Trauma, War, and Managing Vascular and Orthopedic Injuries

Abstract

The anesthetic evaluation and management of wartime casualties differs from routine trauma in the USA and developed countries as compared to the lesser developed countries (LDC). Focusing on key similarities and differences between the LDC patient population and care environment in the developed world, a review of injury patterns for different patient groups, including orthopedic and vascular injuries, is presented. There is also a review of preoperative considerations, beginning with initial intake of the patient, airway management, and resuscitation with blood products, along with the intraoperative phase emphasizing the concepts of damage control surgery and damage control resuscitation, as well as maintenance of anesthesia. An examination of the postoperative period includes both management and medical evacuation considerations. The indications for blood products and adjunctive agents are reviewed. The implications of regional anesthesia for pain management in the wartime environment are also considered.