1. |
Necessity for rapid evacuation, with minimal stops, to the Forward Operating Centre.
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2. |
Resuscitation, if necessary, at the ADS, continued as an in-ambulance drip transfusion, but full resuscitation only just before operation.
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3. |
Operation preferably carried out at the CCS level.
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4. |
Operate without delay but only when optimum resuscitation by blood, plasma, and serum has been achieved.
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5. |
Urgent operation without full resuscitation is called for in continued intra-abdominal haemorrhage, traumatic amputation, and severe muscle injuries.
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6. |
Utilisation of an experienced senior surgeon for the diagnosis and listing of cases.
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7. |
Auscultation of the abdomen to eliminate possibility of intestinal injury and so save laparotomy.
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8. |
Use of the X-ray especially to localise foreign bodies in cases of diaphragmatic and retro-peritoneal injury, with a view to saving laparotomy.
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9. |
Routine catheterisation for diagnosis of urological injuries.
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10. |
Careful investigation with rectal examination for possible abdominal injury in wounds of the pelvis and buttocks.
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11. |
Provision of a suction apparatus.
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12. |
Provision of electric lighting-generally by mobile plants.
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13. |
Operation undertaken when the systolic B.P. reached 100 mm. Hg. and is rising. (80 mm. is the minimum level of operatability.)
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14. |
The necessity for highly trained anaesthetists and best available apparatus for these cases.
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15. |
The ample provision of young, well-trained surgeons in Mobile Field Surgical Units for attachment to forward operating units.
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16. |
Laparotomy preferably by a mid-line incision. Loin incisions for localised and renal injuries.
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17. |
Orderly examination of the abdominal organs.
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18. |
Simple, generally one layer, suture, of small intestine injuries. Resection avoided if at all possible.
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19. |
Exteriorisation of all severe lesions of the colon through a separate small incision.
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20. |
Suture of small simple wounds of the right colon. Drainage by Paul's tube, with early secondary closure, of more severe lesions.
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21. |
Proximal colostomy for lower sigmoid and all rectal injuries.
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22. |
Free perineal drainage for lower rectal wounds.
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23. |
Formation of spur for colostomy with care to prevent injury to the mesentery by the clamp during later closure.
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24. |
Conservative treatment of lesser liver and kidney injuries, the large majority of the cases.
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25. |
Nephrectomy when a wound of the colon complicates an open renal injury.
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26. |
Conservative treatment of the late abdomen.
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27. |
Drainage instituted when in doubt, and definitely for wounds of the colon, pancreas, duodenum, biliary passages, bladder, and retro-peritoneal injuries.
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28. |
Thoraco-abdominal exploration, unless the intestine is involved, preferably through the chest.
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29. |
Resuscitation just as necessary after operation as before operation.
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30. |
Gastric suction instituted till peristalsis definitely reestablished.
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31. |
Intravenous fluid given freely, 8 to 10 pints daily, after operation to combat dehydration and prevent the onset of anuria.
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32. |
Water given by mouth early and light nourishment, when possible, after forty-eight hours.
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33. |
Patient nursed in horizontal position following operation.
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34. |
Post-operative administration of plasma and later of high protein and vitamin diet.
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35. |
Administration of penicillin parenterally in all cases and also local application to the peritoneum and the wound.
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36. |
Evacuation from the forward operating centre to be delayed (especially in cases of wound sepsis) till full stability has been reached. Responsibility of survival placed on the forward surgeon.
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37. |
Closure of colostomy wounds as soon as possible.
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38. |
Conservative treatment of late sepsis with drainage of established abscesses.
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39. |
Burst wound always associated with infection of the wound and also of the peritoneum.
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40. |
Provision of body armour to protect the abdomen and chest is recommended.
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