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of military traumas: teaching workbook on Combat Surgery for 5th year
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CONTENTS ?. GENERAL QUESTION OF MILITARY TRAUMA 8 I. ORGANIZATION OF SURGICAL CARE IN ARMY AND
IN EMERGENCY SITUATIONS 8 1. Definition and content of military surgery 8
2. Main stages of military surgery development 8
3. N. Pirogov - the founder of scientific military surgery 9
4. Role of surgeons in a modern system organization of evacuation
and levels of medical care 9
5. Development of military surgery in postwar (WW II) period 9
6. Perspectives and future of combat surgical care 10
7. Modern combat trauma 10
8. General characteristics of modern weapons 11
9. Influence of modern gunshot wounds on medical care organization 11
10. Possible structure of mortality in modern warfare and its
variability 13
11. Medical care in evacuation echelon 13
12. Role of the triage in medical care organization 14
13. Organization of surgical care in an emergency is an urgent problem
of military surgery nova days 15 II. Gunshot wound and principles of its treatment on medical care levels
16 1. Modern types of firearms 16
2. Wound ballistics and mechanisms of projectile impact 16
3. Mechanism of gunshot injury. Morphological and functional changes
in tissues 17
4. Features of harmful effect of modern firearms, mine and other
explosive weapons 17
5. Zones of tissue damage in gunshot wound. Morphology of wound
canal (entrance or exit wounds, zone characteristics) 17
6. Concept of primary and secondary wounds microbial contamination 19
7. Early prevention of infectious complications 19
8. Medical care in gunshot wounds on the battlefield and in evacuation
echelons. Wound Care. Recent views on surgical debridement 20
9. Indications and contraindications for debridement 21
10. Wound Management after Initial Surgery. Early, delayed and late
debridement 22
11. Primary and secondary wound healing. Ways to close gunshot
wounds after debridement. Primary, primary delayed and secondary
(early and late) sutures. Conditions for the use of a primary suture 22
12. The most common errors in the surgical debridement 22
B. COMPLICATIONS IN MILITARY TRAUMA 23 III. INFECTION COMPLICATIONS IN GUNSHOT WOUNDS.
TETANUS 23 1. Concept of wound infection 23
2. Factors contributing to the development of wound infection 23
3. The wound Microenvironment 23
4. Local purulent infection 24
5. Prophylactic and therapeutic value of antibiotics 25
6. Treatment of infectious complications in gunshot wounds on medical
evacuation levels 26
7. Anaerobic infection of wounds 27
8. Terms of the appearance, symptoms and signs 27
9. Characteristics of different clinical forms 28
10. Prevention of anaerobic infections 28
11. Specific and nonspecific treatment at medical care echelon 28
12. Outcomes of treatment 29
13. Anaerobic non-clostridial (decay) wounds infection 29
14. Tetanus, its etiology and pathogenesis 30
15. Tetanus symptoms and signs 31
16. Diagnosis, prevention and treatment guidelines for tetanus 32
17. Complications and outcomes 32 IV. BLEEDING, BLOOD LOSS 33 1. Calculating methods for determining the volume of blood loss 33
2. Vascular injury 34
3. Treatment on medical care levels 35
4. Methods of temporary and final bleeding arrest 35
5. Indications for blood transfusion 36
6. Classification of transfusion solutions and blood products,
indications
for their use 36
7. Possible complications of blood transfusion, prevention and
treatment 38 V. TRAUMATIC SHOCK 39 1. Definition of traumatic shock. Frequency and severity of shock
state in the war 39
2. Resent views on traumatic shock etiology and pathogenesis 39
3. Clinical shock manifestations in different locations of wounds 40
4. Value of modern anesthesiology achievements and resuscitation
management in treating shock state 40
5. Modern corrective methods of hemodynamic and respiratory disorders
40
6. Content of antishock measures on medical care echelon 41
7. Early prevention of shock state 42
VI. CRUSH SYNDROME 42 1. Crush syndrome pathophysiology 42
2. Classification. Dependence of clinical manifestations from the
volume
of damaged tissue, compression strength and duration 44
3. Stage 45
4. Clinic 45
5. Treatment at medical care echelon 45 ?. SPECIAL TYPES OF MILITARY TRAUMA 49 VII. INJURIES OF THE HEAD 49 1. Frequency of open and closed injuries 49
2. Classification by injury nature and clinical manifestations 50
3. Clinical course and diagnostics 51
4. Complications 51
5. Primary care in head injuries on the battlefield 51
6. Content of primary medical and surgical care 51
7. Triage of the wounded in a skull 51
8. Organization of specialized surgical care 52 VIII. INJURIES OF THE SPINE 53 1. Classification of open and closed spine and spinal cord injuries 53
2. Symptoms and Diagnostics 53
3. Primary care on the battlefield 55
4. Content of primary medical and surgical care 55
5. Organization of specialized surgical care 55 IX. GUNSHOT WOUNDS AND CLOSED CHEST INJURIES 56 1. Frequency and classification of chest injuries 56
2. Clinical manifestations of different kinds in chest injuries, their
diagnostics 56
3. Hemothorax 57
4. Pneumothorax (closed, open, tension) 58
5. Subcutaneous and mediastinal emphysema 59
6. Pathophysiology features of these complications 59
7. Acute respiratory distress syndrome or acute lung injury 61
8. Late complications of chest gunshot wounds 62
9. Closed chest injuries 62
10. Multiple rib fractures with the formation of «?ostal valve» 63
X. ABDOMEN GUNSHOT WOUNDS AND CLOSED INJURIES 63 1. Frequency and classification of abdominal injuries 63
2. Clinical manifestations of open abdominal injury 64
3. Symptoms of abdominal penetrating wounds 64
4. Shock, hemorrhage and peritonitis, and their roles in penetrating
wound outcomes 65
5. Clinical picture of closed abdominal injuries 65
6. Diagnostics of penetrating wounds and closed abdominal injuries 66
7. Treatment of abdominal i