Index

A airway intervention, 126–129 Abdominal injury, operative management of codeine, 145 laparoscopy, 165 diamorphine, 144–145 laparotomy, 165 Entonox, 143–144 re-look laparotomy, 167 fentanyl, 139–142 temporary abdominal closure and definitive induction and maintenance, 129–130 repair, 167 ketamine, 142–143 Absolute emergencies (AE), 2 methoxyflurane, 144 Activated protein C (APC), 114 morphine, 139 Acute pain, 135 NSAID, 146 Acute trauma coagulopathy (ATC), 111, 113 paracetamol, 146 Addiction, 138 RA techniques, 130 Aeromedical evacuation, 458, 459 tramadol, 144 Air embolism, 385 trauma team and human factors, 126 Alert; verbal; pain; unresponsive (AVPU) unconventional analgesics, 146–147 assessment, 178 gabapentinoids, 147 Amitryptilline, 147 TCADs, 147 Ammunition, 10–13 Anaesthetist’s non-technical skills framework Amniotic fluid embolism (AFE), 385 (ANTS), 347, 348 Amputation Analgesia, 131, 133 acute trans-tibial amputation, 496 ballistic trauma, 132 free-tissue transfer, 497 pain (see Pain) healthcare system, 492 Anatomic injury patterns, 39 hip disarticulation, 498 Angioembolization, 165, 313 injury patterns, 497 Angiography, PNI, 262 level decision making, 493 Ankle: Brachial Pressure Index (ABPI), 280 marked inflammatory response, 496–497 Antepartum haemorrhage (APH), 383 neurovascular structures, 494 Anterior segment injuries residual limbs, 500 cornea, 228 revision surgery, 500 epithelial defects, 229 scoring systems, 493 foreign bodies, 228 vs. soft tissue reconstruction, 492 funus, retina and optic nerve, 230 surgical resources, 494 hyphaema, 227 tissue damage and contamination, 497 lens, 228 tissue excision, 494 ocular surface burns, 229 transected diaphysis, 495 pupils, 227 upper limbs, 497 red reflex, 227 wound sepsis, 492 Antibiotics, 185, 192, 210, 221, 228, 342, Amputee rehabilitation, 514 477, 478 Anaesthesia, 125, 147 Anticoagulants, 119

© Springer International Publishing AG 2017 525 J. Breeze et al. (eds.), Ballistic Trauma, https://doi.org/10.1007/978-3-319-61364-2 526 Index

Anti-personnel mines, 23–24 ballistics-neurosurgical Archbars, 247 considerations, 178 Armed Forces, 47 prognosis, 192–194 Armed Services Trauma Rehabilitation surgical treatment, 191 Outcome (ADVANCE) postoperative care, 192 Study, 521 preoperative treatment, 188–189 Artillery, 25–26 surgical management, 190–191 Ascaris lumbricoides worm, 404 Basic Symptom Control in Paediatric Assault rifle, 10 Palliative Care, 370 ATMIST handover, 89 Battlefield Advanced Trauma Life Support Atypical gunshot entrance wounds, 423, 424 (BATLS), 177, 207 Aviation physiology, 459–461 Battlefield fragment injuries, 206 Behind armour blunt trauma (BABT), 49, 58, 59 B Birmingham eye trauma terminology system, Bacteria, 22 217, 218 Ballistic injury, 13, 75–83 Bladder organ injury scoring system, 322 developments, 84 Bladder trauma drag, 14 clinical signs and symptoms, 319 medical interventions complicated extraperitoneal, 319 ABC, 82 cystography, 320 cervical spine control, 83 diagnostic approach, 320 haemorrhage control, 82–83 gross haematuria, 319 medical management intraperitoneal, 319 buddy-buddy/self-aid, 81 lacerations, 323 CUF, 80 management, 322 permissive environment, 81 operative approach, 322–324 TFC, 81 penetrating injury, 320 preparation, 83–84 retrograde cystogram, 324 scene management uncomplicated extraperitoneal, 319 assessment, 79 Blast injuries, children vs. adults, 360 command and control, 77–78 Blood-borne viruses (BBV), 31 initial approach and communication, Blunt chest injury, 367 75–76 Blunt scrotal trauma, 324 safety, 79 Body armour, 50 triage, 80 Bone strike, 178 Ballistic maxillofacial trauma, 237 Boyle’s law, 460 DCS, 242 Bracing, 211 early management, 249–250 Brain parenchyma, 178, 192 immediate management, 241–242 Bullet flight, 14–16 longer-term rehabilitation, 250–252 Bupivacaine, 132 pathophysiology, 238–240 treatment timelines, 240–241 Ballistic trauma, 178, 180–182, 191–194 C initial resuscitation and management, Calibre, 13 183–185 Cantholyis, 245 injury classification, 178–179 Cardiac injury, 160 perforating wound, 182 Care Flight triage system, 69 tangential wounds, 180 Care under fire (CUF), 81 wound penetration, 181–182 Carotid artery injuries, 268–270 MNSU, 177 Casualty, 26 neuroimaging, 185–188 evacuation, 446 PHI, 175, 176 labeling, 70 Index 527

CELOX™, 82 multi-disciplinary assessment, 509 Central venous access, children, 364 musculo-skeletal and neurological Cepahlosporins, 189 examination, 509 Cerebral perfusion pressure (CPP), 189, 192 neuropathic pain, 508 Cervical oesophagus, injuries, 400 stages, 508 Cervical spine injuries, 364 patient pathway, 505 Charlie Hebdo attack, 1 patient tracking, 508 Chemical injury, 230 psycho-social factors, 506 Chest injury, operative management, 161 surgical and medical management, 505 Child injuries therapeutic exercise/intervention, 507 assessment, 362, 363 treatment goals, 507, 510 gastric decompression, 363 Conjuctiva, 228 hypovolaemia, 362 Conjunctival swelling, 223 intravenous analgesia, 363 Contact wounds, 416, 417, 424 peripheral venous access, 363 Contemporary mandibular fracture, 250 psychological trauma, 362 Copper poisoning, 207 Chronic pain, 135 Cornea, 228 Civilian injuries, epidemiology, 361, 362 Cricothyroidotomy, 241 Clamshell thoracotomy, 161, 162 Critical Care Air Support Teams (CCASTs), Clinical forensic medicine 447, 451 definition, 409 Critical care unit, trauma documentation and handling of evidence, 409 analgesics, 440 emergency physicians, 409 assessment, admission, 437 firearm-related injury, 410 enteral feeding, 440 gunshot-wound documentation, 411 evacuation, 441 longer-term reduction, 409 extracorporeal carbon dioxide removal wound characteristics, 410 therapy, 439 Close-range and loose-contact wounds, 418 extracorporeal membrane oxygenator Cluster munitions, 24 circuits, 439 Coagulopathy, 112 low tidal volume ventilation, 438 Codeine, 145 lung protective ventilation, 439 Collecting system injury, 312 medical and nursing care, 442 Colour doppler ultrasound, 263 microbiology, 441 Combat applicator tourniquet (CAT), 281 nasojejunal feeding, 440 Combat helmets, 54 neurotrauma, 440 Command Huddle, 157 organisational factors, 442 Component separation technique, 405 pastoral support, 442 Computerised tomographic angiography, postoperative cardiovascular PNI, 260 instability, 438 Conflict rehabilitation, 508, 509 renal replacement therapy, 440 active case management, 506 resuscitation, 438 bladder management, 512 staff training, 442 case management, 512 surgical treatment, 441 discharge planning, 513 thromboprophylaxis, 439 discharge, readmission process, 513 transfusion, 440 enhanced survivability, operations, 521 Cross-leg flap, 406 exercise programs, 507 Crystalloid fluids, 114 mild traumatic brain injury, 506 CSCATTT (Command, Safety, multi-system nature, injuries, 506 Communications, Assessment, musculo-skeletal system, 505 Triage, Treatment, Transport), 64 neurological system, 505 CT traumagram, 97 outcomes measurement, 513 Cushing’s tabulation, 179 patient assessment, 506 Custodian Helmet, 58 528 Index

D Decompression, 91 Damage control resuscitation (DCR), Defence Medical Rehabilitation Programme, 111, 113–120, 125, 153, 337, 365, 507 396, 397 Definitive care, 208 components, 114 Definitive repair, 167 anticoagulants, 119 Dependence, 138 DCS, 120 Diamorphine, 144 factor concentrates and fresh whole DIC. See Disseminated intravascular blood, 119–120 coagulation (DIC) HR, 115–118 Difficult airway society (DAS), 127 hypocalcaemia and hyperkalaemia, 119 Digital radiography (DR), 101 hypothermia, 118 Disseminated intravascular coagulation (DIC), permissive hypotension, 114–115 192, 385 TXA, 118 Distant-range entrance wounds, 420–422 history, 112–113 Distraction osteogenesis, 486 multiple ballistic casualties, 120 Drag force, 14 physiology Dua classification, 230 acute trauma coagulopathy, 113–114 lethal triad, 113 Damage control surgery (DCS), 120, 125, 151, E 163–169 Elective dysvascular amputee, 514 abdominal injury, operative Emergency Department management, 87, management of 90–92 laparoscopy, 165 arrival, 89 laparotomy, 165–167 decision making, 92–93 re-look laparotomy, 167 handover, 93 temporary abdominal closure initial investigations, 92 and definitive repair, 167–169 major incident, factors, 93 assessment preparation, 87–88 stable patient, 163–164 primary survey, 90 unstable patient, 163 decompression, 91 ballistic maxillofacial trauma, 242–248 definitive airway, 90 cardiac injury, 160–161 hemorrhagic shock, 91–92 Command Huddle, 157 uncontrolled external communication, 156 hemorrhage, 90 development, 152 secondary survey, 92 haemothorax and simple pneumothorax, Endophthalmitis, 226 159–160 Enhanced combat body armour (ECBA), 51 indications, 155–156 Enophthalmos, 222 integral component, 154 Entonox, 137, 143 liver injury, 152 Epidural analgesia, 131 management, 153 Epithelial defects, 229 operative management, chest injury, Ertl procedure, 499 161–163 Escharotomy, 407 outcomes, 158 Essential coverage, 50 patient selection, factors in, 155 Evacuation PNI, 259 clinical priorities, 446 posterior mediastinum, 161 definitive care, 445 and resuscitation, 446 domestic terror incident, 447, 448 Sit Rep, 158 interventions, 445 Snap Brief, 157 medical planning, 447 stages, 153 patient transfer service, 445 techniques, 154–155 strategic, 446 tension pneumothorax, 158–159 trauma network, 446 Index 529

Evisceration, 233 management, 221 Exercise-based rehabilitation ocular trauma scoring, 217 group therapy, 510 open globe injury medical social work, 511 assessment, 224 nursing team, 512 management, 226 occupational therapy, 511, 512 orbital and zygomatic injuries, 222 physical training, injury, 507 orbital compartment syndrome, 223 physiotherapy, 511 Eye protection, 56 Exit wounds, 422, 423, 425 Eyelid injury, 223, 224 Extensive subconjunctival haemorrhage, 225 External ballistics, 13 External genital injuries, men F AAST scrotal injury scale, 328, 329 Fabrics, 49 AAST testicular injury scale, 325 Faces pain scales (FPS), 136 blast injuries, 324 FAST scans, 363 ecchymotic hemiscrotum, 325 Fentanyl, 139 on gonadal endocrine function, 330 Fertility, 329, 330 haematocele, 327 Fibrinolysis, 366 hormonal and surgical interventions, 329 Fibula osteocutaneous free flap, 251 hormone replacement therapy, 331 Firearms, 7, 9, 10 intratesticular haematomas, 327 ammunition, 10 lacerations, scrotal skin, 326, 327 ballistics, 13–14 protective equipment, 324 history, 8 psychology, 331 marauding terrorist firearms attacks, 20 scrotal injury, 326 types of scrotal reconstruction, 327 handgun, 9 testicular rupture, 327 rifles, 9–10 testicular salvage, 326 shotguns, 9 traumatic dislocation, 328 Focused assessment aonography in trauma ultrasonography, 325 (FAST), 102 wound contamination, 326 Fogarty catheter, 269 Eye injury, 215, 220, 224, 226–230 Foley catheter, 244 anatomy, 216 Footprint, 24 anterior segment injuries Foreign bodies (FB), 106, 209, 228 cornea, 228 Forensic aspects, 416 epithelial defects, 229 bloody garments, 430 foreign bodies, 228 bullets/projectile fragments, 430 funus, retina and optic nerve, 230 bullet-wipe residue, 429 hyphaema, 227 cartridge cases, 430 lens, 228 chain of custody, 431 ocular surface burns, 229 clothing of victims, 429 pupils, 227 deceased gunshot victim, 430–433 red reflex, 227 deformed sharp-edged bullets, 430 classification, 217 emergency personnel, 429 evisceration, 233 firearms and ammunition, 412, 413 examination GSR testing, 428 fundoscopy, 220 and gunshot wound appearances swinging torch test, 220 entrance wounds, 416 visual acuity, 220 penetrating wound, 416 eyelid injury, 223, 224 perforating wound, 416 history, 219 informational evidence, 427 lateral canthotomy and interior injurious explosions, 431, 432 cantholysis, 233 kinetic energy transfer, 414, 415 lid lacerations, surgical management, 231 physical evidence, 428 530 Index

Forensic aspects (cont.) Hepatitis B virus (HBV), 31 propellant residue and soot, 429 Heterotopic ossification (HO), 500 retrieved projectile, 430 HIV, 31, 32 SEM-EDX GSR trace analysis, 429 Hollow point (HP) bullets, 16 surgical debridement, 429 Human factors trace evidence, 428 AT-MIST handover, 351 wound ballistics, 412–414 Command Huddle, 353, 354 Formal percutaneous angiography, 262 critical care team, 354 Fragmentation damage control resuscitation, 348 anti-personnel mines, 23 decision making and communication, 352 artillery, 25 description, 347 classification, explosive devices, 22 fixation errors, 352 cluster munitions, 24–25 healthcare setting, 347 grenades, 22–23 management tasks, 352 IED, 26 multi-professional team-working, 348 injury, head, 391, 398 non-technical skills frameworks, 347 retained ordnance within casualty, 26–27 patient approach, 351 Frangible bullets, 18 patient arrival, 351 Fresh whole blood (FWB), 120 SIT REPS (situation reports), 354 Full Metal Jacket (FMJ), 16–17 snap brief, 354 Fundoscopy, 220 trauma team activation criteria, 349 Funus, 230 trauma team leader, 350 UK National Health Service Trauma Team, 350 G Hyperkalaemia, 119 Gabapentin, 147 Hyphaema, 227 Gabapentinoids, 147 Hypocalcaemia, 119 Gas expansion, 460, 461 Hypoperfusion, 114 Gastrografin®, 263 Hypothermia, 113, 118 Geneva conventions and international Hypoxia, 460 humanitarian law, 392 Genitourinary trauma bladder injury, 310 I blunt trauma, 310 Imaging, 95, 105–108 cross sectional imaging, 310 CT traumagram, 97–100 military conflicts, 309 imaging multiple casualties, organ injury, 310 108–109 Glasgow Coma Scale (GCS), 178, 184, 193 injury patterns Gun, 25 foreign bodies, 106 Gunpowder, 8 junctional injuries, 105 Gunshot wounding (GSW), 36, 38, 39 operation, 106–107 paediatrics, 108 pregnancy, 106 H MRI, 104 Haemostatic agents, 241 orbital ultrasound, 103–104 Haemostatic resuscitation (HR), 115 plain film, 101–102 massive transfusion protocols, 115 trauma algorithm, 95–97 targeted resuscitation, 117 ultrasound, 102–103 Haemothorax, 159 Immunological etiology, 329 Handgun, 9 Impact brain apnoea (IBA), 193 Hard-contact gunshot wound, 418 Improvised explosive device (IED), 26, 27, 30, Hazardous area response and incident teams 178, 238 (HART), 79 Infectious keratitis, 229 Helmets, 49, 50 InfraRed devices, 186 Hemorrhage control, 82 Injury patterns Index 531

foreign bodies, 106 Magnetic resonance imaging (MRI), 104, 188 junctional injuries, 105 Maintenance fluids, 369 operation, 106 Major Incident Medical Management and paediatrics, 108 Support (MIMMS) training manual, pregnancy, 106 63, 75 Interior cantholysis, 233 Major trauma networks (MTNs), 183 Intermaxillary fixation (IMF), 248 Mandible-specific devices, 247 Intermediate ballistics, 13 Marauding terrorist firearms attack (MTFA), Intermediate-range wounds, 419, 420 63, 76–79, 108, 135, 463 Internal ballistics, 13 Masquelet technique/induced membranes, 486 Intracranial pressure (ICP), 188 Mass casualty incidents, 394, 396 Intraoccular foreign body (IOFB) Massive transfusion protocols, 115 injuries, 217 Maxillofacial and cervical trauma, 368 Intravenous anaesthesia, 130 Medical coverage, 50 Methoxyflurane, 144 Military body armour, 49 J Military facial fractures, 245 Jackson model of burns, 338 Military injuries Joint Emergency Services Interoperability epidemiology, 358 programme (JESIP), 76, 84 medical infrastructure, 358 patterns of, 358–360 predeployment training, 393 K Military personal armour systems Ketamine, 142 combat helmets, 54 Kidney organ injury scoring system, 311 ECBA, 51 Kinetic energy (KE), 36, 40 eye protection, 56 Knee disarticulations (KD), 498 OSPREY system, 52 pelvic protection, 54 VIRTUS, 52 L Military, trauma management, 446, 447 Laparoscopy, 165 Miniplate osteosynthesis, 250 Laparotomy, 165 Mk6 combat helmet, 54 Laryngo-tracheal injuries, surgical treatment, Mobile Neurosurgical Unit (MNSU), 177 270 Modified Early Obstetric Warning Score Laser injury, 231 (MEOWS) charts, 378, 379 Lateral canthotomy, 233 Modified Physiological Triage Tool (MPTT), Lead poisoning, 207 72 Lens, 228 Morphine, 139 Lethal triad, 113 Mortar, 25 Lid lacerations, surgical management, 231 Multiple Launch Rocket Systems Lidocaine, 132 (MLRS), 23 Limbal ischaemia, 229 Musculoskeletal trauma, 385 Limb injuries Mushrooming/expanding bullets, 16 formal exploration, 367 Muskets, 9 fragmentation, 367 Myodesis, 495 Low energy-transfer injury, 167 Myoplasty, 495 Lower-extremity amputation project (LEAP), 498 N National Ambulance Resilience Unit M (NARU), 65, 80 M67, 22 National Institute of Health and Care Magazine, 13 Excellence (NICE), 183 Magnetic resonance angiography Needle pericardiocentesis, 160 (MRA), PNI, 263 Neonatal anaemia, 383 532 Index

Neuroimaging, 185 Open globe injury Neurological rehabilitation assessment, 224 cognitive deficits, 517 imaging, 224 comprehensive assessment, 517 management, 226 concomitant injuries, 519 Open Tip Match (OTM), 16 healed split skin grafts, 518 Ophthalmic injury. See Eye injury injury severity scores, 518 Opioid, 138 knee disarticulation, 519 analgesia, 130 limb salvage/amputation, 518 Optic nerve, 230 management, 517 Orbital compartment syndrome, 223 mild traumatic brain injury, 517 Orbital injuries, 222 neuropathic pain, 520 Orbital ultrasound, 103 peripheral nerve injury, 520 OSPREY system, 52, 60 phantom pain control, 520 Osseointegration (OI), implant, 500 polytrauma and amputation, 521 post-operative oedema, 519 psychological status, 520 P stump length, quality and scarring, 518 Paediatric trauma bay, 362 trans-tibial amputation, 518, 519 Pain, 133, 134, 140, 141 vocational assessment, 517 recognition, assessment and treatment, Neuropathic pain, 135 136–138 New Triage Sieve, 69 relief, importance, 135–136 NGO environment, 397–400, 402, 403, types of, 134–135 405–408 Pancreatic injuries, 166 vs. military environment, 393 Paracetamol, 146 prehospital care, 392 Patient management, NGO, 392 resuscitative thoracotomy, 401, 402 Pediatric massive hemorrhage resuscitation surgical management protocol, 366 abdominal injuries, 402, 405 Pedicle avulsion/major segmental arterial head examination, 397–399 injury, 313 limb injuries, 405, 406 Pelvic protection system (PPS), 54 massive arterial and venous Penetrating head injuries (PHI), injuries, 403 175, 176 neck injuries, 399 ballistics-neurosurgical severe burns, 406, 407 considerations, 178 soft tissue injuries, 406 in children, 368 thoracic injuries, 400 infection in, 189 training, 408 prognosis, 193 team work, 393 surgical management, 190 Nociceptive pain, 135 surgical treatment, 191 Non-steroidal anti-inflammatory drugs Penetrating neck injury (PNI), 257, 258, (NSAID), 146 266–271 Novel oral anticoagulants (NOAC), 119 angiography, 262 Numerical rating scales (NRS), 136 CTA, 260 Nutation, 15 DCS, 259 Nutrition, 369 laryngo-tracheal injuries, surgical treatment, 270 management, 264–265 O oesophageal injuries, surgical Ocular surface burns, 229 treatment, 271 Ocular trauma scoring, 217 operative surgical approaches Oesophageal injuries, surgical treatment, zone I, 266 260, 271 zone II, 267–268 Oesophagoscopy, 263 zone III, 268–269 Index 533

physical examinations, 260 body armour, 57–58 potential airway injury, investigations police helmets, 58 for, 263 Plasminogen activator inhibitor (PAI), 114 potential oesophageal injury, investigations Plate osteosynthesis, 480 for, 263–264 Platelet dysfunction, 114 pre-hospital haemostatic agents, 259 Police body armour, 51, 57 trajectory determination, 264 Police helmets, 58 ultrasound and MRA, 263 Polytetrafluoroethylene (PTFE) grafts, 269 vascular injury Posterior mediastinum, 161 surgical treatment, 268 Postpartum haemorrhage (PPH), 383 treatment, 270–271 Potential airway injury, PNI, 263 Penetrating spinal injuries, 201–207 Potential oesophageal injury, 263 anatomy and pathophysiological parts, Precession, 15 204–205 Pre-deployment training, 361 lead and copper poisoning, 207 Pregabalin, 147 shock, 206–207 Pregnancy, trauma, 378, 380–384 stability, 205–206 abruption, 373 types, 205 AFE, 385 assessment and initial treatment, 207–208 air embolism, 385 definitive care, 208 anatomical changes, 374, 376–378 historical perspective and epidemiology, caesarean delivery, 382 202 DIC, 385 civilian data, 202 gastrointestinal changes, 376 military data, 202–203 haemorrhage control twenty-first century, 203–204 APH, 383 investigations, 208 interventional radiology, 384 management goals, 207 PPH, 383, 384 non-surgical management, 210–212 initial management outcomes, 211 primary survey, 378, 380 surgical management, 208–211 secondary survey, 381, 382 Penetrating wound, 181 intermittent partner violence, 373 Penthrox, 144 management, 388 Peripheral nerve blocks, 131 manual uterine displacement, 376 Permanent cavity, 38 maternal collapse, 386, 387 Permissive environment, 81 modified B Lynch suture, 384 Permissive hypotension (PH), 114 mortality rate, 373 Personal armour, 47, 49–52, 54–58 musculoskeletal, 385, 386 BABT, 59 neonatal team, 387 coverage and sizing patient management, 374 military body armour, 49–50 physiological changes, 374, 375 police body armour, 51 plasma volume, 374 UK military helmets, 50 resuscitation, 387, 388 materials, 48–49 structured laparotomy military and civilian, 48 intraoperative cell salvage, 382 military personal armour systems vaginal birth, 382 combat helmets, 54–56 Primary Care Rehabilitation Facilities, 507 ECBA, 51 Primer, 11 eye protection, 56 Pringle manoeuvre, 154, 165 OSPREY system, 52 Projectiles, 16, 36, 41–45 pelvic protection, 54 anatomic injury patterns, 39–40 VIRTUS, 52 expanding and semi jacketed bullets, removal of, 60 16–18 types of, 48 FMJ, 16 UK police armour systems frangible bullets, 18 534 Index

Projectiles (cont.) Renal replacement therapy, 440 permanent cavity, 38–39 Resuscitative Endovascular Balloon shockwave, 36 Occlusion of the Aorta temporary cavity, 37 (REBOA), 295 tissue injury patterns, 40 Resuscitative thoracotomy, tissue density, 42–45 401, 402 tumbling and fragmentation, 41–42 Retina, 230 Proprietary negative pressure dressings, 168 Rifles, 10 Prosthetic fitting Rotary wing aircraft, 447, 450 ankle and foot, 515 Rotational thromboelastography, 365 axial units, 516 Royal Air Force (RAF), 447 endoskelatal form, 514 gait cycle, 515 hip disarticulation, 516 S knee joints, 515, 516 Selective non-operative management prosthetic limb, 516 (SNOM), 164 residual limb volume, 516 Self-aid, 81 socket shape, 515 Semi jacketed bullets, 16 suspension, 515 Severe genital blast injury, 309 trans-femoral amputee, 515 Shock, 206 Pseudo-addiction, 138 Shock wave, 36, 178 Pseudo-gunshot wound, 424, 425 Shotguns, 9 Pseudo-soot blackening effects, 424 wounds, 425, 426 Public Order Helmet, 58 Simple pneumothorax, 159 Pupils, 227 Simple Triage And Rapid Treatment (START) triage system, 69 Sit Rep, 158 R Skeletal reconstruction, 476, 480–482, Rapid sequence induction (RSI), 81, 90, 485, 486 126, 127, 290 antibiotics, 477 Red reflex, 227 cephalosporin, 478 Regional anaesthetic (RA), 130–132 corticotomy, 487 Relative afferent pupillary defect damage control orthopaedics, 479 (RAPD), 220 dead space management, 479 Relative emergencies (RE), 2 definitive fixation, 479, 480 Re-look laparotomy, 167 dermal substitutes and acellular Renal injuries matrices, 479 active bleeding, 312 epidemiologic studies, 473 angioembolisation, 313 exploratory laparotomy, 474 angioembolisation/arterial stenting, 311 external fixation, 483 collecting system injury, 312 fasciotomies, 479 complications, 316 immediate prehospital care, 476 cross sectional imaging, 313 injury characteristics, 473 diagnosis, 311 internal fixation, 479 entry and exit wounds, 313 intraarticular fracture CT, 477 in hospital conservative management, 315 intra-articular proximal tibia operative management, 315, 316 fracture, 485 pedicle, 313 low-velocity gunshot wound, 475 preservation, 315 operative stabilization, 477 primary embolization, 312 peri-articular injuries, 474 renorrhaphy, 315 stabilization retroperitoneal tamponade, 311 bone loss, 485, 486 staging, 311 external fixation, 482 urinary leakage, 312 intramedullary nails, 481 vascular, 316 plates, 480 Index 535

surgical exposures, 480 T temporary techniques, 476 Tactical Emergency Medical Support temporary skeletal stabilization, 474 (TEMS), 79 topical negative pressure wound Tactical field care (TFC), 81 dressings, 478 Tangential wounds, 180 trauma and life-support guidelines, 477 Targeted resuscitation, 117 vascular repair, 475 Temporary abdominal closure, 167 Small arms, 7 Temporary cavitation, 37, 38, 415 Snap Brief, 157 Tenon’s capsule, 216 Soft armour, 48 Tension pneumothorax, 158 Soft point bullets, 18 Terminal ballistics, 13, 36 Soft tissue reconstruction Terrible injuries, 370 abdominal closure, 469 Terrorist attacks, 3–4 components separation technique, 470 Testicular atrophy, 330 free tissue transfer anastomotic Testicular prosthesis, 331 patency, 464 THREAT, 76 free tissue transfer/local flaps, 466 Thromboprophylaxis, 439 limb salvage, 466, 467 Tissue density, 42 medical photography, 466 Tissue injury patterns, 40 microbiological control, 464 Tolerance, 138 microsurgical free tissue transfer, 465 Tramadol, 144 multidisciplinary team, 466 Tranexamic acid (TXA), 113, 118, 184 muscle/tendon injuries, 468, 469 Transarterial embolisation, 270 nerve injuries, 467, 468 Trans-femoral amputation, 498 open fractures, 466, 467 Transfer, trauma patients, 452–458 patient’s nutritional status, 464 by air, 449, 450 physiological optimisation, 464 critical care, 450, 451 physiological, psychological and logistical administrative elements, 457 constraints, 465 aeromedical transfer environment, 452 rehabilitation programmes, 464 central venous cannulation, 453 thumb amputation, 469 electromagnetic interference, 452 tissue excision and wound equipments, 452 contaminants, 465 in-flight care, 458 toe to hand transfer, 469 intracranial pressure, 453 trauma management, 464 monitoring, 452, 453 Specialist children’s hospital, 370 patient preparation, 456, 457 Sperm and testicular tissue rechargeable battery cryopreservation, 330 technology, 454 Splenic injuries, 166 supplemental oxygen, 455 Stab attacks, 48 ventilators, 455, 456 Sternocleidomastoid (SCM) muscle, 257 by land, 449 Sternotomy, 161 Transtibial amputation, 499 Steroids, 211 Trauma team leader (TTL), 126 Subfertility, 330 Traumatic brain injury (TBI), 179 Suicide bombing, 29–30 Traumatic optic neuropathy, 231 attack, 394 Triage, 63 biological foreign body implantation ballistic injury, 80 and blood borne virus casualty labeling, 70–71 infection, 31 guidance, 72 guidance and ethico-legal considerations, history, 64–65 31–32 Modern Day triage, 64–65 security and forensic issues, primary, 68–70 30–31 principles, 65–68 Surgical humanitarian intervention, 391 secondary, 70 Swinging torch test, 220 systems research, 71–73 536 Index

Triage Sort, 70, 72 definitive repair of vessels, 287, 288 Tricyclic anti-depressants (TCADs), 147 dressings/drain material, 288 Tumbling, 41 internal carotid artery ligation, 286 large venous and neurological injuries, 288 U portal vein ligation, 286 UK police armour systems principles, 279 body armour, 57 proximal and distal control, 283, 284 police helmets, 58 thoracotomy, 283 Ultrasound, 102 data collection and record keeping, 275 Unexploded Ordnance (UXO), 25 decision making process, 289 Uppsala Conflict Data Programme, 357 diagnosis and management, 296 Urban mass casualty incidents, 450 diagnostic angiography, 280 Ureteral injuries endovascular management, 296, 298 clinical signs, 316 formal contrast angiography, 279 management, 317 haemorrhage, 276, 278 reconstruction, 317 haemostatic agents, 281 segmental defects, 317 hard and soft signs, 278 ureteric repair selection, 318 incidence, 275 ureteroureterostomy, 318 initial assessment, 277 Ureteric organ injury scoring system, 317 long term management, 303 multi-detector CT angiography, 280 neck trauma V algorithm, 290 Vacuum pack, 168 complications, 292 Vascular injury signs and symptoms, 289 surgical treatment, 268 zones of injury, 291, 292 treatment, 270 pathophysiology, 275 Vascularised composite allotransplantation patient physiology, 275 (VCA), 253, 470 pelvic region and groin, 296 Vascular trauma management, 279, 283–294, penetrating trauma, 276 299–303 plain chest X-rays, 279 abdominal trauma prehospital intervention, 276, 289 inferior vena caval injuries, 294 REBOA, 295 medial visceral rotation, 294 skeletal fixation, 296 supra coeliac aortic control, 294 thorax, 293 surgical repair, 293 toolkit, 303 algorithm, 298 tourniquet use, 280, 281 catastrophic haemorrhage, 275, 293 treatment algorithms, 276 Clamshell thoracotomy, 293 types of, 277 clinical features, 276 wound management, 282 Color flow duplex, 280 Vasopressors, 211 complications Vertebral artery injuries, 269 compartment syndrome, 299 Victims, 2 dressings after fasciotomy, 302 VIRTUS helmet, 50, 56, 60 foot fasciotomy, 300 Visual acuity, 220 lower limb fasciotomy, 299 Volatile gases, 130 reperfusion injury, 302 traumatic arteriovenous fistulae, 303 upper limb fasciotomy, 301 W damage control vascular surgery Weaker opioids, 137 amputation vs. limb salvage, Wound ballistics, 36 286, 287 Wound management antibiotic use, 288 antibiotics, 342 arterial shunts, 285, 286 benefits, 339 Index 537

conceptual model, 338 patient’s immune system, 338 excision, 339 pressure saline irrigation, 343 healthy dressings, 342, 343 splints, 343 high energy vs. low energy gunshot surgical treatment, 338, 343 wounds, 340, 341 tissue excision, 338 hyperaemia, 339 TNP dressings, 343 irrigation, 341 longitudinal incisions, 339 necrotic tissue, 339 Z neurovascular structures, 340 Zygomatic injuries, 222