Abbreviations and Acronyms

AAAN: American Academy of NeurologyABA: American Burn AssociationABC: airway, breathing, and circulationABLS: Advanced Burn Life SupportA/C: assist-control ACTH: adrenocorticotropic hormoneADDRESS: Administration of Drotrecogin Alfa (activated) in Early Stage Severe Sepsis (trial)AFSOC: Air Force Special Operations CommandAFTH: Air Force Theater HospitalAIREVAC: air evacuationAIS: Abbreviated Injury ScaleALI: acute lung injuryALRT: Acute Lung Rescue TeamALVEOLI: Assessment of Low Tidal Volume and Elevated End-Expiratory Lung Volume to Obviate Lung Injury (trial)AMEDD: US Army Medical DepartmentANFO: ammonium nitrate/fuel oilAOR: area of responsibilityAP: anteroposteriorAPD: afferent papillary defectaPLT: apheresis plateletAPRV: alternating pressure release ventilationaPTT: activated partial thromboplastin timeARDS: acute respiratory distress syndromeARDSnet: Acute Respiratory Distress Syndrome Clinical Trials NetworkATLS: Advanced Trauma and Life SupportATP: adenosine triphosphate

BBAL: bronchoalveolar lavageBAMC: Brooke Army Medical CenterBP: blood pressureBSMC: Brigade Support Medical CompanyBSS: balanced salt solutionBTBIS: Brief TBI ScreenBUMED: Bureau of Medicine and Surgery

CCASEVAC: casualty evacuationCBF: cerebral blood flowCCATT: Critical Care Air Transport Team/Critical Care Aeromedical Transport TeamCCC: combat casualty careCDC: Centers for Disease Control and PreventionCENTCOM: US Central CommandCHS: combat health supportcm: centimeterCN: cranial nerveCOG: Clinical Operating GuidelinesCONUS: continental United StatesCOPD: chronic obstructive pulmonary diseaseCORTICUS: Corticosteroid Therapy of Septic Shock (trial)CPAP: continuous positive airway pressureCPG: Clinical Practice GuidelinesCPK: creatinine phosphokinase

Abbreviations and Acronyms | xv

xvi | Combat Casualty Care

CPP: cerebral perfusion pressureCPR: cardiopulmonary resuscitationCRTS: Casualty Receiving and Treatment ShipCS: compartment syndromeCSH: Combat Support HospitalCT: computed tomographyCTA: computed tomographic angiographyCVP: central venous pressureCVR: cerebral vascular resistance

DD10: 10% dextroseD25: 25% dextroseD5: 5% dextroseD50: 50% dextroseDCR: damage control resuscitationDCS: damage control surgeryDECRA: Decompressive Craniectomy (trial)DIC: disseminated intravascular coagulationDIMOC: Defense Imagery Management Operations CenterDO2: oxygen deliveryDOD: Department of DefenseDVT: deep venous thrombosis

EECCO2R: extracorporeal carbon dioxide removalECMO: extracorporeal membrane oxygenationED: emergency departmentEFP: explosively formed projectileEMEDS: Expeditionary Medical SupportEMF: Expeditionary Medical FacilityEMS: emergency medical servicesEMT: emergency medical technician; also Emergency & Military TourniquetEMT-B: emergency medical technician–basicENT: ear-nose-throatEOD: explosive ordnance disposalER: oxygen extraction ratioEtCO2/ETCO2: end-tidal carbon dioxideETT: endotracheal tubeexam: examination

FFAST: Focused Assessment with Sonography for TraumaFDA: Food and Drug AdministrationFFP: fresh frozen plasmaFiO2: fraction of inspired oxygenFr: French (gauge system used to measure catheter size)FRC: functional residual capacityFRSS: Forward Resuscitative Surgical SystemFST: Forward Surgical TeamFTSG: full-thickness skin graftFWB: fresh whole blood

Gg: gramGCS: Glasgow Coma ScaleGSW: gunshot wound

Index | xvii

HHEAT: high-explosive antitankHFJV: high-frequency jet ventilationHFOV: high-frequency oscillation ventilationHFV: high-frequency ventilationHgb: hemoglobinHIV: human immunodeficiency virusHME: heat and moisture exchangerHMMWV: High-Mobility Multipurpose Wheeled Vehicle (“Humvee”)HMX: cyclotetramethylene tetranitramineHPMK: Hypothermia Prevention and Management KitHPPL: high-pressure pulsatile lavageHR: heart rateHSS: Health Services SupportHTS: hypertonic saline

II:E: inspiratory to expiratory ratioICP: intracranial pressureICRC: International Committee for the Red CrossICU: intensive care unitIED: improvised explosive deviceI MEF: First Marine Expeditionary Forcein-lbs: inch-poundsiNO: inhaled nitric oxideINR: international normalized ratioIO: intraosseousIOFB: intraocular foreign bodyIOP: intraocular pressureIPEEP: intrinsic positive end-expiratory pressureISS: Injury Severity ScoreIV: intravenousIVC: inferior vena cava

JJP: Jackson PrattJPTA: Joint Patient Tracking ApplicationJTTR: Joint Theater Trauma RegistryJTTS: Joint Theater Trauma System

KKCl: potassium chlorideK.E.D.: Kendrick® Extrication DeviceKIA: killed in actionK-wires: Kirschner wires

Llabs: laboratory testsLMA: laryngeal-mask airwayLOC: loss of consciousnessLOS: length of hospital stayL:P: lactate to pyruvate ratioLR: lactated Ringer’s LRMC: Landstuhl Regional Medical CenterLZ: landing zone

Abbreviations and Acronyms | xvii

xviii | Combat Casualty Care

MMACE: Military Acute Concussion EvaluationMAP: mean arterial pressureMASH: Mobile Army Surgical Hospitalmcg: microgramMEDEVAC: medical evacuationmEq: milliequivalentMETTAG: Medical Emergency Triage TagMETT-TC: mission, equipment, terrain and weather, time, troops, and civiliansMFST: Mobile Field Surgical Teammg: milligramml: millilitermm: millimeterMODS: multiple organ dysfunction syndromemOsm: milliosmoleMRAP: mine-resistant ambush-protected (vehicles)MRI: magnetic resonance imagingMRSA: methicillin-resistant Staphylococcus aureusm/sec: meters per secondMTF: Medical Treatment Facility

NNASCIS: National Acute Spinal Cord Injury StudyNATO: North Atlantic Treaty OrganizationNG: nasogastricNICE-SUGAR: Normoglycemia in Intensive Care Evaluation-Survival Using Glucose Algorithm Regulation (study)NIPPV: noninvasive positive-pressure ventilationNIRS: near infrared spectroscopyNOE: naso-orbito-ethmoidNPO: nil per os (nothing by mouth)NPV: negative-pressure ventilationNS: normal salineNSAID: nonsteroidal anti-inflammatory drug

OOEF: Operation Enduring FreedomOIF: Operation Iraqi FreedomOR: operating roomOTFC: oral transmucosal fentanyl citrate

PPA: posterior-anteriorPAd: pulmonary artery diastolicPAI-1: plasminogen-activator inhibitor type 1PALS: Pediatric Advanced Life SupportPalv: alveolar pressure2-PAM: pralidoxime chloridePaO2: partial pressure of oxygen in arterial blood/arterial blood gasPAs: pulmonary artery systolicPatm: pressure above atmospheric pressurePBW: predicted (ideal) body weightPCO2: partial pressure of carbon dioxidePCR: patient care reportPCV: pressure-control ventilationPCWP: pulmonary capillary wedge pressurePE: pulmonary embolismPEEP: positive end-expiratory pressure

Index | xix

PEEPh: high positive end-expiratory pressurePEEPl: low positive end-expiratory pressurePETN: pentaerythritol tetranitratepHi: gastric mucosal pHPPE: personal protective equipmentPplat: peak plateau pressurePPV: positive-pressure ventilationPRBCs: packed red blood cellsPROWESS: Recominant Human Activated Protein C Worldwide Evaluation in Severe Sepsis (trial)PRVC: pressure-regulated volume controlPslCO2: sublingual PCO2

PSV: pressure-support ventilationPT: prothrombin timePTSD: posttraumatic stress disorderPTTV: percutaneous transtracheal ventilation

QQ: cardiac output; also areas of perfusion

RRBC: red blood cellRDX: cyclotrimethylene trinitramineREACH: Registry of Emergency Airways at Combat HospitalRESCUEip: Randomized Evaluation of Surgery with Craniectomy for Uncontrollable Elevation of Intra-Cranial Pressure (trial)RFVIIa: recombinant factor VIIaRhAPC: recombinant human activated proteinRPG: rocket-propelled grenadeRR: respiratory rateRSI: rapid sequence intubationRTS: Revised Trauma Score

SSALT: Sort, Assess, Life-Saving, Triage/Treat/TransportSaO2: oxygen saturation of hemoglobinSAPS: simplified acute physiology scoreSBIR: Small Business Innovation ResearchSBP: systolic blood pressureSCIWORA: spinal cord injury without radiographic abnormalityScvO2: central venous oxygen saturationSEAL: Sea-Air-Land (US Navy)SIADH: syndrome of inappropriate antidiuretic hormone SIMV: synchronized intermittent mandatory ventilationSIRS: systemic inflammatory response syndromeSOF: Special Operations ForcesSOMI: sternal occipital mandibular immobilizerSPO2: pulse oximeter oxygen saturationSSTP: Surgical Shock Trauma PlatoonSTART®: Simple Triage And Rapid TreatmentStO2: oxygen saturation of hemoglobin in tissueSTP: Shock Trauma PlatoonSTSG: split-thickness skin graftSvO2: mixed venous oxygen saturation

TTACC: Tanker Airlift Control CenterTACEVAC: tactical evacuationTATRC: Telemedicine and Advanced Technology and Research Center

Abbreviations and Acronyms | xix

xx | Combat Casualty Care

TBI: traumatic brain injuryTBSA: total body surface areaTCA: tricarboxylic acidTCCC: Tactical Combat Casualty CareTh: high PEEP levelTHAM: tromethamineTIC: Troops in ContactTl: low PEEP levelTNT: 2,4,6-trinitrotolueneTOC: Tactical Operations CenterTPN: total parenteral nutritionTRICC: Tranfusion Requirements in Critical Care

UUS: United StatesUSAF: United States Air ForceUSAISR: United States Army Institute of Surgical ResearchUSMC: United States Marine CorpsUSN: United States NavyUSSOCOM: US Special Operations CommandUXO: unexploded ordnance

VV: areas of ventilationVa: alveolar ventilationV.A.C.®: vacuum-assisted closureVAP: ventilated-associated pneumoniaVASST: Vassopressin and Septic Shock TrialVBIED: vehicle-borne improvised explosive deviceVCO2: carbon dioxide generated by the bodyVd: dead-space ventilationVDR-4®: Volumetric Diffusive Respiration (ventilator)Ve: minute ventilationVEC: Vertebrace® Extrication CollarVILI: ventilator-induced lung injuryVO2: oxygen uptakeVS: vital signs; also Valsella Meccanotechnica SpA (producer of the VS-16 Italian antitank blast mine)Vt: tidal volumeVTOL: Vertical Take-Off and Landing

WWBB: walking blood bankWBC: white blood cellWDMET: Wound Data and Munitions Effectiveness TeamWRAMC: Walter Reed Army Medical CenterWWI: World War IWWII: World War II

Index | xxi

Index

A A/C. See Assist-controlAAN. See American Academy of NeurologyABA. See American Burn AssociationAbbe-Estlander flaps, 266Abbreviations and acronyms, xv–xxAbdominal compartment syndrome

burn care, 611–612effects of, 194–195pediatric, 541–542prevention of, 27

Abdominal injuriesabdominal wall closure, 194–195damage control laparotomy, 184–192duodenal injury, 187–188hepatic parenchymal injury, 186–187intestinal injuries, 192–193large soft-tissue wounds, 192pancreatic injury, 187–188pediatric, 561–564perihepatic vascular injury, 186rectal injury, 193renal injury, 188–190retrohepatic hematoma, 186retroperitoneal wounds, 192splenic injury, 190–192ureteral injury, 190–191

Abdominal packing, 27–28ABLS. See Advanced Burn Life SupportAcceleration-deceleration injuries, 58Acetabular fractures, 454Acid burns. See also Chemical burn injuries

eye injuries, 331–332Acidemia, 23, 139Acidosis

damage control resuscitation, 22–23, 124–125damage control surgery and, 170

ACTH. See Adrenocorticotropic hormoneAcute airway obstruction, 97–98Acute burn care

abdominal compartment syndrome, 611–612aeromedical transport, 628–629airway and breathing interventions, 601–603burn center referral criteria, 629Burn Flow Sheet documentation, 608burn severity estimation, 606combat compared to civilian burns, 597–598comorbid life-threatening injury care, 603complications, 611–615decontamination, 600–601degree of burn, 604–605depth of burn estimation, 604–606electrolyte disturbances, 612–613engraftment, 625escharotomy, 613–615

xxii | Combat Casualty Care

fascial excision, 619–621fasciotomy, 613–615fluid resuscitation, 607–611full-thickness skin grafts, 625hypothermia, 616–617infection control, 626–627initial evaluation and management, 598–603location of burn, 606meshed skin grafts, 623–625metabolic considerations, 627–628modified Brooke Formula, 609–611nutritional considerations, 627–628overview, 596pain control, 617patient exposure, 616–617patient inspection, 600–601patient resuscitation, 603–630primary survey, 599–600Rule of Nines, 606Rule of Ten, 609–610secondary survey, 599–600skin grafting, 621–625skin harvesting, 622tangential excision, 619total body surface area, 597–598, 606, 610traumatic rhabdomyolysis, 612triage criteria, 598wound care, 615–627wound evaluation, 603–630wound excision, 617–621

Acute lung injury, 661Acute respiratory distress syndrome

adjunctive strategies, 668–669airway pressure release ventilation, 667–668basic concepts, 661–663corticosteroid therapy, 669–670fluid management, 669mechanical ventilation, 663–669nutritional goals, 671pediatric, 553positive end-expiratory pressure, 665–667prone positioning, 670–671tidal volume, 663–665

Acute Respiratory Distress Syndrome Clinical Trials Network, 664ADDRESS trial. See Administration of Drotrecogin Alfa (activated) in Early Stage Severe SepsisAdenosine, 560Administration of Drotrecogin Alfa (activated) in Early Stage Severe Sepsis, 689Adrenocorticotropic hormone, 685Advanced Burn Life Support, 599–600Advanced Trauma Life Support, 22, 599–600Aeromedical evacuation system, 21. See also MEDEVACAfferent pupillary defect, 309Afghanistan. See also Operation Enduring Freedom

Combat Support Hospitals, 19landmine prevalence, 47

AFTH. See Air Force Theater HospitalsAir Ambulances. See MEDEVAC unitsAir evacuation. See Patient evacuation

Index | xxiii

Air Forcecombat health support, 109Expeditionary Medical Support, 7, 108Mobile Field Surgical Teams, 7, 108

Air Force Theater Hospitals, 19, 108Air medical evacuation. See MEDEVACAirway compromise

acute airway obstruction, 97–98awake endotracheal intubation, 245–246burn care, 601–603confirmation of endotracheal tube placement, 246–247crash endotracheal intubation, 246cricothyroidotomy, 97, 247–250difficult airways, 250–251endotracheal intubation preparation, 243–244endotracheal intubation technique, 244–247initial management, 251–256maxillofacial injuries, 237–242neck injuries, 281pediatric, 534–537, 548–550preventable death from, 88–89pulmonary contusion, 657–658rapid sequence intubation, 245surgical airway management, 247–250traumatic brain injuries, 363–365, 367

Airway pressure release ventilation, 652, 667–668ALI. See Acute lung injuryAlkali burns. See also Chemical burn injuries

eye injuries, 331–332Allograft, 618–619Alternating pressure release ventilation, 553Alveolar pressure, 645ALVEOLI trial. See Assessment of Low Tidal Volume and Elevated End-Expiratory Lung Volume to Obviate Lung InjuryAmerican Academy of Neurology, 354American Burn Association, 600, 628Aminocaproic acid, 144Amiodarone, 560Ammonium nitrate/fuel oil, 45Amputations

degree of, 481delayed amputation, 420–421fasciotomy, 419–420initial assessment, 415–416initial resuscitation, 417–421mechanism of, 481number of limbs, 481primary amputation, 417rehabilitation, 422surgical amputation, 420–421surgical technique, 481–482timing of, 481wound care, 420–421wound debridement, 417–419

Anaerobic metabolism, 23Analgesics, 102ANFO. See Ammonium nitrate/fuel oilAngiography. See also Computed tomographic angiography

pelvic injuries, 205

xxiv | Combat Casualty Care

Anterior cord syndrome, 504–505Antibiotics

antibiotic impregnated pellets, 439extremity injuries, 439–441maxillofacial wound infection management, 261prophylactic use, 102, 259, 362, 440

Anticonvulsants, 375–377Antiepileptic drugs, 376Antifibrinolytics, 144Antipersonnel landmines, 46–47Antitank landmines, 54Antitank munitions, 52–54Anxiety disorders, 354Aprotinin, 144APRV. See Airway pressure release ventilation; Alternating pressure release ventilationARDS. See Acute respiratory distress syndromeARDSnet. See Acute Respiratory Distress Syndrome Clinical Trials NetworkArmy

combat health support, 109Forward Surgical Teams, 5, 7–8, 17–19Medical Treatment Facilities, 7

Arterial injuries, 195–200Assessment of Low Tidal Volume and Elevated End-Expiratory Lung Volume to Obviate Lung Injury, 667Assist-control positive-pressure ventilation, 649Asystole, pediatric, 558Atelectotrauma, 646Atlanto-occipital disassociation, 508ATLS. See Advanced Trauma Life SupportAtypical stump flaps, 421Audiology, 60Awake endotracheal intubation, 245–246Axial traction, 508–510

BBacteria. See Wound floraBag-valve-mask ventilatory support, 97Ballistic injuries, 54Barotrauma, 646Base deficit, 674–675Battalion Aid Stations, 103Bedside clinical findings, 133–134Benzodiazepines, 364, 556, 617Berlin’s edema, 318Bicarbonate therapy, 690–691Biotrauma, 647–648Bladder injuries, 208–210Blast landmines, 47–48Blast traumatic brain injuries, 353–354Bleeding. See HemorrhageBlood pH, 23Blood transfusions. See TransfusionsBody armor, 15Bone fractures. See FracturesBone grafting

mandibular reconstruction, 276“Bouncing Betty,” 49Bounding fragmentation landmines, 48–49Bowstring test, 270

Index | xxv

Bradycardia, pediatric, 559Brain injuries, traumatic. See Traumatic brain injuriesBrain Trauma Foundation, 367Breathing support

acute airway obstruction, 97–98awake endotracheal intubation, 245–246burn care, 601–603confirmation of endotracheal tube placement, 246–247crash endotracheal intubation, 246cricothyroidotomy, 97, 247–250difficult airways, 250–251endotracheal intubation preparation, 243–244endotracheal intubation technique, 244–247initial management, 251–256maxillofacial injuries, 237–242neck injuries, 281pediatric, 534–537, 548–550preventable death from airway compromise, 88–89pulmonary contusion, 657–658rapid sequence intubation, 245surgical airway management, 247–250traumatic brain injuries, 363–365, 367

Brief TBI Screen, 64Brigade Support Medical Company, 103, 107–108Bronchopleural fistulas, 62Bronchoscopy, fiberoptic, 658Brooke Army Medical Center, 19Brooke Formula, modified, 609–611Brown-Séquard syndrome, 505–506BSMC. See Brigade Support Medical CompanyBTBIS. See Brief TBI ScreenBureau of Medicine and Surgery, 93Burn care

abdominal compartment syndrome, 611–612aeromedical transport, 628–629airway and breathing interventions, 601–603burn center referral criteria, 629Burn Flow Sheet documentation, 608burn severity estimation, 606combat compared to civilian burns, 597–598comorbid life-threatening injury care, 603complications, 611–615decontamination, 600–601degree of burn, 604–605depth of burn estimation, 604–606electrolyte disturbances, 612–613engraftment, 625escharotomy, 613–615facial, 267–268fascial excision, 619–621fasciotomy, 613–615fluid resuscitation, 607–611full-thickness skin grafts, 625hypothermia, 616–617infection control, 626–627initial evaluation and management, 598–603location of burn, 606meshed skin grafts, 623–625

xxvi | Combat Casualty Care

metabolic considerations, 627–628modified Brooke Formula, 609–611nutritional considerations, 627–628overview, 596pain control, 617patient exposure, 616–617patient inspection, 600–601patient resuscitation, 603–630pediatric, 564primary survey, 599–600Rule of Nines, 606Rule of Ten, 609–610secondary survey, 599–600skin grafting, 621–625skin harvesting, 622tangential excision, 619total body surface area, 597–598, 606, 610traumatic rhabdomyolysis, 612triage criteria, 598wound care, 615–627wound evaluation, 603–630wound excision, 617–21

Burn Flight Team, 628Buttock wounds, 437–438

CCantholysis, inferior, 329–330Canthotomy, lateral, 329–330Carbamazepine, 376Cardiac rhythm disturbances

pediatric, 558–560Cardiopulmonary resuscitation, 14, 558–559Care-under-fire, 93–94Case studies

damage control resuscitation, 29–31damage control surgery, 29–31eye injuries, 333–338out-of-hospital care, 89–91, 111–112

CASEVAC. See Casualty evacuationCasualty evacuation. See also Patient evacuation

considerations, 18, 20Tactical Combat Casualty Care, 104

Casualty Receiving and Treatment Ships, 7Catecholamine-resistant shock, 555Catecholamines, 143Cauda equina syndrome, 506CBF. See Cerebral blood flowCCATT. See Critical Care Air Transport TeamsCCC. See Combat casualty careCelox™ powder, 17Cement bead therapy, 439Centers for Disease Control and Prevention, 111Central brain herniation, 358–360Central cord syndrome, 504–506Central venous oxygen saturation, 676–677, 686–687Central venous pressure, 682–683Cerebral blood flow, 350, 367–368Cerebral edema, 349

Index | xxvii

Cerebral herniation, 358–360, 556Cerebral hypoperfusion, 100, 349Cerebral perfusion pressure, 350, 364–366, 368–369, 541Cerebral vascular resistance, 350Cerebrospinal fluid fistulae, 512–513Cerebrospinal fluid leaks, 362Cervical spine injuries, 242–243Chemical burn injuries, 419, 600–601Chemical eye injuries, 331–332Children. See Pediatric traumaChitosan dressings, 129Choroidal injuries, 318Civilian casualties

explosive-related injuries, 55–56Claymore mine, 49–50Clinical Practice Guidelines, 64, 471–480, 483–484Closed wounds

globe injuries, 315–318head injuries, 351spinal injuries, 576–580

Clot-promoting agents, 17Coagulopathy

damage control resuscitation, 22–23, 124–125damage control surgery and, 170massive transfusion-associated, 138–140

Codman® ICP EXPRESS, 572Cold shock, 555Colloid solutions, 142, 369Colostomy, 193Combat Application Tourniquets, 128, 404–405, 469–470Combat-associated pneumonia prevention, 692–694Combat casualty care

adjusting to the environment, 5–8causes of preventable death, 11–13, 88–89challenges, 4damage control strategies, 22–29damage control surgery, 170–172echelons of care, 17–20equipment advancements, 15–17extremity injuries, 422–426ICU structure, 696levels of ophthalmic care, 304–307organizational innovations, 17–22out-of-hospital care, 89–92, 111–112spinal injuries, 490–493tactical care, 92–107training advancements, 13–14

Combat Gauze™, 17, 95, 130Combat health support, 109Combat injury patterns, 11Combat Support Hospitals

evacuation times, 5–6function of, 19

Commotio retinae, 318Compartment syndrome, abdominal. See Abdominal compartment syndromeCompartment syndrome, limb. See Limb compartment syndromeComplete cord syndrome, 503–504Completion amputation, 417

xxviii | Combat Casualty Care

Composition C4, 45Compressible hemorrhage

pressure points, 17, 126–127preventable death from, 88–89

Computed tomographic angiographyneck injuries assessment, 283, 285traumatic brain injuries, 362

Computed tomography imagingfacial injuries, 262maxillofacial wound infection diagnosis, 260–261ocular injuries, 314–315pediatric injuries, 568–570pelvic injuries, 204–205spinal injuries, 501–503traumatic brain injuries, 351–352, 357, 359, 362–363

Conflagration, 45Conjunctival lacerations, 328Continuous positive airway pressure, 667Copper sulfate, 419Corneal abrasion, 315Corneal foreign bodies, 315–316Corneal perforation, 313Corneoscleral laceration, 321–322Corticosteroid Therapy of Septic Shock trial, 685Corticosteroids, 669–670, 685–686CORTICUS. See Corticosteroid Therapy of Septic Shock trialCough control, 661Coup injuries, 355CPAP. See Continuous positive airway pressureCPGs. See Clinical Practice GuidelinesCPP. See Cerebral perfusion pressureCPR. See Cardiopulmonary resuscitationCranialization, 270Craniectomy, decompressive, 374–377Cricothyroidotomy, 97, 247–250Critical care

acute respiratory distress syndrome, 661–672airway pressure release ventilation, 667–668assist-control positive-pressure ventilation, 659atelectotrauma, 646barotrauma, 646biotrauma, 647–648central venous oxygen saturation, 676–677combat-associated pneumonia prevention, 692–694combat casualty care ICU structure, 696Critical Care Air Transport team, 697–700deep venous thrombosis prophylaxis, 694gastric intramucosal pH, 677gastrointestinal bleeding prophylaxis, 695high-frequency ventilation, 653infection control, 695lactate, 673–674mechanical ventilation, 643–655, 663–669mixed venous oxygen saturation, 676–677positive end-expiratory pressure, 665–667positive-pressure ventilation, 648–653pressure-control ventilation, 650–651pressure-regulated volume control, 652–653

Index | xxix

pressure-support ventilation, 651–652preventive care, 695pulmonary contusion, 655–661resuscitation endpoints, 672–679sepsis, 679–691sublingual PCO2, 677–678supraphysiologic oxygen delivery attainment, 675synchronized intermittent mandatory ventilation, 649–650tissue carbon dioxide and oxygen assessment, 678traumatic brain injuries, 376–377ventilator-induced lung injury, 646–648ventilator settings for normal lungs, 653–655volutrauma, 646

Critical Care Air Transport Teams, 20–21, 172, 377, 697–700CRTS. See Casualty Receiving and Treatment ShipsCrush syndrome, 68Crystalloid solutions, 22–23, 142, 369CSH. See Combat Support HospitalsCT. See Computed tomography imagingCTA. See Computed tomographic angiographyCVP. See Central venous pressureCVR. See Cerebral vascular resistanceCyclotetramethylene tetranitramine, 45Cyclotrimethylene trinitramine, 45

DDamage control resuscitation

adjunctive measures, 140–144Advanced Trauma and Life Support, 22antifibrinolytics, 144bedside clinical findings, 133–134blood product transfusion ratios, 24–26blood products transfusion, 135–138case study, 29–31coagulopathy, 138–140colloid solutions, 142crystalloid solutions, 142electrolyte disorders, 138fibrinogen, 137fresh frozen plasma transfusion, 136–137fresh whole blood transfusion, 137–138goal of, 23hemorrhage control techniques, 126–127hemostatic dressings, 127–130hypotensive resuscitation, 140–142hypothermia prevention, 130–131key components of, 125–126, 171laboratory testing, 134lethal triad, 22–23, 124–125massive transfusion-associated complications, 138–140massive transfusion need prediction, 132–135massive transfusion prevention, 126–131mechanism of injury, 132–133new technologies, 134–135nonsurgical hemostatic agents, 143–144pediatric, 551–552permissive hypotension, 24platelets transfusion, 137

xxx | Combat Casualty Care

recombinant factor VIIa, 143–144red blood cells transfusion, 135role of fresh whole blood, 26–27role of recombinant factor VIIa, 27topical sealants, 143tourniquets, 127–130vasoactive agents, 143

Damage control surgeryabdominal injuries, 184–195neck injuries, 181–183pelvic injuries, 202–211peripheral vascular injuries, 195–201principles of, 27–31, 169–172thoracic injuries, 173–181

Dandy clamps, 571DCR. See Damage control resuscitationDCS. See Damage control surgeryDead-space ventilation, 644Debridement, 259, 261, 417–419, 433–438Decompressive craniectomy, 374–377Decompressive Craniectomy trial, 374–375Decontamination plans, 72DECRA, 374–375Decubitus ulcers, 377Deep venous thrombosis prophylaxis, 694Defense and Veterans Brain Injury Center, 64Dental injuries, 253–254Depression, 354Dermatomes, 619Destot’s sign, 203Dextrose, 544Diazepam, 556DIC. See Disseminated intravascular coagulationDiffuse traumatic brain injuries, 355Digital subtraction angiography, 362Dilutional coagulopathy, 140Diplopia, 310Direct pressure, 17Directional fragmentation landmines, 49–50Disseminated intravascular coagulation, 140, 688Distal pancreatectomy, 187Dobutamine, 555, 688–689Dopamine, 555, 685Doppler ultrasonography, 363Drotrecogin alfa (activated), 689Duodenal injuries, 187–188, 562–563Duodenojejeunostomy, 187Dural substitutes, 574DVBIC. See Defense and Veterans Brain Injury CenterDynamite, 45

EEar injuries, 58–60Echelons of care, 17–20, 104ECMO. See Extracorporeal membrane oxygenationEEG. See ElectroencephalographyEFP. See Explosively formed projectileElectrical injuries, 601

Index | xxxi

Electrocautery, 621Electroencephalography, 373Electrolyte disorders, 138, 612–613Embedded unexploded ordnances, 72–73EMEDS. See Expeditionary Medical SupportEmergency and Military Tourniquets, 404Emergency medical services, 91–92Emergency medical technicians, 91Emergency thoracotomy, 173–175EMF. See Expeditionary Medical FacilitiesEMS. See Emergency medical servicesEMTs. See Emergency medical techniciansEn-route nursing care, 21End-of-life care, pediatric, 580End-tidal carbon dioxide detection, 246–247, 546–547Endotracheal intubation

awake endotracheal intubation, 245–246combat casualty care, 97confirmation of tube placement, 246–247crash intubation, 246displacement, 546–547pediatric, 535–537, 549preparation, 243–244rapid sequence intubation, 245technique, 244–247

Engraftment, 625Enteral feeding

pediatric, 543, 544sepsis, 691

Enteric injuries, 192–193Enucleation, 323–325EOD. See Explosive ordnance disposalEpidural hematomas, 355–357Epinephrine, 555Epsilon aminocaproic acid, 144Equipment advancements, 15–17Erythropoietin, 688Escharotomy, 613–615Esophageal gastric tube airways, 97Esophageal injuries, 180–181, 286–287Etomidate, 364–365ETT. See Endotracheal intubationEvacuation. See Patient evacuationExpeditionary Medical Facilities, 108Expeditionary Medical Support

function of, 108transporting casualties, 7

Explosive ordnance disposal, 73Explosive-related injuries

categories, 58–73civilian casualties, 55–56embedded unexploded ordnances, 72–73management considerations, 72military casualties, 54–55patterns, 54–56potentiators, 56–57primary blast injuries, 58–65quaternary blast injuries, 69–70

xxxii | Combat Casualty Care

quinary blast injuries, 70–72secondary blast injuries, 65–68tertiary blast injuries, 68–69

Explosively formed projectile, 52–54Explosives

antipersonnel landmines, 46–47antitank munitions, 52–54blast landmines, 47–48devices, 46–54directional fragmentation landmines, 49–50fragmentation landmines, 48–49high-order, 45–46improvised explosive devices, 50–52low-order, 45physics of, 44–45rocket-propelled grenades, 50unexploded ordnances, 46–47

Exsanguinating oropharyngeal hemorrhage, 283External fixation

initial fracture stabilization, 443–444pelvic injuries, 206

External ventricular drains, 369–370Extracorporeal membrane oxygenation, 669Extradural hemorrhages, 576Extremity injuries

acetabular fractures, 454amputation, 415–422, 481–482antibiotic impregnated pellets, 439antibiotics, 439–441assessing muscle viability, 437burden of, 398–399cement bead therapy, 439combat casualty wound care, 422–426debridement, 431, 433–438emergency tourniquet application, 403–405external fixation of fractures, 445–454extremity resuscitation, 423–424fasciotomy surgical steps, 411fasciotomy techniques, 412–414femur fracture fixation, 449–450forearm fasciotomy, 413fracture management, 441–454genitourinary complications, 453hand compartment fasciotomy, 413hip dislocations, 453–454infection prevention, 431–441irrigation, 432–433, 483–484Joint Theater Trauma System guidelines, 471–480ligament injury, 424–425limb compartment syndrome, 405–414lower extremity fracture fixation, 448–449lower leg fasciotomy, 412–413massive wounds, 437–438morbidity risk, 410mortality, 400–403muscle injury, 424–425negative-pressure wound dressings, 438–439nerve repair, 426

Index | xxxiii

open fractures, 444–445open joint injury, 425–426open pelvic trauma, 452–453overview, 397pelvic fracture fixation, 450–454primary blast injuries, 65special wounds, 424–426surgical wound debridement, 434–438tendon injury, 424–425tetanus immunization, 439–441thigh fasciotomy, 413tourniquet use, 16, 127–129upper arm fasciotomy, 413upper extremity fracture fixation, 447–448vascular injury, 424–425wet-to-dry dressing debridement, 433–434wound closure, 426–431wound flora, 431wound management, 423–424

Extremity tourniquets, 127–129, 200Eye injuries

anterior segment examination, 311–313assessment of, 268–269case studies, 333–338chemical, 331–332choroidal injuries, 318closed globe injuries, 315–318conjunctival lacerations, 328corneal abrasion, 315corneal foreign bodies, 315–316enucleation, 323–325external ocular examination, 310–311eyelid lacerations, 326–328globe repair, 323–324hyphema, 316imaging techniques, 314–315incidence of, 303intraocular foreign body, 325–326intraocular pressure measurement, 310lens subluxation or dislocation, 317levels of ophthalmic combat casualty care, 304–307ocular adnexal trauma, 326–328ocular motility, 309–310open globe injuries, 318–326orbital foreign bodies, 330–331orbital fractures, 331orbital trauma, 329–331patient history, 307–308posterior segment examination, 313primary blast injuries, 65pupil examination, 309retinal injuries, 318retrobulbar hemorrhage, 329–330sympathetic ophthalmia, 323traumatic iritis, 317traumatic optic neuropathy, 332visual acuity, 308–309visual field testing, 310

xxxiv | Combat Casualty Care

vitreous hemorrhage, 317–318Eyelid lacerations, 326–328

FFacial injuries

burns, 267–268facial lacerations, 255–256facial nerve injury, 254–255lower face, 274–277parotid nerve injury, 254–255soft-tissue injuries, 266–267

Fascial excision, 619–621Fasciotomy

burn care, 613–615forearm, 413hand compartment, 413Joint Theater Trauma System guidelines, 471–480lower leg, 412–413morbidity risk, 410prophylactic, 409surgical steps, 411techniques, 412–414thigh, 413traumatic limb amputations, 419–420upper arm, 413

FAST. See Focused abdominal sonography in traumaFDA. See Food and Drug AdministrationFemoral vasculature injuries, 201Femur fracture fixation, 449–450Fentanyl, 364, 617Fentanyl citrate, oral transmucosal, 103FFP. See Fresh frozen plasmaFiberoptic bronchoscopy, 658Fibrin-impregnated bandages, 129Fibrinogen, 137Field care, tactical

acute airway obstruction, 97–98air medical evacuation considerations, 103fluid resuscitation, 96–97hemorrhage control, 95hemostatic agents, 95hypothermia prevention and management, 101–102infection prophylaxis, 102pain management, 102–103spinal injury precautions, 99tension pneumothorax, 98–99tourniquet use, 95traumatic brain injuries, 99–101vascular access, 96–97ventilatory support, 97–98

FiO2. See Fraction of inspired oxygenFlail chest, 657Fluid therapy

acute respiratory distress syndrome, 669traumatic brain injuries, 100vascular access, 96–97

Focal traumatic brain injuries, 355Focused abdominal sonography in trauma, 110, xi

Index | xxxv

Foley catheters, 209Food and Drug Administration, 27, 103Forearm fasciotomy, 413Foreign bodies

corneal, 315–316orbital, 330–331

Forward Resuscitative Surgical Systemfunction of, 108transporting casualties, 7

Forward Surgical Teamsfacilities, 18–19situational awareness, 8transporting casualties, 5, 7, 17triage issues, 8

Fosphenytoin, 376, 557Fraction of inspired oxygen, 645, 653, 661, 664, 667Fractures

acetabular, 454external fixation, 445–454extremity injuries, 441–454femur, 449–450frontal sinus, 269–270initial stabilization, 443–444initial wound management, 443LeFort fractures, 274lower extremity, 448–449mandible, 251–253naso-orbito-ethmoid region, 270–273open fracture management, 444–445open pelvic fractures, 207–208orbit, 274orbital, 331panfacial, 277pelvis, 450–454skull, 573–576stabilization of maxillofacial injuries, 262–263upper extremity, 447–448zygoma, 273–274

Fragment wounds, 66–67Fragmentation landmines, 48–49Fresh frozen plasma, 26, 136–137Fresh whole blood

role of, 26–27transfusions, 137–138use in damage control resuscitation, 23

Frontal sinus fractures, 269–270FRSS. See Forward Resuscitative Surgical SystemFST. See Forward Surgical TeamsFTSG. See Full-thickness skin graftsFull-thickness skin grafts, 625Fundoscopic exam, 313FWB. See Fresh whole blood

GGammagraft®, 619Gardner-Wells tongs, 509–510Gastric intramucosal pH, 677Gastric stress ulcers, 377

xxxvi | Combat Casualty Care

Gastrointestinal bleeding prophylaxis, 695Gastrointestinal tract injuries, 63GCS. See Glasgow Coma ScaleGenitalia injuries, 210–211Genitourinary injuries, 208–210, 453Gerota’s fascia, 188–190Glasgow Coma Scale, 14, 134, 351, 353, 567–568, 570Glucocorticosteroids, 499Glucose metabolism

pediatric, 542–544sepsis, 689–690

Granular zeolite, 129Grenades, rocket-propelled, 50Grey-Turner’s sign, 203Guillotine amputation, 481–482Gunpowder, 45

HH2-receptor antagonists, 377, 695Halo ring apparatus, 509–510Hand compartment fasciotomy, 413Harriet Lane Handbook, 545Head injuries. See also Traumatic brain injuries

pediatric, 537–540Health Services Support, 107–109HEAT. See High-explosive antitank roundsHematomas

epidural, 355–357retrohepatic, 186subdural, 355–356

HemCon™ dressings, 17, 369Hemicraniectomy, 374Hemodilution, 23Hemorrhage

complications of, 11–13control adjuncts, 15–17control techniques, 126–127damage control resuscitation, 22–27damage control surgery, 27–28extradural, 576gastrointestinal bleeding prophylaxis, 695intradural, 576neck injuries, 281–283pressure points, 17, 126–127preventable death from, 88–89, 124tactical field care, 95tourniquet use, 15, 16, 95, 127–130traumatic intracerebral, 357–358vitreous, 317–318

Hemorrhagic chemosis, 311–313Hemorrhagic shock

pediatric, 551–552treatment of, 30

Hemostatic agentshemorrhage control, 17nonsurgical, 143–144tactical field care, 95traumatic brain injury, 369

Index | xxxvii

Hemostatic dressings, 127–130Heparin, 377Hepatic parenchymal injuries, 186–187Herniation syndromes, 358–360, 556Hetastarch, 96–97Hextend®, 96–97HFOV. See High-frequency oscillation ventilationHFV. See High-frequency ventilationHHS. See Health Services SupportHigh-explosive antitank rounds, 50, 52High-frequency oscillation ventilation, 553, 668–669High-frequency ventilation, 653High-Mobility Multipurpose Wheeled Vehicles, 89, 112High-order explosives, 45–46High-pressure lavage devices, 432–433Hilar clamping, 180Hip dislocations, 453–454HMMWVs. See High-Mobility Multipurpose Wheeled VehiclesHMX. See Cyclotetramethylene tetranitramineHollow organ injuries, 63Host-nation patients, 19HSS. See Health Services SupportHTS. See Hypertonic salineHydrocortisone, 555Hyperglycemia, 689–690Hyperkalemia, 138Hypertension, intracranial, 375Hypertonic saline, 96–97, 370–373, 556Hyperventilation, 350, 367–368Hyphema, 316Hypocapnia, 350Hypoglycemia, 544Hypoperfusion, cerebral, 100, 349Hypotension

pediatric, 541permissive, 24, 140–142sepsis, 685systemic, 100traumatic brain injury and, 349, 368

Hypotensive resuscitation, 140–142Hypothermia

burn care, 616–617coagulation system effect, 140damage control resuscitation, 22–23, 124–125damage control surgery and, 170induced, 374prevention and management, 101–102, 130–131

Hypothermia Prevention and Management Kit, 101Hypotonic fluids, 369Hypovolemic shock, 673

IICP. See Intracranial pressureICRC. See International Committee for the Red CrossICU. See Intensive care unitIEDs. See Improvised explosive devicesImmobilization, spinal, 496–497, 507Implosion, 58

xxxviii | Combat Casualty Care

Improvised explosive devices, 50–52, 353Improvised tourniquets, 403–405Incomplete cord syndromes, 504–06Induced hypothermia, 374Infection

burn care, 626–627critical care, 682, 695diagnosis of, 260–261epidemiology of wound infection, 260irrigation, 432–433management of, 261negative-pressure wound dressings, 438–441prophylaxis, 102, 259, 362sepsis, 682spinal injuries, 513–514surgical management, 260traumatic brain injuries, 362war wounds, 258–259wound debridement, 431, 433–438wound flora, 431

Inferior cantholysis, 329–330Informed consent, 263Infrarenal aortic injuries, 185Infrarenal vena cava injuries, 186Inhalation injuries, 69–70Inhaled nitric oxide, 668–669Injury patterns, 11Injury Severity Score, 56Inotropic therapy, 688–689INR. See International normalized ratioInsulin, 690Intensive care unit, 696International Committee for the Red Cross, 111International normalized ratio, 22, 134, 688Intestinal injuries, 192–193, 562–564Intraabdominal hypertension, 194Intracerebral hemorrhage, traumatic, 357–358Intracranial hypertension, 375Intracranial pressure

monitoring, 572–573pediatric, 541, 572–573traumatic brain injury and, 349–350, 364–375

Intradural hemorrhages, 576Intraocular air, 323Intraocular foreign body, 325–326Intraocular pressure measurement, 310Intrathoracic vascular injury, 175–178Intravascular volume, 683–684Intubation

awake endotracheal intubation, 245–246combat casualty care, 97confirmation of tube placement, 246–247crash intubation, 246displacement, 546–547orotracheal, 97pediatric, 535–537, 549–550preparation, 243–244rapid sequence, 245, 364–365, 549–550

Index | xxxix

technique, 244–247IOFB. See Intraocular foreign bodyIOP. See Intraocular pressure measurementIraq. See also Operation Iraqi Freedom

Combat Support Hospitals, 19landmine prevalence, 46–47

Iritis, traumatic, 317Irrigation, wound, 432–433, 483–484ISS. See Injury Severity Score

JJaw-thrust maneuver, 239Jejeunostomy, 187Joint injuries, open, 425–426Joint Patient Movement Requirement Center, 698Joint Patient Tracking Application, 22, 31Joint Theater Trauma Registry

creation of, 4, 9injury patterns, 43maxillofacial injury type, distribution and mechanism, 232–234physician trauma admitting record, 10

Joint Theater Trauma Systemcombat injury patterns, 11creation of, 9extremity wounds guidelines, 471–480, 483–484function of, 20preventable death causes, 11–13

JPMRC. See Joint Patient Movement Requirement CenterJPTA. See Joint Patient Tracking ApplicationJTTR. See Joint Theater Trauma RegistryJTTS. See Joint Theater Trauma System

KK-wires, 443–444Kaolin-impregnated gauze, 130KIA. See Killed in actionKilled in action, rates, 12–13Kinetic energy rounds, 54

LLaboratory testing, 134Lactate, 673–674Lactated Ringer’s solution, 23, 142, 369, 542–543, 609–611Lactic acidosis, 690Landmines

antipersonnel, 46–47antitank, 54blast, 47–49directional fragmentation, 49–50fragmentation, 48–49

Landstuhl Regional Medical Center, Germany, 19, 697–698Laparotomy, pediatric, 561Laryngeal-mask airways, 97Laryngoscopes, 244Laryngoscopic orotracheal intubation, 97Laryngotracheal injuries, 287Lateral canthotomy, 329–330Lavage devices, 432–433

xl | Combat Casualty Care

LeFort fractures, 274Length of hospital stay, 54Lens subluxation/dislocation, 317Lethal triad, 22–23, 124–125, 170Levetiracetam, 376Lidocaine, 364Ligament injuries, 424–425Limb amputations, traumatic, 415–422Limb compartment syndrome

clinical findings, 407–408definition, 406diagnosis, 408–409fasciotomy techniques, 412–414forearm fasciotomy, 413hand compartment fasciotomy, 413incidence of, 405Joint Theater Trauma System guidelines, 471–480lower leg fasciotomy, 412–413mechanisms, 406overview, 405recurrent, 408risk, 406thigh fasciotomy, 413treatment, 409–414upper arm fasciotomy, 413

Liver injuries, pediatric, 562LMA. See Laryngeal-mask airwaysLocal rotational tissue transfer, 428Lorazepam, 556LOS. See Length of hospital stayLow-order explosives, 45Lower extremities

fasciotomy, 412–413fracture fixation, 448–449

Lower face injuries, 274–277Lund-Browder chart, 606Lung injuries

acute lung injury, 661damage control surgery, 178–180primary blast injuries, 60–63pulmonary contusion, 655–661

MM16A2 landmine, 49MACE. See Military Acute Concussion EvaluationMagnetic resonance imaging

maxillofacial wound infection diagnosis, 260–261ocular injuries, 314–315spinal injuries, 501–503traumatic brain injuries, 351

Malnutrition, pediatric, 543–544Mandible fractures, 251–253Mandibular reconstruction, 275–276Mannitol, 69, 370–372, 556Manometry, 408MAP. See Mean arterial pressureMarcus Gunn pupil, 268, 309Marine Corps. See Forward Resuscitative Surgical System

Index | xli

Mass-casualty-incident management, 109–111Massive transfusions

coagulopathy, 138–140complications, 138–140defined, 125electrolyte disorders, 138predicting need for, 132–135preventing need for, 126–131

Maxillofacial injuries. See also Neck injuriesairway control, 237–242awake endotracheal intubation, 245–246breathing support, 237–242cervical spine protection and control, 242–243confirmation of endotracheal tube placement, 246–247crash endotracheal intubation, 246cricothyroidotomy, 247–250definitive management, 261–266dental injury, 253–254difficult airways, 250–251endotracheal intubation preparation, 243–244endotracheal intubation technique, 244–247evaluation of, 262facial burns, 267–268facial injury, 254–256facial lacerations, 255–256facial nerve injury, 254–255facial soft-tissue injuries, 266–267fracture stabilization, 262–263frontal sinus fractures, 269–270infection prevention and management, 258–261initial airway control, 251–256initial management, 257LeFort fractures, 274lower face injuries, 274–277mandible fractures, 251–253nasal airway, 241–242naso-orbito-ethmoid region fractures, 270–273ocular assessment, 268–269oral airway, 241–242orbit fractures, 274overview, 229–236, 256–257panfacial fractures, 277parotid nerve injury, 254–255percutaneous transtracheal ventilation, 250radiographic imaging, 262rapid sequence intubation, 245surgery informed consent, 263surgical airway management, 247–250surgical principles, 264–266timing of surgery, 263–264treatment planning, 262wound care, 257–258zygoma fractures, 273–274

Mean arterial pressure, 350, 369Mechanical ventilation

atelectotrauma, 646barotrauma, 646biotrauma, 647–648

xlii | Combat Casualty Care

key concepts, 643–645ventilator-induced lung injury, 646–648volutrauma, 646

MEDEVAC units, 20–21, 103–107, 112Medical Emergency Triage Tags, 110Medical evacuation. See Patient evacuationMedical Treatment Facilities, 7Meloxicam, 103Meshed skin grafts, 623–625Metabolic acidosis, 546METTAG. See Medical Emergency Triage TagsMETT-TC information, 105MFST. See Mobile Field Surgical TeamsMicroporous crystalline aluminosilicate, 129Midazolam, 364Military Acute Concussion Evaluation, 64–65Military casualties

explosive-related injuries, 54–55Milrinone, 555Mine-resistant ambush protected vehicles, 50, 52Mixed venous oxygen saturation, 676–677Mobile Field Surgical Teams

function of, 108transporting casualties, 7

Modified Brooke Formula, 609–611MODS. See Multiple organ dysfunction syndromeMolotov cocktails, 45Morphine, 617MRAP. See Mine-resistant ambush protected vehiclesMRI. See Magnetic resonance imagingMTF. See Medical Treatment FacilitiesMultiple organ dysfunction syndrome, 24Muscle injuries, 424–425Myoglobinuria, 68–69

NNarrow complex tachycardia, 560Nasal airway, 241–242Naso-orbito-ethmoid region fractures, 270–273Nasoduodenal tubes, 543Nasopharyngeal airway, 241–242National Acute Spinal Cord Injury Study, 540National Heart Lung and Blood Institute, 664National Naval Medical Center Bethesda, 19National Training Center, 13NATO. See North Atlantic Treaty OrganizationNaval Special Warfare Command, 92Navy

Casualty Receiving and Treatment Ships, 7combat health support, 109

Near infrared spectroscopy, 678Neck injuries. See also Maxillofacial injuries

airway assessment and management, 281bleeding assessment and management, 281–283damage control surgery, 181–183esophageal injury, 286–287hard signs mandating immediate exploration, 182imaging, 283

Index | xliii

immediate hemorrhage control, 283laryngotracheal injury, 287neck anatomy, 279neck zones, 279–280, 284–286operative indications, 283overview, 229–234penetrating wounds, 278–288

Needle cricothyroidotomy, 250Needle thoracostomy, 15Negative-pressure ventilation, 643Negative-pressure wound dressings, 438–439, 618Nephrectomies, 190Nerve repair, 426Nerve root syndromes, spinal, 506Neurogenic shock, 499Neuroimaging, 362–363Neurosurgical interventions, 565–576NICE-SUGAR study. See Normoglycemia in Intensive Care Evaluation-Survival Using Glucose Algorithm RegulationNIPPV. See Noninvasive positive-pressure ventilationNIRS. See Near infrared spectroscopyNitric oxide, inhaled, 668–669Nitrocellulose, 45Nitroglycerin, 45NOE region. See Naso-orbito-ethmoid region fracturesNondepolarizing neuromuscular blocking agents, 365Noninvasive positive-pressure ventilation, 657–658, 659Nonsteroidal antiinflammatory drugs, 103Nonsurgical hemostatic agents, 143–144Norepinephrine, 369Normal saline, 23, 142Normoglycemia in Intensive Care Evaluation-Survival Using Glucose Algorithm Regulation, 689–690North Atlantic Treaty Organization

burn triage criteria, 598mass-casualty-incident management, 109–111nine-line MEDEVAC request, 106Roles of Care, 109

NovaLung®, 669NPV. See Negative-pressure ventilationNSAIDs. See Nonsteroidal antiinflammatory drugsNTC. See National Training CenterNutritional goals

acute respiratory distress syndrome, 671burn care, 627–628pediatric, 543–544sepsis, 691

OOcular adnexal trauma, 326–328Ocular injuries

anterior segment examination, 311–313assessment of, 268–269case studies, 333–338chemical eye injuries, 331–332choroidal injuries, 318closed globe injuries, 315–318conjunctival lacerations, 328corneal abrasion, 315corneal foreign bodies, 315–316

xliv | Combat Casualty Care

enucleation, 323–325external ocular examination, 310–311eyelid lacerations, 326–328globe repair, 323–324hyphema, 316imaging techniques, 314–315incidence of, 303intraocular foreign body, 325–326intraocular pressure measurement, 310lens subluxation or dislocation, 317levels of ophthalmic combat casualty care, 304–307ocular adnexal trauma, 326–328ocular motility, 309–310open globe injuries, 318–326orbital foreign bodies, 330–331orbital fractures, 331orbital trauma, 329–331patient history, 307–308posterior segment examination, 313primary blast injuries, 65pupil examination, 309retinal injuries, 318retrobulbar hemorrhage, 329–330sympathetic ophthalmia, 323traumatic iritis, 317traumatic optic neuropathy, 332visual acuity, 308–309visual field testing, 310vitreous hemorrhage, 317–318

Ocular motility, 309–310Ocular Trauma Score, 319OEF. See Operation Enduring FreedomOIF. See Operation Iraqi FreedomOmental packing, 187Open globe injuries, 318–326Open joint injuries, 425–426Open pelvic fractures, 207–208Open pelvic trauma, 452–453Operation Enduring Freedom

damage control resuscitation components, 125–126injury patterns, 43killed in action rates, 13mortality and survival rates, 4use of temporary vascular shunts, 196–200

Operation Iraqi Freedomdamage control resuscitation components, 125–126injury patterns, 43killed in action rates, 13mortality and survival rates, 4use of temporary vascular shunts, 196–200

Opioid analgesics, 103Optic neuropathy, traumatic, 332Oral airway, 241–242Oral transmucosal fentanyl citrate, 103Orbit fractures, 274Orbital foreign bodies, 330–331Orbital fractures, 331Orchiectomy, 211

Index | xlv

Organizational innovations, 17–22Oropharyngeal airway, 239, 241Orotracheal intubation, 97Osteomyelitis, 260–261OTFC. See Oral transmucosal fentanyl citrateOtolaryngology, 60Out-of-hospital care

case study, 89–91, 111–112combat and civil sector care, 91–92

Oxygen saturation, 676–678Oxygen toxicity, 647–648Oxygenation, 367

PPacked red blood cells, 22–23PaCO2. See Partial pressure of carbon dioxide in arterial bloodPain management, 102–103, 617PALS. See Pediatric Advanced Life SupportPancreatic injuries, 187–188Pancreaticoduodenectomy, 187–188Pancuronium, 365Panfacial fractures, 277Panoramic tomography, 262Panorex, 262PaO2. See Partial pressure of oxygen in arterial bloodParadoxical brain herniation, 360Parotid nerve injuries, 254–255Partial pressure of carbon dioxide, 547Partial pressure of carbon dioxide in arterial blood, 645Partial pressure of oxygen in arterial blood, 661Patient evacuation. See also Patient transportation

aeromedical evacuation system, 21air medical evacuation considerations, 103burn care, 628–629Critical Care Air Transport Teams, 20–21, 172, 377, 697–700echelons of care, 17–20, 104en-route nursing care, 21evacuation chain for combat casualties, 17Joint Patient Tracking Application, 22MEDEVAC units, 20–21, 103–107, 112spinal injuries, 507Tactical Combat Casualty Care, 103–107tactical evacuation, 199times, 5–6traumatic brain injuries, 376–377

Patient informationJoint Patient Tracking Application, 22

Patient transportation, 5, 7, 17. See also Patient evacuationPCV. See Pressure-control ventilationPCWP. See Pulmonary capillary wedge pressurePediatric Advanced Life Support, 549, 558Pediatric trauma

abdominal interventions, 561–564acute respiratory distress syndrome, 553airway, 534–537, 548–550anatomic considerations, 534–547asystole, 558blood product transfusion, 553

xlvi | Combat Casualty Care

body surface area, 540bradycardia with poor perfusion, 559burn care, 564cardiac rhythm disturbances, 558–560cerebral herniation syndromes, 556circulation, 551–553electrolytes, 542–544end-of-life care, 580epidemiology, 533extradural hemorrhage, 576fluid requirements, 542–544glucose metabolism, 542–544head, 537–540, 566initial assessment, 566–568intracranial pressure monitoring, 572–573intradural hemorrhage, 576narrow complex tachycardia, 560neurosurgical interventions, 565–576nutrition, 542–544patient monitoring, 546–547Pediatric Advanced Life Support, 549, 558pharmacology, 545–546physiology, 541–547pulseless electrical activity, 558pulseless ventricular tachycardia, 559rapid sequence intubation, 549–550respiratory system, 544–545resuscitation, 548–553scalp injuries, 568–572seizure management, 556–557septic shock, 553–556severe sepsis, 553–556skeleton, 540skull fractures, 573–576spinal cord, 537–540, 576–580thoracic interventions, 560–561triage, 566–568vascular access, 550–551ventricular fibrillation, 559vital signs, 541–542weight-based dosing, 567wide complex tachycardia, 560

PEEP. See Positive end-expiratory pressurePelvic injuries

acute management, 205–207angiography, 205background, 202bladder injury, 208–210computed tomography imaging, 204–205fracture fixation, 450–454genitalia injury, 210–211open pelvic fractures, 207–208open pelvic trauma, 452–453physical examination, 203radiographic examination, 203–205urethral injury, 208–210

Penetrating woundsneck injuries, 278–288

Index | xlvii

spinal injuries, 510–514, 580traumatic brain injuries, 361–363

Penile injuries, 210–211Pentaerythritol tetranitrate, 45Pentobarbital, 373Percutaneous transtracheal ventilation, 250, 536–537Perihepatic vascular injuries, 186Peripheral vascular injuries

arterial injury, 195–200extremity tourniquets, 200femoral vasculature injury, 201popliteal vasculature injury, 201proximity to great vessel injury, 200temporary vascular shunts, 196–200tibial vasculature injury, 210upper extremity arterial injury, 201venous injury, 200

Permissive hypotension, 24, 140–142Person-borne devices, 51PETN. See Pentaerythritol tetranitratepH

blood, 23, 142gastric intramucosal, 677

Phenobarbital, 376, 557Phenylephrine, 369Phenytoin, 375–376, 556–557Photopsias, 318Physician trauma admitting record, 10Ping-pong fractures, 574Pipe bombs, 45PIRO staging system, 680Plasma transfusion ratios, 25Platelets

transfusion, 137transfusion ratios, 25

Pneumonectomy, 178–179Pneumonia, combat-associated, 692–694Pneumothorax, tension

air medical evacuation considerations, 103preventable death from, 88–89tactical field care, 98–99treatment of, 14, 15

Popliteal vasculature injuries, 201Positive end-expiratory pressure, 62, 659, 664–667Positive-pressure ventilation

airway pressure release ventilation, 652assist-control, 649blast lung injuries, 62high-frequency ventilation, 653overview, 648–649pressure-control ventilation, 650–651pressure-regulated volume control, 652–653pressure-support ventilation, 651–652pulmonary contusion, 659synchronized intermittent mandatory ventilation, 649–650

Post-traumatic stress disorder, 64, 354Potentiators, 56–57PPV. See Positive-pressure ventilation

xlviii | Combat Casualty Care

Pressure-control ventilation, 650–651Pressure differentials, 58Pressure points, 17, 126–127Pressure-regulated volume control, 652–653Pressure-support ventilation, 651–652Preventable death causes, 11–13, 88–89, 124Primary amputation, 417Primary blast injuries

brain, 63–65ears, 58–60extremities, 65eyes, 65hollow organs, 63injury effects based on distance from open-space explosion, 68lungs, 60–63mechanism of injury, 57solid organs, 63

Pringle maneuver, 186Prone positioning, 670–671Prophylactic antibiotic therapy, 102, 259, 362, 440Propofol, 373, 545–546Propofol infusion syndrome, 373, 546Proton-pump inhibitors, 377, 695PROWESS trial. See Recombinant Human Activated Protein C Worldwide Evaluation in Severe SepsisPRVC. See Pressure-regulated volume controlPseudo Jefferson fracture, 548PSV. See Pressure-support ventilationPtosis, 310–311PTSD. See Post-traumatic stress disorderPTTV. See Percutaneous transtracheal ventilationPulmonary artery pressure, 645Pulmonary capillary wedge pressure, 661Pulmonary contusion

adjunctive strategies, 659–661airway protection, 657–658basic concepts, 655–657management, 657–661positive-pressure ventilation, 659pulmonary toilet, 657–658

Pulmonary injuries, 178–180Pulse oximetry, 100, 246Pulseless electrical activity, 558Pulseless ventricular tachycardia, 559Pupil examination, 309

QQRS complex, 558, 560Quaternary blast injuries

explosive-related injuries, 69–70mechanism of injury, 57

QuikClot® dressings, 17, 129, 369Quinary blast injuries

explosive-related injuries, 70–72mechanism of injury, 57

RRadiographic imaging

maxillofacial injuries, 262

Index | xlix

ocular injuries, 314–315pelvic injuries, 203–205spinal injuries, 501–503

Radionuclide scanning, 260–261Randomized Evaluation of Surgery with Craniectomy for Uncontrollable Elevation of Intra-Cranial Pressure, 374Rapid sequence intubation, 245, 364–365, 549–550RDX. See Cyclotrimethylene trinitramineREACH. See Registry of Emergency Airways at Combat HospitalsRecombinant factor VIIa

role in hemorrhage control, 27, 143–144use in damage control resuscitation, 23

Recombinant human activated protein C, 689Recombinant Human Activated Protein C Worldwide Evaluation in Severe Sepsis, 689Rectal injuries, 193Red blood cells

lifespan, 26massive transfusions, 125packed, 22–23transfusion ratios, 25transfusions, 135

Red reflex, 313Registry of Emergency Airways at Combat Hospitals, 97Rehabilitation, traumatic limb amputations, 422Renal injuries, 188–190Reperfusion injury, 199RESCUEicp, 374Respiratory system, pediatric, 544–545Resuscitation

base deficit, 674–675basic concepts, 672–673central venous oxygen saturation, 676–677critical care, 672–678damage control, 22–27endpoints, 672–679gastric intramucosal pH, 677lactate, 673–674mixed venous oxygen saturation, 676–677pediatric, 548–553sepsis, 682–683spinal, 498–499sublingual PCO2, 677–678supraphysiologic oxygen delivery attainment, 675tissue carbon dioxide and oxygen assessment, 678

Resuscitative thoracotomies, 560–561Retinal injuries, 318Retrobulbar hemorrhage, 329–330Retrohepatic hematomas, 186Retroperitoneal injuries, 192, 562Revised Trauma Score, 134rFVIIa. See Recombinant factor VIIaRhabdomyolysis, traumatic, 68, 612Ringer’s solution, lactated, 23, 142, 369, 542–543, 609–611Rocket-propelled grenades, 50, 89–90Rocuronium, 545–546Roux-en-Y jejeunostomy, 187RPGs. See Rocket-propelled grenadesRTS. See Revised Trauma Score

l | Combat Casualty Care

SSaline solution, 23, 542–543, 556SALT. See Triage/Treat/Transport systemSAM® SPLINTS, 5780SAPS II. See Simplified acute physiology scoreSBP. See Systolic blood pressureScalp injuries, 568–572Schiotz tonometer, 310SCIWORA. See Spinal cord injury without radiographic abnormalityScrotal injuries, 210–211Sea-Air-Land special warfare corpsmen

Tactical Combat Casualty Care training, 93SEALs, 93Second impact syndrome, 354–355Secondary blast injuries

fragment physics, 66fragment range, 67–68fragment wounds, 66–67injury effects based on distance from open-space explosion, 68mechanism of injury, 57primary and secondary fragments, 65–66

Secretary of Defense for Health Affairs, Office of, xiSeidel’s sign, 312–313Seizure management, 556–557Sepsis

bicarbonate therapy, 690–691blood product transfusion, 687–688corticosteroids use, 685–686critical care, 679–691definition, 679–680hyperglycemia, 689–690infection source control, 682inotropic therapy, 688–689intravascular volume, 683–684management, 680–691nutritional goals, 691oxygen delivery adequacy assessment, 686–687pathophysiology, 680prognosis, 680recombinant human activated protein C, 689resuscitation goals, 682–683vasopressors use, 684–685

Septic shock, 553–556, 679Severe sepsis, 553–556, 679–680Shaped-charges, 52–54Shear injuries, 58Sheet explosives, 45Shock Trauma Platoons, 30, 108SIADH. See Syndrome of inappropriate secretion of antidiuretic hormoneSilver-impregnated dressings, 268Simple Triage and Rapid Treatment, 111Simplified acute physiology score, 670SIMV. See Synchronized intermittent mandatory ventilationSIRS. See Systemic inflammatory response syndromeSkin grafting, 621–625Skull fractures, 573–576Small arms casualties, 44Small Business Innovative Research Program, xi

Index | li

Smectite, 130SOF. See Special Operations ForcesSoft-tissue injuries

facial, 266–267large wounds, 192

Solid organ injuries, 63Sort, Assess, Lifesaving Interventions, 111Space of Retzius, 202, 207Spalling, 58Special Operations Forces, 13Spermatic cord injuries, 210–211Spinal cord injury without radiographic abnormality, 506, 537, 539–540Spinal injuries

anatomy, 500–501anterior cord syndrome, 504–505assessment of, 500–506axial traction, 508–510Brown-Séquard syndrome, 505–506cauda equina syndrome, 506central cord syndrome, 504–506cerebrospinal fluid fistulae, 512–513cervical spine protection and control, 242–243closed, 576–580complete cord syndrome, 503–504emergency management, 493–497epidemiology, 490glucocorticosteroids use, 499incomplete cord syndromes, 504–06infection control, 511–512infections, 513–514levels of combat casualty care, 490–493management considerations, 507––516mechanical stability, 510–511neurogenic shock, 499overview, 489–490pediatric, 537–540, 576–580penetrating, 580penetrating injury, 510–514precautions, 99projectiles in disc space, 514–515projectiles in spinal canal, 515–radiographic considerations, 501–503restoring alignment, 499spinal cord injury patterns, 503–506spinal cord injury without radiographic abnormality, 506spinal immobilization, 496–497, 507spinal nerve root syndromes, 506spinal reduction interventions, 508–510spinal resuscitation, 498–499spinal shock, 496spinal stability determination, 503tactical combat casualty care, 497–498timing of surgical interventions, 507–508transport considerations, 507vascular injuries, 514

Spinal nerve root syndromes, 506Splenic injuries, 190–192Split-thickness skin graft, 622–623

lii | Combat Casualty Care

SSTP. See Surgical Shock Trauma PlatoonSTART®. See Simple Triage and Rapid TreatmentStatic landmines, 47–48Steroids, 686STP. See Shock Trauma PlatoonsStress gastritis, 695Stryker frame, 670STSG. See Split-thickness skin graftSubdural hematomas, 355–356Subfalcine brain herniation, 358–360Sublingual PCO2, 677–678Succinylcholine, 365, 545–546Suicide bombs, 51Sulfamyalont®, 625Supraphysiologic oxygen delivery attainment, 675Suprarenal aorta injuries, 185Suprarenal vena cava injuries, 186Supraventricular tachycardia, 560Surgery. See Damage control surgery; specific injury typeSurgery informed consent, 263Surgical Shock Trauma Platoon, 108Surgical wound debridement, 434–438Surviving Sepsis Campaign 2008, 682, 685Sympathetic ophthalmia, 323Synchronized intermittent mandatory ventilation, 649–650Syndrome of inappropriate secretion of antidiuretic hormone, 612Systemic hypotension, 100Systemic inflammatory response syndrome, 673, 679Systolic blood pressure, 134

TTACC. See Tanker Airlift Control CenterTACEVAC. See Tactical evacuationTactical combat casualty care

acute airway obstruction, 97–98advancements in, 13–14air medical evacuation considerations, 103care-under-fire issues, 93–94evacuation care, 103–107field care, 95–103fluid resuscitation, 96–98Health Services Support, 107–109hemorrhage control, 95hemostatic agents, 95hypothermia prevention and management, 101–102infection prophylaxis, 102mass-casualty-incident management, 109–111pain management, 102–103phases of, 93program development, 92–93spinal injuries, 497–498spinal injury precautions, 99tension pneumothorax, 98–99tourniquet use, 95traumatic brain injuries, 99–101treatment measures, 93vascular access, 96–98ventilatory support, 97–98

Index | liii

Tactical evacuation, 199Tangential excision, 619Tanker Airlift Control Center, 698TBI. See Traumatic brain injuriesTBSA. See Total body surface areaTCCC. See Tactical combat casualty careTelemedicine, 696TELFATM, 621Temporary vascular shunts, 196–200Tendon injuries, 424–425Tension pneumothorax

air medical evacuation considerations, 103preventable death from, 88–89tactical field care, 98–99treatment of, 14, 15

Tertiary blast injuriesexplosive-related injuries, 68–69mechanism of injury, 57

Testicular injuries, 210–211Tetanus immunization, 439–441Thermal Angel®, 130Thigh fasciotomy, 413Thiopental, 373Thoracic injuries

emergency thoracotomy, 173–175esophageal injury, 180–181intrathoracic vascular injury, 175–178pediatric, 560–561pulmonary injury, 178–180rates of, 15tracheobronchial injury, 178–180

Thoracostomies, needle, 15Thoracotomies

emergency, 173–175resuscitative, 560–561

Thromboelastography, 139Tibial vasculature injuries, 210Tidal volume, 654, 663–665, 719TNT. See 2,4,6-TrinitrotolueneTonic-clonic seizures, 556–557Tono-Pen®, 310Tonsillar brain herniation, 360Topical sealants, 143Total body surface area, 597–598, 606, 610Total parenteral nutrition, 674Tourniquets

advancements in, 15–16Combat Application Tourniquets, 128, 404–405, 469–470damage control resuscitation, 127–130extremity injuries, 16, 127–129, 200, 403–405improvised, 403–405tactical field care, 95

Toxic gases, 54–55Tracheal injuries, 287Tracheobronchial injuries, 178–180Tractotomy, pulmonary, 178–179Training advancements, 13–14Tranexamic acid, 144

liv | Combat Casualty Care

Transcranial herniation, 360Transcutaneous oxygen content, 678Transfusion Requirements in Critical Care, 687Transfusions

blood product ratios, 24–26fibrinogen, 137fresh frozen plasma, 136–137fresh whole blood, 137–138massive, 125–135pediatric, 553platelets, 137ratios, 24–26red blood cells, 135sepsis, 687–688

Transient nerve palsy, 16Translational blast injuries, 54–55Transportation. See Patient transportationTraumatic brain injuries. See also Head injuries

air evacuation, 376–377airway and breathing management, 363–365, 367anticonvulsants use, 375–377blast injury, 353–354central herniation, 358–360cerebrospinal fluid leaks, 362Clinical Practice Guidelines, 64closed head injury, 351combat casualty care, 99–101critical care, 376–377decompressive craniectomy, 374–377diffuse, 355effects of, 64epidural hematomas, 355–357external ventricular drains, 369–370focal, 355head positioning, 366hemodynamic management, 368–369herniation syndromes, 358–360hypertonic saline, 370–373hyperventilation, 367–368induced hypothermia, 374infection, 362initial management, 363–367intracranial pressure, 349–350, 364–375intractable intracranial hypertension, 375management considerations, 363–378mannitol use, 370–372mild injury, 351–360moderate injury, 351–360neuroimaging, 362–363overview, 347–348paradoxical herniation, 360pathophysiology of, 348–351penetrating, 361–363pharmacologic agents to reduce intracranial pressure, 373–375prevalence of, 63prevention of, 65second impact syndrome, 354–355secondary survey, 366–367

Index | lv

severe injury, 351–360subdural hematomas, 355–356subfalcine herniation, 358–360tonsillar herniation, 360transcranial herniation, 360traumatic intracerebral hemorrhage, 357–358uncal herniation, 358–360upward herniation, 360ventilation, 367

Traumatic Data Coma Bank Classification Scale, 568Traumatic iritis, 317Traumatic limb amputations

degree of, 481delayed amputation, 420–421fasciotomy, 419–420initial assessment, 415–416initial resuscitation, 417–421mechanism of, 481number of limbs, 481primary amputation, 417rehabilitation, 422surgical amputation, 420–421surgical technique, 481–482timing of, 481wound care, 420–421wound debridement, 417–419

Traumatic optic neuropathy, 332Traumatic rhabdomyolysis, 68, 612Triage Officers responsibilities, 8Triage systems

mass-casualty-incident management, 109–111Triage/Treat/Transport system, 111TRICC. See Transfusion Requirements in Critical Care2,4,6-Trinitrotoluene, 45Tromethamine, 690–691TXP®, 629Tympanic membranes, 59–60

UUltrasonography

intravascular volume, 683maxillofacial wound infection diagnosis, 260ocular injuries, 314–315traumatic brain injuries, 363

Uncal brain herniation, 358–360Unexploded ordnances

embedded, 72–73injuries from, 46–47

United States mass-casualty-incident management, 109–111Upper extremities

fasciotomy, 413fracture fixation, 447–448

Upper thigh wounds, 437–438Upward brain herniation, 360Ureteral injuries, 190–191Urethral injuries, 208–210US Army Institute of Surgical Research, 69, 130, 609–610, 628–629US Marine Corps

lvi | Combat Casualty Care

combat health support, 109en-route nursing care, 21

US Special Operations Command, 13, 92USAISR. See US Army Institute of Surgical ResearchUSSOCOM. See US Special Operations CommandUXOs. See Unexploded ordnances

VValproate, 376VAP. See Ventilator-associated pneumoniaVascular access, 96–97, 550–551Vascular injuries

arterial injury, 195–200extremity tourniquets, 200femoral vasculature injury, 201intrathoracic, 175–178perihepatic, 186peripheral, 195–201, 210popliteal vasculature injury, 201proximity to great vessel injury, 200spinal, 514temporary vascular shunts, 195–200tibial vasculature injury, 210upper extremity arterial injury, 201venous injury, 200wound care, 424–425

Vascular shunts, 196–200Vasoactive agents, 143Vasopressin, 143Vasopressin and Septic Shock Trial, 685Vasopressors, 684–685VASST. See Vasopressin and Septic Shock TrialVDR-4t®, 629Vecuronium, 365Vehicle-borne devices, 51Venous injuries, 200Venous thromboembolism, 377Ventilation, positive-pressure. See Positive-pressure ventilationVentilator-associated pneumonia, 692Ventilator-induced lung injury

atelectotrauma, 646barotrauma, 646biotrauma, 647–648volutrauma, 646

Ventilatorsprocedures, 719settings for normal lungs, 653–655Volumetric Diffusive Respiration ventilators, 629

Ventilatory compromise, 88–89Ventilatory support, 97–98, 367Ventricular drains, external, 369–370Ventricular fibrillation, 559Ventricular tachycardia, 560Victim-actuated devices, 51Video-based laryngoscopic devices, 97Vietnam War

Wound Data and Munitions Effectiveness Team, 12VILI. See Ventilator-induced lung injury

Index | lvii

Visual acuity, 308–309Visual field testing, 310Vital signs, pediatric, 541–542Vitreous hemorrhage, 317–318Volumetric Diffusive Respiration ventilator, 629Volutrauma, 646

WWalter Reed Army Medical Center, 19Warm shock, 555WDMET. See Wound Data and Munitions Effectiveness TeamWeapons effects

explosive-related injuries, 54–73explosives, 44–54small arms, 44weapons, 44

Wet-to-dry dressing debridement, 433–434Whipple procedure, 187White phosphorus injuries, 419, 600–601Whole blood, fresh

role in transfusion, 26–27use in damage control resuscitation, 23

Wide complex tachycardia, 560Windlass tourniquets, 403–405Woods lamp, 601Wound closure

overview, 426techniques, 427–430timing of, 427wound coverage, 430

Wound Data and Munitions Effectiveness Team, 12, 88Wound debridement, 259, 261, 417–419Wound flora, 431Wound irrigation

additives, 432irrigants, 432irrigation devices, 432–433timing of, 432

WoundStat™ granules, 17, 130

XXylocaine®, 571

ZZygoma fractures, 273–274

lviii | Combat Casualty Care