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