Front Line Surgery: A Practical Approach

913 Pages·2017·37.038 MB·English

by  Matthew J. Martin,, Alec C. Beekley,, Matthew J. Eckert (eds.)

Matthew J. Martin
Alec C. Beekley
Matthew J. Eckert Editors
Front Line Surgery
A Practical Approach
Second Edition
123
Front Line Surgery
Matthew J. Martin
Alec C. Beekley • Matthew J. Eckert
Editors
Front Line Surgery
A Practical Approach
Second Edition
Editors
Matthew J. Martin Alec C. Beekley
Trauma Medical Director Thomas Jefferson University Hospitals
Professor of Surgery Paoli Hospital
Uniformed Services University The Lankenau Hospital
Madigan Army Medical Center Division of Acute Care Surgery
Department of Surgery Division of Bariatric Surgery
Tacoma, WA, USA Philadelphia, PA, USA
Matthew J. Eckert
Associate Trauma Medical Director
Assistant Professor of Surgery
Uniformed Services University
Madigan Army Medical Center
Department of Surgery
Tacoma, WA, USA
ISBN 978-3-319-56779-2 ISBN 978-3-319-56780-8 (eBook)
DOI 10.1007/978-3-319-56780-8
Library of Congress Control Number: 2017943353
© Springer International Publishing AG 2011, 2017
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of
the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation,
broadcasting, reproduction on microfilms or in any other physical way, and transmission or information
storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology
now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
does not imply, even in the absence of a specific statement, that such names are exempt from the relevant
protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in this book
are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the
editors give a warranty, express or implied, with respect to the material contained herein or for any errors
or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims
in published maps and institutional affiliations.
Printed on acid-free paper
This Springer imprint is published by Springer Nature
The registered company is Springer International Publishing AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
We dedicate this book first to the military service members, those “rough” men
and women who always stand ready to put life and limb at risk to protect and
defend their families, friends, and homeland. We dedicate it to the countless
soldiers and civilians who have made it their life’s mission to provide comfort and
care during times of war, and who have trained others to carry on this sacred
mission.
We dedicate it to the most important assets of the soldier at war – the spouses,
children, parents, family, and friends who give us the will to carry on and a reason
to come home. This book would not have been possible without the three most
important people in our Chain of Command: our wives – Becky, Melodie, and
Carly. In the “fog of war” they serve as a constant reminder that strength, grace,
and beauty still exist.
Finally, we dedicate this book on combat surgery to our surgical comrades
who have made the ultimate sacrifice in the conflicts in Iraq and Afghanistan: to
Lieutenant Colonel Mark Taylor, MD, killed in action in Fallujah, Iraq, in 2004;
to Colonel Brian Allgood, MD, killed in action in Baghdad, Iraq, in 2007; and to
Major John Pryor, MD, killed in action in Mosul, Iraq, in 2008. A common
uniting factor among these heroes was their dedication as both surgeons and
teachers. We pray that their spirit is reflected in this effort to pass on lessons
learned from the recent front line combat experiences. These lessons have come
at too high a price to ever allow them to fade or be forgotten.
“Who kept the faith and fought the fight;
The glory theirs, the duty ours.”
Wallace Bruce
Foreword1
The current war will be the first in history from which detailed concurrent analyses of the
epidemiology, nature, and severity of injuries, care provided, and patient outcomes can be used
to guide research, training, and resource allocation for improved combat casualty care [1].
As the US military enters a tenuous interwar period, the second edition of Front
Line Surgery and the considerable experience at its foundation embody the quote
from Holcomb published during the height of the wars in Afghanistan and Iraq. As
the editors of this text have stated, regardless of where, when, or in what proportion
or operational stance US service members deploy, a surgeon will be with them. To
best prepare those surgeons, and all members of the combat casualty care team,
Front Line Surgery (2nd ed.) builds on the success of its 2011 edition, to provide an
easily accessible repository of trauma management, trauma systems, and trauma
readiness information. Arranged by an accomplished group of authors, this edition
summarizes the pearls and best-practice standards for all facets of trauma and injury
care today and promises to inform “research, training and resource allocation to
improve combat casualty care” in years to come2.
Equal to its relevance to military providers, Front Line Surgery contains a wealth
of useful information for those tackling trauma and injury care in austere, nonmili-
tary settings. As highlighted in a 2016 National Academy of Medicine report, rates
of trauma and injury from accidents, intentional acts of violence, and natural disas-
ters are increasing at home and abroad [2]. Increasingly, the shared ethos touted by
Knudson and colleagues between military and civilian surgeons is seen to be vital
to optimizing trauma care [3]. Both in its range of military and civilian authors and
in its breadth of content, this edition of Front Line Surgery epitomizes the beneficial
synergy between military and civilian surgery. As aptly pointed out by Dr. Donald
Berwick, lead author of the National Academies’ report, “when it comes to
success in optimizing injury care, the civilian and military communities will either
1 Disclaimer: The views herein are those of the author and do not reflect the official position or
policy of the US Air Force, US Army, or the Department of Defense.
2 See footnote 1.
vii
viii Foreword
succeed together or will fail together” [2]. The second edition of this textbook offers
a prime example of shared success!
The breadth of topics addressed in the second edition is impressive and includes
all phases of trauma and injury care – point of injury, en route, and facility-based –
as well as new focus areas related to trauma systems development, resident readi-
ness and training and response to mass shooting events. The book has an exciting
table of contents that will be interesting and useful to those with all levels of experi-
ence – students, trainees, and experienced providers. Additionally, the range of top-
ics goes beyond the limits of “surgery,” allowing the text to be an informative
resource for all members of the trauma care team, including prehospital and emer-
gency medical systems specialists, emergency medicine physicians, and critical and
intensive care providers.
Surgery team (left to right: Joe DuBose, surgeon; Elaine Spotts, OR technician; Todd Rasmussen,
surgeon; and Danny Kim, surgeon) after a long day sewing in circles at Craig Joint Theater
Hospital (U.S. Role III facility), Bagram, Afghanistan (circa February 2012)
Making use of the familiar Bottom Line Up Front, or BLUF, approach, each
chapter provides key “take home points” and follows these summary sections with a
more thorough, evidence-based discussion of the various management strategies.
Many of the chapters also provide a summary of ongoing research and development
efforts in the different areas of resuscitation and injury care (i.e., discuss new and
emerging approaches to challenging problems). By doing this, the text emphasizes the
importance of research and new innovation in this topic area and provides a glimpse
of what front line trauma care and surgery may look like a decade from now.
Foreword ix
In a similar vein as the quote from Holcomb et al., the 2016 National Academies’
report stated that “those who serve in the military need and deserve a promise that,
should they sustain a traumatic injury, the best care known will come to their assis-
tance to offer them the best chance possible for survival and recovery and, further,
that over time, learning and innovation will steadily increase that chance” [1]. In its
second edition, Front Line Surgery has taken this important step over time and now
instructs us as we look back at the wars in Afghanistan and Iraq. It’s our job to con-
sider the experience in the pages of this edition and to read and study its content.
Done with diligence, the use of this resource will improve efforts to increase that
chance of survival and recovery for those injured in military and civilian settings in
years to come. Now get to work!
Todd E. Rasmussen
Program Director
Combat Casualty Care Research Program
U.S. Army Medical Research and Materiel Command
Fort Detrick, MD, USA
References
1. Holcomb JB, Stansbury LG, Champion HR, Wade C, Bellamy RF. Understanding combat
casualty care statistics. J Trauma. 2006;60:397–401.
2. National Academies of Sciences, Engineering, and Medicine. A national trauma care system:
integrating military and civilian trauma systems to achieve zero preventable deaths after injury.
Washington, DC: National Academies Press; 2016.
3. Knudson MM, Elster EE, Woodson J, Kirk G, Hoyt DB. A shared ethos: the Military Health
System Strategic Partnership with the American College of Surgeons. J Am Coll Surg.
2016;222(6):1251–7.
Foreword
Kenneth L. Mattox, MD, FACS
It is a unique honor to be asked to write a foreword for this book on combat casualty
care, entitled Front Line Surgery: A Practical Approach. A foreword provides the
opportunity to set the tone and “prepare the brain” for what the textbook is about.
More than anywhere else in the broad field of medicine and health care delivery, the
surgeon providing front line actions must be poised, ready, and accurate, without
hesitation. The editors wrote the first edition of this book to codify the critical infor-
mation that is passed on from surgeon to surgeon in the military war zone and,
secondly, for all to benefit from lessons learned in the military theaters. The reader
is alerted as to what the hands and brain must do when faced with a front line surgi-
cal judgment situation, be it technical/procedural or decision making. And, of
course, the response is the culmination of training, reflex, experience, and insight.
I was told by one of the editors that Front Line Surgery was somewhat inspired by
a little book that Asher Hirshberg and I had written, entitled Top Knife. We are both
humbled and honored that Top Knife could contribute, in this way, to this project. The
fact that the military editors of this book are now producing a second edition reflects
the continuing advances and innovations of our surgical and medical crafts, as well
xi
xii Foreword
as the thirst (and need) for such knowledge in both the military and the civilian sec-
tors. The addition of civilian contributors demonstrates the ever-b roadening implica-
tions of the lessons learned and the fact that the pendulum swings between the
civilian and military partnership environments, benefiting both. We have learned, do
learn, and will continue to learn from each other.
As one reads previous handbooks of front line trauma response, misconceptions
and shallow assumptions of the past, often occurring because of overstatement of
tradition and bias, stand out – overhydration, use of solutions containing hepatitis
virus, and the rise and fall of various drugs, devices, gauzes, and theories, to name
just a few, among many other ever-changing approaches. We learn from each oth-
er’s successes, failures, and evidence-based data.
Many of the chapters in this textbook are especially germane to military medi-
cine and the type of injuries seen in the combat zone, and most information trans-
lates well to the civilian sector. Of note:
• Chapter 4. Damage Control Resuscitation
• Chapter 5. To Operate or Image? (Pulling the Trigger)
• Chapter 9. Pancreatic and Duodenal Injuries (Don’t Mess with the…)
• Chapter 12. To Close or Not to Close: Managing the Open Abdomen
• Chapter 21. Traumatic Amputations
Each chapter in the book begins with documentation of the military experience
and credibility of the author, followed by a BLUF (Bottom Line Up Front) box list-
ing that quickly and succinctly provides the reader the operational points of the
chapter. Immediately under each BLUF box is a short phrase in the form of a perti-
nent quote to evoke a philosophical chuckle from the past. For this new edition,
civilian surgeons were involved, and selected chapters have a “civilian translation”
commentary that discusses key military lessons learned that have been incorporated
into the civilian arena, as well as key differences between the civilian approach to
trauma and combat trauma.
Although a book of more than 500 pages, it is an easy read because of its orienta-
tion and format. Many of the chapters are anatomically focused. Some of the more
militarily unique chapters include:
• Chapter 6. Ultrasound in Combat Trauma
• Chapter 38. Patient Transfer, En route Care, and Critical Care Air Transport
Team (CCATT)
• Chapter 42. Humanitarian and Local National Care
• Chapter 43. Expectant and End of Life Care in the Combat Zone