Emergency War Surgery NATO Handbook: Part IV: Regional Wounds and Injuries: Chapter XXIX: Wounds of the Abdomen

Preparation for Operation

United States Department of Defense

Preparation of the patient for operation must be accomplished simultaneously with the other actions. Well-briefed and welltrained nursing personnel are invaluable. Simple routines that are understood by all hospital personnel must be established.

Two large-bore intravenous catheters should be inserted as soon as the patient arrives in the receiving area. Blood must be taken for typing and cross-matching. Antibiotics and tetanus toxoid should be administered as soon as the patient arrives in the receiving area.

An indwelling urinary catheter should be in place. The volume and character (i.e., bloody or not) of the urine should be noted at the time of catheterization and the time recorded so that urinary output after catheterization can be determined later.

A nasogastric tube should be in place.

Associated injuries must be dealt with appropriately. This is especially true in cases of intrathoracic injuries or massive blood loss in which the patient's ability to survive the operation can be affected. It is important to remember that these patients can spend hours "out of sight" under operative drapes where significant extremity blood loss and the loss of distal pulses may go unappreciated.

Endotracheal tubes must be in place and properly secured. The neurological status must be known prior to induction of anesthesia.

Finally, accurate but succinct notes must be recorded. The ever-present possibility of evacuation makes this essential.

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Operational Medicine 2001

Health Care in Military Settings

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