Principles and Practice of Trauma Care SK Kochar
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1Principles and Practice of TRAUMA CARE2
3Principles and Practice of TRAUMA CARE
Second Edition
SK KocharMS (Gen Surg) Formerly Senior Adviser and Head Department of Surgery Army Base Hospital New Delhi, India Past President Indian Association of Traumatology and Critical Care
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Principles and Practice of Trauma Care
First Edition: 1998
Second Edition: 2013
9789350257173
Printed at
5Contributors
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7Preface to the Second Edition
Till recently, trauma was limited to military precincts and trauma care evolved under constraints of military operations. Slow and difficult evacuation, poor lighting and operative conditions, nonavailability of diagnostic aids, inadequate and irregular supply of blood, paucity of potent antibiotics, primitive intensive care facility, transient patient and surgeon population were some of the controlling factors for safe and staged procedures to evolve. Stress was to save the life and limb, and the morbidity took the back seat. Principles of trauma surgery learned and practiced during war became the Bible for surgeons in civil practice, who, as such, had sporadic exposure to trauma care.
However, the scene has changed. Wars have become far and few, industrialization, increased road traffic accidents, upsurge of violence and terrorism have brought trauma at the doorsteps of the surgeon whether he is at subdistrict hospital or in a university hospital. Simultaneously, with it has evolved, rapid evacuation, energetic resuscitation, easy availability of blood, good paraoperative care, ideal operative conditions, potent antibiotics, widespread use of diagnostic peritoneal lavage and ready availability of ultrasonography (USG) and computed tomography (CT) scan. These developments are responsible for the current trends in trauma care. Older concepts have been challenged and new methods of treatment have been advocated, leaving the poor surgeon in a dilemma. The aim of this book is to steer clear of controversies and present a balanced view. It was intended to be a single author effort; but, I soon realized that in this era of superspecialization, multidisciplinary approach is the order of the day. My colleagues in the Armed Forces Medical College and trauma experts in the civil services soon joined hands and we produced the first edition in 1998.
Since the first edition, there have been increasing understanding the need of organizing and providing trauma care. Prehospital and inhospital trauma care is finding its way into planning 8of health care, diagnostics had a quantum jump. Computed tomography (CT) scan and magnetic resonance imaging (MRI) are easily available and affordable. Ambulances have improved. Noninvasive investigations and nonoperative management is making headway; endoscopy and laparoscopy are being added to the trauma surgeon�s armamentarium. All these changes have necessitated the need of second edition. Few chapters have been written by new authors and few new chapters have been added.
I am grateful to Professor (Brig) Gurjit Singh, Professor Siddharth Pramod Dubhashi, Dr (Col) SV Kotwal, Dr Alok Kumar Jha, Dr (Col) Kumud Rai, Dr (Brig) PK Sahoo, Dr (Brig) VK Sinha, Professor PM Deka, Professor DK Sarma, and (Col) M Arora, for contributing specialized chapters. Illustrations by nursing colleagues Swapna Basu and Tara Rajan have been retained. You may write a book but it cannot see the light of the day till it is not published. M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, extended their golden hand no sooner than I approached them. Their constant inspiration and support boosted my morale.
Well, the person who suffers most when you spend your leisure hours sitting in front of computer and burn midnight electricity is none other than your better half. My sincere gratitude to Dr (Mrs) Shalini Kochar for bearing with me. I am indebted to Professor GC Sharma, Maj Gen P Subhas, Air Marshal NB Amaresh, my “Gurus”and mentors in surgery, who have greatly influenced my surgical practice.
SK Kochar
9Preface to the First Edition
Till recently trauma was limited to military precincts and trauma care evolved under constraints of military operations. Slow and difficult evacuation, poor lighting and operative conditions, nonavailability of diagnostic aids, inadequate and irregular supply of blood, paucity of potent antibiotics, primitive intensive care facility, transient patient and surgeon population were some of the controlling factors for safe and staged procedures to evolve. Stress was to save the life and limb, and the morbidity took the back seat. Principles of trauma surgery learned and practiced during war became the Bible for surgeons in civil practice, who as such had sporadic exposure to trauma care. However, the scene has changed. Wars have become far and few, industrialization, increased road traffic accidents, upsurge of violence and terrorism have brought trauma at the doorsteps of the surgeon whether he is at subdistrict hospital or in a university hospital. Simultaneously, it has evolved, rapid evacuation, energetic resuscitation, easy availability of blood, good paraoperative care, ideal operative conditions, potent antibiotics, wide�spread use of diagnostic peritoneal lavage and ready availa�bility of ultrasonography (USG) and computed tomography (CT) scan. These developments are respon�sible for the current trends in trauma care. Older concepts have been challenged and new methods of treatment have been advocated, leaving the poor surgeon in a dilemma. The aim of this book is to steer clear of controversies and present a balanced view. It was intended to be a single author effort; but, I soon realized that in this era of superspecialization, multidisciplinary approach is the order of the day. My colleagues in the Armed Forces Medical College and trauma experts in the civil services soon joined hands and here we are with our efforts. I am grateful to Col SK Kotwal, Lt Col Kumud Rai, Lt Col PK Sahoo, Lt Col VK Sinha, Professor A Indrayan, Professor PS Ramani, Professor AK Mahapatra, Professor PM Deka, Professor DK Sarma and Professor DP Sanan, for 10contributing specialized chapters. Illustrations became a necessity and my nursing colleagues Swapna Basu and Tara Rajan chipped in with excellent diagrams. You may write a book but it cannot see the light of the day till it is not published. M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, extended their golden hand no sooner than I approached them. Their constant inspiration and support boosted my morale. Well, the person who suffers most when you spend your leisure hours sitting in front of computer and burn midnight electricity is none other than your better half. My sincere gratitude to Dr (Mrs) Shalini Kochar for bearing with me. I am grateful to Brig YD Sharma, Commandant, 151 Base Hospital, for encouraging me from time-to-time and granting me permission to publish the work. I am indebted to Professor GC Sharma, Formerly Professor and Head, Department of Surgery, Sawai Man Singh (SMS) Medical College, Jaipur, Rajasthan, India, and Brig (Dr) P Subhas, my teachers and Guru in surgery, who have greatly influenced my surgical practice.
SK Kochar