Anaesthesia for emergency care 1st ed Edition

Jerry Nolan pdf download

https://ebookname.com/product/anaesthesia-for-emergency-care-1st-
ed-edition-jerry-nolan/

Get the full ebook with Bonus Features for a Better Reading Experience on ebookname.com
Instant digital products (PDF, ePub, MOBI) available
Download now and explore formats that suit you...

Radiology for Anaesthesia and Intensive Care 1st

Edition Richard Hopkins

https://ebookname.com/product/radiology-for-anaesthesia-and-
intensive-care-1st-edition-richard-hopkins/

Emergency Care 12th Edition Limmer

https://ebookname.com/product/emergency-care-12th-edition-limmer/

Practical Procedures in Anaesthesia and Critical Care

1st Edition Guy Jackson

https://ebookname.com/product/practical-procedures-in-
anaesthesia-and-critical-care-1st-edition-guy-jackson/

Interview Research in Political Science 1st Edition

Layna Mosley (Editor)

https://ebookname.com/product/interview-research-in-political-
science-1st-edition-layna-mosley-editor/
Union Combined Operations in the Civil War 1st Edition
Craig Symonds

https://ebookname.com/product/union-combined-operations-in-the-
civil-war-1st-edition-craig-symonds/

Previously Developed Land Industrial Activities and

Contamination Second Edition Paul Syms(Auth.)

https://ebookname.com/product/previously-developed-land-
industrial-activities-and-contamination-second-edition-paul-
symsauth/

Cat Owner s Home Veterinary Handbook 3rd ed Edition

Debra M Eldredge

https://ebookname.com/product/cat-owner-s-home-veterinary-
handbook-3rd-ed-edition-debra-m-eldredge/

Human Welfare and Moral Worth Thomas E. Hill

https://ebookname.com/product/human-welfare-and-moral-worth-
thomas-e-hill/

Better Homes Gardens year round slow cooker recipes 1st

Edition Better Homes And Gardens

https://ebookname.com/product/better-homes-gardens-year-round-
slow-cooker-recipes-1st-edition-better-homes-and-gardens/
An Atlas of Hair Pathology with Clinical Correlations
The Encyclopedia of Visual Medicine Series 1st Edition
Leonard Sperling

https://ebookname.com/product/an-atlas-of-hair-pathology-with-
clinical-correlations-the-encyclopedia-of-visual-medicine-
series-1st-edition-leonard-sperling/
OXFORD MEDICAL PUBLICATIONS

Anaesthesia for
Emergency Care
Oxford Specialist Handbooks published and forthcoming
General Oxford Specialist Oxford Specialist Handbooks
Handbooks in Neurology
A Resuscitation Room Guide Epilepsy
Addiction Medicine Parkinson’s Disease and
Day Case Surgery Other Movement Disorders
Hypertension Stroke Medicine
Perioperative Medicine,
Second Edition Oxford Specialist Handbooks
Postoperative Complications, in Paediatrics
Second Edition Paediatric Dermatology
Renal Transplantation Paediatric Endocrinology
and Diabetes
Oxford Specialist Handbooks Paediatric Gastroenterology,
in Anaesthesia Hepatology, and Nutrition
Anaesthesia for Emergency Care Paediatric Haematology and
Cardiac Anaesthesia Oncology
Neuroanaethesia Paediatric Intensive Care
Obstetric Anaesthesia Paediatric Nephrology, Second
Ophthalmic Anaesthesia Edition
Paediatric Anaesthesia Paediatric Neurology, Second Edition
Regional Anaesthesia, Stimulation and Paediatric Radiology
Ultrasound Techniques Paediatric Respiratory Medicine
Thoracic Anaesthesia
Oxford Specialist Handbooks
Oxford Specialist Handbooks in Pain
in Cardiology Spinal Interventions in Pain
Adult Congenital Heart Disease Management
Cardiac Catheterization and
Coronary Intervention Oxford Specialist Handbooks
Cardiac Electrophysiology and in Psychiatry
Catheter Ablation Child and Adolescent Psychiatry
Cardiovascular Computed Forensic Psychiatry
Tomography Old Age Psychiatry
Cardiovascular Magnetic Resonance Oxford Specialist Handbooks
Echocardiography, Second Edition in Radiology
Fetal Cardiology
Heart Failure Interventional Radiology
Hypertension Musculoskeletal Imaging
Inherited Cardiac Disease Pulmonary Imaging
Nuclear Cardiology Thoracic Imaging
Pulmonary Hypertension Oxford Specialist Handbooks
Valvular Heart Disease in Surgery
Oxford Specialist Handbooks Cardiothoracic Surgery
in Critical Care Colorectal Surgery
Advanced Respiratory Hand Surgery
Critical Care Hepatopancreatobiliary Surgery
Neurosurgery
Oxford Specialist Handbooks Operative Surgery, Second Edition
in End of Life Care Oral Maxillofacial Surgery
End of Life Care in Cardiology Otolaryngology and Head and
End of Life Care in Dementia Neck Surgery
End of Life Care in Nephrology Paediatric Surgery
End of Life Care in Respiratory Plastic and Reconstructive Surgery
Disease Surgical Oncology
End of Life in the Intensive Urological Surgery
Care Unit Vascular Surgery
Oxford Specialist
Handbooks in
Anaesthesia
Anaesthesia
for Emergency
Care
Edited by

Jerry Nolan
Consultant in Anaesthesia and Intensive Care Medicine
Royal United Hospital NHS Trust,
Bath, UK

Jasmeet Soar
Consultant in Anaesthesia and Intensive Care Medicine
Southmead Hospital, North Bristol NHS Trust,
Bristol, UK

1
1
Great Clarendon Street, Oxford OX2 6DP,
United Kingdom
Oxford University Press is a department of the University of Oxford.
It furthers the University’s objective of excellence in research, scholarship,
and education by publishing worldwide. Oxford is a registered trade mark of
Oxford University Press in the UK and in certain other countries
© Oxford University Press 2012
The moral rights of the authors have been asserted
First Edition published in 2012
Impression: 1
All rights reserved. No part of this publication may be reproduced, stored in
a retrieval system, or transmitted, in any form or by any means, without the
prior permission in writing of Oxford University Press, or as expressly permitted
by law, by licence or under terms agreed with the appropriate reprographics
rights organization. Enquiries concerning reproduction outside the scope of the
above should be sent to the Rights Department, Oxford University Press, at the
address above
You must not circulate this work in any other form
and you must impose this same condition on any acquirer
British Library Cataloguing in Publication Data
Data available
Library of Congress Cataloging in Publication Data
Library of Congress Control Number: 2012933283
ISBN 978–0–19–958897–8
Printed in China by
C & C Offset Printing Co, Ltd
Oxford University Press makes no representation, express or implied, that the
drug dosages in this book are correct. Readers must therefore always check
the product information and clinical procedures with the most up-to-date
published product information and data sheets provided by the manufacturers
and the most recent codes of conduct and safety regulations. The authors and
the publishers do not accept responsibility or legal liability for any errors in the
text or for the misuse or misapplication of material in this work. Except where
otherwise stated, drug dosages and recommendations are for the non-pregnant
adult who is not breastfeeding.
Links to third party websites are provided by Oxford in good faith and
for information only. Oxford disclaims any responsibility for the materials
contained in any third party website referenced in this work.
 v

Preface

Anaesthetizing patients for surgical and medical emergencies can be chal-

lenging. The time critical nature of the intervention may mean proceeding
with a limited medical history and only a brief assessment with minimal
investigations. Ideally, these patients should be fully resuscitated, but in
some circumstances (e.g. after major trauma) anaesthetizing the patient
can be an essential component of the initial resuscitation.
When planning this book, we aimed to include most of procedures
encountered by the ‘on-call’ anaesthetist, both during the day and out-of-
hours. In keeping with the Oxford Handbook series, the style is concise but
we have tried to include the essential information needed to anaesthetize
these patients safely. The first section comprises a series of topics that
are generic to many emergencies and the remaining sections cover
a full range of conditions that may require anaesthesia in the operating
room, emergency department, critical care unit, and radiology suite. In
recognition of the increasing role of doctors in prehospital emergency
medicine, we have included a section on prehospital anaesthesia and
transport. Clearly, every possible scenario cannot be covered in this book.
If there is any doubt about the best way to proceed in an emergency, seek
expert help early.
Although aimed principally at the anaesthetic trainee, this book should
be of value to consultants in anaesthesia and critical care and to trainees
and consultants in emergency medicine.
We would appreciate feedback (to the e mail address below) about this
book, particularly in relation to topics that we have omitted or any errors
that we have missed. Finally, we thank all the authors for their high quality
contributions in the face of pressing deadlines and our wives and children
who now struggle to remember what we look like.

Jerry and Jasmeet

[email protected]
2012
This page intentionally left blank
 vii

Contents

Contributors ix
Symbols and Abbreviations xiii

1 General Principles 1
2 Prehospital 53
3 The Injured Patient 63
4 Anaesthesia for the Critically Ill Patient 109
5 General Surgical Emergencies 137
6 Ear, Nose, and Throat Emergencies 155
7 Maxillofacial Emergencies 171
8 Cardiovascular Emergencies 179
9 Neurological Emergencies 215
10 Plastic Surgery 249
11 Obstetric Emergencies 261
12 Urological Emergencies 289
13 Paediatric Emergencies 297
14 Ophthalmic Emergencies 337
15 Anaesthesia for Emergency Radiological
Procedures 343
16 Anaesthetic Emergencies 355

Index 393
This page intentionally left blank
 ix

Contributors

Anne-Marie Amphlett Charles Deakin

Specialist Trainee Consultant in Cardiac Anaesthesia
Bristol School of Anaesthesia and Intensive Care Medicine
University Hospital Southampton
Monica Baird
Consultant in Anaesthesia Simon Finney
Royal United Hospital NHS Trust Consultant in Anaesthesia and
Bath Intensive Care Medicine
Guy Bayley Royal Brompton Hospital, London
Consultant in Paediatric Andrew Georgiou
Anaesthesia, Specialist Trainee
Bristol Royal Hospital for Children
Bristol School of Anaesthesia
Jonathan Benger
Professor of Emergency Care,
Ben Gibbison
University of the West of England, Specialist Trainee
Bristol and Consultant in Bristol School of Anaesthesia
Emergency Medicine,
University Hospitals Bristol Amit Goswami
NHS Foundation Trust Specialist Trainee
Bristol School of Anaesthesia
Craig Carroll
Consultant in Anaesthesia Richard Griffiths
Salford Royal Hospital NHS Consultant in Anaesthesia
Foundation Trust Peterborough and Stamford
Hospitals NHS Trust
Emma Clow
Specialist Trainee Kim J. Gupta
Bristol School of Anaesthesia Consultant in Anaesthesia and
Intensive Care Medicine,
Tim Cook
Royal United Hospital NHS Trust,
Consultant in Anaesthesia Bath
and Intensive Care,
Royal United Hospital NHS Carl Gwinnutt
Trust, Bath Formerly Consultant in
Anaesthesia
Jules Cranshaw
Salford Royal Hospital NHS
Consultant in Anaesthesia and Foundation Trust
Intensive Care Medicine
Royal Bournemouth Hospital, Clare Hommers
Bournemouth Specialist Trainee
Rhys Davies Bristol School of Anaesthesia
Consultant in Anaesthesia
North Bristol NHS Trust, Bristol
x CONTRIBUTORS

Tim Hooper Henry Murdoch

Specialist Trainee Specialist Trainee
Bristol School of Anaesthesia Bristol School of Anaesthesia
Dom Hurford Jerry Nolan
Specialist Trainee Consultant in Anaesthesia and
Bristol School of Anaesthesia Intensive Care Medicine,
Royal United Hospital NHS Trust,
Rob Jackson Bath
Specialist Trainee
Bristol School of Anaesthesia Judith Nolan
Consultant in Paediatric
Chris Johnson Anaesthesia,
Consultant in Anaesthesia Bristol Royal Hospital for Children
North Bristol NHS Trust, Bristol
Sonja Payne
Alistair Johnstone Specialist Trainee
Specialist Trainee Bristol School of Anaesthesia
Bristol School of Anaesthesia
Carol J. Peden
Rebecca Leslie Consultant in Anaesthesia and
Specialist Trainee Intensive Care Medicine,
Bristol School of Anaesthesia Royal United Hospital NHS Trust,
Bath
David Lockey
Consultant in Anaesthesia and Susanna Ritchie-McLean
Intensive Care Medicine, North Specialist Traineee in Anaesthesia,
Bristol NHS Trust and London Peterborough & Stamford
Helicopter Emergency Hospitals NHS Foundation Trust
Medical Service,
Royal London Hospital Edward Scarth
Specialist Trainee
Melanie McDonald Bristol School of Anaesthesia
Specialist Trainee
Bristol School of Anaesthesia Joe Sebastian
Consultant in Anaesthesia
Patrick Magee Salford Royal Hospital NHS
Consultant in Anaesthesia Foundation Trust
Royal United Hospital NHS Trust,
Bath Jasmeet Soar
Consultant in Anaesthesia
Thomas Martin and Intensive Care Medicine,
Specialist Trainee North Bristol NHS Trust,
Bristol School of Anaesthesia Bristol
Lucy Miller Matt Thomas
Specialist Trainee Consultant in Anaesthesia and
Bristol School of Anaesthesia Intensive Care Medicine,
University Hospitals Bristol NHS
Ronelle Mouton Foundation Trust
Consultant in Anaesthesia
Royal United Hospital NHS Trust,
Bath
 CONTRIBUTORS xi
Julian Thompson Andy Weale
Specialist Registrar in Prehospital Consultant Vascular Surgeon
Care, London Helicopter North Bristol NHS Trust, Bristol
Emergency Medical Service,
Royal London Hospital Nicola Weale
Consultant in Anaesthesia
Jenny Tuckey North Bristol NHS Trust, Bristol
Consultant in Anaesthesia
Royal United Hospital NHS Trust, David Windsor
Bath Specialist Trainee
Bristol School of Anaesthesia
Medha Vanarase
Consultant in Anaesthesia Helen Wise
John Radcliffe Hospital, Oxford Consultant in Anaesthesia, Poole
Hospital NHS Foundation Trust
Michelle White
Consultant in Anaesthesia,
Mercy Ships, formerly Consultant
in Paediatric Anaesthesia,
Bristol Royal Hospital for Children
This page intentionally left blank
 xiii

Symbols and Abbreviations

b cross reference
i increased
d decreased
~ approximately
l leading to
± plus/minus
2 important
# fracture
#NOF fractured neck of femur
M website
A–a alveolar–arterial
AAA abdominal aortic aneurysm
AAGBI Association of Anaesthetists of Great Britain and Ireland
ABCDE airway, breathing, circulation, disability, exposure
ABG arterial blood gas
ACEI angiotensin converting enzyme inhibitor
ADH anti-diuretic hormone
AKI acute kidney injury
ALI acute lung injury
ALS advanced life support
APTT activated partial thromboplastin time
ARDS acute respiratory distress syndrome
ASA American Society of Anesthesiologists
AV atrioventricular
BP blood pressure
Ca calcium
CABG coronary artery bypass grafting
CBF cerebral blood flow
CDH Congenital diaphragmatic hernia
CEA carotid endarterectomy
CICV can’t intubate, can’t ventilate’
cLMA classic laryngeal mask airway
CMRO2 cerebral metabolic rate of O2
CNB central neuraxial block
CNS central nervous system
xiv SYMBOLS AND ABBREVIATIONS

CO2 carbon dioxide

COPD chronic obstructive pulmonary disease
CP cricoid pressure
CPAP continuous positive airway pressure
CPB cardiopulmonary bypass
CPP cerebral perfusion pressure
CPR cardiopulmonary resuscitation
Cr creatinine
CS Caesarean section
CSF cerebrospinal fluid
CSI cervical spine injury
CT computed tomography
CTPA computed tomography pulmonary angiography
CV central venous
CVC central venous catheter
CVP central venous pressure
DBD donation after brain death
DBP diastolic blood pressure
DCD donation after circulatory death
DI diabetes insipidus
DIC disseminated intravascular coagulation
DND delayed neurological deficit
DVT deep venous thrombosis
ECG electrocardiogram
ED emergency department
EDH extradural haematoma
EEG electroencephalogram
EMG electromyograph
ENT ear, nose, and throat
ET end-tidal
ETO2 end-tidal oxygen concentration
EVAR endovascular aneurysm repair
EVD external ventricular drain
FAST focused assessment by sonography in trauma
FBC full blood count
FETO2 fraction of end-tidal oxygen
FFP fresh frozen plasma
FiO2 fraction of inspired oxygen
FOI fibreoptic intubation
FRC functional residual capacity
 SYMBOLS AND ABBREVIATIONS xv
GA general anaesthesia/anaesthetic
GCS Glasgow Coma Scale
GI gastrointestinal
h hour/s
H+ hydrogen ion
HAS human albumin solution
Hb haemoglobin
HDU high-dependency unit
HELLP haemolysis, elevated liver enzymes, low platelets
HFOV high-frequency oscillatory ventilation
HIV human immunodeficiency virus
HLA human leucocyte antigen
HME heat and moisture exchanger
HTLV human T-lymphotropic virus
ICD implantable cardioverter-defibrillator
ICH intracerebral haematoma
ICP intracranial pressure
ICS Intensive Care Society
ICU intensive care unit
Ig immunoglobulin
ILM intubating laryngeal mask
IM intramuscular
INR international normalized ratio
IO intraosseous
IOP intraocular pressure
IPPV intermittent positive pressure ventilation
IVC intravenous
IVC inferior vena cava
K+ potassium ion
LA local anaesthesia/anaesthetic
LFT liver function test
LMA laryngeal mask airway
LMWH low-molecular-weight heparin
LV left ventricular
MAC minimum alveolar concentration
MAP mean arterial pressure
mg milligram/s
MH malignant hyperthermia
MI myocardial infarction
MILS manual in-line stabilization
xvi SYMBOLS AND ABBREVIATIONS

min minute/s
mL millilitre/s
MRI magnetic resonance imaging
Na+ sodium ion
NICE National Institute for Health and Clinical Excellence
NIV non-invasive ventilation
NMBA neuromuscular blocking agent
NSAID non-steroidal anti-inflammatory drug
O2 oxygen
PA pulmonary artery
PaCO2 partial pressure of arterial carbon dioxide
PCA patient-controlled analgesia
PCC prothrombin complex concentrate
PCI percutaneous coronary intervention
PCO2 partial pressure of carbon dioxide
PE pulmonary embolism
PEA pulseless electrical activity
PEEP positive end-expiratory pressure
PET pre-eclamptic toxaemia
PICU paediatric intensive care unit
PIP peak inspiratory pressure
PNB peripheral nerve block
PO orally (per os)
PO2 partial pressure of oxygen
PONV postoperative nausea and vomiting
PPH postpartum haemorrhage
PR rectally (per rectum)
PRN as needed (pro re nata)
PT prothrombin time
RA regional anaesthesia/anaesthetic
RBC red blood cell
rFVIIa recombinant Factor VIIa
RNA ribonucleic acid
RRT renal replacement therapy
RSI rapid sequence induction
RV right ventricular
s second/s
SAD supraglottic airway device
SAH subarachnoid haemorrhage
SaO2 arterial oxygen saturation
 SYMBOLS AND ABBREVIATIONS xvii
SBP systolic blood pressure
SC subcutaneous
ScvO2 oxygen saturation of central venous blood
SIGN Scottish Intercollegiate Guidelines Network
SIRS systemic inflammatory response syndrome
SSEP somatosensory evoked potential
STEMI ST-elevation myocardial infarction
SVC superior vena cava
SVR systemic vascular resistance
TAP transversus abdominis plane
TBI traumatic brain injury
TEG thromboelastogram
TIA transient ischaemic attack
TIPSS transjugular intrahepatic portosystemic shunt
TIVA total intravenous anaesthesia
TOF tracheo-oesophageal fistula
TRALI transfusion-related acute lung injury
TT tracheal tube
U&Es urea and electrolytes
US ultrasound
VF ventricular fibrillation
VP ventriculoperitoneal
VT ventricular tachycardia
VTE venous thromboembolism
WFNS World Federation of Neurological Surgeons
This page intentionally left blank
 Chapter 1 1

General Principles

Preoperative assessment 2
Rob Jackson
Rapid sequence induction and tracheal intubation 6
Rob Jackson
Drugs for emergency anaesthesia 10
Rob Jackson
Vascular access 16
Jerry Nolan
Transfusion 20
Jerry Nolan
Fluid therapy 26
Jerry Nolan
Electrolytes 30
Jerry Nolan
Acute pain management 40
Tim Cook
Monitoring 46
Patrick Magee
Regional versus general anaesthesia 50
Tim Cook
2 CHAPTER 1 General Principles

Preoperative assessment
Key points
The principles of preoperative assessment for the emergency patient
are the same as those that apply to the elective situation but they may
need to be abbreviated in an emergency.

Background
• Thorough preoperative assessment of the emergency patient is as
important as that of the patient attending for planned surgery.
• The usual principles of obtaining a history, examining the patient, and
performing investigations apply, although potentially in an abbreviated
form appropriate to the degree of urgency of surgery.
2 Assessment can be made more challenging by the lack of a complete
set of patient notes and investigations. Consideration must be given to
which investigations are essential for safe anaesthesia to continue, and
those that will cause unnecessary delays to surgical management.
History
Obtain a focused history, concentrating on those areas likely to have the
greatest impact on choice of anaesthetic technique, postoperative care,
and potential complications. Emergency patients may have a depressed
conscious level; in this case, seek a history from all available sources such
as patient notes and relatives/carers.
• Nature of the acute problem—timescale over which it has occurred
and details of the surgical plan and urgency of surgery.
• Previous medical history—pay particular attention to cardiovascular
and respiratory disease. Obtain an indication of exercise tolerance and
frequency of angina. Orthopnoea and paroxysmal nocturnal dyspnoea
imply poor cardiovascular reserve.
• Previous anaesthetic history—any known problems with previous
anaesthetics? If the notes are available, scrutinize previous charts
(if available) for details of airway problems or drug reactions.
• Drug history—obtain an accurate list of current medication and any
changes made in hospital. Anticoagulants or antiplatelet drugs may not
have been stopped in advance, precluding use of neuraxial techniques.
Patients may have been nil by mouth for many days and not have
received their usual medication. Check that appropriate antibiotic
therapy has been given in sepsis; if not, give immediately.
• Allergies—document confirmed or suspected drug reactions.
• Fasting times should be identified carefully. Patients may be considered
fasted after the following intervals:
• 6 h since solid food/formula milk.
• 4 h since breast milk.
• 2 h since clear fluids.
• Gastric emptying is prolonged in trauma (especially in children) when
fasting times are considered to be the duration between last oral intake
and the injury. Opioid use, poorly controlled diabetes mellitus, and
renal failure may also delay gastric emptying. Patients with peritonitis
should be assumed to have a full stomach.
 PREOPERATIVE ASSESSMENT 3

• Social history—ensure pregnancy has been either excluded or

identified in women of childbearing age. Ascertain functional level, and
support required at home. This may be particularly important if an
intensive care unit (ICU) admission is being considered.
Examination
• Airway—airway management problems are disproportionately
common in emergency cases. Examine the airway carefully to identify
potential difficulties and plan ahead for failed intubation or ventilation.
Difficult intubation may be more likely to occur in the morbidly obese,
patients with musculoskeletal disease resulting in reduced neck and
jaw movement, patients with small mouths, large incisors, hypognathia,
macroglossia, and short thyromental distance. Assessment should
include inspection of the mouth, the Mallampati score, and assessment
of range of motion of the neck. Maintain cervical spine immobilization
in trauma patients until cervical spine fracture has been excluded. No
simple bedside test can exclude all difficult airways. It is vital to have a
well-rehearsed approach to dealing with airway management problems.
• Respiratory—untreated pulmonary oedema is associated with a poor
outcome and should be excluded. Baseline oxygen saturation of arterial
blood on air or supplemental oxygen may indicate likelihood of success
of postoperative extubation. Evidence of acute lung injury may justify
use of reduced tidal volume ventilation intraoperatively.
• Cardiovascular—identify the patient’s normal blood pressure (BP):
intraoperative mean arterial pressure (MAP) should be kept within 20%
of this. Assess intravascular volume and extracellular fluid loss. Patients
may be inadequately resuscitated; consider a period of stabilization
prior to induction, this may need to occur in the anaesthetic room
or ICU. Consider measuring central venous saturation and applying
goal-directed therapy protocols. Arrhythmias are more common in
emergency patients and may require preoperative treatment.
• Neurological—accurate documentation of pre-induction Glasgow
Coma Scale (GCS) score can be vital for postoperative assessment and
management. Pre-existing neurological deficit should be documented.
Investigations
The time available to obtain information from investigations is frequently
limited; avoid unnecessary delays awaiting results. The choice of investiga-
tions is guided by the clinical situation, but generally includes the following:
• Electrocardiogram (ECG).
• Full blood count (FBC), creatinine, urea and electrolytes (U&Es), blood
sugar.
• Group and screen or formal crossmatch.
• Arterial blood gas (ABG) analysis including lactate—will give valuable
information about adequacy of resuscitation and severity of metabolic
disturbance. The patient with severe metabolic acidosis will require
extreme care on induction, and attention to ventilator settings.
• Clotting screen—especially if taking anticoagulants, or after transfusion.
• Liver function tests—if malnourished, alcoholic, or known liver disease.
4 CHAPTER 1 General Principles

• Echocardiogram—focused studies may rule out significant pathology

and give useful information on ventricular function and filling status.
• Pregnancy test.
• Chest X-ray—if specifically indicated.
• Computed tomography (CT) scanning—ensure cervical spine has been
cleared in trauma.
Consent
• Obtaining valid, informed consent from all patients is an ethical and
professional duty. In an emergency, make reasonable efforts to obtain
appropriate consent. Focus discussions on:
• The proposed techniques.
• The potential benefits and risk of complications (see Box 1.1).
• Alternative treatments available.
• In life-threatening emergencies where obtaining consent would cause
unacceptable delays it is acceptable to treat patients in their best
interests without waiting. Consent obtained in an anaesthetic room
immediately pre-induction may be later considered invalid. Where
the patient is unconscious or deemed ‘incompetent’ the opinions of
family members or close friends should be sought. If such opinions are
unavailable, and time allows, the opinion of an Independent Mental
Capacity Advocate (IMCA) may need to be sought to comply with the
Mental Capacity Act 2005.
• A ‘competent’ child aged 16–18 yrs may give consent for their own
treatment and separate parental consent is not required. If a child
aged 16–18 refuses treatment, consent may be obtained from their
parents provided failure to act will result in permanent injury or death.
Consent should be obtained from parents or guardians for all children
below the age of 18, who are unable to give consent themselves. In life-
threatening emergencies it is acceptable to treat in best interests if time
does not allow for consent to occur.
• If patients are expected to be admitted to the ICU postoperatively,
discuss with them the treatment they will receive there, including
details of intravenous (IV) access, catheters, monitoring, and
ventilation.
• Advanced directives (living wills) may impose legal restrictions on
what treatment can be given. Any such directive should be examined
carefully and its contents and implications discussed fully with the
patient or relatives. Seek expert opinion (e.g. from hospital legal teams)
if there is doubt over the application of the advance directive.
• Jehovah’s Witnesses may place limits on the use of blood products.
Each patient must be treated individually because attitudes toward use
of cell salvage and other blood conservation strategies differ.
 PREOPERATIVE ASSESSMENT 5

Box 1.1 Royal College of Anaesthetists’ definitions of risk

• Very common: ~1 in 10.
• Rare: ~1 in 10,000.
• Very rare: ~1 in 100,000.

Further reading
Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis
and septic shock. N Engl J Med 2001; 345:1368–77.
6 CHAPTER 1 General Principles

Rapid sequence induction and tracheal

intubation
Key points
• The aim of raid sequence induction (RSI) and tracheal intubation is to
reduce the risk of aspiration by minimizing the time between loss of
protective airway reflexes and placement of a cuffed tracheal tube.
• Considerations and controversies include choice of drugs, use of an
opioid, application of cricoid pressure, ventilation of the lungs during
the procedure, and the choice of rescue techniques in the event of
failed intubation.

Choice of anaesthetic technique

• The exact method of induction and the choice of airway will be
determined by the nature of the patient’s acute and chronic illness, and
the operative procedure.
2 Some emergency cases will be managed best by postponement of surgery
until the patient is fasted adequately, followed by use of supraglottic
airways or regional techniques. In many cases, however, tracheal
intubation is the method of choice, the usual route being orotracheal.
• Inadequate fasting times, severe injury, peritonitis, pregnancy, or other
causes of i risk of aspiration generally require the use of RSI of anaesthesia.
• Communication with the surgical and operating room teams is essential.
• In the haemodynamically unstable patient it may be necessary to induce
the patient on the operating table with the abdomen prepared and surgical
team scrubbed and ready to proceed as soon as the airway is secured.
• It may also be necessary to defer some procedures performed
normally before surgery (e.g. central venous pressure (CVP) lines) until
after surgery commences.
• Cases where airway management is anticipated to be problematic may
also require surgeons to be present and scrubbed to assist with 2nd- or
3rd-line airway plans.
Rapid sequence induction
• The aim of the RSI is to reduce the risk of aspiration by minimizing
the length of time between abolition of protective airway reflexes by
anaesthesia and establishment of a secure airway by tracheal intubation
with a cuffed tube.
• Additional precautions to help prevent aspiration of stomach contents
include application of cricoid pressure and avoidance of manual
ventilation by facemask to reduce the risk of inflating the stomach
with gas. A period of preoxygenation before induction prolongs the
duration of apnoea before desaturation occurs.
• Use of RSI increases the incidence of intubation failure by 8–10-fold;
rescue techniques will be needed in 0.3–1.0% of RSIs. Planning for
failure is essential.
• The Difficult Airway Society has produced specific guidelines for
the management of failed intubation following RSI (see b Failed
tracheal intubation, p.356). Repeated attempts at intubation may result
 RAPID SEQUENCE INDUCTION AND TRACHEAL INTUBATION 7

in desaturation of arterial blood, airway injury, and aspiration. In many

cases the correct procedure is to wake the patient and use a different
approach (e.g. awake fibreoptic intubation). If abandoning surgery is
inappropriate, a balance must be struck between achieving an airway via
other means (e.g. supraglottic airway) to facilitate surgery, and the risk
of aspiration.
• All anaesthetists must be practised in failed intubation and ‘can’t
intubate, can’t ventilate’ (CICV) drills and be familiar with the use of
difficult airway equipment and rescue devices—specifically the ones
available to them locally.
• During RSI, a precalculated dose of induction drug is given, which may
cause haemodynamic compromise in the unstable patient. Consider
pre-induction fluid loading and ensure appropriate vasopressor drugs
are immediately available.
• Insertion of an arterial line before induction is often invaluable.
• Patients who require RSI generally remain at risk of aspiration at the
end of surgery. Appropriate management of emergence and extubation
(usually extubation awake in the lateral position) is as important as that
of induction.
Conduct of rapid sequence induction
• Obtain informed consent from patient.
• Ensure sufficient personnel who are appropriately trained and briefed
are present.
• Perform pre-induction checks (e.g. World Health Organization surgical
safety checklist).
• Ensure adequate IV access and monitoring.
• Ensure availability and correct function of equipment (see Box 1.2).
• Pre-oxygenate (generally 3–5 min of 100% oxygen via tight-fitting mask
and anaesthetic breathing system) until end-tidal oxygen concentration
(ETO2) is 90%. Consider head-up position and use of continuous
positive airway pressure (CPAP) to optimize pre-oxygenation.
• Consider use of a short-acting opioid (e.g. alfentanil).
• Induce anaesthesia using pre-calculated dose of rapid onset IV induction
drug.
• Apply cricoid pressure—10 N (1 kg) applied with injection of induction
drug, increasing to 30 N (3 kg) with loss of consciousness. Avoid higher
forces.
• Paralyse with rapid onset muscle relaxant (normally suxamethonium
1–2 mg kg–1 or rocuronium 1 mg kg–1).
• Continue passive oxygenation until relaxation has occurred (about
30 s); facemask ventilation is not usually undertaken but may be
essential if normal arterial oxygen saturation could not be achieved
despite attempted pre-oxygenation (e.g. acute lung injury).
• Intubate the trachea, inflate the tracheal tube cuff, and secure the tube.
• Confirm tracheal intubation by presence of exhaled carbon dioxide
(CO2) trace on waveform capnography and bilateral auscultation of
chest before release of cricoid pressure.
• Continue anaesthesia and controlled ventilation.
• If suxamethonium has been used, give a non-depolarizing
neuromuscular blocker to maintain muscle relaxation.
8 CHAPTER 1 General Principles

Box 1.2 Equipment required for rapid sequence intubation

• Patient trolley with head-down tilt function.
• Suction (Yankauer tip) on and within reach of intubator.
• Suitable pillow for patient positioning.
• Laryngoscopes with variety of suitable blades (checked and working).
• Bougie/stylet.
• Tracheal tubes of appropriate size and smaller in reserve.
• Lubricating gel.
• Magill forceps.
• Syringe for cuff inflation.
• Waveform capnograph connected to breathing circuit.
• Breathing circuit.
• Separate reserve oxygen supply and self-inflating bag.
• Means to secure tracheal tube (tape or tie).
• Stethoscope.
• Equipment for failed intubation (supraglottic and front-of-neck
devices).
• Drugs (induction agent/relaxant/vasopressors/atropine).

Additional considerations and modifications

Choice of induction agent and neuromuscular blocking drug
See also b Drugs for emergency anaesthesia, p.10.
• Thiopental and propofol achieve rapid anaesthesia but cause
hypotension. Consider using ketamine in septic, shocked, and trauma
patients—it is cardiovascularly more stable and considered by some
to be the optimal drug for critically ill patients. Etomidate is associated
with i mortality in septic patients.
• Suxamethonium: use a dose of 1–2 mg kg–1 for RSI. Higher doses
produce better intubation conditions but prolong the duration of
apnoea (median 5–10 min).
• Rocuronium: doses of 1.0 mg kg–1 will produce similar intubating
conditions to suxamethonium within 1 min. Addition of a short-acting
opioid improves intubation conditions. Sugammadex will reverse the
neuromuscular blockade produced by rocuronium within minutes
(dose dictated by scenario).
• Emergency intubation without neuromuscular blockade is associated with
i rates of aspiration, airway trauma, and death. It is not recommended.
Cricoid pressure
• Although regarded as standard practice, use of cricoid pressure (CP) is
controversial: it lacks a robust evidence base but evidence of its harm is
also absent.
• While RSI/CP does not guarantee prevention of aspiration, failure to
perform CP during RSI is currently medicolegally indefensible.
• When performed well, CP is unlikely to interfere with laryngoscopy.
• CP is frequently taught poorly and performed poorly.
• Bimanual CP is not recommended for routine use.
• If laryngoscopy is difficult, change the CP to BURP (backwards,
upwards, and rightward pressure).
 RAPID SEQUENCE INDUCTION AND TRACHEAL INTUBATION 9

• If laryngoscopy remains difficult, reduce the CP and if no improvement

occurs, remove completely while having suction immediately available.
• If a supraglottic airway device (SAD), e.g. classic laryngeal mask airway
(cLMA) or a Pro-Seal® LMA, is used to rescue failed intubation, remove
the CP to enable correct placement and function of the airway device.
Use of opioids
• The addition of an opioid to RSI attenuates the sympathetic response
to laryngoscopy.
• Frequency of awareness may also be decreased.
• If RSI is abandoned, the risks of prolonged apnoea can be reduced by
use of short-acting drugs (e.g. alfentanil) and availability of naloxone.
• Use of opioids has not been associated with worse outcome following RSI.
Ventilation during rapid sequence induction
• The original description of CP included ventilation via facemask.
Although generally avoided to reduce risk of stomach inflation it is
used occasionally during RSI in small children and in those patients at
high risk of developing hypoxaemia rapidly.
• Correctly applied CP will avoid gastric inflation.
Nasogastric tubes
• If a nasogastric tube is in place prior to anaesthesia it should be
aspirated before induction and left on free drainage.
• It is unlikely that the presence of a nasogastric tube decreases efficacy
of cricoid pressure.
Failed intubation and rescue techniques
• Poor view at laryngoscopy and failed intubation is a potentially
dangerous situation. All anaesthetists should be familiar with
approaches for maintaining patient safety in this scenario.
• Oxygenation is the priority. It is important to have prepared for failed
intubation in advance. This includes communication and planning
(equipment, roles) by the whole ‘airway team’. The default management
technique is to wake the patient; however, the airway usually needs to
be managed actively during this period to prevent hypoxaemia.
• Facemask ventilation or insertion of a SAD is indicated in order to achieve
adequate oxygenation and/or continue anaesthesia where necessary.
Insertion of, and ventilation through, a SAD is impeded by CP. Insertion of a
Pro-Seal® LMA by ‘railroading’ over an inverted bougie inserted deliberately
into the oesophagus is a reliable method of achieving an effective
airway with reasonable protection from aspiration in a failed intubation.
• Where rescue with facemask ventilation or a SAD fails, emergency
access to the trachea (cricothyroidotomy or immediate surgical airway)
is likely to be lifesaving. Those performing RSI should be trained, able,
and willing to perform such techniques.
• Following airway rescue, empty the stomach.
Further reading
Difficult Airway Society Guidelines. Available at: M http://www.das.uk.com.
El-Orbany M, Connolly LA. Rapid sequence induction and intubation: current controversy.
Anaesth Analg 2010; 110:1318–25.
Vanner RG, Asai T. Safe use of cricoid pressure. Anaesthesia 1999; 54:1–3.
10 CHAPTER 1 General Principles

Drugs for emergency anaesthesia

Key points
• None of the current hypnotic drugs or neuromuscular blockers is
ideal for inducing anaesthesia in an emergency.
• Despite its tendency to cause hypotension, propofol is a popular
choice because of its familiarity.
• Ketamine is more cardiovascularly stable and may be the drug of
choice in critically ill patients.
• Although suxamethonium remains the most commonly used
neuromuscular blocking drug for RSI, more experienced anaesthetists
are increasingly using rocuronium, particularly with the introduction
of sugammadex, which enables rapid reversal.

General principles
• Patients undergoing emergency anaesthesia are acutely unwell, may be
haemodynamically unstable, and frequently have co-morbid disease.
• The pharmacokinetic properties of drugs may be affected by
intravascular volume, cardiac output, and variation in protein binding.
2 Drugs may act in a more potent manner or have more pronounced
side effects and longer duration of action in the critically ill patient.
• The ideal anaesthetic drugs would have the following properties:
• Easily calculable doses.
• Rapid onset and predictable duration of action.
• Minimal impact on cardiovascular status.
• No unwanted side effects.
• No drug interactions.
• Reliable metabolism despite acute or chronic illness.
• Such drugs do not exist and therefore any choice will be a
compromise. Selection of drugs for use in emergencies may be based
purely on pharmacological properties; however, familiarity of the
anaesthetist with the drug may also have a role.
• It is possible that a frequently used drug will be used more safely than
one with which the anaesthetist has limited experience.
• Emergency drugs (suxamethonium, atropine, adrenaline, dantrolene)
should always be checked and available prior to commencing
anaesthesia.
Induction drugs
Thiopental
• Typical dose 3–7 mg kg–1.
• A barbiturate; produces reliable, rapid-onset anaesthesia with inhibition
of airway reflexes and respiratory drive.
• Decreases cardiac output and systemic vascular resistance with
resulting reduction in BP, especially in shocked patients.
• Reduces cerebral metabolism, cerebral blood flow, intracranial
pressure, and intraocular pressure.
• Has a long history of use in RSI, but works less well when used with
supraglottic airways.
 DRUGS FOR EMERGENCY ANAESTHESIA 11

• Severe anaphylactic reactions in 1:20,000.

• Metabolized in the liver with inactive products excreted by the kidneys.
No effect on uterine tone.
Propofol
• Typical dose 1.5–2.5 mg kg–1.
• A phenol derivative; produces rapid-onset anaesthesia, though large
dose reductions are required in the shocked and unwell patient.
• Marked airway reflex inhibition, making it very suitable for use with
supraglottic airways.
• Surveys suggest widespread use in RSI, though its tendency to cause
profound hypotension in susceptible patients makes this controversial.
• Pharmacokinetics enable target-controlled infusion for sedation and
anaesthesia. Renal and hepatic disease do not affect metabolism
significantly.
• Propofol infusion syndrome may complicate use on intensive care,
especially in the young, resulting in i mortality.
Ketamine
• Typical dose 1–2 mg kg–1.
• Produces dissociative anaesthesia and an increase in sympathetic tone
resulting in a slight rise in BP.
• Airway reflexes are preserved and mild respiratory stimulation occurs.
• Considered by some to be the optimal drug for critically ill patients
because of its cardiovascular stability.
• Use in traumatic brain injury is more controversial because of concerns
about elevation in intracranial pressure; this may be balanced by a
reduction in cerebral oxygen consumption and i systemic BP.
• Prolongs duration of neuromuscular blockade achieved with muscle
relaxants.
Etomidate
• Typical dose 0.3 mg kg–1.
• Rapid induction of anaesthesia though frequently associated with
involuntary muscle movement.
• Limited impact on the cardiovascular system with preservation of
pressor response to laryngoscopy.
• Associated with marked suppression of endogenous steroid synthesis,
even after a single dose, and associated with i mortality in patients with
sepsis. Its use in critically ill patients has diminished as a result.
Benzodiazepines
Midazolam
• Typical dose 0.07–0.1 mg kg–1.
• Produces anxiolysis, amnesia, and sedation; may be used as a
co-induction drug.
• Slow onset (5–7 min) limits its use in RSI.
• May reduce BP slightly; responses in the unwell and very old may be
variable.
• Hepatically metabolized; inactive metabolites are renally cleared.
• Effects may be reversed by flumazenil (0.1–1 mg in titrated doses).
Exploring the Variety of Random
Documents with Different Content
 372 The Past and Present Reputation had been in South
Africa on January 1, 1902. Clasps were granted for various battles,
sieges, and series of operations, and for service in certain specified
areas during the years 1899-1900; and also for service in any part of
South Africa during the years 1901-1902. The battle clasps obtained
by the first battalion were for Wittebergen {i.e., Bethlehem,
Slabbert's Nek, Brand water Basin), and Bergendal ; the Royal Irish
section of the 1st mounted infantry received clasps for the Relief of
Kimberley, Paardeberg, Driefontein, Johannesburg, Diamond Hill,
and Bergendal, and the Royal Irish company of the 5th mounted
infantry for the Relief of Kimberley, Paardeberg, Johannesburg,
Diamond Hill, and Wittebergen. During the war the militia battalions
of the regiment were embodied, and formed part of the garrison of
the United Kingdom.^ In memory of the members of the regular or
militia battalions who died in South Africa two memorials have been
erected, one in St Patrick's Cathedral, the other in the barracks at
Clonmel. Both are described in Appendix 10. It has been decided
that this history should end with the close of the South African war,
and therefore nothing will be said about the doings of the regiment
since May, 1902. And indeed, a detailed record would show little
beyond that unceasing training for active service for which the army
and the nation have to thank the campaign in South Africa. During
this period there have been only two incidents of note. In December,
1905, the first battalion had the honour of sending three officers and
a hundred men to guard His Majesty George V. when, during his tour
in India as Prince of Wales, he was encamped at Kala-Ki-Serai. Three
years later the same battalion was mobilized for active service in the
expedition against the Mohmands on the north-west frontier of India
; but unfortunately for the Royal Irish, this hill campaign was
brought to so speedy and successful a conclusion that they were not
called up to the front. During the two hundred and twenty-seven
years of its existence the XVIIIth regiment has served in nearly all
the important wars in which England has been engaged, and has
earned undying laurels whenever it has had an opportunity of
distinguishing itself. The roll of battle honours, long as it is, by no
means commemorates all the achievements of the regiment : in the
Low Countries the Royal Irish took a leading part in the storming,
not only of Namur, but of many other fortresses ; in the capture of
the Schellenberg, in the engagement at Bunker's Hill, in the defence
of Toulon, and in the fighting in Corsica the regiment won great
praise, but the names of none of 1 The names of most of the militia
officers who were seconded in these battalions for service in South
Africa have been mentioned already ; among the others who did
duty either with mounted infantry or with other infantry corps at the
seat of war were : Captains G. H. P. Colley, J. 0. Johnson, A. J. Fox,
and Lieutenant E. H. B. Thompson.
 of the XVIIItk, The Royal Irish Regiment. 373 these
operations are emblazoned on its Colours. Early in its career, the
regiment earned the reputation of being second to none in the
British army. This reputation it has maintained to the present day;
and the author is convinced that when in years to come, his
successor writes the continuation of this history, it will be seen that
the future generations of oflScers and men of the Royal Irish
regiment have carried on the glorious traditions of the XVIIIth, and
have rivalled, though they could not surpass the brilliant feats of
arms which have been described in these pages.
The text on this page is estimated to be only 15.75%
accurate

I^^lpil THE SOUTH AFRICAN WAR MONUMENT AT

CLONMEL.
 APPENDIX 1. THE MOVEMENTS OF THE XVIIIth ROYAL
IRISH REGIMENT FROM THE TIME OF ITS FORMATION IN 1684 TO
THE END OF THE WAR IN SOUTH AFRICA IN 1902, AND THE
PLACES WHERE IT HAS BEEN QUARTERED IN TIME OF PEACE. 1685
. 1687 , 1688 • 1689. April 1689. August . 1689 to 1691 . 1691.
December 1692 , 1693. May 1694 to 1697 . 1698 1699 . 1700 1701 .
1702 to 1712 . 1713-14 . 1715 • 1716. February 1717. May 1718 ,
1727 Sailed for England ; quartered at Chester, and then returned to
Ireland. At the Curragh during the summer. At the Cui-ragh dm-ing
the summer : then sailed for England, and marched to London,
thence to Salisbury ; returned to Colnbrook near London, and in the
winter quartered in Hertfordshire. Hertfordshire to Chester ; thence
to Wales. Ordered to Ireland on active service. (See Chapter I.) On
active service in Ireland. (See Chapter I.) At Waterford and Youghal.
Embarked at Waterford for Bristol ; marched to Portsmouth and
sailed to the Low Countries on active service, returning in the
autumn to Bristol. Bristol to Portsmouth where the regiment was
embarked on men-of-war to serve as Marines ; in the autumn it was
landed, and after a short time at Norwich, returned to the Low
Countries on active service. (See Chapter I.) On active service in the
Low Countries until the end of 1697, when the regiment was sent to
Cork. (See Chapter I.) Moved from Cork to Waterford. Moved from
Waterford to Dublin. Moved from Dublin to Kinsale. Ordered to Low
Countries in anticipation of active sei'vice. On active service in the
Low Countries and Germany. (See Chapter II.) In garrison at Ghent.
In the autumn part of the regiment returned to England, and was
quartered at Gloucester. The remainder arrived at Gloucester ; later
in the year the whole regiment moved from Gloucester to Oxford.
Moved to Portsmouth. Embarked at Portsmouth for ]\Iinorca. A
detachment was sent from Minorca to reinforce the garrison of
Gibraltar during the siege of 1727. (See Chapter III.)
 76 Appendix i. 1727 1 to 1741 1742 1743 1744 • 1745
1746. March April May 1747 1748 1749. February 1750 1751 1752
1753 . • . 1754 1755. 1756. 1757 1758 to 1766 1767 1775 1776
1777 1778 1779 1780 1782 1783. July 1784 to 1792 1793 1794 to
1797 1798-1799 1800-1801 1802 1803 1804 1805. January 1806
1807 1808 At Minorca. Embarked at Minorca for Portsmouth ;
quartered on arrival in and ai'ound Taunton. Taunton to Exeter and
Plymouth. Exeter and Plymouth to the neighboiu-hood of Hounslow
and thence to Fareham. To the Low Countries on active service (see
Chapter III.) ; returned to England in the autumn and quartered at
Dartford. Dartford to Gravesend, where the regiment embarked for
Scotland, but arrived too late to take part in the suppression of the
Jacobite rising. Leith to Nairn, Inverness, and Elgin. Concentrated for
the summer at Fort Augustus ; during the winter quartered at
Edinburgh and Stirling. Edinburgh and Stirling to Berwick, Newcastle,
and Carlisle, and thence to Glasgow. Glasgow to Ireland ; stationed
at Enniskillen and Ballyshannon. At Kinsale. At Cork. At Waterford. At
Dublin. At Londonderiy and Ballyshannon. Embarked for Liverpool ;
marched to Berwick, in October to Edinburgh. Edinburgh to Fort
William, with detachments in the Highlands. Returned to Ireland. In
Ireland. Ireland to Philadelphia, North America. On active service in
North America. (See Chapter III.) North America to England ;
quartered at Dover. At Dover. At Coxheath encampment. At Warley
encampment. At the encampments at Finchley, and " Hyde Park in
London." England to Jersey and Guernsey. Guernsey to Portsmouth,
and in October to Gibraltar. At Gibraltar. Embarked at Gibraltar for
active service at Toulon. (See Chapter IV.) On active service in the
Mediterranean. At Gibraltar. On active service in the Mediterranean.
(See Chapter IV.) In the summer embarked at Elba for Cork, where
they landed on August 29th ; quartered at Armagh. In the summer
ordered from Armagh to Newry, where a second battalion was
raised. Both battahons were quartered in Scotland during the
autumn of 1803, at Edinburgh, Haddington, and Dunbar. In the
summer both battalions sent to the camp on Barham Downs near
Canterbury ; the second battalion sent later in the year to Jersey.
First battalion embarked for Jamaica, where it arrived at the end of
April or beginning of I\Iay. First battalion in Jamaica ; second
battalion in Jersey. First battalion in Jamaica : second battalion
embarked for West Indies and was stationed at the island of
Curagoa. No change of stations.
 Appendix i. 377 1809. June 7th First hattalion from Jamaica
to the Island of San Domingo (see Chapter IV.) on active service and
back to Jamaica ; second battalion at Cura§oa. 1810 . . First
battalion at Jamaica : second battalion returned to England. 1811 . .
Fir st battalion 3Xi&mA\c&-. second battalion ov^sxQdi to Sevs,Qj.
1812 to 1813 . No change of stations. 1814 . . First battalion at
Jamaica : second battalion disbanded. 1815-16 . . The regiment at
Jamaica. 1817 . . Returned to England, landing in March, and was
stationed at Brighton, Chatham, Sheerness, and finally at Hilsea
Barracks. 1818 . . Hilsea Barracks to Haslar and Gosport ; in
December returned to Ireland, landing at Cork, and was stationed at
Fermoy. 1819. January . Fermoy to Waterford, Wexford, Carlow,
Duncanuon Fort, Kilkenny. 1820. July . Ordered to Cork. 1821.
February Cork to Malta. 1824. May -June Malta to Ionian Isles. 1825
to 1831 . In the Ionian Isles. 1832. February 6 Embarked for
Portsmouth ; landed on March 7th, and marched to Weedon,
whence a Wing was sent in July to Tynemouth and Shefl&eld ; the
remainder of the regiment followed soon afterwards to Ashton. Later
in the year the regiment sent detachments to Wigan, Chester, and
INIold. 1833. August . Headquarters ordered to Salford Barracks,
Manchester, where the detachments rejoined. ^Manchester to
Dublin. Dublin to Limerick, with detachments at Newcastle, Killaloe,
Tipperary, Tarbert Fort, Carrick Island, and New Port. Limerick to
Birr. Birr to Athlone, with detachments at Roscommon and Shannon
Bridge. Detachment of the regiment embarked at Cork for Ceylon.
Headquarters and remainder of regiment embarked at Cork for
Ceylon, The detachment arrived in Ceylon. Headquarters and
remainder of regiment arrived in Ceylon ; regiment stationed at
Colombo with detachment at Point de GaUe ; later headquarters
moved to Trincomalee. 1840. May 1 . Headquarters and part of
regiment embarked for the C%ina war, followed shortly by the
remainder of the XVIIIth. (See Chapter V. ) On active service. 1841 .
. On active service. 1842 . . On active service till peace signed : then
quartered at Chusan and Kulangsu, 1845. May , Concentrated at
Hong Kong, 1846 . . At Hong Kong. 1847 . . At Hong Kong, and for a
few days on active service in the Canton river, „ Nov. 20 , Embarked
for Calcutta. 1848. January 10 Landed at Calcutta and quartered at
Fort William, with a detachment at Dum-Dum. „ Dec. 19 .
Headquarters and the greater part of regiment embarked on river
steamers for Allahabad, whither they had been preceded by a
detachment. 1849. Jan. 22 . Headquarters arrived at Allahabad ;
ordered to Umballa. „ March 24 Arrived at Umballa. „ Dec. 25 .
Began the march to Meerut. 1850. Jan. 4 , Arrived at Meerut ;
detachment sent to Ctiwnpore, 1834, May 8 . )) October , j> August
. 1836. March . )> Nov, 15. 1837 to 1840 J) Jan. 10 . » April 10 . ?»
May 31 .
 37^ Appendix i. 1850. Oct. 14 . 9) Nov. 21 . )) Nov. 22 . »)
Dec. 14 . 1851. January 2$ It Feb. 15 . 1852. Jan. 19 . >j March 14
1853 5) Dec. 27 . 1854. ]\Iay-June )5 Dec. 8 . 55 „ 30 . 1855 1856
5) July 10 . 5J Aug. 27 . 1857. March to April )5 Sept. 24 . \ Began
the march to Allahabad. Arrived at Allahabad. A wing of the regiment
embarked at Allahabad for Calcutta. Arrived at Calcutta. 1851.
January 22 Headquarters and the other wing embarked at Allahabad
for Calcutta. Arrived at Calcutta. Headquarters and a wing of the
regiment embarked for Burma on active service. (See Chapter VI.)
The remainder of the regiment followed. On active service in Burma
; returned in November to Calcutta. Embarked in four transports for
England. Arrived in England : stationed cxt Chatham with a
detachment at Canterbuiy, and for a short time also at Windsor
Castle and Wellington Barracks, London. Embarked for active service
in the Crimea. (See Chapter VII.) Landed at Balaclava. On active
service in the Crimea. On active service in the Crimea till the
declaration of peace. Landed at Portsmouth, and after a few days at
Aldershot, proceeded to Kingstown for Dublin. Dublin to the Curragh.
i^A detachment sent from the Curragh to Kilkenny on duty during
the election. A detachment embarked at Cork for Bombay on active
service against the mutineers of the Bengal army. 1857. Nov, 12 .
The detachment was followed from the Cun'agh by headquarters
and the remainder of the regiment, which embarked at Cork. „ Dec.
3 . The detachment arrived at Bombay, and was sent to Poona. (See
Chapter VIIL) 1858. Feb. 6 . Headquarters and remainder of the
regiment arrived at Bombay, and were sent to Poona. For the next
twelve months the regiment was split up into many detachments,
which frequently changed their stations. Among other places they
were temporarily quartered at Colaba (Bombay), Mahableshwar,
Poona, Singhur, I\Ialligaum, Nassick, Ahmednagar, Jaulnah, Sattara,
Asseerghur, Sholapore, and Adjunta. " *A^^'"i*^ \^ second
battalion was raised at Enniskillen, in Ireland. „ Aug. 30 . Enniskillen
to Londonderiy. First Battalion. 1859. May 26 . Headquarters and five
companies left Sholapore for Secunderabad. „ June 21 . Arrived at
Secunderabad, where they were gradually joined by the
detachments, the last of which did not reach headquarters till the
spring of 1860. Second Battalion. „ March 29 Londonderry to the
Curragh. „ Oct. 17 . The Curragh to Aldershot. First Battalion. 1860 .
. At Secunderabad. Second Battalion. „ October . Aldershot to
Shomcliffe.
 Appendix i. 379 First Battalion, 1861 , . .At Secunderabad.
Second Battalion. „ Aug. 21 . Shorncliffe to Portsmouth. First
Battalion. 1862 . . .At Secunderabad. Second Battalion, „ May 28 ,
Portsmouth to Jersey with a detachment at Alderney. First Battalion.
1863 , . .At Secunderabad. Second Battalion. „ Feb. 21 . Jersey and
Alderney to Parkhurst, „ April 1 . Headquarter and eight Companies
embarked at Portsmouth for New Zealand. „ „ 12 . The remainder of
the battalion followed. „ July 2 . Headquarters reached Auckland,
New Zealand ; the second ship arrived somewhat later. The battalion
was at once employed on active service, (See Chapter IX.) First
Battalion. 1864. . , At Secunderabad. Second Battalion. On active
service in New Zealand. 1865 . , , The same. First Battalion, 1866,
Jan, 16 . Marched from Secunderabad to Sholapore, arriving on
February 8 : train to Poona and on to Bombay, where it embarked on
two ships, the slower of which did not reach England till Jime 30th.
The battalion was quartered at Shorncliffe, „ Dec. 13 . Shorncliffe to
Aldershot, Second Battalion, On active service in New Zealand. First
Battalion. 1867. Aug. 19 . Aldershot to Chester, with detachments at
Weedou, Bradford, and Liverpool. Second Battalion. In New Zealand
; headquarters at Auckland, with detachments at Taranaki and
Napier. First Battalion. 1868, May 21 . Chester to Edinburgh with
detachment at Greenlaw, „ Oct. 14 , Edinburgh to the Ciu-ragh, „
November Detachments were sent during the elections to Dublin and
Naas, Second Battalion. In New Zealand : the headquarters and
detachments as in 1867, with a company at Wellington.
 3^0 Appendix i. First Battalion. 1869. Oct. 26 . The Curragh
to Belfast ; detachments sent at various times to Londonderry,
Carrickfergus, Newry, Monaghan, Armagh, Galway, Gort, Portumna,
Oughterard, and Birr. Second Battalion. In New Zealand : stations as
in 1868. First Battalion. 1870. June 21 . Belfast to Birr. „ July 12 .
Birr to the Curragh. Second Battalion. From New Zealand to Sydney
(New South Wales), with detachments at Melbom-ne (Victoria),
Adelaide (South Australia), and Hobart (Tasmania). „ August . The
battalion embarked at Sydney and Melbourne in two ships, the
slower of which arrived at Plymouth on December 4th. First
Battalion. 1871. May 22 . The Curragh to Cork, with a detachment at
Camden Fort. „ Aug. 26 . Cork to Fermoy. Second Battalion. At
Devonport. First Battalion. 1872. Jan. 18 . Embarked at Cork for
Malta. „ Jan. 30 . Landed at Malta. Second Battalion. „ July .
Devonport to Aldershot. First Battalion. 1873. . . At Malta. Second
Battalion. „ August . Aldershot to Gosport. First Battalion. 1874. Oct.
20 . Embarked at Malta for Bombay. „ Nov. 15 . Landed at Bombay. „
„ 25 . Arrived at Bareilly ; detachment at Moradabad. Second
Battalion. „ May . Gosport to ShornclifFe. First Battalion. 1875. . . At
Bareilly. Second Battalion. „ June- July ShornclifFe to Aldershot for
summer drills and then to Colchester. First Battalion. 1876. . . At
Bareilly. Second Battalion. „ July . Colchester to Fermoy, with
detachments at Hardbowline, Eocky Island, Tralee, Clonmel, and
Mitchelstown.
 Appendix i. 381 First Battalion. 1877. . . AtBareilly. Second
Battalion. Fermoy to the Curragh for summer drills and then to
Kilkenny, with detachments at Waterford, Clonmel, Duncannon Fort,
Carrick-on-Suir. First Battalion. 1878. Feb. 13 . Bareilly to Loodianah
by train, marching on to Ferozepore. „ Feb. 24 . Arrived at
Ferozepore. „ Sept. 29 . Detachments sent to Multan and Dera Ismail
Khan. Second Battalion. „ May 1 . Kilkenny to the Curragh. „ Aug. 9 .
The Curragh to Dublin. First Battalion. 1879 . . .At Ferozepore.
Second Battalion. „ May 19 . Dublin to Aldershot. First Battalion.
1880. Jan. 4-25 On march to Peshawar. „ April 30 . Marched to Lundi
Kotal on active service in the Afghan war. (See Chapter X.) Second
Battalion. At Aldershot. First Battalion. 1881. Mar. 18-19 Returned to
Peshawar. „ April 11 . Arrived at Rawal Pindi. „ „ 24 . i\Iarched to
Kuldanah in the Murree Hills with detachments at Chungla gully and
Bara gully. „ No\ . 6 . Kuldanah to Rawal Pindi with a detachment at
Ghariat. Second Battalion. „ Oct. 19 . Aldershot to Chatham. First
Battalion. 1882 . . .At Rawal Pindi. Second Battalion. „ Aug. 11 .
Chatham to Portsmouth, for Egypt on active service. (See Chapter
XL) After the Tel-el-Kebir campaign was over, the battalion was
quartered in Cairo from September 20 to October 11, when it was
sent to Alexandria. First Battalion. Rawal Pindi to Kuldanah, with
detachments as before. Kuldanah to Rawal Pindi, and on to Meerut.
Arrived at Meerut ; detachment at Fategarh. Second Battalion.
Alexandria to [Malta. Malta to Portsmouth. Portsmouth to Aldershot.
1883. t1 ^lay 4 . Oct. 11 . Dec. 11 . )> 55 February May 17 . „ 27 .
 382 Appendix i. First Battalion. 1884. Aug. 20 . Meerut to
Bombay. „ „ 29 . Sailed for Egypt. „ Sept. 29 . Reached Cairo. „ Nov.
12 . Left Cairo on active service in the Nile expedition. (See Chapter
XII.) Second Battalion. „ Feb. 28 . Embarked for Malta. First
Battalion. Embarked at Alexandria. Arrived at Plymouth. Plymouth to
Devonport. Second Battalion. Embarked at Malta for Bombay. Arrived
at Bombay. Arrived at Umballa. Umballa to Subathu, with
detachment at Jutogh. First Battalion. 1886 . . .At Devonport.
Second Battalion. 1,^ No change of station, except during camp of
exercise. First Battalion. 1887. Oct. 3 . Devonport to Plymouth.
Second Battalion. „ Nov. 4 . Subathu to Nowshera, arriving there on
December 25th, detachments at Fort Attock and Cherat. First
Battalion. Plymouth to Devonport. Second Battalion. Nowshera to
Derband. On active^; service in the Black Llountain or Hazara
expedition. (See Chapter XIII.) At the end of the operations,
Derband to Nowshera, where the battalion arrived on 29th
November. 1885. Aug. 24 5) Sept. 9 » Dec. 16 )J Jan. 7 It „ 26 )5
Feb. 4 5) April 24 1888. Oct. 11 >? Sept. 21 >) Nov. 15 1889. May 6
11 Oct. 24 ?) Nov. 3 )) Dec. 18 First Battalion. Devonport to Harwich
by sea and thence to Colchester. Second Battalion. To Peshawar for
a review by the Viceroy. Peshawar to Nowshera. Nowshera to
Peshawar. First Battalion. 1890 . . .At Colchester. Second Battalion. „
April 21 . Peshawar to Cherat ; detachment at Peshawar. ,, Oct. 1 .
Cherat to Peshawar. „ November At camp of exercise. „ Dec. 5 .
Besran march to Lucknow.
 Appendix i. 383 1891. Nov. 4 )) Mar. 3 1892-93 . 1894. Oct.
31 First Battalion. Colchester to the Curragh. Second Battalion.
Arrived at Lucknow ; detachment at Fategarh. Neither battalion
changed station, except during manoeuvres and camps of exercise.
First Battalion. After the summer manoeuvres, the battalion made a
short halt at Birr, and then proceeded to Limerick. Second Battalion.
„ Nov. 29 . Began march from Lucknow to Jubbulpore. First
Battalion. 1895 . . .At Limerick. Second Battalion. „ Jan. 2 . Ai'rived
at Jubbulpore from Lucknow ; detachment at Sangor. First Battalion.
1896 . . . While the drainage of the barracks at Limerick was being
modernised, part of the battalion was temporarily quartered at
Templemore, and then returned to Limerick. (A section of mounted
infantry were sent to South Africa, and were employed in the
Mashonaland expedition. (See Chapter XIV.) Second Battalion. At
Jubbulpore. First Battalion. 1897 . . .At Limerick. Second Battalion. ,,
Sept. 15 . Jubbulpore for Eawal Pindi, on active service on the Tirah
campaign. (See Chapter XIII.) First Battalion. 1898. Aug. 30 .
Limerick to Butte vant, with detachment at Clonmel. Second
Battalion. „ April . Arrived at Mhow from Rawal Pindi ; detachment at
Indore. First Battalion. 1899. Nov. 23 . Buttevant to Aldershot. „ Dec.
16 . Embarked at Southami)ton for South Africa on active service.
(See Chapters XIV. and XV.) Second Battalion. At Mhow. First
Battalion. 1 900 . . .On active service in South Africa. Second
Battalion. At Mhow.
The text on this page is estimated to be only 24.82%
accurate

^g^ Appendix i. First Battalion. 1901 . . .On active service

iu South Africa. Second Battalion. At Mhow ; detachments at Indore,
Kamptee, and Sitabaldee. First Battalion. 1902. (to June 1) On active
service in South Africa. Second Battalion. April 28 . Mhow to
Kamptee.
 3^0 APPENDIX 2. CASUALTY ROLL. (In this Ai^pendix an
attempt has been made to collect the names of the officers,
noncommissioned officers, and private soldiers of the regiment who
in its many campaigns have been killed or wounded, or who died
from accident or disease. The information about the losses in the
wars of William III. and of Marlborough is very incomplete, for it is
obvious that far greater numbers of officers and men must have
perished than are recorded by Parker, Kane, and Stearne, who only
mention the casualties in battles and sieges of great importance.
The names of non-commissioned officers and men who, though
wounded, recovered from their injuries cannot be traced further
back than the Crimean war.) (A). WILLIAM III.'s CAMPAIGNS. 1690.
1st Siege of Limerick. (Though seven officers are said to have been
killed and eight wounded, the following are the only names that can
be traced.) Officers . Killed . Died of wounds Wounded Other ranks
1691. Battle of Aughrim. Officers . Killed . Wounded Other ranks
1695. Siege of Namur. Officers . Killed . Died of wounds Wounded
Other ranks Captains K. Needham and C. Brabazon ; Lieutenant P.
Latham and Ensign Smith. Lieutenant-Colonel G. Newcomb (or
Newcomen). Colonel the Earl of Meath ; Lieutenants R. Blakeney and
C. Hubblethorne. More than 100 killed or wounded. Captain Butler. A
major, a captain, and two subalterns (names unknown). 7 killed, 8
wounded. Lieutenant-Colonel A. Ormsby ; Captains B. Purefoy, H.
Pinsent, N. Carteret ; Lieutenants C. Fitzmorris and S. Ramme ;
Ensigns A. Fettyplace, Blunt, H. Baker, and S. Hayter. Captain John
Southwell ; Ensign B. Lister (or Leycester) and an officer whose
name cannot be traced. Colonel Frederick Hamilton ; Captains R.
Kane, F. Duroure, H. Seymour, and W. Southwell ; Lieutenants L. La
Blanche, T. Brereton, C. Hybert (or Hibbert), and A. RoUeston ;
Ensigns T. Gifford, J. Ormsby, and W. Blakeney. The losses in killed
or wounded were 380 or 271. (See Chapter I. p. 21.) 2b
 386 Appendix 2. (B). MARLBOROUGH'S CAMPAIGNS IN THE
WAR OF THE SPANISH SUCCESSION. 1704. Captm'e of the
Schellenberg. Officers . Wounded . . Captain M. Leathes ; Ensigns J.
S. Oilman, and E. Walsh. Non-commissioned officers . 1 killed, 3
wounded. Privates 11 killed, 32 wounded. Pinsent (or Pensant),
Battle of Blenheim. Officers . Killed . Died of wounds Wounded Non-
commissioned officers Privates .... Captains H. Browne and A.
Rolleston ; Ensign W. Moyle. Captain W. Vaughan (or Vauclin). Major
R. Kane ; Captains F. de la Penotifere and N. Hussey ; Lieutenants
W. Weddall (or Weddell), S. Roberts, J. Harvey, B. Smith, W.
Blakeney, and Ensign R. Tripp. 5 killed, 9 wounded. 52 killed, 87
wounded. 1706. Battle of Ramillies . The regiment is said to have
been " greatly mauled " in the battle. (See Chapter II. p. 44.) 1706.
Siege of Menin. Officers . Killed . . .2 captains and 5 subalterns.
Wounded . . Captain-Lieutenant Parker and seven others. (Other
names unknown.) Other ranks .... About 100 killed or wounded.
1708. Battle of Oudenarde. Officers. . Killed . Other ranks Siege of
Lille. Officers . Killed . Wounded Other ranks 1 lieutenant (name not
known). 8 killed, 12 wounded. 2 captains, 3 subalterns. (Names not
known.) Major and several others. (Names not known.) 200 killed or
wounded. 1709. Siege of Tournai. See Chapter II. p. 55. It is obvious
that the regiment suffered considerably ; but the numbers are not
clear. Battle of Malplaquet. Officers . Wounded Other ranks 1710.
Siege of Aire. Officers . Killed . Wounded Other ranks 1711. Siege of
Bouchain. Officers . Wounded Other ranks 2 (names not known). 10
killed or wounded. 3 (names not known). 5 (names not known). 80
killed or wounded. 4 (names not known). About 40 killed or
wounded.
 Appe7idix 2. 387 (C). THE WAR WITH THE AMERICAN
COLONISTS. 1775. Retreat from Concord and Lexington. Killed . . .
Privates S. Lee and J. Russell. Wounded . . 4 private soldiers. Battle
of Bunker's Hill. Officers . Wounded Other ranks Killed . Wounded
Lieutenant W. Richardson. Privates D. Flynn, T. Smith, and W. Sorrel.
7 private soldiers. 1793. Otiicers (D). THE DEFENCE OF TOULON.
Missing (prisoner of war) . . Lieutenant George Minchin. Other ranks
— Killed or died from wounds or of disease — Sergeants . R. House,
J. Russell, M. Nowlan. Corporal . P. Hanson. Privates . E. Murdoch, T.
Griffiths, W. Briggs, W. Wilkinson, P. M'Gurke, J, Harper, J. ]Molloy,
W. Allen, D. Madden, J. Shelly, C. Reed, H. Allen, T. Border, W.
Warren, J. Church, M. M'llvany, J. Winch, A. Price, W. Sheen, T. Field,
J. Mayo, P. White, J. Riddell, G. Lacey, J. Cruickshanks, E. Strange, P.
Roberts, H. Foy, H. Costello, B. Blazor, J. Smith, W. Bowyer, W. Cable,
B. Johnson. (E). 1794. CORSICA. (Killed in action or died from
wounds, accident, or disease between April 1794 and December
1794.) Officers . Lieutenant W. Byron (killed); Ensign F. Pennyman,
Surgeons C. Kennelly, and T. Jackson (died of disease). Sergeants .
A. White, A. TurnbuU, J. Abraham, E. Turnbull, W. Taylor, J.
Antwhiste, D. M'Donald, T. Astley, W. Slade. Corporals . T. Porter, S.
Kerns, W. Moran, W. Irwin, J. Bishop, W. Cooper. Privates . T. Philips,
C. Chaplain, J. Browning, C. Sheridan, D. Fielding. J. Eadon, G.
M'Lean, J. Derry, J. Willington, J. Blacker, C. Turner, T. Hopkins, W.
Bennett, J. Blake, J. Quinn, C. Riche, M. Striffen, M. Reilly, H.
M'MuUen, J. Crowley, W. Huskins, J. Carey,
 o SS Appendix 2. M. Lloyd, T. Walsh, H. Marshall, J. Cooke,
T. Connor, J. Joyce, J. Rubb, M. Finlan, G. Diamond, E. Warr, P.
Gallov;gher senr., P. Rian, W. O'Neill, E. Doyle, W. Keane, T. Coyle, O.
Kelly, R. German, J. Henly, M. Healy, C. Stagman, P. Dunn, M. Rian,
J. M'Surley, H. Collins, J. Butcher, V. Smith, T, David, D. Mott, J.
Donolly, M. Martin, J. Monaghan, M. Flanaghan, B. Harrison, T.
Cooper, W. Jael, J. Birch, T. Ledgerwood, W. Cooke, T. Campbell, T.
Martin, W. Callaghan, S. Bland, W. Scott, J. Red, J. Eagon, T.
Crumlish, W. Garilt, G. Benson, J. Thompson, J. Millar, B. Cooke, T.
Abraham, F. Walsh, J. Reynolds, J. Douch, J. Carleton, G. Plumer, M.
Burke, J. O'Brien, J. Edwards, J. Paterson, J. Weir, C. Harrison, F.
Rearden, G. Westwood, W. Watson, F. Evans, P. Gallougher junr., T.
Hughes, J. Smith, J. Shonplatter, W. Hervey, W. Honoretta, F. Lynder,
T. Handley, P. Carr, D. Houlahan, A. Jordan, T. Murphy, J. Conlin, W.
Bowland, J. Fisher, A. Hai't, G. Texter, W. Anderson, J. Hengly, T.
Tuesby, G. Nockton, J. Spense, P. Kennedy, J. Garden, W. ScuUard, J.
Roarke, W. Tatton, J. Nolan, T. Drinnett, C. Dyson, T. Kinch, E.
Eamer, J. Campbell, D. Ford, J. Morgan, J. Branan, W. Newton, J.
Duffy, J. M'Donagh, J. Gallougher, M. M'Loughlin, M. Murphy, T.
Perkins, H. Loughrie, P. Cummins, J. Irwin, T. Moorhouse, W.
Taggart, G. Mosey, W. Browse, W. Ellis, J. Farnsworth, J. Shields, T.
Harris, G. Robinson, T. Lee, A. Pithie, R. Divers, C. Reardon, J.
Mulconray, C. Reeny, T. Bergin, T. Wilson, J. Lee, J. Kelly. (F). 180L
EGYPT. Killed— Officers . Captain-Lieutenant G. Jones. Other ranks
None. Died of wounds, accident, or disease — Officers . Captain W.
Morgue ; Ensigns H. Bruley and W. Brand ; Quartermaster M.
M'Dermott. Sergeants . T. Houlahen, P. Marten, P. Bennett, J.
Maxwell, H. Francis. Corporals . J. Burrows, J. Sanders, E. Cassidy.
Drummers T. Acton, S. Acton, G. Rutledge, J. Kyatt. Privates . J.
Gallougher, L. Doyle, J. Farrell, 0. Brislow, P. Robinson, M. Milkerrine,
J. Clark, J. Dufree, S. Bacon, L. Delancy, P. Ennisy, J. Grimshaw, J.
Hammond, P. Kiguire, T. Connolly, J. Oliver, J. Tonar, W. Hillier, G.
Needhem, W. Thompson, J. Cummins, R. Graham, W. Harris, G.
Newbold, W. WilUngton, J. Boyle, W. Dempsey, J. M'Cawley, T. Kelly,
J. Mayor, W. Burgess, S. Bryan, T. Marsden, H. Athe, T. Marten, J.
Hunt, D. Mahoney, P. Marsh, J, Skiene, J. Neil, D. Clarke, J.
Dempsey, T. Finlin, H. Poole.
 Appendix 2. 389 1840-2. OflBcers , Killed in action Died of
disease Sergeants Corporals Drummers. Privates Wounded Killed .
Died of wounds Died of disease Died of wounds Died of disease Died
of disease . Killed . Died of Wounds . Died from accident or drowning
Died of disease . (G). CHINA. Lieutenant - Colonel N. R. Tomlinson ;
Captain C. J. R. CoUinson. Major R. Hammill (1841) ; Lieutenants H.
F. Vavasour (1840), S. Haly (1841), G. W. Davis (1841), A. Wilson
(adjutant) (1841), F. Swinburne (1841), J. Cockrane (1842), D.
Edwardes (1842), Hon. C. H. Stratford (1842) ; Ensign L. M. T.
Humphreys (1842) ; AssistantSurgeon J. Baker. Captain J. J. Sargent
; Lieutenants D. Edwards, G. Hilliard, A. Murray, E. Jodrell, S.
Bernard. Paymaster-Sergeant E. Fitzgerald. Colour- Sergeant W.
Kiscadden. Orderly - Room Clerk R. Bullock ; Colour - Sergeant M.
Switzer, B. M'Clennon, H. Smith, J. Brady, J. Cummin, P. Molan. J.
Bushell. J. M'Carthy, J. Farlow, J. Spratt, J. Wilson, J. Henry, J.
M'Carthy, M. M'Entaggart, W. Peake, A. Dixon, J. Connors. D. Moore,
E. Poulteney, P. Callopy. J. Henry, P. Sheppard. J. Mulhaven, G. Bond,
P. Gorman, J. Power. P. Mineham, A. Scott. H. Crozier, J. Turner, G.
M'Cormick, E. M'Cabe, J. Dailey, J. Short, J. Hensey, J. Warrell, M.
Mackay, G. Cullwell, E. Haslam, J. Maginniss, T. Short, R. Pawell, W.
Abraham, R. M'Henry, E. Gallagnet, M. Connors, H. Kelly, W. Holey, J.
Spears, R. M'Garthy, J. Connell, M. M'Wheney, P. Burke, M. M'Grath,
H. Crangle, M. Nowland, W. M'Keown, G. Moirow, J. Murphy, M.
FuUerton, P. Haran, T. Grace, M. Harsham, H. Frederick, M. White, D.
Hogan, A. Woods, M. Kenna, D. Carroll, J. Short, J. M'Combe, H.
Quierland, J. Houston, J. Parry, A. Macauley, J. LI'Murray, T.
Denahey, J. Shaw, W. Devine, A. M'Donald, A. Meehan, J. Connell, G.
Banks, A. Muldoon, R. Hayes, J. Ward, B. Thompson, D. M'Auliffe, J.
Maley, D. Chambers, J. Slattery, C. Flanagan, D. Evans, G. Douglass,
R. Johnston, P. Downs, M. Murray, J. Mackay, J. Coady, S. Gaffney, E.
Hewitt, D. Hoolohan, T. M'Elvasey, R. M'Giiiday, M. Carroll, M.
M'Grath, G. Crummey, C. Burke, J. Taylor, D. Hogan, T. Paine, M.
Shanahan, P. Bratman, M. Bollard, A. Carroll, L. Downey, M. Hayes,
T. M'Donald, P. Meighan, J. Mulharen, M. Punlan, J. Raftery, J.
Welcome to our website – the ideal destination for book lovers and
knowledge seekers. With a mission to inspire endlessly, we offer a
vast collection of books, ranging from classic literary works to
specialized publications, self-development books, and children's
literature. Each book is a new journey of discovery, expanding
knowledge and enriching the soul of the reade

Our website is not just a platform for buying books, but a bridge
connecting readers to the timeless values of culture and wisdom. With
an elegant, user-friendly interface and an intelligent search system,
we are committed to providing a quick and convenient shopping
experience. Additionally, our special promotions and home delivery
services ensure that you save time and fully enjoy the joy of reading.

Let us accompany you on the journey of exploring knowledge and

personal growth!

ebookname.com