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Ⅰ General Considerations of Forward Surgery 1

Echelons of Medical Care 2

Thermonuclear Warfare 6

Purposes of This Handbook 8

Part Ⅰ．Types of Wounds and Injuries 11

Ⅱ Missile-Caused Wounds 13

Mechanical Effects of War Missiles 13

Regional Distribution of Missile Wounds 18

Clinical Considerations 18

Mass Casualties 19

Ⅲ Thermal Burns 20

Causes 20

Classification 21

Pathologic Process 23

Sorting and Evacuation 25

Management 26

Shock and Fluid Therapy 28

Complications 32

Burns of the Respiratory Passages 32

Mass Casualties 32

Ⅳ Cold Injury 35

Classification 35

Pathogenesis and Pathologic Process 36

Epidemiology 38

Clinical Manifestations 40

Management 42

Prophylaxis 45

Mass Casualties 46

Ⅴ Crush Injury 48

Pathogenesis 48

Clinical Considerations 49

Laboratory Data 50

Management 50

Evacuation 52

Mass Casualties 52

Ⅵ Blast Injury 54

Types of Blast Injury 54

Clinical Manifestations and Diagnosis 56

Regional Injuries 56

Preventive Measures 60

Mass Casualties 61

Ⅶ Chemical Injury 62

General Principles of Management 63

Convulsants 63

Skin Irritants 65

Lung Irritants 70

Nasal Irritants 71

Paralysants 71

Lacrimators 72

Phosphorus 72

Mass Casualties 73

Ⅷ Radiation Injuries 74

General Effects of Radiation Exposure 74

Pathologic Process 76

Clinical Manifestations，Diagnosis，and Prognosis 76

Management 78

Contamination of Food and Water 79

Mass Casualties 79

Ⅸ Multiple Injuries 81

Etiologic Considerations 81

Management 82

Mass Casualties 86

Part Ⅱ．Response of the Body to Wounding 89

Ⅹ Shock and Resuscitation 91

Pathogenesis and Etiologic Factors 91

Clinical Considerations 92

Organization of a Resuscitation Ward 95

Diagnosis and Assessment of Shock 96

Patterns of Shock 99

Principles of Management 102

General Measures 102

Vasovagal Shock 103

Oligemic Shock 104

Blood Transfusion 107

Timing of Surgery 112

Vasopressor Drugs 114

Artificial Hibernation 114

Mass Casualties 116

Ⅺ Metabolic Disturbances After Trauma 118

Autonomic Cardiovascular Response 118

Adrenocortical Response 119

Changes in the Electrolyte Balance 120

Oliguria Without Renal Insufficiency 121

Acute Renal Insufficiency 124

Mass Casualties 131

Ⅻ Infection 133

General Considerations 133

Etiologic Factors 134

Bacteriology 135

Classification of Wound Infection 137

Antibiotic Therapy 139

Clostridial Myositis 144

Anaerobic Cellulitis 151

Streptococcic Myositis 152

Tetanus 152

Mass Casualties 159

Part Ⅲ．General Considerations of Wound Management 161

ⅩⅢ Sorting of Casualties 163

General Considerations 163

Evacuation 164

Sorting at the Battalion Aid Station 168

Sorting at Level of Initial Wound Surgery 169

Concepts of Sorting 169

Priorities of Treatment 171

Mass Casualties 172

ⅩⅣ Care at the Battalion Aid Station 174

General Examination 174

Maintenance of the Respiratory Function 175

Control of Hemorrhage 177

Control of Shock 179

Relief of Pain 180

Control of Infection 180

Hydration 180

Dressings and Splints 181

Evacuation 182

Recording 182

Regional Injuries 183

Artificial Respiration 187

Mass Casualties 189

ⅩⅤ Anesthesia and Analgesia 195

Duties of the Anesthetist 195

Anesthetic Equipment 196

Preoperative Preparation 197

Techniques of Analgesia 199

Techniques of Anesthesia 201

Muscle Relaxants 202

Special Anesthetic Problems 203

Postoperative Management 204

Mass Casualties 205

ⅩⅥ Wounds and Injuries of the Soft Tissues 207

Principles of Management 207

Preoperative Preparation 208

Technique of Debridement 209

Management of Special Types of Soft-Tissue Wounds 214

Postoperative Management and Evacuation 217

Mass Casualties 217

ⅩⅦ Vascular Injuries 219

General Principles of Management 219

Techniques of Management 221

Postoperative Management 228

Adjunct Therapy 229

Complications of Vascular Injury 230

Mass Casualties 230

ⅩⅧ Wounds and Injuries of Bones and Joints 232

General Principles of Management 232

Management at the Battalion Aid Station 233

Preoperative Preparation 233

Management of Bone Injuries 234

Management of Joint Injuries 238

Mass Casualties 242

ⅩⅨ Wounds and Injuries of Peripheral Nerves 244

Classification 244

Initial Wound Surgery 244

Transportation Splinting 246

Mass Casualties 246

ⅩⅩ Amputations 247

Indications 247

Technique 249

Postoperative Management 252

Amputation for Massive Infection 253

Management of Multiple Injuries 253

Evacuation 254

Delayed Primary Wound Closure 254

Mass Casualties 255

Part Ⅳ．Regional Wounds and Injuries 257

ⅩⅩⅠ Craniocerebral Wounds and Injuries 259

Management at the Battalion Aid Station 259

General Principles of Management 261

Massive Intracranial Hemorrhage 263

Prognosis 265

Timing of Surgery 265

Anesthesia 266

Initial Wound Surgery 267

Expedient Measures in Wounds of Magnitude 269

Mass Casualties 269

ⅩⅩⅡ Wounds and Injuries of the Spinal Cord 271

Psychologic Considerations 271

Initial Evaluation 272

Principles of Management 272

Initial Management 273

Surgical Measures 275

Reduction of Cervical Dislocations and Flexion Fractures 277

General Measures 279

Physical Therapy 282

Mass Casualties 284

ⅩⅩⅢ Maxillofacial Wounds and Injuries 285

Diagnosis 285

Evacuation 286

Initial Management 287

Initial Wound Surgery 288

Fracture Management 289

Postoperative Management 291

Regional Fractures 291

Mass Casualties 295

XXIV Wounds and Injuries of the Eye 297

Examination and Diagnosis 297

Removal of the Eye 298

Management of Minor Injuries 299

Evacuation 300

Forward Ocular Surgery 301

Adjunct Therapy 304

Mass Casualties 305

ⅩⅩⅤ Wounds and Injuries of the Ear 306

Injuries of the External Ear 306

Injuries of the Middle Ear 307

Injuries of the Inner Ear 308

Aero-Otitis (Otitic Barotrauma) 308

Mass Casualties 309

ⅩⅩⅥ Wounds and Injuries of the Neck 310

Wounds of the Larynx and Trachea 310

Wounds of the Pharynx and Esophagus 312

Wounds of Blood Vessels and Nerves 314

Emergency Tracheotomy 315

Mass Casualties 317

ⅩⅩⅦ Wounds and Injuries of the Chest 318

Pathologic Process 318

Thoracoabdominal Wounds 322

Principles of Management 325

Management at the Battalion Aid Station 327

Initial Wound Surgery 329

Blast Injuries 331

Mass Casualties 332

ⅩⅩⅧ Wounds and Injuries of the Abdomen 333

Wounding Agents 333

Management at the Battalion Aid Station 335

Preoperative Sorting 335

Operation 338

Postoperative Management 344

Postoperative Peritonitis 346

Evacuation 350

Mass Casualties 350

ⅩⅩⅨ Wounds and Injuries of the Genitourinary Tract 353

Wounds of the Kidney 354

Wounds of the Ureter 355

Wounds of the Bladder 356

Wounds of the Urethra 357

Wounds of the Male Genitalia 358

Mass Casualties 359

ⅩⅩⅩ Wounds and Injuries of the Hand 360

Care at the Battalion Aid Station 361

Initial Wound Surgery 362

Mass Casualties 365

APPENDIXES 366

A Glossary of Drugs With National Nomenclatures 366

B Useful Tables 373

C Artificial Respiration 379

INDEX 391