Complicated War Trauma and Care of the Wounded : The Israeli Experience in Medical Care and Humanitarian Support of Syrian Refugees

"This book presents carefully selected case reports that document some of the most important lessons learned at Ziv Medical Center, the northernmost Israeli hospital responsible for the medical care and support of wounded and patients from the Syrian civil war. The aim is to provide practitioners with new knowledge on effective ways of dealing with the emergencies encountered in the context of such conflicts. The case reports cover in particular the specialties of Trauma and Critical Care, Orthopedics, and Surgery, but also relate to Internal Medicine, Ophthalmology, Obstetrics and Gynecology, and Psychiatric Care. Some of the cases of trauma are of a nature not previously encountered by Western medicine, and include instances in which multidisciplinary care played a vital role. Featuring many informative illustrations, the book will be of value for all who work in emergency and military medicine and related disciplines, from novices to the more experienced"-- Provided by publisher Preface 5 Acknowledgements 7 Contents 8 Part I: Introduction 11 1: Introduction 12 References 16 2: Ethical Challenges 17 2.1 Ethics and Conflict 17 2.2 Humanitarian Aid Standard 17 2.3 Agreement to Treatment—Legal and Bioethical Aspects 18 2.4 Partial Information 18 2.5 Treatment Priority 19 References 19 Part II: Psychiatrics 21 3: Mental Trauma in Injured War Refugees 22 4: Treatment and Support for Patients with Mental War Trauma 24 Part III: Trauma 26 5: Abdominal Injury 27 5.1 Case Presentation 27 5.2 Teaching Points 27 5.3 Clinical Implications 27 5.4 Damage Control 28 5.5 Summary 28 6: Things Aren’t Always What They Seem: The Case of Hala 29 6.1 Case Presentation 29 6.1.1 Teaching Points 31 6.2 Clinical Implications 32 6.3 Summary 32 References 32 7: Damage Control 33 7.1 Case Presentation 33 7.2 Teaching Points 33 7.3 Clinical Implications 34 7.4 Damage Control 34 7.5 Summary 34 8: Pelvic Injury 35 8.1 Case Presentation 35 8.2 Teaching Points 35 8.3 Clinical Implications 35 8.4 Damage Control 36 8.5 Summary 36 9: Vascular Trauma 37 10: Chest Trauma 39 10.1 Case Presentation 39 10.2 Teaching Points 40 10.3 Clinical Implications 40 10.4 Damage Control 40 10.5 Summary 40 Reference 40 11: Multidisciplinary Care of 13-Year-­Old Syrian Child 41 11.1 Case Description 41 11.2 Discussion 42 References 42 12: Anesthesia for Trauma Wounded 43 12.1 Case Presentation 44 12.1.1 General Information 44 12.1.2 Teaching Points 44 12.1.3 Clinical Implications 44 13: High-Velocity Bullets Urogenital Combat Injuries: Lessons from the Syrian War 45 13.1 Upper Ureteral Injury: Case Presentation 45 13.1.1 Teaching Points 46 13.1.2 Clinical Implications 46 13.1.3 Damage Control and Final Reconstruction 46 13.2 Lower Ureteral Injury: Case Presentation 47 13.2.1 Teaching Points 47 13.2.2 Clinical Implications 47 13.2.3 Damage Control and Definitive Reconstruction 48 13.3 Proximal Urethral Injury: Case Presentation 48 13.3.1 Teaching Points 48 13.3.2 Clinical Implications 48 13.3.3 Damage Control and Definitive Reconstruction 49 13.4 Penile Urethral Injury 49 13.4.1 Teaching Points 49 13.4.2 Clinical Implications 49 13.4.3 Damage Control and Definitive Reconstruction 49 13.5 Discussion 50 Part IV: Orthopedics 52 14: Neglected Fracture of the Femoral Head with Hip Dislocation 53 14.1 Introduction 53 14.2 Case Report 54 14.3 Radiologic Findings 54 14.4 Diagnosis 54 14.5 Surgical Management 55 14.6 Postoperative Management 56 14.7 Discussion 56 References 57 15: Complex Lower Limb Deformity in Paediatric Patient After Blast Injury with Extensive Tissue Damage and Loss: A Case Report 58 15.1 Case Presentation 58 15.2 Clinical implications and Conclusions 60 16: Acute Shortening and Angulation for Limb Salvage in Pediatric Patient After High-Energy Blast Injury 61 16.1 Case Presentation 61 16.2 Damage Control 62 16.3 Clinical Implications 62 16.4 Teaching Points 62 16.5 Summary 63 17: Staged External Fixation Protocol in Treatment of Complex Limb Trauma 64 17.1 Damage Control 65 17.2 Clinical Implications 65 17.3 Teaching Points 66 17.4 Summary 66 References 66 18: Upper Extremity War Injuries: Syrian Patients 67 18.1 Our Strategy to Proximal Extremity War Injuries 67 18.2 Case 1 67 18.3 Case 2 68 18.4 Case 3 68 18.5 Case 4 70 18.6 Case 5 71 18.7 Case 6 73 18.8 Case 7 74 18.9 Case 8 75 References 76 19: Open Comminuted Femoral Fracture: Staged Treatment Protocol 77 19.1 Case Presentation 77 19.2 Damage Control 78 19.3 Clinical Implications 78 19.4 Teaching Points 78 19.5 Summary 79 20: Staged Treatment Protocol for Salvage After Hindfoot Blast Injury 80 20.1 Case Report 80 Part V: Internal Medicine 84 21: Complicated Pneumonia 85 21.1 Case Presentation 85 21.2 Teaching Points 85 21.2.1 Management 86 References 86 22: Acute Myeloid Leukemia (AML) 87 22.1 Patient Description 87 22.2 Teaching Points 88 22.3 Therapy 88 References 88 23: Reversible War-Induced Renal Failure 89 23.1 Case Report 89 23.2 Discussion 89 23.2.1 Initial Evaluation After Diagnosis 90 References 90 24: Mediastinal Masses 92 24.1 Case Presentation 92 24.2 Conclusion 92 24.3 Discussion 93 References 94 Part VI: Surgery 95 25: Complex War Injuries: Addressing the Needs of the War Wounded 96 25.1 Case Presentation 96 25.2 Teaching Points 97 25.3 Clinical Implications 97 25.4 Damage Control 97 25.5 Summary 97 References 97 26: Savage War Injuries: The Alleviation of Suffering 98 26.1 Case Presentation 98 26.2 Teaching Points 98 26.3 Clinical Implications 99 26.4 Damage Control 99 26.5 Summary 99 References 99 27: Nonconventional Management of Bleeding Dysgerminoma in Adolescent Syrian Female 100 27.1 Patient Description 100 27.2 Discussion 100 References 102 28: Craniomaxillofacial Bullet Injury 103 28.1 Case Description 103 28.2 Discussion 103 References 104 Part VII: Ophthalmology 105 29: Ophthalmic Surgery in a Combat Zone: Functioning Under Stress and Shortage 106 29.1 Introduction 106 29.2 Patient Description 106 29.3 Discussion 106 30: Delivering Bad News: Can We Do Better? 108 30.1 Case Presentation 108 30.2 Discussion 109 References 110 Part VIII: Obstetrics and Gynecology 111 31: Delivery of a 15-Year-Old Syrian Woman with Transverse Lie Twins 112 31.1 Case Presentation 112 31.2 Teaching Points 112 31.3 Clinical Implications 112 31.4 Damage Control 113 31.5 Summary 113 References 113 32: Multiple Malformations Embryo in a Syrian Pregnant Patient 114 32.1 Case Presentation 114 32.2 Teaching Points 115 32.3 Clinical Implications 115 32.3.1 Damage Control 115 32.3.2 Summary 115 References 115 Index 116 Front Matter....Pages i-xi Front Matter....Pages 1-1 Introduction....Pages 3-7 Ethical Challenges....Pages 9-12 Front Matter....Pages 13-13 Mental Trauma in Injured War Refugees....Pages 15-16 Treatment and Support for Patients with Mental War Trauma....Pages 17-18 Front Matter....Pages 19-19 Abdominal Injury....Pages 21-22 Things Aren’t Always What They Seem: The Case of Hala....Pages 23-26 Damage Control....Pages 27-28 Pelvic Injury....Pages 29-30 Vascular Trauma....Pages 31-32 Chest Trauma....Pages 33-34 Multidisciplinary Care of 13-Year-Old Syrian Child....Pages 35-36 Anesthesia for Trauma Wounded....Pages 37-38 High-Velocity Bullets Urogenital Combat Injuries: Lessons from the Syrian War....Pages 39-45 Front Matter....Pages 47-47 Neglected Fracture of the Femoral Head with Hip Dislocation....Pages 49-53 Complex Lower Limb Deformity in Paediatric Patient After Blast Injury with Extensive Tissue Damage and Loss: A Case Report....Pages 55-57 Acute Shortening and Angulation for Limb Salvage in Pediatric Patient After High-Energy Blast Injury....Pages 59-61 Staged External Fixation Protocol in Treatment of Complex Limb Trauma....Pages 63-65 Upper Extremity War Injuries: Syrian Patients....Pages 67-76 Open Comminuted Femoral Fracture: Staged Treatment Protocol....Pages 77-79 Staged Treatment Protocol for Salvage After Hindfoot Blast Injury....Pages 81-84 Front Matter....Pages 85-85 Complicated Pneumonia....Pages 87-88 Acute Myeloid Leukemia (AML)....Pages 89-90 Reversible War-Induced Renal Failure....Pages 91-93 Mediastinal Masses....Pages 95-97 Front Matter....Pages 99-99 Complex War Injuries: Addressing the Needs of the War Wounded....Pages 101-102 Savage War Injuries: The Alleviation of Suffering....Pages 103-104 Nonconventional Management of Bleeding Dysgerminoma in Adolescent Syrian Female....Pages 105-107 Craniomaxillofacial Bullet Injury....Pages 109-110 Front Matter....Pages 111-111 Ophthalmic Surgery in a Combat Zone: Functioning Under Stress and Shortage....Pages 113-114 Delivering Bad News: Can We Do Better?....Pages 115-117 Front Matter....Pages 119-119 Delivery of a 15-Year-Old Syrian Woman with Transverse Lie Twins....Pages 121-122 Multiple Malformations Embryo in a Syrian Pregnant Patient....Pages 123-124 Back Matter....Pages 125-126 "This book presents carefully selected case reports that document some of the most important lessons learned at Ziv Medical Center, the northernmost Israeli hospital responsible for the medical care and support of wounded and patients from the Syrian civil war. The aim is to provide practitioners with new knowledge on effective ways of dealing with the emergencies encountered in the context of such conflicts. The case reports cover in particular the specialties of Trauma and Critical Care, Orthopedics, and Surgery, but also relate to Internal Medicine, Ophthalmology, Obstetrics and Gynecology, and Psychiatric Care. Some of the cases of trauma are of a nature not previously encountered by Western medicine, and include instances in which multidisciplinary care played a vital role. Featuring many informative illustrations, the book will be of value for all who work in emergency and military medicine and related disciplines, from novices to the more experienced"--Résumé de l'éditeur