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PEDIATRIC SURGERY AND MEDICINE FOR HOSTILE ENVIRONMENTS Kevin M. Creamer, MD • Michael M. Fuenfer, MD MY MEDI AR CA S L E D T E A P T A S R T D M E T E I N N T U B O E R T D TU EN INSTI Second Edition Pediatric Surgery and Medicine for Hostile Environments Second Edition Borden Institute US Army Medical Department Center and School Health Readiness Center of Excellence Fort Sam Houston, Texas Office of The Surgeon General United States Army Falls Church, Virginia i The test of the morality of a society is what it does for its children. —Dietrich Bonhoeffer (1906–1945) ii This book is dedicated to the military medical professional in a land far from home, standing at the bedside of a critically ill child. iii Dosage Selection: The authors and publisher have made every effort to ensure the accuracy of dosages cited herein. However, it is the responsibility of every practitioner to consult appropriate information sources to ascertain correct dosages for each clinical situation, especially for new or unfamiliar drugs and procedures. The authors, editors, publisher, and the Department of Defense cannot be held responsible for any errors found in this book. Use of Trade or Brand Names: Use of trade or brand names in this publication is for illustrative purposes only and does not imply endorsement by the Department of Defense. Neutral Language: Unless this publication states otherwise, masculine nouns and pronouns do not refer exclusively to men. The opinions or assertions contained herein are the personal views of the authors and are not to be construed as doctrine of the Department of the Army or the Department of Defense. For comments or suggestions on additional contents in forthcoming editions, please contact the publisher (www.cs.amedd.army.mil/borden). CERTAIN PARTS OF THIS PUBLICATION PERTAIN TO COPYRIGHT RESTRICTIONS. ALL RIGHTS RESERVED. NO COPYRIGHTED PARTS OF THIS PUBLICATION MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM OR BY ANY MEANS, ELECTRONIC OR MECHANICAL (INCLUDING PHOTOCOPY, RECORDING, OR ANY INFORMATION STORAGE AND RETRIEVAL SYSTEM), WITHOUT PERMISSION IN WRITING FROM THE PUBLISHER OR COPYRIGHT OWNER. Published by the Office of The Surgeon General Borden Institute Fort Sam Houston, Texas 2016 Library of Congress Cataloging-in-Publication Data Names: Creamer, Kevin M., editor. | Fuenfer, Michael M., editor. | Borden Institute (U.S.), issuing body. | United States. Department of the Army. Office of the Surgeon General, issuing body. Title: Pediatric surgery and medicine for hostile environments / senior medical and critical care editor, Kevin M. Creamer ; senior surgical editor, Michael M. Fuenfer. Other titles: Pediatric version of (work): Emergency war surgery (Borden Institute) Fourth United States revision. 2013. Description: Second edition. | Fort Sam Houston, Texas : Borden Institute, US Army Medical Department Center and School, Health Readiness Center of Excellence ; Falls Church, Virginia : Office of The Surgeon General, United States Army, 2016. | Includes bibliographical references and index. Identifiers: LCCN 2016049173 Subjects: | MESH: Emergencies | Wounds and Injuries--surgery | Child | Infant | Military Medicine | Handbooks Classification: LCC RJ370 | NLM WO 39 | DDC 618.92/0025--dc23 LC record available at Caution- https://lccn.loc.gov/2016049173 Printed in the United States of America 21, 20, 19, 18, 17, 16 5 4 3 2 1 ISBN 978-0-16-093629-6 F ro as el t yb eh S epu ir tn e edn tn fo D co mu e tn .U s S G , . evo r emn tn P ublishing O eciff 90000 I tn re en :t skoob t ro e . opg . vog enohP : lot l f eer ( 668 ) 215 - 0081 ; D C a er ( a 202 ) 215 - 0081 aF :x ( 202 ) 215 - 4012 aM :li S t I po CCD W , ihsa gn t no D , C 20402 - 1000 ISBN 978-0-16-093629-6 9 780160 936296 Foreword xi Prologue xiii Introduction xix Resuscitation and Critical Care 1 1. Basic Approach to Pediatric Trauma 3 2. Anesthesia 15 3. Vascular Access 27 4. Mechanical Ventilation 35 5. Transfusion Medicine 47 6. Hemodynamics and Shock 57 7. Managing Intracranial Pressure 65 8. Status Epilepticus 71 9. Care of the Newborn 75 10. Clinician-Operated Ultrasound 93 11. Aeromedical Evacuation 121 Surgery 129 12. Burns 131 13. Neurosurgery 153 14. Ophthalmology 175 15. Pediatric Dental Surgery 205 16. Face and Neck 217 17. Orthopedics 245 18. Thoracic Cavity 265 19. Vascular Surgery 279 20. Abdominal Wall, Peritoneum, and Diaphragm 291 21. Gastrointestinal Tract 313 22. Hepatobiliary Tract 355 23. Pancreas and Spleen 365 24. Genitourinary Tract 377 v Medicine 405 25. Basic Fluid and Electrolytes 407 26. Respiratory Emergencies 415 27. Cardiology 431 28. Gastroenterology 445 29. Infectious Diseases 455 30. Endocrinology 493 31. Common Neurological Problems 507 32. Hematology and Oncology 521 33. Pediatric Nephrology 543 34. Dermatology 549 35. Malnutrition and Emergency Nutrition for Sick or 577 Injured Infants and Children 36. Nursing Assessment 593 37. Behavioral Healthcare of Children in Austere 609 Environments 38. Pharmacotherapeutics 629 39. Bites and Stings 641 40. Hypothermia, Cold, and Heat Injuries 647 41. Casualties of Chemical, Biological, Radiological, 651 Nuclear, and Explosive Weapons 42. Children in Disasters 675 43. Humanitarian Operations and Medical 687 Civil-Military Activities Appendix A: Resources for Deployed Physicians Caring 705 for Children Appendix B: Contributors to First Edition 711 Appendix C: Comprehensive Pediatric Equipment 713 Sizing Table Author Biographies 717 Abbreviations and Acronyms xxvii Index xxxiii vi Pediatric Surgery and Medicine for Hostile Environments Senior Medical and Critical Care Editor Kevin M. Creamer, MD, FAAP Colonel, Medical Corps, US Army Retired Pediatric Hospitalist, Children’s National Medical Center, Washington, DC Associate Professor of Pediatrics, Uniformed Services University of the Health Sciences and George Washington University School of Medicine Senior Surgical Editor Michael M. Fuenfer, MD, FAAP, FACS Colonel, Medical Corps, US Army Reserve Assistant Professor of Surgery and Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland Associate Pediatrician, Massachusetts General Hospital, Boston, Massachusetts Instructor in Pediatrics, Harvard Medical School, Boston, Massachusetts Borden Institute Editorial Staff John H. Garr, MD, MSE, FACEP Colonel, MC, US Army Director and Editor in Chief Ronda Lindsay Douglas Wise Volume Editor Layout Editor Joan Redding Managing Editor vii viii Editorial Board Thomas R. Burklow, COL, MC, US Army Mary J. Edwards, COL, MC, US Army Patrick W. Hickey, LTC, MC, US Army Brian F. Gilchrist, MD Marc S. Lessin, MD, JD Bruce A. Ong, LTC, MC, US Army Peggy Rahbani, PharmD Cynthia H. Shields, COL, MC, US Army (Ret) Steven E. Spencer, COL, MC, US Army Christopher M. Watson, CDR, MC, US Navy Martin E. Weisse, COL, MC, US Army Contributors Calliope Allen, CDR, MC, US Navy Kelly A. Bear, MAJ, MC, US Army Matthew A. Borgman, LTC, MC, US Army Mark E. Boston, COL, MC, US Air Force Mark W. Burnett, COL, MC, US Army Benjamin B. Cable, COL, MC, US Army Charles W. Callahan, COL, MC, US Army (Ret) Debora S. Chan, PharmD Theodore J. Cieslak, COL, MC, US Army (Ret) Margaret E. Clark, CPT, MC, US Army Stephen J. Cozza, COL, MC, US Army (Ret) Kevin M. Creamer, COL, MC, US Army (Ret) David H. Dennison, LTC, MC, US Army Mary J. Edwards, COL, MC, US Army Colleen M. Fitzpatrick, LTC, MC, US Air Force Michael M. Fuenfer, COL, MC, US Army Gregory H. Gorman, CAPT, MC, US Navy Brian P. Green, MAJ, MC, US Army John Hanna, DDS Patrick W. Hickey, LTC, MC, US Army Peyton H. Hurt, COL, MC, US Army Romeo C. Ignacio, Jr, CAPT, MC, US Navy David Jarrett, COL, MC, US Army (Ret) Jefferson W. Jex, LTC, MC, US Army ix Dwight C. Kellicut, III, COL, MC, US Army Brent L. Lechner, LTC, MC, US Army Martha K. Lenhart, COL, MC, US Army Douglas A Lougee, COL, MC, US Army Jamie Mancuso, LTC, MC, US Army Ashley Maranich, LTC, MC, US Army Renee I. Matos, MAJ, MC, US Air Force Joseph W. May, MAJ(P), MC, US Army Randell R. McCafferty, COL, MC, US Air Force Thomas C. Newton, COL, MC, US Air Force Scott A. Norton, COL, MC, US Army (Ret) Bruce A. Ong, LTC, MC, US Army James Palma, CDR, MC, US Navy Dina Parekh, LTC, MC, US Army Timothy M. Phillips, LTC, MC, US Air Force Thomas A. Pluim, CDR, MC, US Navy William R. Raymond, COL, MC, US Army (Ret) Katherine I. Schexneider, CAPT, MC, US Navy Robert L. Sheridan, COL, MC, US Army Cynthia H. Shields, COL, MC, US Army (Ret) James B. Solomon, LCDR, MC, US Navy Steven E. Spencer, COL, MC, US Army Robert Steelman, MD, DMD Frederick J. Stoddard Jr, MD Erik Su, MD Christopher M. Watson, CDR, MC, US Navy Martin E. Weisse, COL, MC, US Army Luke A. Zabrocki, CDR, MC, US Navy Kathryn L. Zahner, RN x Foreword The top priority for the Joint Health Services Enterprise is readiness and health. In support of Combatant Commanders, a key component of readiness is the ability to deploy responsive medical capabilities: these include the provision of medical care to the full spectrum of patients that may present to our deployed medical facilities. Traditionally, military planning for medical support of combat operations has not included provisions for pediatric care. However, in response to unexpectedly large numbers of children presenting to US military medical facilities for treatment in the Iraq and Afghanistan theaters, the Borden Institute published a book, based on the pediatric experiences of deployed providers, that would serve as a basic reference for providers of pediatric care in practice environments with limited resources. The 2010 edition of Pediatric Surgery and Medicine for Hostile Environments significantly enhanced the ability of deployed military physicians whose scope of practice is primarily limited to adults in diagnosing and treating many of the most common medical and surgical conditions of childhood.
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