BOOK
Current Therapy of Trauma and Surgical Critical Care E-Book
Juan A. Asensio | Donald D. Trunkey
(2008)
Additional Information
Book Details
Abstract
Here’s a unified evidence-based approach to problems encountered in trauma and critical care surgical situations. Comprehensive and concise, it is ideal for a quick overview before entering the operating room or ICU, or as a review for board certification or recertification.
- Be prepared for the unexpected with practical, concise coverage of major surgical problems in trauma and critical care.
- Get expert practical and up-to-date guidance on ventilator management, damage control, noninvasive techniques, imaging, infection control, dealing with mass casualties, treating injuries induced by chemical and biological agents, and much more.
- Find the information you need quickly and easily through numerous illustrations, key points boxes, algorithms, and tables.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Current Therapy of Trauma and Surgical Critical Care | iii | ||
| Copyright Page | iv | ||
| Contributors | v | ||
| Foreword | xix | ||
| Preface | xxi | ||
| Table of Contents | xxiii | ||
| 1 Trauma Systems | 1 | ||
| 1 The Development of Trauma Systems | 1 | ||
| Modern Trauma System Development | 2 | ||
| Are Trauma Systems Effective? | 3 | ||
| What are the Current Problems? | 4 | ||
| Solutions | 4 | ||
| 2 Trauma Center Organization and Verification | 6 | ||
| Trauma System and Trauma Center Organization | 6 | ||
| Trauma System Organization | 6 | ||
| Trauma Center Organization | 6 | ||
| Trauma Performance Improvement Process | 7 | ||
| Trauma Center Verification | 8 | ||
| 3 Injury Severity Scoring: Its Definitionand Practical Application | 10 | ||
| Injury Description and Scoring: Conceptual Background | 10 | ||
| Testing a Test: Statistical Measures of Predictive Accuracy and Power | 11 | ||
| Measuring Anatomic Injury | 12 | ||
| Measuring Physiologic Injury | 15 | ||
| Measuring Physiologic Reserve and Comorbidity Risk | 15 | ||
| More Powerful Predictions: Combining Several Types of Information | 16 | ||
| Statistical Considerations | 18 | ||
| Improved Prediction in Trauma Scoring | 19 | ||
| How Good are Current Scoring Systems? | 19 | ||
| The Uses of Injury Scoring | 19 | ||
| Recommendations | 20 | ||
| Conclusions | 20 | ||
| 4 The Role of Alcohol and Other Drugs in Trauma | 21 | ||
| Effects of Alcohol and Drugs on Management and Outcome | 21 | ||
| Alcohol and Injury Recidivism | 22 | ||
| Withdrawal Syndromes: Prophylaxis and Treatment | 22 | ||
| Definition of Alcohol Problems | 22 | ||
| Rationale for Brief Alcohol Interventions in Trauma Centers | 23 | ||
| Screening for Alcohol Problems | 23 | ||
| Goals of Brief Interventions | 23 | ||
| Brief Intervention Techniques | 24 | ||
| Summary | 24 | ||
| Key Points | 24 | ||
| 5 The Role of Trauma Prevention in Reducing Interpersonal Violence | 25 | ||
| Understanding the Problem | 25 | ||
| Impact of Enhanced Trauma Commitment on Patient Outcomes | 25 | ||
| In-Hospital Prevention: Shortcomings | 25 | ||
| Effectiveness of a Violence Prevention Program | 25 | ||
| Culture of Violence | 26 | ||
| 6 Trauma Scoring | 26 | ||
| Anatomic Scoring Systems | 27 | ||
| Abbreviated Injury Scale | 27 | ||
| Injury Severity Scale | 27 | ||
| Anatomic Profile and New Injury Severity Score | 28 | ||
| ICD-9 Injury Severity Score | 28 | ||
| Physiologic Scoring Systems | 28 | ||
| Glasgow Coma Scale | 28 | ||
| Revised Trauma Score | 29 | ||
| Acute Physiology and Chronic Health Evaluation | 29 | ||
| Physiologic Reserve | 29 | ||
| Risk-Adjustment Scoring Systems | 29 | ||
| Trauma and Injury Severity Score | 29 | ||
| A Severity Characterization of Trauma | 29 | ||
| Mechanism of Injury | 30 | ||
| Scoring Systems Evaluation | 30 | ||
| Data Collection | 30 | ||
| Databases | 30 | ||
| Outcome Measures | 30 | ||
| Summary | 31 | ||
| 7 Trauma Systems and Trauma Triage Algorithms | 32 | ||
| Trauma Systems | 33 | ||
| Trauma Systems Summary | 34 | ||
| Support for Regionalized Trauma Care | 34 | ||
| Initial Approach to the Critically Injured Patient | 35 | ||
| Prehospital Care: Intervention at Injury Site | 35 | ||
| Field Triage | 35 | ||
| Declaration of Death at Scene | 35 | ||
| Guidelines for Withholding or Termination of Resuscitation in Prehospital Cardiopulmonary Arrest | 35 | ||
| Initial Electrocardiographic Rhythm | 35 | ||
| Resuscitation Duration | 35 | ||
| Emergency Department Thoracotomy | 37 | ||
| Rapid Transport versus Field Stabilization | 38 | ||
| Air Medical Transport | 38 | ||
| Exceptions | 39 | ||
| Prehospital Care Controversies | 39 | ||
| Advanced Trauma Life Support | 39 | ||
| Airway Management | 40 | ||
| Prehospital Intubation of Patients with Traumatic Brain Injury | 40 | ||
| Prehospital Volume Resuscitation | 40 | ||
| Resuscitation with Hypertonic Saline | 40 | ||
| Pediatric Trauma System | 41 | ||
| Conclusions | 41 | ||
| Practice Management Guidelines for Geriatric Trauma | 43 | ||
| Triage Issues in Geriatric Trauma | 43 | ||
| Predictors of Mortality in Geriatric Population | 44 | ||
| Complications and Outcome | 45 | ||
| Parameters for Resuscitation of the Geriatric Trauma Patient | 45 | ||
| Summary | 45 | ||
| Conclusion | 46 | ||
| 2 Prehospital Trauma Care | 47 | ||
| 8 Delivering Multidisciplinary Trauma care: Current Challenges and Furutre Directions | 47 | ||
| Organizing the Initial Care of Trauma Patients | 48 | ||
| Prehospital Communication | 48 | ||
| Tiered Trauma Team Activation | 48 | ||
| In-House Trauma Attending | 49 | ||
| Captain of the Ship Concept | 49 | ||
| Trauma Coverage by Specialists | 49 | ||
| Organizing Subsequent Care of Trauma Patients | 49 | ||
| Role of Tertiary Survey | 49 | ||
| Communication | 50 | ||
| Morning Report | 50 | ||
| Check-Out Rounds | 50 | ||
| Multidisciplinary Rounds | 50 | ||
| Role of Physician Extenders | 50 | ||
| Next Generation of Trauma Surgeons | 51 | ||
| Working Hours | 51 | ||
| Trauma as a Nonoperative Specialty | 51 | ||
| Operative Trauma Education | 52 | ||
| Other Challenges in Organizing Trauma Care | 52 | ||
| Alcohol and Substance Abuse | 52 | ||
| Social and Financial Issues | 53 | ||
| Rehabilitation and Further Disposition | 53 | ||
| Nutritional Support | 53 | ||
| Populations at Risk | 53 | ||
| Geriatric Population | 53 | ||
| Obstetric Trauma Patients | 53 | ||
| Pediatric Population | 53 | ||
| Funding for Educational Outreach and Research | 54 | ||
| Summary | 54 | ||
| 9 Triage | 55 | ||
| Field Triage | 55 | ||
| Mass Casualty Triage | 56 | ||
| Comments | 57 | ||
| 10 Prehospital Airway Management: Intubation, Devices, and Controversies | 58 | ||
| Who Needs an Airway? | 58 | ||
| Difficult Airway | 58 | ||
| Which Strategy should be Used? | 58 | ||
| Laryngeal Mask Airway | 58 | ||
| Combitube | 58 | ||
| Orotracheal Intubation | 59 | ||
| Confirmation of Orotracheal Tube Placement | 60 | ||
| Controversies in Prehospital Intubation | 60 | ||
| Prehospital Intubation in Traumatic Brain Injury | 60 | ||
| Who Should Perform Prehospital RSI? | 60 | ||
| Role of Capnometry in Prehospital Intubation | 61 | ||
| Use of Positive End-Expiratory Pressure | 61 | ||
| Final Comments | 62 | ||
| 11 Prehospital Fluid Resuscitation: What Type, How Much, and Controversies | 63 | ||
| Epidemiology | 63 | ||
| Causes of Significant Hemorrhage | 63 | ||
| Diagnosis/Assessment | 63 | ||
| Classes of Hemorrhagic Shock | 64 | ||
| Management | 64 | ||
| Access | 64 | ||
| Types of Fluid | 64 | ||
| Resuscitation Targets | 66 | ||
| Morbidity and Complications | 66 | ||
| Summary | 66 | ||
| 12 Civilian Hospital Response to Mass Casualty Events | 67 | ||
| Key Definitions | 67 | ||
| Prehospital Care in Mass Casualty Event | 67 | ||
| Hospital Triage | 67 | ||
| Hospital Emergency Incident Command System | 69 | ||
| Disaster Preparedness through Simulation | 69 | ||
| Causes of Mass Casualty Events | 69 | ||
| Conventional Weapons/Blast Injury | 69 | ||
| Biological Agents | 70 | ||
| Chemical Agents | 71 | ||
| Radiation Injuries | 72 | ||
| Conclusion | 73 | ||
| 13 Blast Injuries | 73 | ||
| Mechanisms of Injury and Injury Patterns in Explosions | 73 | ||
| Blast Injury: Clinical Aspects | 74 | ||
| Primary Blast Injury | 74 | ||
| Secondary Blast Injury | 75 | ||
| Tertiary Blast Injury | 76 | ||
| Quaternary Blast Injury | 76 | ||
| Quinary Blast Injury | 76 | ||
| Multidimensional Injury Pattern | 76 | ||
| Treatment of Blast Injuries | 76 | ||
| 14 Prehospital Care of Biological Agent–Induced Injuries | 78 | ||
| 15 Wound Ballistics: What Every Trauma Surgeon should Know | 82 | ||
| Firearm and Projectile Design | 82 | ||
| Handguns | 83 | ||
| Hunting Rifles | 84 | ||
| Assault Rifles | 85 | ||
| Shotguns | 85 | ||
| Protective Vests | 86 | ||
| Landmines and Improvised Explosive Devices | 87 | ||
| Red Cross Wound Classification | 87 | ||
| Bullet Removal | 87 | ||
| 16 Common Prehospital Complications and Pitfalls in the Trauma Patient | 88 | ||
| Incidence | 88 | ||
| Airway | 89 | ||
| Breathing | 89 | ||
| Circulation | 90 | ||
| Disability | 92 | ||
| Transport | 92 | ||
| Comorbidities | 92 | ||
| Conclusion | 93 | ||
| 3 Inital Assessment and Resuscititation | 95 | ||
| 17 Airway Management: what every trauma surgeon shouls know, from intubation to cricothyroidotomy | 95 | ||
| Airway Anatomy | 95 | ||
| Assessing the Airway | 97 | ||
| Controlling the Airway | 97 | ||
| Documentation of Proper Endotracheal Tube Placement | 98 | ||
| Combitube© | 100 | ||
| Endotracheal Intubation | 101 | ||
| Nasal Intubation | 101 | ||
| Orotracheal Intubation | 101 | ||
| Surgical Airway | 103 | ||
| Needle Cricothyroidotomy | 104 | ||
| Cricothyroidotomy | 104 | ||
| Emergency Surgical Tracheostomy | 104 | ||
| Management of Airway When Neck is Lacerated | 105 | ||
| Summary | 105 | ||
| 18 Resuscitation Fluids | 106 | ||
| Classes of Shock | 106 | ||
| Autoresuscitation | 106 | ||
| Vasoconstriction and Reduction of Capillary Hydrostatic Pressure | 106 | ||
| Hormonal Response | 106 | ||
| Hypotensive Resuscitation | 108 | ||
| Choice of Fluids | 108 | ||
| Crystalloid Solutions | 109 | ||
| Hypertonic Saline | 110 | ||
| Artificial Oxygen-Carrying Blood Substitutes | 110 | ||
| Blood Transfusions | 110 | ||
| Complications of Resuscitation | 111 | ||
| Hypothermia | 111 | ||
| Coagulopathy | 112 | ||
| Acidosis | 113 | ||
| Summary | 114 | ||
| 19 Emergency Department Thoracotomy | 114 | ||
| Historic Perspective | 114 | ||
| Objectives | 115 | ||
| Physiology | 115 | ||
| Positive Effects | 115 | ||
| Negative Effects | 115 | ||
| Indications | 115 | ||
| Accepted Indications | 115 | ||
| Selective Indications | 115 | ||
| Rare Indications | 116 | ||
| Techniques for Cardiac Injury Repair | 116 | ||
| Incisions | 116 | ||
| Adjunct Maneuvers | 116 | ||
| Repair of Atrial Injuries | 118 | ||
| Repair of Ventricular Injuries | 118 | ||
| Coronary Artery Injuries | 118 | ||
| Use of Bioprosthetic and Autogenous Materials | 119 | ||
| Complex and Combined Injuries | 119 | ||
| Results | 119 | ||
| 20 The Role of Focused Assessment with Sonography for Trauma: Indications, Limitations, and Controversies | 125 | ||
| Formation of an Ultrasound Image | 125 | ||
| Technique | 125 | ||
| Troubleshooting | 128 | ||
| Indications | 128 | ||
| Accuracy | 130 | ||
| Learning Curve and Training | 130 | ||
| Fluid Volume and Scoring Systems | 131 | ||
| Algorithm: Blunt Abdominal Trauma | 131 | ||
| Algorithm: Penetrating Thoracoabdominal Trauma | 131 | ||
| Extensions to Fast | 132 | ||
| Hemothorax | 132 | ||
| Pneumothorax | 132 | ||
| Sternal Fracture | 132 | ||
| Fast for Pediatric Trauma | 133 | ||
| Fast for Reproductive-Age Females | 133 | ||
| Limitations of Fast | 134 | ||
| Controversies | 134 | ||
| Summary | 135 | ||
| 21 The Use of Computed Tomography in Initial Trauma Evaluation | 136 | ||
| History | 136 | ||
| Computed Tomography of Head/Brain (Cranium) | 136 | ||
| Computed Tomography of Face and Orbits | 136 | ||
| Computed Tomography of Spine | 136 | ||
| Computed Tomography of Neck and Great Vessels | 137 | ||
| Computed Tomography of Chest | 137 | ||
| Computed Tomography of Abdomen and Pelvis | 138 | ||
| Computed Tomography of Orthopedic Injuries | 138 | ||
| 22 Interventional Radiology: Diagnosticsand Therapeutics | 139 | ||
| Indications | 139 | ||
| Blunt Cerebrovascular Injury | 139 | ||
| Brachiocephalic Trauma | 140 | ||
| Thoracic Injury | 140 | ||
| Abdominal Trauma | 141 | ||
| Pelvic Trauma | 142 | ||
| Extremity Trauma | 142 | ||
| Management of Late Complications | 143 | ||
| 23 Endpoints of Resuscitation | 143 | ||
| Hemodynamic Parameters | 143 | ||
| Vital Signs and Clinical Endpoints | 143 | ||
| Invasive Monitoring | 144 | ||
| Metabolic Parameters | 145 | ||
| Lactate | 145 | ||
| Base Deficit | 145 | ||
| Regional Perfusion Endpoints | 145 | ||
| Summary | 146 | ||
| 4 Head and Central Nervous System Injuries | 147 | ||
| 24 Traumatic Brain Injury: Pathophysiology, Clinical Diagnosis, and prehospital and Emergency Center Care | 147 | ||
| Incidence | 147 | ||
| Mechanism of injury | 147 | ||
| Subdural Hematoma | 147 | ||
| Epidural Hematoma | 147 | ||
| Subarachnoid Hemorrhage | 148 | ||
| Parenchymal Lesions | 148 | ||
| Ischemia | 148 | ||
| Diffuse Axonal Injury | 149 | ||
| Cellular and Molecular Factors | 149 | ||
| Clinical Diagnosis | 149 | ||
| Clinical Examination | 149 | ||
| Initial Clinical Interventions: Prehospital and Emergency Center Care | 149 | ||
| Airway | 149 | ||
| Breathing | 149 | ||
| Circulation | 150 | ||
| Imaging Modalities: What, When, and Why | 150 | ||
| Computed Tomography Scanning | 150 | ||
| Magnetic Resonance Imaging | 150 | ||
| Angiography | 150 | ||
| Injury Grading | 151 | ||
| Glasgow Coma Scale | 151 | ||
| Marshall Computed Tomography Scale | 151 | ||
| Abbreviated Injury Scale | 151 | ||
| Mild and Moderate Traumatic Brain Injury | 151 | ||
| Conclusions and Algorithm | 152 | ||
| 25 Traumatic Brain Injury: Imaging, Operativeand Nonoperative Care, and Complications | 153 | ||
| Surgical Management | 153 | ||
| Positioning | 153 | ||
| Bone Flap | 153 | ||
| Brain Swelling | 153 | ||
| Epidural Hematomas | 154 | ||
| Intraparenchymal Lesions | 154 | ||
| Intracranial Pressure Monitoring | 154 | ||
| Coagulopathy | 154 | ||
| Summary | 154 | ||
| Nonoperative Management | 154 | ||
| Location of Care | 154 | ||
| Secondary Insults | 154 | ||
| Ventilator Weaning and Tracheostomy | 155 | ||
| Sedation | 155 | ||
| Cerebral Monitoring | 155 | ||
| Nutrition | 155 | ||
| Fluids and Electrolytes | 155 | ||
| Physical, Occupational, and Speech Therapy | 155 | ||
| Fever | 155 | ||
| Deep Venous Thrombosis | 155 | ||
| Transfusion Thresholds | 156 | ||
| Treatment of Intracranial Hypertension | 156 | ||
| Individualization of Treatment | 158 | ||
| Failure of Intracranial Pressure Prophylaxis | 158 | ||
| Guidelines | 158 | ||
| Failure of Clinical Trials | 158 | ||
| Morbidity and Complications | 158 | ||
| Mortality | 158 | ||
| Penetrating Brain Injury | 159 | ||
| Conclusions and Algorithm | 159 | ||
| 26 Spine: Spinal Cord Injury, Blunt and Penetrating, Neurogenic and Spinal Shock | 160 | ||
| Incidence | 160 | ||
| Mechanism of Injury | 161 | ||
| Biomechanics of the Spine | 161 | ||
| Mechanism of Injury | 162 | ||
| Penetrating Spinal Cord Injury | 162 | ||
| Blunt Spinal Cord Injury | 162 | ||
| Severity/Grading of Spinal Cord Injuries | 162 | ||
| Neurological and Functional Outcome Scales | 162 | ||
| Spinal Cord Syndromes | 163 | ||
| Diagnosis | 164 | ||
| Management of Acute Spinal Cord Injury | 164 | ||
| Prehospital Care | 166 | ||
| Acute Emergency Department Evaluation/Management | 166 | ||
| Surgical Intervention | 166 | ||
| Thoracolumbar Fractures | 167 | ||
| Optimal Timing of Surgical Intervention in Spinal Cord Injuries | 167 | ||
| Surgery in Penetrating Spinal Cord Injuries | 167 | ||
| Nonoperative Acute Interventions | 169 | ||
| Pharmacotherapy and Spinal Cord Injury | 169 | ||
| Institution of Blood Pressure Parameters | 170 | ||
| Subacute Management of SCI | 170 | ||
| Morbidity and Complications Management in Spinal Cord Injury | 171 | ||
| Neurogenic Shock | 171 | ||
| Spinal Shock | 171 | ||
| Pulmonary Complications | 171 | ||
| Thromboembolism | 171 | ||
| Genitourinary Complications | 172 | ||
| Gastrointestinal Complications | 172 | ||
| Skin Care | 172 | ||
| Post-Traumatic Syringomyelia | 172 | ||
| Mortality | 172 | ||
| Conclusion | 172 | ||
| 5 Maxillofacial and Ocular Injuries | 175 | ||
| 27 Maxillofacial Injuries | 175 | ||
| Airway and breathing | 175 | ||
| Circulation and Control of Hemorrhage | 175 | ||
| Epistaxis | 175 | ||
| Scalp Lacerations | 176 | ||
| Tongue Lacerations | 176 | ||
| Hemorrhage from LeFort Fractures | 176 | ||
| History and Physical Exam | 176 | ||
| Radiographs | 176 | ||
| Soft Tissue Injuries | 176 | ||
| General Considerations | 176 | ||
| Local Anesthesia | 176 | ||
| Antibiotics | 177 | ||
| Abrasions | 177 | ||
| Foreign Bodies | 177 | ||
| Treatment of Lacerations—General Concepts | 177 | ||
| Lip Lacerations | 177 | ||
| Nasal Lacerations | 177 | ||
| Ear Lacerations | 178 | ||
| Orbital Soft Tissue Injuries | 178 | ||
| Lacrimal System Injuries | 178 | ||
| Parotid Duct Injuries | 178 | ||
| Facial Nerve Injuries | 178 | ||
| Intraoral Injuries | 179 | ||
| Facial Fractures | 179 | ||
| General Principles | 179 | ||
| Frontal Sinus/Frontobasilar Fractures | 179 | ||
| Naso-Orbital-Ethmoid Fractures | 179 | ||
| Orbital Fractures | 179 | ||
| Zygoma Fractures | 180 | ||
| Maxillary LeFort Fractures | 180 | ||
| Nasal Fractures | 180 | ||
| Mandibular Fractures | 180 | ||
| 28 Trauma to the Eye and Orbit | 181 | ||
| Incidence | 181 | ||
| Mechanism of Injury | 182 | ||
| Diagnosis | 184 | ||
| Orbital Trauma | 184 | ||
| Ocular Trauma | 185 | ||
| Anatomic Location of Injury and Injury Grading—Ocular Trauma Classification Group | 191 | ||
| Medical and Surgical Management | 193 | ||
| Trauma to the Orbit | 193 | ||
| Conclusions and Algorithm | 194 | ||
| 6 Neck Injuries | 197 | ||
| 29 Penetrating Neck Injuries: Diagnosis and Selective Management | 197 | ||
| Anatomy of the Neck | 197 | ||
| Initial Evaluation | 197 | ||
| Aero-Digestive Injury | 197 | ||
| Soft Tissue Injury | 199 | ||
| Thoracic Duct Injury | 199 | ||
| Vascular Injury in the Neck | 199 | ||
| Treatment of Carotid Artery Injuries | 201 | ||
| Conclusion | 202 | ||
| 30 Carotid, Vertebral Artery, and Jugular Venous Injuries | 203 | ||
| Carotid Artery Injuries | 203 | ||
| Incidence | 203 | ||
| Mechanism of Injury | 203 | ||
| Diagnosis | 203 | ||
| Treatment | 204 | ||
| Vertebral Artery Injuries | 205 | ||
| Incidence | 205 | ||
| Mechanism of Injury | 205 | ||
| Associated Injuries | 205 | ||
| Diagnosis | 205 | ||
| Treatment | 205 | ||
| Jugular Venous Injuries | 206 | ||
| 31 Blunt Cerebrovascular Injuries | 207 | ||
| Signs and Symptoms | 207 | ||
| Mechanism and Patterns of Injury | 207 | ||
| Diagnostic Imaging | 207 | ||
| Injury Grading Scale | 209 | ||
| Incidence of blunt Cerebrovascular Injuries | 210 | ||
| Antithrombotic Treatment | 211 | ||
| Role of Endovascular Stents | 213 | ||
| Long-Term Follow-Up and Outcome | 213 | ||
| Conclusions | 213 | ||
| 32 Tracheal, Laryngeal, and Oropharyngeal Injuries | 215 | ||
| Anatomy of Upper Airway | 215 | ||
| Oral Cavity | 215 | ||
| Pharynx | 215 | ||
| Pharyngeal Injury | 217 | ||
| Incidence | 217 | ||
| Mechanism of Injury | 217 | ||
| Diagnosis | 217 | ||
| Larynx | 218 | ||
| Surgical Anatomy | 218 | ||
| Laryngeal Injury | 219 | ||
| Trachea | 219 | ||
| Surgical Anatomy | 219 | ||
| Tracheal Injury | 219 | ||
| Surgical Management | 222 | ||
| Nonoperative Management | 222 | ||
| Operative Management | 222 | ||
| Morbidity | 223 | ||
| Early Complications | 223 | ||
| Late Complications | 224 | ||
| Other Potentially Life-Threatening Complications | 225 | ||
| Mortality | 225 | ||
| 7 Thoracic Injuries | 227 | ||
| 33 Pertinent Surgical Anatomy of the Thorax and Mediastinum | 227 | ||
| Chest wall | 227 | ||
| Muscles of the Chest Wall | 229 | ||
| Intercostal Space | 232 | ||
| Pleural Space | 232 | ||
| Diaphragm | 232 | ||
| Pericardium | 234 | ||
| Subxiphoid Space | 236 | ||
| Heart | 237 | ||
| Body Surface Markings for Heart | 237 | ||
| External Features | 237 | ||
| Coronary Arteries and Veins | 239 | ||
| Conduction System | 239 | ||
| Internal Features of Heart Chambers | 241 | ||
| Anatomy of Pulmonary Artery/ Swan-Ganz Catheter Placement | 241 | ||
| Hilum of Lung | 246 | ||
| Right Hilum | 246 | ||
| Left Hilum | 247 | ||
| Lung Anatomy | 248 | ||
| Aorta,Trachea, Esophagus, and Thoracic Duct | 249 | ||
| Aorta | 249 | ||
| Trachea | 249 | ||
| Esophagus | 250 | ||
| Thoracic Duct | 251 | ||
| 34 Thoracic Wall Injuries: Ribs, Sternal Scapular Fractures, Hemothoraces, and Pneumothoraces | 252 | ||
| Incidence | 252 | ||
| Mechanism | 252 | ||
| Diagnosis | 252 | ||
| Physical Examination | 252 | ||
| Radiographic Studies | 253 | ||
| Aast-Ois Grading | 255 | ||
| Management of Specific Injuries to Chest Wall | 255 | ||
| Chest Wall Defects | 255 | ||
| Rib Fractures and Flail Chest | 256 | ||
| Narcotics | 256 | ||
| Regional Anesthesia | 256 | ||
| Pneumothorax and Hemothorax | 257 | ||
| Tube Thoracostomy: Technique and Management | 257 | ||
| Sternal Fractures | 258 | ||
| Scapular Fractures | 258 | ||
| Scapulothoracic Dissociation | 258 | ||
| Clavicular Fractures | 259 | ||
| Complications of Hemopneumothorax | 259 | ||
| Empyema | 259 | ||
| Pneumatocele | 259 | ||
| Persistent Air Leaks and Bronchopleural Fistula | 259 | ||
| Complications of Bony Injuries | 260 | ||
| Conclusions | 260 | ||
| 35 Diagnostic and Therapeutic Roles of Bronchoscopy | 261 | ||
| Incidence | 261 | ||
| Diagnostic and Therapeutic Roles of Vats in Chest Trauma | 262 | ||
| Indications and Patient Selection | 262 | ||
| Surgical Approach | 263 | ||
| Morbidity and Complication Management | 264 | ||
| Diagnostic and Therapeutic Role of Bronchoscopy | 264 | ||
| Basic Technique of Flexible Fibroptic Bronchoscopy | 264 | ||
| Diagnostic Role of Flexible Fibroptic Bronchoscopy | 265 | ||
| Therapeutic Role of Flexible Fibroptic Bronchoscopy | 266 | ||
| Conclusion | 268 | ||
| 36 Pulmonary Contusion and Flail Chest | 269 | ||
| Incidence | 269 | ||
| Physical Mechanisms of Injury | 269 | ||
| Mechanisms of Physiologic Injury | 270 | ||
| Diagnosis | 271 | ||
| Physical Examination | 271 | ||
| Chest X-Rays | 271 | ||
| Chest Computed Tomography | 271 | ||
| Physiologic Studies | 272 | ||
| Anatomic Location of Injury and Injury Grading | 273 | ||
| Management | 273 | ||
| Immediate Management | 273 | ||
| Intensive Care Unit Management | 273 | ||
| General Principles of Ventilator Management | 273 | ||
| Pain Management | 275 | ||
| Steroids | 276 | ||
| Tracheostomy | 276 | ||
| Operative Stabilization of Flail Chest | 276 | ||
| Mortality | 276 | ||
| Conclusion | 276 | ||
| 37 Tracheal and Tracheobronchial Tree Injuries | 278 | ||
| Incidence and Mechanisms of Injury | 278 | ||
| Diagnosis | 278 | ||
| Presentation | 278 | ||
| Evaluation | 279 | ||
| Management | 280 | ||
| Initial Management | 280 | ||
| Nonoperative Management | 280 | ||
| Operative Management | 280 | ||
| Outcomes | 281 | ||
| 38 Operative management of pulmonary injuries: lung-sparing and formal resections | 282 | ||
| Incidence | 283 | ||
| Etiology | 284 | ||
| Classification | 284 | ||
| Diagnosis | 284 | ||
| Physical Examination | 284 | ||
| Adjunctive Diagnostic Modalities | 284 | ||
| Associated Injuries | 285 | ||
| Anatomic Location of Injury | 286 | ||
| Management | 286 | ||
| Surgical Decisions | 286 | ||
| Operative Management | 287 | ||
| Surgical Techniques of Repair and Resection | 291 | ||
| Tissue-Sparing Procedures | 291 | ||
| Resectional Procedures | 292 | ||
| Prognostic Factors and Outcomes | 293 | ||
| Mechanism of Injury and Type of Wounding Agents | 293 | ||
| Prehospital Transport Time | 293 | ||
| Presence of Shock at Scene or upon Arrival | 293 | ||
| Loss of Airway | 294 | ||
| Presence of Associated Injuries | 294 | ||
| Complexity of Surgical Procedure | 294 | ||
| Location of Injury | 294 | ||
| Morbidity | 294 | ||
| Intraoperative Complications | 294 | ||
| Short-Term Postoperative Complications | 294 | ||
| Long-Term Postoperative Complications | 294 | ||
| Mortality | 295 | ||
| Conclusions | 295 | ||
| 39 Complications of Pulmonary and Pleural Injury | 298 | ||
| Pulmonary | 298 | ||
| Persistent Air Leak | 298 | ||
| Pneumatocoele/Hematoma | 299 | ||
| Pneumonia | 299 | ||
| Necrotizing Lung Infection | 299 | ||
| Bronchial Stricture | 300 | ||
| Pulmonary Torsion | 300 | ||
| Retained Parenchyma Missiles | 300 | ||
| Pleural | 301 | ||
| Retained Hemothorax | 301 | ||
| Empyema | 301 | ||
| Chylothorax | 303 | ||
| Fibrothorax | 303 | ||
| 40 Cardiac Injuries | 304 | ||
| Penetrating Cardiac Injury | 304 | ||
| Historical Perspective | 304 | ||
| Incidence | 304 | ||
| Etiology | 304 | ||
| Clinical Presentation | 304 | ||
| Diagnosis | 305 | ||
| Management | 305 | ||
| Techniques for Cardiac Injury Repair | 306 | ||
| Anatomic Location of Injury | 309 | ||
| Associated Injuries | 309 | ||
| Prognostic Factors | 309 | ||
| Blunt Cardiac Injury | 309 | ||
| Historical Perspective | 309 | ||
| Mechanism, Pathophysiology, and Incidence | 311 | ||
| Clinical Presentation | 311 | ||
| Diagnosis | 311 | ||
| Spectrum of Blunt Cardiac Injury | 311 | ||
| Myocardial Contusion | 312 | ||
| Conclusions | 313 | ||
| 41 Thoracic Vascular Injury | 315 | ||
| Incidence | 316 | ||
| Mechanism of Injury | 316 | ||
| Diagnosis | 316 | ||
| American Association for The Surgery of Trauma, Organ Injury Scale | 318 | ||
| Surgical Management | 318 | ||
| Morbidity and Management Complications | 320 | ||
| Mortality | 320 | ||
| Conclusions | 320 | ||
| 42 Treatment of Esophageal Injury | 321 | ||
| Incidence | 321 | ||
| Diagnosis | 322 | ||
| Surgical Treatment | 322 | ||
| Cervical Esophagus | 323 | ||
| Thoracic Esophagus | 323 | ||
| Abdominal Esophagus | 323 | ||
| Devastating Injuries | 324 | ||
| Management of Complications | 325 | ||
| Conclusions | 326 | ||
| 43 Diaphragmatic Injury | 326 | ||
| Anatomy and Physiology | 326 | ||
| Incidence of Diaphragmatic Injuries | 328 | ||
| Mechanism and Location of Injury | 329 | ||
| Severity of Injury | 330 | ||
| Diagnosis of Diaphragmatic Injury | 330 | ||
| Management of Diaphragmatic Injury | 331 | ||
| Mortality | 333 | ||
| Morbidity | 333 | ||
| Complicated Diaphragmatic Repair with Thoracic Injury | 334 | ||
| Combined Chest Wall and Abdominal Defect with Diaphragmatic Rupture | 335 | ||
| 8 Abdominal Injuries | 341 | ||
| 44 Surgical Anatomy of the Abdomen and Retroperitoneum | 341 | ||
| Making the Incision | 341 | ||
| Exploring the Abdomen | 341 | ||
| Exploring the Retroperitoneum | 343 | ||
| Future Challenges | 346 | ||
| Summary | 347 | ||
| 45 Diagnostic Peritoneal Lavage and Laparoscopy in Evaluation of Abdominal Trauma | 347 | ||
| Laparoscopy in Trauma | 350 | ||
| 46 Nonoperative Management of Blunt and Penetrating Abdominal Injuries | 352 | ||
| Blunt Abdominal Injury | 352 | ||
| Incidence | 352 | ||
| Mechanism of Injury | 352 | ||
| Diagnosis | 353 | ||
| Anatomic Location of Injury and AAST-OIS Grading | 353 | ||
| Management | 353 | ||
| Morbidity and Complications Management | 356 | ||
| Mortality | 357 | ||
| Conclusions | 357 | ||
| Penetrating Abdominal Injury | 357 | ||
| Incidence | 358 | ||
| Mechanism of Injury | 358 | ||
| Diagnosis | 358 | ||
| Anatomic Location of Injury and AAST-OIS Grading | 359 | ||
| Management | 359 | ||
| Morbidity and Complications Management | 360 | ||
| Mortality | 360 | ||
| Conclusions and Algorithm | 361 | ||
| 47 Gastric Injuries | 362 | ||
| Incidence | 362 | ||
| Mechanism of Injury | 362 | ||
| Diagnosis | 362 | ||
| Surgical Management | 363 | ||
| Mortality | 364 | ||
| Morbidity | 364 | ||
| Conclusion | 364 | ||
| 48 Small Bowel Injury | 365 | ||
| Incidence | 365 | ||
| Mechanism of Injury | 365 | ||
| Diagnosis | 365 | ||
| Injury Grading | 368 | ||
| Surgical Management | 368 | ||
| Complications | 370 | ||
| Mortality | 371 | ||
| Conclusions | 372 | ||
| 49 Duodenal Injuries | 372 | ||
| Determinants of Outcome | 372 | ||
| Anatomy and Physiology | 373 | ||
| Diagnostic Adjuvants | 373 | ||
| Treatment | 374 | ||
| Duodenal Hematoma | 377 | ||
| 50 Pancreatic Injuries | 379 | ||
| Anatomy | 379 | ||
| Physiology | 379 | ||
| Diagnosis | 380 | ||
| Classification of Pancreatic Injuries | 381 | ||
| Surgical Management of Pancreatic Injuries | 381 | ||
| Morbidity and Complications Management | 384 | ||
| Conclusions | 384 | ||
| 51 Liver Injury | 385 | ||
| Incidence | 385 | ||
| Mechanism of Injury | 385 | ||
| Blunt Hepatic Injury | 385 | ||
| Penetrating Hepatic Injury | 385 | ||
| Diagnosis | 386 | ||
| Hemodynamically Unstable Patients | 386 | ||
| Hemodynamically Stable Patients | 386 | ||
| Anatomic Location of Injury and Injury Grading—Aast-Ois | 387 | ||
| Management | 387 | ||
| Nonoperative Management/Blunt Hepatic Trauma | 387 | ||
| Contrast “Blush” on CT | 388 | ||
| Nonoperative Management/Penetrating Hepatic Trauma | 388 | ||
| Operative Management/General Principles | 388 | ||
| Operative Management/Minor Injuries (Grades I and II) | 389 | ||
| Operative Management/Complex Injuries (Grades III to V) | 389 | ||
| Juxtahepatic Venous Injuries (Grade V) | 391 | ||
| Portal Triad Injuries | 395 | ||
| Damage Control/Perihepatic Packing and Planned Re-Exploration | 395 | ||
| Adjuncts to Operative Management | 395 | ||
| Morbidity and Complications Management | 396 | ||
| Failure of Nonoperative Management | 396 | ||
| Hemorrhage | 396 | ||
| Perihepatic Sepsis/Abscess | 397 | ||
| Bile Collections/Fistula | 397 | ||
| Hemobilia | 397 | ||
| Injury to the Intrahepatic Bile Ducts and Late Stricture | 397 | ||
| Postobservational CT Scanning | 397 | ||
| Resumption of Normal Activities | 397 | ||
| Mortality | 397 | ||
| Conclusions/Algorithm | 398 | ||
| 52 Splenic Injuries | 400 | ||
| Incidence and Mechanism of Injury | 400 | ||
| Diagnosis | 401 | ||
| Anatomic Location of Injury and Injury Grading: American Association for the Surgery of Trauma Organ Injury Scale | 402 | ||
| Management | 403 | ||
| Nonoperative Management | 403 | ||
| Transcatheter Embolization | 405 | ||
| Operative Management | 405 | ||
| Morbidity and Complications of Management | 407 | ||
| Mortality | 407 | ||
| Conclusions and Algorithm: | 408 | ||
| 53 Abdominal Vascular Injuries | 410 | ||
| Epidemiology | 410 | ||
| Initial Resuscitation | 410 | ||
| General Operative Maneuvers | 411 | ||
| Classification of Injuries | 411 | ||
| Injuries in Supramesocolic Region of Zone 1 | 411 | ||
| Injuries in Inframesocolic Region of Zone 1 | 412 | ||
| Injuries in Zone 2 | 413 | ||
| Injuries in Zone 3 | 413 | ||
| Injuries in Porta Hepatis or to Retrohepatic Inferior Vena Cava | 413 | ||
| Injury Grading | 413 | ||
| Conclusions | 414 | ||
| 54 Colon and Rectal Injuries | 416 | ||
| Incidence and Mechanism | 416 | ||
| Diagnosis | 416 | ||
| Anatomic Location and Injury Grading | 416 | ||
| Surgical Management | 416 | ||
| Morbidity and Complications Management | 419 | ||
| Mortality | 419 | ||
| Conclusions and Algorithm | 419 | ||
| 55 Genitourinary Tract Injury | 420 | ||
| Kidney Injury | 420 | ||
| Ureteral Injury | 421 | ||
| Bladder Injury | 422 | ||
| Urethral Injury | 422 | ||
| Genital Injury | 423 | ||
| 56 Gynecologic Injuries | 423 | ||
| Trauma in Pregnancy | 423 | ||
| Incidence | 424 | ||
| Mechanism of Injury | 424 | ||
| Diagnosis | 424 | ||
| Surgical Treatment | 426 | ||
| Morbidity and Mortality | 427 | ||
| Conclusions | 427 | ||
| Trauma to Nongravid Uterus and Female Genitalia | 427 | ||
| Incidence | 428 | ||
| Mechanism of Injury | 428 | ||
| Diagnosis | 428 | ||
| Surgical Management | 429 | ||
| Morbidity and Mortality | 429 | ||
| Conclusions | 429 | ||
| 57 Multidisciplinary Management of Pelvic Fractures: Operative and Nonoperative Hemostasis | 430 | ||
| Pelvic Bleeding: Making the Diagnosis | 430 | ||
| Pelvic Fracture Classifications | 431 | ||
| Treating Pelvic Fracture Bleeding | 432 | ||
| Management of Open Pelvic Fractures | 435 | ||
| Summary | 436 | ||
| 9 Special Issues in Major Torso Trauma | 437 | ||
| 58 Current Concepts in the Diagnosis and Management of Hemorrhagic Shock | 437 | ||
| Epidemiology of Severe Hemorrhagic Shock | 437 | ||
| Clinical Perspective: Length and Depth of Hypotension | 437 | ||
| Discrepancies between Clinical Syndrome of Shock and Animal Models Used to Study Shock | 438 | ||
| Diagnosis of Shock | 438 | ||
| Assessment of Tissue Perfusion | 438 | ||
| Management of Shock | 439 | ||
| Hemorrhage Control | 439 | ||
| Local Hemorrhage Control | 439 | ||
| Systemic Hemorrhage Control | 439 | ||
| Factor VIIa | 439 | ||
| Fluids | 439 | ||
| Vascular Access for Patients with Severe Hemorrhage | 440 | ||
| Timing and Volume of Resuscitation Fluid Therapy | 440 | ||
| Type of Fluid | 440 | ||
| Pharmacotherapy | 442 | ||
| Vasopressin | 442 | ||
| New Therapeutic Possibilities | 442 | ||
| Hypothermia and Hemorrhagic Shock | 443 | ||
| Summary | 443 | ||
| 59 Exsanguination: Reliable Models to Indicate Damage Control | 445 | ||
| History | 445 | ||
| Metabolic Failure | 446 | ||
| Models for Damage Control | 446 | ||
| Patient Selection | 447 | ||
| Technique of Damage Control | 447 | ||
| Conclusions | 448 | ||
| 60 Surgical Techniques for Thoracic, Abdominal, Pelvic, and Extremity Damage Control | 449 | ||
| Predisposing Factors | 449 | ||
| Initial Resuscitation Concerns | 449 | ||
| Phase I: Damage Control Operation | 450 | ||
| Damage Control Laparotomy | 450 | ||
| Damage Control Thoracotomy | 451 | ||
| Damage Control Orthopedics | 451 | ||
| Phase 2: Resuscitation in Intensive Care Unit | 452 | ||
| Phase 3: Definitive Operative Management | 452 | ||
| Complications Following Damage Control Surgery | 452 | ||
| Immediate | 452 | ||
| Delayed | 453 | ||
| Summary | 453 | ||
| Table 3: Indications for Early Return to Operating Room | 453 | ||
| 61 Abdominal Compartment Syndrome, Damage Control, and the Post-Traumatic Open Abdomen | 454 | ||
| Abdominal Compartment Syndrome | 454 | ||
| Damage Control | 455 | ||
| Temporary Abdominal Closure | 457 | ||
| Planned Ventral Hernia and Delayed Abdominal Wall Reconstruction | 463 | ||
| Conclusion | 464 | ||
| 10 Peripheral Vascular Injury | 467 | ||
| 62 Vascular Anatomy of the Extremities | 467 | ||
| Diagnosis | 467 | ||
| Management | 467 | ||
| Vascular Anatomy of Upper Extremity | 467 | ||
| Axillary Artery | 467 | ||
| Axillary Vein | 468 | ||
| Surgical Exposure of Axillary Vessels | 468 | ||
| Brachial Artery | 468 | ||
| Surgical Exposure of Brachial Artery | 468 | ||
| Radial Artery | 469 | ||
| Ulnar Artery | 469 | ||
| Surgical Exposure of Ulnar and Radial Arteries | 469 | ||
| Veins of Upper Extremity | 469 | ||
| Basilic Vein | 469 | ||
| Cephalic Vein | 469 | ||
| Axillary Vein | 469 | ||
| Nerves of Upper Extremity | 469 | ||
| Median Nerve | 470 | ||
| Ulnar Nerve | 470 | ||
| Radial Nerve | 470 | ||
| Vascular Anatomy of Lower Extremity | 470 | ||
| Femoral Artery | 470 | ||
| Profunda Femoris Artery | 470 | ||
| Superficial Femoral Artery | 470 | ||
| Surgical Exposure of Femoral Artery | 471 | ||
| Popliteal Artery | 471 | ||
| Anterior Tibial Artery | 471 | ||
| Tibioperoneal Trunk | 471 | ||
| Posterior Tibial Artery | 471 | ||
| Peroneal Artery | 471 | ||
| Surgical Exposure of Vessels in Leg | 472 | ||
| Veins of Lower Extremity | 472 | ||
| Long Saphenous Vein | 472 | ||
| Short Saphenous Vein | 472 | ||
| 63 The Diagnosis of Vascular Trauma | 473 | ||
| DIAGNOSIS | 473 | ||
| History | 473 | ||
| Physical Examination | 473 | ||
| Hard and Soft Signs of Vascular Injury | 474 | ||
| Additional Ancillary Tests | 474 | ||
| Specific Areas of Injury | 475 | ||
| Acknowledgment | 476 | ||
| 64 Upper Extremity Vascular Trauma | 477 | ||
| Incidence | 478 | ||
| Mechanism of Injury | 478 | ||
| Diagnosis | 479 | ||
| Anatomic Location of Injury and Injury Grading | 480 | ||
| Surgical Management | 481 | ||
| Morbidity and Complications Management | 483 | ||
| Mortality | 483 | ||
| Conclusions and Algorithm | 483 | ||
| 65 Lower Extremity Vascular Injuries: Femoral, Popliteal, and Shank Vessel Injury | 484 | ||
| Incidence and Mechanism of Injury | 484 | ||
| Diagnosis | 485 | ||
| Operative Management for all Peripheral Vascular Injury | 485 | ||
| Preoperative Management | 485 | ||
| Intraoperative Management | 486 | ||
| Approach to Specific Vascular Injuries | 486 | ||
| Postoperative Management | 488 | ||
| Morbidity and Complications | 488 | ||
| Outcome | 488 | ||
| Conclusion | 488 | ||
| 66 Compartment Syndromes | 489 | ||
| Incidence | 489 | ||
| Mechanism of Injury | 489 | ||
| Diagnosis | 489 | ||
| Physical Examination | 489 | ||
| Compartment Measurements | 490 | ||
| Noninvasive Methods | 490 | ||
| Laboratory Studies | 490 | ||
| Anatomic Location and Grading of Injury | 491 | ||
| Surgical Management | 492 | ||
| Morbidity and Complication Management | 494 | ||
| Mortality | 494 | ||
| Conclusions and Algorithms | 494 | ||
| 11 Musculoskeletal and Peripheral Central Nervous System Injuries | 497 | ||
| 67 Upper Extremity Fractures: Orthopedic Management | 497 | ||
| Open Fractures | 497 | ||
| Dislocations | 497 | ||
| Gunshot Wounds | 497 | ||
| Imaging Studies | 498 | ||
| Injuries to Shoulder Girdle and Humerus | 498 | ||
| Scapula Fractures | 498 | ||
| Scapulothoracic Dissociation | 499 | ||
| Glenohumeral Dislocation | 499 | ||
| Proximal Humerus Fractures | 499 | ||
| Humeral Shaft Fractures | 500 | ||
| Elbow | 500 | ||
| Distal Humerus Fractures | 500 | ||
| Elbow Dislocation | 502 | ||
| Radial Head Fractures | 503 | ||
| Coronoid Fractures | 503 | ||
| Olecranon Fractures | 503 | ||
| Forearm | 503 | ||
| Monteggia Fracture | 503 | ||
| Radial and/or Ulnar Shaft Fractures | 505 | ||
| Galeazzi Fractures | 505 | ||
| Wrist | 505 | ||
| Distal Radius Fracture | 505 | ||
| Perilunate Dislocations | 506 | ||
| Carpal Fractures and Ligamentous Injuries | 506 | ||
| Conclusion | 507 | ||
| 68 Lower Extremity and Degloving Injury | 508 | ||
| Radiologic Evaluation | 508 | ||
| Fractures | 509 | ||
| Early Care of Musculoskeletal Injuries | 509 | ||
| Open Fractures | 509 | ||
| Identification and Classification | 509 | ||
| Management | 509 | ||
| Compartment Syndromes | 511 | ||
| Degloving Injuries | 512 | ||
| Mangled Extremities: Delayed Amputation | 512 | ||
| 69 Cervical, Thoracic, and Lumbar Fractures | 513 | ||
| Neurologic Injury | 513 | ||
| Classification of Neurologic Injury | 513 | ||
| Incomplete Spinal Cord Syndromes | 513 | ||
| Spinal Cord Injury | 514 | ||
| Cervical Spine Trauma | 514 | ||
| Evaluation | 514 | ||
| Anatomy | 514 | ||
| Cervical Spinal Ligamentous Instability | 514 | ||
| Occipital Condyle Fracture | 515 | ||
| Occipitocervical Dissociation | 515 | ||
| Atlas Fractures | 515 | ||
| Dens Fractures | 516 | ||
| Traumatic Spondylolisthesis of Axis | 516 | ||
| Subaxial Spine Fractures | 516 | ||
| Subaxial Spine Dislocations | 517 | ||
| Special Considerations | 517 | ||
| Thoracic and Lumbar Spine Trauma | 517 | ||
| Anatomy | 517 | ||
| Fractures | 518 | ||
| Important Considerations | 519 | ||
| 70 Pelvic Fractures | 520 | ||
| Anatomy | 520 | ||
| Radiology | 520 | ||
| Classification | 520 | ||
| Acute Patient Management | 520 | ||
| Hemodynamic Instability | 523 | ||
| Modalities for Initial Treatment | 523 | ||
| Pelvic Binders | 523 | ||
| Angiography | 523 | ||
| External Fixation | 523 | ||
| C-Clamp | 523 | ||
| Surgical Management of Pelvic Bleeding | 523 | ||
| Treatment and Outcomes | 523 | ||
| Summary | 525 | ||
| 71 Hand Fractures | 525 | ||
| Incidence | 525 | ||
| Mechanism of Injury | 525 | ||
| Diagnosis | 526 | ||
| Metacarpal Fractures | 526 | ||
| Metacarpal Shaft Fractures | 526 | ||
| Metacarpal Neck Fractures | 527 | ||
| Metacarpal Head Fractures | 528 | ||
| Thumb Metacarpal Fractures | 528 | ||
| Bennett’s Fracture | 528 | ||
| Rolando Fracture | 529 | ||
| Phalangeal Fractures | 529 | ||
| Distal Phalangeal Fractures | 529 | ||
| Proximal and Middle Phalangeal Fractures | 530 | ||
| Dislocations | 530 | ||
| Proximal Interphalangeal Joint Dislocation | 530 | ||
| Distal Interphalangeal Joint Dislocation | 530 | ||
| Metacarpophalangeal Joints | 530 | ||
| Thumb Metacarpophalangeal Joints | 533 | ||
| Complications | 533 | ||
| 72 Scapulothoracic Dissociation and Degloving Injuries of the Extremities | 533 | ||
| Incidence | 533 | ||
| Mechanism of Injury | 533 | ||
| Diagnosis | 534 | ||
| Injury Grading | 534 | ||
| Management | 534 | ||
| Morbidity and Complications | 535 | ||
| Mortality | 536 | ||
| Conclusions and Algorithm | 536 | ||
| 73 Extremity Replantation: Indications and Timing | 537 | ||
| Incidence | 537 | ||
| Classification | 537 | ||
| Indications | 537 | ||
| Timing | 538 | ||
| Conclusion | 540 | ||
| 74 Techniques in the Management Complex Musculoskeletal Injury: Roles Muscle, Musculocutaneous, and Fasciocutaneous Flaps | 541 | ||
| Diagnosis | 541 | ||
| Anatomy | 541 | ||
| Surgical Management: Primary Flaps | 541 | ||
| Head and Neck | 541 | ||
| Upper Extremity | 542 | ||
| Chest Wall and Trunk | 542 | ||
| Abdominal Wall and Groin | 544 | ||
| Lower Extremity | 544 | ||
| Complications Management | 545 | ||
| 12 Special Issues and Situations in Trauma Management | 547 | ||
| 75 Airway Management in the Trauma Patient: How to Intubate and Manage Neuromuscular Paralytic Agents | 547 | ||
| Airway Considerations in the Trauma Patient | 547 | ||
| Evaluation of Airway and Respiratory Function | 548 | ||
| Indications for Intubation and Controlled Ventilation | 549 | ||
| Induction Agents And Muscle Relaxants | 550 | ||
| Intubation Techniques | 551 | ||
| Summary | 552 | ||
| 76 Pediatric Trauma | 553 | ||
| Incidence of Pediatric Trauma | 553 | ||
| Mechanisms of Pediatric Trauma | 553 | ||
| Initial Assessment, Stabilization, and Management of Injured Child | 553 | ||
| Airway Management | 553 | ||
| Vascular Access | 554 | ||
| Circulatory Management | 554 | ||
| Diagnostic Assessment | 555 | ||
| Management of Specific Injuries | 556 | ||
| Head and Central Nervous System Injury | 556 | ||
| Thoracic Injuries | 557 | ||
| Abdominal Injuries | 557 | ||
| Acknowledgment | 558 | ||
| 77 Trauma in Pregnancy | 559 | ||
| Incidence | 559 | ||
| Mechanism of Injury | 559 | ||
| Blunt Trauma | 559 | ||
| Penetrating Trauma | 559 | ||
| Intimate Partner Violence | 559 | ||
| Physiologic Alterations of Pregnancy | 560 | ||
| Second Trimester | 560 | ||
| Third Trimester | 560 | ||
| Diagnosis | 561 | ||
| Primary Survey | 561 | ||
| Secondary Survey | 561 | ||
| Initial Evaluation of the Fetus | 561 | ||
| Exposure to Radiation from Diagnostic Radiographs | 561 | ||
| Surgical Management | 561 | ||
| Blunt Trauma | 562 | ||
| Penetrating Trauma | 562 | ||
| Cesarean Section | 562 | ||
| Morbidity and Complications Management | 563 | ||
| Fetomaternal Hemorrhage | 563 | ||
| Premature Labor | 563 | ||
| Pre-eclampsia and Eclampsia | 563 | ||
| Placental Abruption | 563 | ||
| Amniotic Fluid Embolization | 563 | ||
| Venous Thromboembolism | 563 | ||
| Intra-Abdominal Infection | 564 | ||
| Mortality | 564 | ||
| Conclusions | 564 | ||
| 78 Trauma in the Elderly | 565 | ||
| Physiology | 565 | ||
| Mechanism of Injury | 566 | ||
| Outcomes | 567 | ||
| Management of Specific Organ Injuries | 567 | ||
| Conclusions | 568 | ||
| 79 Burns | 569 | ||
| INCIDENCE | 569 | ||
| Mechanism of Injury | 569 | ||
| Pathophysiology | 569 | ||
| Local Effects | 569 | ||
| Systemic Response | 570 | ||
| Grading of Burn Wound Depth | 571 | ||
| Resuscitation Priorities | 571 | ||
| Fluid Administration | 571 | ||
| Ventilatory Support | 573 | ||
| Initial Wound Care | 574 | ||
| Burn Wound Excision and Grafting | 575 | ||
| Specialized Injuries: Electrical Burns | 576 | ||
| Specialized Injuries: Chemical Injuries | 576 | ||
| Specialized Injuries: Cold Injuries | 576 | ||
| Morbidity and Complications Management | 577 | ||
| Early Complications | 577 | ||
| Metabolic and Nutritional Support | 577 | ||
| Transportation and Transfer | 578 | ||
| Mortality | 578 | ||
| 80 Soft Tissue Infections | 579 | ||
| Superficial Infections | 579 | ||
| Deep Infection | 579 | ||
| Clinical Presentation | 579 | ||
| Diagnostic Imaging | 580 | ||
| Pathophysiology | 580 | ||
| Surgical Treatment | 580 | ||
| Bacteriology | 582 | ||
| Pharmacologic Therapy | 582 | ||
| Hyperbaric Oxygen | 582 | ||
| Mortality, Morbidity, and Complications Management | 582 | ||
| Conclusions | 582 | ||
| 81 Common Errors in Trauma Care | 583 | ||
| Missed Diaphragmatic Injury | 583 | ||
| Failure to Recognize Extremity Compartment Syndrome | 584 | ||
| Abdominal Compartment Syndrome | 584 | ||
| The Myth of Mandatory Colostomy | 585 | ||
| Delayed Damage-Control Laparotomy | 586 | ||
| Missed Hollow Viscus Injury | 586 | ||
| Failure to Perform Tertiary Survey | 587 | ||
| Futile Resuscitative Thoracotomy | 587 | ||
| Summary | 588 | ||
| 13 Critical Care I, Management of Organ Failures | 589 | ||
| 82 Cardiac Hemodynamics: The Pulmonary Artery Catheter and the Meaning of its Readings | 589 | ||
| History of Controversy | 589 | ||
| Pulmonary Artery Catheter Use and Insertion: What it is and How it Works | 590 | ||
| Insertion Tips and Guidelines | 590 | ||
| Interpretation:What Does it Measure and What Does it Mean? | 591 | ||
| Initial Warnings and Potential Measurement Problems | 591 | ||
| Pressure,Volume, and Work Measures | 591 | ||
| Goal-Directed Therapy Using Pulmonary Artery Catheter | 592 | ||
| Mixed Venous Saturation: Monitoring Tissue Metabolism | 593 | ||
| Right Ventricle End-Diastolic Pressure as Measure of Cardiac Index and Cardiac Function | 593 | ||
| Conclusions: Use the Pulmonary Artery Catheter Wisely | 593 | ||
| 83 Oxygen Transport | 595 | ||
| Energy Generation in the Cell | 595 | ||
| Microcirculation and Oxygen Delivery | 595 | ||
| Hemoglobin, the Ultimate Oxygen Carrier | 595 | ||
| Heart as Oxygen Delivery Pump | 596 | ||
| Putting it all Together: Measuring Cellular Oxygen Consumption and Extraction in Patients | 596 | ||
| Relationship of Oxygen Consumption and Oxygen Delivery during Pathologic States | 596 | ||
| Characteristic Oxygen Transport Variables in States of Shock | 597 | ||
| Conclusions | 597 | ||
| 84 Pharmacologic Support of Cardiac Failure | 598 | ||
| Pathophysiology | 598 | ||
| Treatment | 599 | ||
| Diuretics | 599 | ||
| Vasodilators | 599 | ||
| Inotropes and Vasopressors | 599 | ||
| Special Circumstances | 601 | ||
| Heart Failure in Septic Shock | 601 | ||
| Right Ventricular Failure | 601 | ||
| Blunt Cardiac Injury | 601 | ||
| Summary | 602 | ||
| 85 The Diagnosis and Management of Cardiac Dysrhythmias | 602 | ||
| Incidence | 602 | ||
| Bradyarrythmias | 603 | ||
| Sinus Node | 603 | ||
| Atrioventricular Node | 603 | ||
| Tachyarrhythmias | 604 | ||
| Sinus Tachycardia | 604 | ||
| Paroxysmal Supraventricular Tachycardia | 605 | ||
| Multifocal Atrial Tachycardia | 605 | ||
| Atrial Flutter | 606 | ||
| Atrial Fibrillation | 606 | ||
| Ventricular Tachyarrhythmias | 607 | ||
| Premature Ventricular Contractions | 607 | ||
| Monomorphic Ventricular Tachycardia | 607 | ||
| Polymorphic Ventricular Tachycardia | 608 | ||
| Conclusion | 608 | ||
| 86 Fundamentals of Mechanical Ventilation | 609 | ||
| Noninvasive Ventilation | 609 | ||
| Contraindications to Noninvasive Ventilation | 609 | ||
| Complications of Noninvasive Ventilation | 610 | ||
| Pressure Support Ventilation | 610 | ||
| Heliox | 611 | ||
| Modes of Mechanical Ventilation | 611 | ||
| Assist Control Ventilation | 611 | ||
| Synchronized Intermittent Mandatory Ventilation | 611 | ||
| Positive End-Expiratory Pressure | 611 | ||
| Ventilator “Bundle” | 612 | ||
| Routine Settings | 612 | ||
| Sedation | 613 | ||
| Monitoring | 613 | ||
| Blood Gases | 613 | ||
| Capnography | 613 | ||
| Invasive Hemodynamic Monitoring | 615 | ||
| Arterial Catheterization | 615 | ||
| Central Venous Pressure Monitoring | 616 | ||
| Pulmonary Artery Catheterization | 616 | ||
| Clinical Use Of The Pulmonary Artery Catheter | 616 | ||
| Liberation From Mechanical Ventilation | 617 | ||
| Special Airway Considerations | 618 | ||
| Unplanned Extubation | 618 | ||
| Reintubation | 618 | ||
| Tracheostomy | 618 | ||
| 87 Advanced Techniques in Mechanical Ventilation | 621 | ||
| Improving Oxygenation and Preventing Acute Lung Injury | 621 | ||
| Ventilator-Associated Lung Injury | 621 | ||
| Alternatives to Conventional Mechanical Ventilation | 621 | ||
| Proportional Assist Ventilation | 621 | ||
| Pressure-Controlled Ventilation | 621 | ||
| Inverse-Ratio Ventilation | 622 | ||
| Mandatory Minute Ventilation | 622 | ||
| Airway Pressure Release Ventilation | 622 | ||
| High-Frequency Ventilation | 623 | ||
| Permissive Hypercapnia | 623 | ||
| Pharmacotherapy | 624 | ||
| Liquid Ventilation | 624 | ||
| Surfactant Administration | 624 | ||
| Inhaled Nitric Oxide | 624 | ||
| Unconventional Methods of Pulmonary Support | 625 | ||
| Independent Lung Ventilation | 625 | ||
| Extracorporeal Membrane Oxygenation | 625 | ||
| Prone Positioning | 625 | ||
| The Future | 626 | ||
| 88 The Management of Renal Failure: Replacement Therapy and Dialysis | 627 | ||
| Incidence | 627 | ||
| Mechanism of Injury/Etiology | 627 | ||
| Diagnosis | 627 | ||
| Water and Fluid Homeostasis | 627 | ||
| Assessment of Renal Function | 627 | ||
| Creatinine Clearance | 628 | ||
| Urine Production and Output | 628 | ||
| Management of Patients | 628 | ||
| Conservative Management | 628 | ||
| Nonpharmacologic Strategies for Acute Renal Failure Prevention | 628 | ||
| Pharmacologic Strategies for Acute Renal Failure Prevention | 628 | ||
| Indications for Renal Replacement Therapy in Acute Renal Failure | 629 | ||
| Volume Overload | 629 | ||
| Hyperkalemia | 629 | ||
| Metabolic Acidosis | 629 | ||
| Other Electrolyte Disturbances | 629 | ||
| Timing of Initiation of Renal Replacement Therapy | 630 | ||
| Acute Renal Failure | 630 | ||
| Principles of Renal Replacement Therapy | 630 | ||
| Classification of Renal Replacement Therapies | 630 | ||
| Intermittent Hemodialysis | 630 | ||
| Continuous Renal Replacement Therapy | 631 | ||
| Advantages and Disadvantages | 631 | ||
| Intermittent Hemodialysis versus Continuous Renal Replacement Therapy: Outcomes | 632 | ||
| Sustained Low-Efficiency Dialysis or Extended Daily Dialysis | 632 | ||
| Summary | 632 | ||
| 89 Management of Coagulation Disorders in the Surgical Intensive Care Unit | 633 | ||
| Incidence | 633 | ||
| Congenital Bleeding Disorders | 633 | ||
| Acquired Bleeding Disorders | 634 | ||
| Diagnosis | 636 | ||
| Clinical Evaluation | 636 | ||
| Laboratory Tests of Coagulation | 638 | ||
| Management | 639 | ||
| Blood Product Transfusion | 639 | ||
| Conclusions | 640 | ||
| 90 Management of Endocrine Disorders in the Surgical Intensive Care Unit | 641 | ||
| Brain Problems:Abnormalities in Hypothalamic/Pituitary Response | 641 | ||
| Diabetes Insipidus | 642 | ||
| SIADH and Cerebral Salt Wasting | 643 | ||
| Abnormalities in Thyroid Response | 643 | ||
| Thyroid Excess | 643 | ||
| Thyroid Deficit | 644 | ||
| Sick Euthyroid Syndrome | 644 | ||
| Abnormalities of Adrenal Function | 644 | ||
| Pheochromocytoma | 644 | ||
| Adrenal Insufficiency | 645 | ||
| Problems with Hyperglycemia | 645 | ||
| 91 Transfusion: Management of Blood and Blood Products in Trauma | 648 | ||
| Incidence:Who Needs Blood Transfusion in Trauma? | 648 | ||
| Risks of Blood Transfusion | 650 | ||
| Transfusion-Related Acute Lung Injury | 650 | ||
| Massive Transfusion | 651 | ||
| Blood Component Therapy: Fresh Frozen Plasma, Platelets, and Cryoprecipitate | 651 | ||
| Management of Complications Related to Blood Transfusion | 652 | ||
| Thrombocytopenia | 653 | ||
| Coagulation Factor Depletion | 653 | ||
| Hypocalcemia | 653 | ||
| Hypokalemia and Hyperkalemia | 653 | ||
| Acid/Base Disturbances | 653 | ||
| Hypothermia | 653 | ||
| Blood Transfusion and Postinjury Multiple-Organ Failure | 653 | ||
| Blood Transfusion and SIRS/Mortality | 653 | ||
| Blood Transfusion and Mortality | 653 | ||
| Blood Transfusion and Infection | 654 | ||
| Potential Mechanisms For Transfusion-Associated Adverse Outcome | 655 | ||
| Decreased Red Blood Cell Deformability | 655 | ||
| Hemoglobin-Based Oxygen Carriers | 655 | ||
| Conclusions | 656 | ||
| 14 Critical Care II, Special Issues and treatments | 659 | ||
| 92 Acute respiratory distress syndrom | 659 | ||
| Epidemiology | 659 | ||
| Definition and clinical diagnosis | 659 | ||
| Pathophysiology | 660 | ||
| Treatment | 660 | ||
| Alternative Therapies | 661 | ||
| Conclusions | 661 | ||
| 93 Systemic Inflammatory Response Syndrome and Multiple-Organ Dysfunction Syndrome: Definition, Diagnosis,Management | 663 | ||
| Incidence | 663 | ||
| Mechanisms of Mods | 663 | ||
| Diagnosis | 664 | ||
| Management | 665 | ||
| Resuscitative Phase | 665 | ||
| Operative Intervention | 666 | ||
| Intensive Care Unit Management Phase | 667 | ||
| Conclusions and Algorithm | 668 | ||
| 94 Sepsis, Septic Shock, and Its Treatment | 670 | ||
| Incidence | 670 | ||
| Mechanism of Infection | 670 | ||
| Diagnosis | 670 | ||
| Staging | 671 | ||
| Medical and Surgical Management | 671 | ||
| Morbidity and Complications Management | 673 | ||
| Septic Shock | 673 | ||
| Multiple Organ Dysfunction Syndrome | 675 | ||
| Conclusions | 676 | ||
| 95 The Immunology of Trauma | 677 | ||
| Two-Hit Model | 677 | ||
| Systemic Inflammatory Response Syndrome | 677 | ||
| Compensatory Anti-Inflammatory Response Syndrome | 677 | ||
| Cytokine Response | 677 | ||
| Cell-Mediated Response | 677 | ||
| Leukocyte Recruitment | 679 | ||
| Proteases and Reactive Oxygen Species | 679 | ||
| Complement, Kinins, and Coagulation | 680 | ||
| Acute-Phase Reaction | 680 | ||
| Summary | 680 | ||
| 96 Nosocomial Pneumonia | 682 | ||
| Incidence/Morbidity and Mortality | 682 | ||
| Risk Factors and Preventive Measures | 682 | ||
| Nonmodifiable versus Modifiable Risk Factors | 682 | ||
| Mechanical Ventilation | 682 | ||
| Impaired Host Defenses | 682 | ||
| Oropharyngeal Colonization | 683 | ||
| Aspiration | 683 | ||
| Gastrointestinal Tract Bacterial Overgrowth | 683 | ||
| Resistant Organisms | 683 | ||
| Putting All Risk Factors Together | 683 | ||
| General Prophylaxis | 684 | ||
| Effectiveness of Preventive Measures | 684 | ||
| Diagnosis | 684 | ||
| Diagnostic Strategies | 684 | ||
| Methods of Obtaining Sputum Cultures | 685 | ||
| Impact of Prior Antibiotic Use on Diagnosis | 685 | ||
| Value of Clinical Pulmonary Infection Score in Trauma Patients | 685 | ||
| Management | 685 | ||
| Adequate Initial Antibiotics | 685 | ||
| De-Escalation of Antibiotics | 687 | ||
| Duration of Therapy | 687 | ||
| Antibiotic Prophylaxis and Tube Thoracostomy | 687 | ||
| Prophylactic Antibiotics for Chest Tube Placement | 687 | ||
| 97 Antibacterial Therapy: The Old, the New, and the Future | 689 | ||
| Principles of Pharmacokinetics | 688 | ||
| Principles of Pharmacodynamics | 689 | ||
| Empiric Antibiotic Therapy | 689 | ||
| Duration of Therapy | 690 | ||
| Choice of Antibiotic | 690 | ||
| Development of Bacterial Resistance | 690 | ||
| Antibiotic Spectrum of Activity | 691 | ||
| Cell-Wall–Active Agents: b-lactam Antibiotics | 691 | ||
| Penicillins | 691 | ||
| Cephalosporins | 692 | ||
| Second-Generation Cephalosporins | 692 | ||
| Third-Generation Cephalosporins | 692 | ||
| Fourth-Generation Cephalosporins | 693 | ||
| Monobactams | 693 | ||
| Carbapenems | 693 | ||
| Cell-Wall–Active Agents | 693 | ||
| Protein Synthesis Inhibitors | 694 | ||
| Aminoglycosides | 694 | ||
| Tetracyclines | 694 | ||
| Oxazolidinones | 695 | ||
| Chloramphenicol | 695 | ||
| The Macrolide-Lincosamide-Streptogramin Family | 695 | ||
| Drugs that Disrupt Nucleic Acids | 696 | ||
| Quinolones | 696 | ||
| Rifampin | 696 | ||
| Cytotoxic Antibiotics | 697 | ||
| Metronidazole | 697 | ||
| Trimethoprim-Sulfamethoxazole | 697 | ||
| Antibiotic Toxicities | 697 | ||
| Beta-Lactam Allergy | 697 | ||
| “Red Man” Syndrome | 698 | ||
| Nephrotoxicity | 698 | ||
| Ototoxicity | 698 | ||
| Metronidazole Toxicity | 699 | ||
| Quinolone Toxicity | 699 | ||
| Tetracycline Toxicity | 699 | ||
| Trimethoprim-Sulfamethoxazole Toxicity | 699 | ||
| Avoiding Toxicity | 699 | ||
| Adjustment of Antibiotic Therapy in Hepatic Insufficiency | 699 | ||
| Adjustment of Antibiotic Therapy in Renal Insufficiency | 699 | ||
| 98 Fungal Infections and Antifungal Therapy in the Surgical Intensive Care Unit | 702 | ||
| Predictors of Fungal Infections | 702 | ||
| Diabetes Mellitus | 702 | ||
| Neutropenia | 702 | ||
| Organ Transplantation and Immunosuppression | 703 | ||
| Solid and Hematological Malignant Tumors | 703 | ||
| Long-Term Use of Central Venous Catheters | 703 | ||
| Candida Colonization | 703 | ||
| Use of Broad-Spectrum Antibiotics | 703 | ||
| Duration of ICU Care and Invasive Mechanical Ventilation | 704 | ||
| Pathogenic Organisms | 704 | ||
| Candida albicans | 704 | ||
| Non–albicans Candida | 705 | ||
| Aspergillus | 705 | ||
| Other Emerging Fungal Pathogens | 705 | ||
| Principles of Therapy | 705 | ||
| Neutropenic Patients and Preemptive Therapy | 707 | ||
| Antifungal Prophylaxis in Solid Organ Transplant Recipients | 708 | ||
| Acquired Immunodeficiency Syndrome and Empiric Antifungal Therapy | 708 | ||
| Therapy Tailored to Specific Risk Factors and Likely Offending Organisms | 708 | ||
| Fungi as an Epiphenomenon | 709 | ||
| Summary | 710 | ||
| 99 Preoperative and Postoperative Nutritional Support: Strategies for Enteral and Parenteral Therapies | 710 | ||
| Malnutrition | 710 | ||
| Metabolic Stress | 711 | ||
| Preoperative Nutrition | 711 | ||
| Preoperative Total Parenteral Nutrition | 712 | ||
| Preoperative Enteral Nutrition | 712 | ||
| Postoperative Nutrition | 714 | ||
| Postoperative Parenteral Nutrition | 715 | ||
| Postoperative Enteral Nutrition | 715 | ||
| Technical Aspects of Parenteral and Enteral Access | 716 | ||
| Central Venous Access | 716 | ||
| Gastrointestinal Access | 716 | ||
| Morbidity and Complications Management | 716 | ||
| Metabolic Complications | 716 | ||
| Complications of Enteral Nutrition | 717 | ||
| Complications of Parenteral Nutrition | 717 | ||
| Summary and Algorithms | 717 | ||
| 100 Diagnosis and Treatment of Deep Venous Thrombosis: Drugs and Filters | 718 | ||
| Current Therapies | 718 | ||
| Sequential Compression Devices | 718 | ||
| Low-Dose Heparin | 718 | ||
| Low-Molecular-Weight Heparin | 718 | ||
| Inferior Vena Cava Filters | 719 | ||
| Surveillance | 719 | ||
| Recommendation | 719 | ||
| 101 Hypothermia and Trauma | 721 | ||
| Incidence | 721 | ||
| Mechanism of Injury | 721 | ||
| Effects on Coagulation | 721 | ||
| Effects on Vascular Phase of Coagulation | 721 | ||
| Effects on Platelet Count and Function | 721 | ||
| Effect on Clotting Factor Levels and Function | 722 | ||
| Effects on Other Organs | 722 | ||
| Management | 723 | ||
| Passive Rewarming | 724 | ||
| Active External Rewarming | 724 | ||
| Active Core Rewarming | 724 | ||
| Mortality | 725 | ||
| Conclusions | 726 | ||
| 102 Surgical Procedures in the Surgical Intensive Care Unit | 727 | ||
| Historical Perspective | 727 | ||
| Surgical Procedures | 727 | ||
| Bedside Tracheostomy | 727 | ||
| Percutaneous Feeding Catheters | 729 | ||
| Inferior Vena Caval Filter Placement | 730 | ||
| Diagnostic Peritoneal Lavage and Laparoscopy | 730 | ||
| Intra-Abdominal Pressure Monitoring, Decompressive Laparotomy, and the Open Abdomen | 731 | ||
| Management of Extremity Trauma and Vascular Injuries | 732 | ||
| Conclusions | 732 | ||
| 103 Anesthesia in the Surgical Intensive Care Unit—Beyond the Airway: Neuromuscular Paralysis and Pain Management | 733 | ||
| Muscle Relaxants | 733 | ||
| Historic Perspective | 733 | ||
| Current Epidemiology | 733 | ||
| Indications | 733 | ||
| Mode of Action | 733 | ||
| Monitoring of Neuromuscular Blockade | 735 | ||
| Sedation and Analgesia in Critical Care Setting | 737 | ||
| Analgesic Agents and Their Advantages | 737 | ||
| Indications and Patient-Controlled Analgesia | 737 | ||
| Bispectral Index Monitoring | 740 | ||
| Benefits of Bispectral Index in Critical Care Setting | 740 | ||
| Computing the Bispectral Index | 740 | ||
| Limitations | 741 | ||
| Prospective Uses | 741 | ||
| Conclusion | 742 | ||
| Summary | 742 | ||
| 104 Palliative Care in the Trauma Intensive Care Unit | 744 | ||
| When to Start Palliative Care in ICU | 744 | ||
| What is Palliative Care in the ICU? | 745 | ||
| Communication and Shared Decision Making | 745 | ||
| Withholding and Withdrawal of Life Support | 746 | ||
| Pain and Symptom Management | 746 | ||
| Family and Bereavement Support | 747 | ||
| 105 Death from Trauma—Management of Grief and Bereavement and the Role of the Surgeon | 748 | ||
| Incidence | 748 | ||
| Grief | 748 | ||
| Traumatic Grief | 748 | ||
| Grieving Across the Life Span | 748 | ||
| Management of Acute Grief after Traumatic Death | 749 | ||
| Complicated Grief | 750 | ||
| 106 Trauma Rehabilitation | 751 | ||
| Trauma Rehabilitation Team | 751 | ||
| Assessment of Patients with Spinal Cord Injury | 751 | ||
| Epidemiology of Traumatic Spinal Cord Injury in the United States | 751 | ||
| Neurological Classification | 753 | ||
| Acute Medical Management | 753 | ||
| Assessment of Patients with Traumatic Brain Injury | 754 | ||
| Epidemiology of Traumatic Brain Injury in the United States | 754 | ||
| Pathophysiology of Traumatic Brain Injury | 754 | ||
| Initial Physiatric Consultation and Early Rehabilitation Intervention | 754 | ||
| Medical Considerations and Complications in Traumatic Brain Injury | 754 | ||
| Assessment of Patients with Peripheral Nerve Injury | 755 | ||
| Epidemiology of Peripheral Nerve Injuries | 755 | ||
| Electrodiagnostic Testing and Classification of Peripheral Nerve Injury | 755 | ||
| Rehabilitation of Nerve Injuries | 756 | ||
| Assessment of Patients with Multiple Orthopedic Injuries: The Polytrauma Patient | 756 | ||
| Acute Hospital Care | 756 | ||
| Levels of Care After Acute Trauma Hospital Stay | 757 | ||
| Conclusions | 757 | ||
| 107 Trauma Outcomes | 758 | ||
| Outcomes | 758 | ||
| Evidence-Based Medicine | 758 | ||
| Performance Improvement and Patient Safety | 758 | ||
| National Trauma Data Bank | 759 | ||
| National Surgical Quality Improvement Program | 761 | ||
| Summary and Future Direction | 761 | ||
| Index | 763 | ||
| A | 763 | ||
| B | 765 | ||
| C | 766 | ||
| D | 769 | ||
| E | 770 | ||
| F | 771 | ||
| G | 772 | ||
| H | 772 | ||
| I | 773 | ||
| J | 774 | ||
| K | 774 | ||
| L | 774 | ||
| M | 775 | ||
| N | 776 | ||
| O | 777 | ||
| P | 777 | ||
| Q | 779 | ||
| R | 779 | ||
| S | 780 | ||
| T | 782 | ||
| U | 783 | ||
| V | 784 | ||
| W | 784 | ||
| X | 785 | ||
| Y | 785 | ||
| Z | 785 |