Emergency War Surgery NATO Handbook: Part III: General Considerations of Wound Management: Chapter XV: Anesthesia and Analgesia
United States Department of Defense
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Since the typical battle casualty is young and healthy prior to wounding, sophisticated invasive monitoring techniques are not routinely indicated in this patient population. However, during prolonged hypoxia or myocardial contusion, cardiac disease can be present in formerly young healthy adults, In these specific situations, CVP and the pulmonary artery catheter become valuable monitors. Electrocardiogram, blood pressure, and heart sounds are routine measures for every patient. Urine output and such physical signs as pulse rate and volume, skin temperature, and capillary refill are useful indicators of the adequacy of intravascular volume.
If the operative procedure were to involve a major chest wound, major blood loss, or a vascular injury with the potential of major bleeding, direct arterial pressure monitoring is indicated. Disposable transducers are available and may be a reasonable approach. If the tactical situation or geographical location will allow, pulse oximeters, capnographs, and automated arterial blood pressure apparatus should be considered necessary anesthesia equipment.
Respiratory gas and pH measurements of arterial and mixed venous blood were shown to be major indicators of pathology in Vietnam, and are early indicators of life-threatening pathophysiology, as well as reliable guides to therapy. In the absence of instruments for arterial blood gas analysis, measurement of urine pH with indicator paper has been used successfully as a guide for treatment of metabolic acidosis. The vigilance of the anesthetist is the most effective monitor of all.
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