Resuscitation experience in the Falkland Islands campaign.

The recent campaign to retake the Falkland Islands was a novel military exercise from many points of view. This was particularly so for the medical support, which required much improvisation at all levels. Several surgical teams from the Royal Navy and the Royal Army Medical Corps were deployed in support of both the fleet and the troops on land. Two Royal Naval teams embarked in SS Canberra, and the journey south on board provided an opportunity to discuss and decide on a specific resuscitation policy for the casualties that might be encountered. We discuss the details of this policy and the results of using it. Resuscitation policy Thc essence of the resuscitation policy was that it should be simple and straightforward, using a minimum of procedures, drugs, and fluids. This would aid the speed at which large numbers of casualties could be resuscitated. Once formulated, it was taught to all personnel likely to be concerned in resuscitation. Airway-The airway was to be managed in the usual manner with clearance of all foreign material from the mouth and pharynx, support for the jaw, and insertion of a Guedel airway if necessary. Facilities for endotracheal intubation and assisted ventilation would be available in the resuscitation area. Patients with maxillofacial injuries would be nursed prone, but patients with other injuries would probably be supine when attended. Any penetrating injury of the chest or any clinical evidence of pneumothorax would require the insertion of an intercostal chest drain in the mid-axillary line between the fourth and fifth or fifth and six ribs and directed apically on the side of the injury. These patients would be nursed sitting up, if not contraindicated by shock. Anialgesia-Intravenous morphine was to be used, diluted 15 mg in 5 ml of water, and given in small doses (3 mg) often, titrated according to pain. The importance of checking the dose and time of any analgesia given previously was emphasised. For chest injuries it was planned to give buprenorphine hydrochloride 0 3-0 6 mg or, if unavailable, pentazocine 30-60 mg intravenously. Inhalational Entonox (50, nitrous oxide/5000 oxygen) would also be available. Antibiotics-All patients with open wounds were to be given benzyl-penicillin intravenously, one megaunit immediately and repeated every six hours for 24 hours. Patients with penetrating head wounds were to be given sulphadimidine 1 g four times a day intramuscularly in addition. Those with abdominal wounds were to be given …