant Vascular, General and Trauma Surgeon. St Mary’s Hospital, Paddington, London, UK
First edition published 2021 by CRC Press 6000 Broken Sound Parkway NW, Suite 300, Boca Raton, FL 33487-2742
and by CRC Press 2 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN
© 2021 Taylor & Francis Group, LLC
CRC Press is an imprint of Taylor & Francis Group, LLC
This book contains information obtained from authentic and highly regarded sources. While all reasonable efforts have been made to publish reliable data and information, neither the author[s] nor the publisher can accept any legal responsibility or liability for any errors or omissions that may be made. The publishers wish to make clear that any views or opinions expressed in this book by individual editors, authors, or contributors are personal to them and do not necessarily reflect the views/ opinions of the publishers. The information or guidance contained in this book is intended for use by medical, scientific, or health-care professionals and is provided strictly as a supplement to the medical or other professional’s own judgement, their knowledge of the patient’s medical history, relevant manufacturer’s instructions, and the appropriate best practice guidelines. Because of the rapid advances in medical science, any information or advice on dosages, procedures, or diagnoses should be independently verified. The reader is strongly urged to consult the relevant national drug formulary and the drug companies’ device or material manufacturers’ printed instructions and their websites, before administering or utilising any of the drugs, devices, or materials mentioned in this book. This book does not indicate whether a particular treatment is appropriate or suitable for a particular individual. Ultimately, it is the sole responsibility of the medical professional to make his or her own judgments, so as to advise and treat patients appropriately. The authors and publishers have also attempted to trace the copyright holders of all material reproduced in this publication and apologize to copyright holders if permission to publish in this form has not been obtained. If any copyright material has not been acknowledged, please write and let us know so we may rectify in any future reprint.
Except as permitted under US Copyright Law, no part of this book may be reprinted, reproduced, transmitted, or utilized in any form by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying, microfilming, and recording, or in any information storage or retrieval system, without written permission from the publishers.
For permission to photocopy or use material electronically from this work, access www.copyright.com or contact the Copyright Clearance Center, Inc. (CCC), 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400. For works that are not available on CCC please contact mpkbookspermissions@tandf.co.uk
Trademark notice: Product or corporate names may be trademarks or registered trademarks and are used only for identification and explanation without intent to infringe.
Library of Congress CataloginginPublication Data
Names: Khan, Mansoor, 1977- editor. | Nott, David (David M.), editor. Title: Fundamentals of frontline surgery / edited by Professor Mansoor Khan and David Nott. Description: First edition. | Boca Raton : CRC Press, 2021. | Includes bibliographical references and index. | Summary: “Fundamentals of Frontline Surgery is an easy to read text, written by world class faculty, that provides clinicians with succinct and didactic information about what to do in high intensity, resource limited situations. With global conflicts and humanitarian emergencies on the rise, there has been a dramatic uptake in the number of volunteers for both military and humanitarian operations. This manual aids best practice and fast decision making in the field”‐‐ Provided by publisher. Identifiers: LCCN 2020035126 (print) | LCCN 2020035127 (ebook) | ISBN 9780367435592 (paperback) | ISBN 9780367437497 (hardback) | ISBN 9781003005469 (ebook) Subjects: MESH: Surgical Procedures, Operative | Wounds and Injuries‐‐surgery | Armed Conflicts | Disasters | Developing Countries | Health Resources Classification: LCC RD31 (print) | LCC RD31 (ebook) | NLM WO 500 | DDC 617.‐‐dc23
LC record available at https://lccn.loc.gov/2020035126 LC ebook record available at https://lccn.loc.gov/2020035127
ISBN: 978-0-367-43749-7 (hbk) ISBN: 978-0-367-43559-2 (pbk) ISBN: 978-1-003-00546-9 (ebk)
Typeset in Sabon by MPS Limited, Dehradun
‘Ut alii vivant’
(So others may live)

Contents

Forewords ix Preface xi Editors xiii Contributors xv
1 The Resource-Limited Environment 1
Mansoor Khan and David Nott
2 Patterns of Injury 7
Danyal Magnus, Katherine A. Brown, Mansoor Khan, and William Proud
3 Damage Control Resuscitation 25
Mark Midwinter
4 No Blood . . . What to Do? 31
Avi Benov, Roy Nadler, Avishai M. Tsur, Ori Yaslowitz, Andrew P. Cap, Mark H. Yazer, and Elon Glassberg
5 Point-of-Care Ultrasound 37
Carlos Augusto M. Menegozzo and Bruno M. Pereira
6 Thoracic Injury Management 45
David R. King and James V. O’Connor
7 Junctional and Extremity Vascular Trauma 63
David S. Kauvar and Mohammed Mar’ae Asieri
8 Trauma Laparotomy and Damage Control Laparotomy 83
Carrie Valdez and David Nott
9 Damage Control for Severe Pelvic Haemorrhage in Trauma 91
Kristin Hummel and John H. Armstrong
10 Abdominal Injuries 99
Viktor Reva and Boris Kessel
11 Acute Care Emergency Surgery 119
Marcelo A.F. Ribeiro and Mansoor Khan
viii Contents
12 Frontline Consideration for Paediatric Emergency and Trauma Surgery 131
Nicholas Alexander
13 RLE Orthopaedic Injury Management 137
Jowan Penn-Barwell and Daniel Christopher Allison
14 Neurotrauma in the Field 151
Kevin Tsang
15 Management of Ballistic Face and Neck Trauma in an Austere Setting 163
Johno Breeze
16 Management of Ophthalmic Injuries by the Forward Surgical Team 175
Richard J. Blanch, Johno Breeze, and William G. Gensheimer
17 Resource-Limited Environment Plastic Surgery 187
Johann A. Jeevaratnam, Charles Anton Fries, Dimitrios Kanakopoulos, Paul J.H. Drake, and Lorraine Harry
18 Acute Acoustic Trauma and Blast-Related Hearing Loss 213
Jameel Muzaffar, Christopher Coulson, Jonathan D.E. Lee, and Linda E. Orr
19 Obstetrics in Limited-Resource Settings 223
Carlos Pilasi Menichetti and Rebekka Troller
Index 235
Forewords to Fundamentals of
Frontline Surgery
Victims of armed conflict deserve the best trauma care possible. They already endure too much misery. Traditionally, humanitarian assistance has not excelled in the quality of care delivered. Good intentions are not good enough. Austere environments do not justify assistance with limited resources or poor skills. If a deployment for assistance is undertaken, there should be a well-prepared team, with the necessary skills, and the equipment as required.
Currently, there is a clear picture of the minimum requirements for emergency medical teams in disasters and conflicts. The (regrettable) experience of our military medical colleagues in recent conflicts has changed the concept of trauma care. Over the past 10 years, there have been good examples of sharing this military medical experience with humanitarian actors. The WHO Emergency Medical Team project, with professional input from humanitarian, military, and academic colleagues, has now defined these minimum requirements, and is in the process of verifying that emergency medical teams meet these standards. Patients with injuries from armed conflict and natural disasters do require a different approach as compared to trauma management ‘at home’.
Additional training of the surgical teams is required. The book in front of you, Fundamentals of Frontline Surgery, will be an important tool for colleagues who would embark on humanitarian assistance or on military deployments. Extensive field experience of the international faculty is shared in this book, and thus, you will be able to identify your skill gaps, and act on it, before going on a mission.
On behalf of your future patients, I hereby thank you for your efforts in making good preparations for a mission, and optimising the assistance you will deliver. The victims deserve it!
Harald Veen, FRCSEd
Humanitarian and Conflict Surgeon
The end of the combat operations in Iraq and Afghanistan provided a sense of relief to all who bore the burden of those wars. However, the return to a period of relative peace can have the insidious effect of eroding the knowledge base and operational skills needed to manage the first casualties of the next war. This has been referred to as the peacetime effect. surgical currency for future casualty care, there is an abundant need for proficiency in managing those who are ill or injured around the world as a result of political unrest, cross-border conflicts, natural disasters, poverty or a combination of these situations.
In this context, the editors of Fundamentals of Frontline Surgery have assembled a comprehensive set of exceptionally informative chapters that represents a weighty contribution to mitigating the peacetime effect. Professors Khan and Nott have combined decades of their own patient care experiences in resource-limited settings with their international prominence to provide a timely resource that is practical and straightforward to read, and that is addressed to all levels of training and experience. The range of topics explored in the textbook stretches from managing common injury patterns, to treatment of non-traumatic life­threatening conditions, to tips on the use of basic diagnostic tools and simple lifesaving maneuvers.
The opening chapter, entitled ‘The Resource Limited Environment’, is written by the editors and provides a strong foundation for the remainder of the book’s content. In their opening, Professors Khan and Nott ready the reader with an overview of the utility of various echelons of care, the categories of humanitarian response and the laws of conflict. The subsequent chapters, written by seasoned, international experts, build upon the book’s opening to provide a resource that is a
1
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