The Hip book

9. Fogarty Catheter Use

CPT David Crawford MAJ Joanna Branstetter Insert catheter into thrombosed vessel proximal to area of thrombus. The vessel should be clamped proximal to catheter insertion. Inflate the balloon once distal to the thrombus and remove catheter and thrombus. The view(s) expressed herein are those of the author(s) and do not reflect the official policy or … Read more

8. Vascular Shunt

CPT David Crawford MAJ Joanna Branstetter I. Patient Preparation             A. Always prep to allow access for proximal vascular control                         1. upper extremity: subclavian artery                         2. lower extremity: common femoral artery             B. Preparation should include access to uninvolved limb in case vein graft is needed to be harvested             C. Systemic heparinization (50-75 … Read more

7. Cut-down for Vascular Access

CPT David Crawford MAJ Joanna Branstetter Cutdown for vascular access: Locate the saphenous vein along the anteromedial distal tibia. Incise skin overlying the vein and insert 18-G catheter. The view(s) expressed herein are those of the author(s) and do not reflect the official policy or position of Brooke Army Medical Center, the U.S. Army Medical … Read more

6. Soft Tissue Coverage (Austere Environment) — Flaps and Vacuum-Assisted Closure (VAC)

COL Richard Pope MAJ Michelle Fontaine CPT Charles Grooters I. Soft Tissue Coverage in Austere Environment             A. Normally best performed in controlled environment with availability of microscope or loupe magnification             B. In rare circumstances, surgeons may need to perform soft tissue coverage procedures in austere environment when evacuation to higher echelon of care not feasible             … Read more

5. Escharotomy

CPT Daniel J. Stinner, M.D.   Introduction (see figure 3) Typically performed at bedside under sterile condition with IV sedation using electrocautery Can also be performed in operating room if immediate access available Electrocautery has added benefit of haemostatic control, but if unavailable, scalpel can be used General principle to make surgical incisions through burned eschar to … Read more

4. Fasciotomy

CPT Brendan Masini, MD I. Onset of Tissue Injury             A. Muscle and nerves may survive up to 4 hours of ischemia without development of irreversible damage             B. Nerves may have neuropraxic damage at 4 hours, however greater ischemic time will produce irreversible injury including axonotmesis at 8 hours II. Indications for Fasciotomy in Austere Combat … Read more

II. Battlefield/Austere Environment Trauma Systems (continued 2)

Dr. Brandon Horne Dr. Benjamin Kam, LtCol, AF E. Demonstrate the ability to determine extremity care logistical needs for a health care operation I. Introduction             A. Logistical needs for extremity care run gamut from surgical supplies for extremity trauma to inpatient musculoskeletal nursing and therapy to outpatient clinic supplies and durable medical equipment to prostheses             … Read more

II. Battlefield/Austere Environment Trauma Systems (continued 3)

II. Battlefield/Austere Environment Trauma Systems (continued) Dr. Brandon Horne Dr. Benjamin Kam, LtCol, AF F. Describe the fundamentals of safe transport of patients with extremity wounds I. Stabilization II. Critical Components of Safe Transport of Extremity Wounds             A. Cessation of bleeding             B. Prevention of further injury                         1. stabilization of fractures                         2. … Read more

3. External Fixation of Upper Extremity/Lower Extremity/Periarticular Fractures with Limited Resources (no X-ray)

CPT Jessica D. Cross CPT Daniel R. Possley I. Introduction             A. External fixation may be performed in austere environment without use of fluoroscopy             B. Ideally, pins should be placed to minimize impact on future internal fixation II. Pin Placement             A. Should be performed as follows (see femoral external fixation placement video) External Fixation – Joe … Read more

VI. Compartment Syndrome in an Austere Environment

CPT Brendan Masini, MD     A. Define compartment syndrome and describe the diagnostic limitations presented by an austere environment   I. Acute Compartment Syndrome             A. Occurs when pressure within myofascial compartment exceeds threshold perfusion gradient across capillary beds                         1. if unchecked, leads to tissue hypoxia and cell death                         2. ischemia and necrosis … Read more

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