Emergency War Surgery NATO Handbook: Part I: Types of Wounds and Injuries: Chapter VII: Mass Causalties in Thermonuclear Warfare
United States Department of Defense
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In spite of antibiotics, infections with opportunistic pathogens are still a major problem. The majority of these organisms today are gram-negative bacteria such as Escherichia coli and Pseudomonas aeruginosa. These infections occur as a consequence of profound immunosuppression, abnormal colonization of body surfaces, and invasive medical devices. Susceptible body surfaces include the oropharyngeal-respiratory tree and the intestine. Wound sites and artificial invasive devices, such as catheters, are also important sources of infection. Infections may be more prevalent and severe if patients are maintained for long periods in environments containing antibiotic-resistant pathogens.
Wound debridement, appropriate wound dressings, and antibiotics are key elements in infection control. Since infections will be extremely difficult to control in neutropenic subjects, every effort at preventive measures should be made. Antibiotics, preferably in combination therapy, should be used promptly to treat any new fever. When signs or symptoms of infection do appear in the granulocytopenic patient, treatment should be started without waiting for culture and sensitivity studies. Initial coverage should be directed against gram-negative organisms and Staphylococcus aureus. Prevalent organisms and antimicrobial susceptibility patterns in the particular medical facility should also be considered. The drugs most often used now for the initial treatment are the synthetic penicillins, such as ticarcillin, combined with an aminoglycoside such as tobramycin. It is recommended either that the treatment continue until the granulocytes return to more than 500, or that the treatment continue for only two weeks and then stop, even if the white cell count is still depressed, as long as all signs of infection have cleared.
Decontamination and Decorporation After External Contamination by Radioactive Materials
The tremendously increased use of radionuclides in medicine, research, Navy nuclear power, and space, in addition to the increased transport of these materials, has increased the likelihood of exposure to military personnel. A nuclear weapon may have its high explosive detonate, scattering plutonium debris. In addition, a weapon may be detonated by a terrorist, a third world country, or by major power in a single strike. All of these scenarios may result in radionuclide contamination and traumatic injury one or many casualties. Because of the increased probability of exposure, it is important for military physicians to be trained in decontamination procedures and in the decorporation of radionuclides.
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