Current Therapy of Trauma and Surgical Critical Care

3rd Edition - March 18, 2023
Editors: Juan A. Asensio, Wayne J. Meredith
Language: English
Hardback ISBN:
9 7 8 - 0 - 3 2 3 - 6 9 7 8 7 - 3
eBook ISBN:
9 7 8 - 0 - 3 2 3 - 8 4 6 4 1 - 7

Drawing on the experience and knowledge of master world-renowned trauma surgeons, Current Therapy of Trauma and Surgical Critical Care, 3rd Edition, offers a comprehensive summary… Read more

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Drawing on the experience and knowledge of master world-renowned trauma surgeons, Current Therapy of Trauma and Surgical Critical Care, 3rd Edition, offers a comprehensive summary of optimal treatment and post-operative management of traumatic injuries. Ideally suited for everyday use, this practical, concise reference highlights the most important aspects of urgent surgical care, from damage control to noninvasive techniques to chemical and biological injuries. A focus on the surgical techniques required to manage even the most complex injuries makes it both an excellent resource for quick review before entering the operating room and a valuable review tool for board certification or recertification.

Covers the entire spectrum of Trauma Surgery and Surgical Critical Care—from initial evaluation, military and civilian field and trauma center evaluation and resuscitation, to diagnosis, operative, and postoperative critical care and outcomes—in nearly 100 print and 39 online-exclusive chapters, all newly streamlined to emphasize frontline procedural treatment.
Features extensive new data and updates to Cardiac, Thoracic, Vascular, and Military Surgery chapters, plus numerous new intraoperative photographs and high-quality line drawings that highlight the most important aspects of urgent surgical care.
Contains 14 new chapters, including Innovations in Trauma Surgery Simulation; Air Evacuation and Critical Care in Military Casualties; REBOA: Indications and Controversies; Penetrating Extracranial Vertebral Artery; Penetrating Arterio-Venous Fistulas; The Genomics of Profound Shock and Trauma; ECMO; and newer strategies, such as nerve blocks for pain management to combat the opioid epidemic.
Incorporates a wealth of military knowledge from both recent and past military conflicts, as well as from asymmetric warfare; many of the authors and co-authors have extensive past and present military experience.
Uses a consistent, easy-to-follow chapter format throughout, for quick and easy reference and review.
Reviews the essential principles of diagnosis and treatment, as well as the specifics of surgical therapy, making it useful for surgeons across all specialties.
Integrates evidence-based practice guidelines into the text whenever possible, as well as comprehensive utilization of the American Association for the Surgery of Trauma – Organ Injury Scales (AAST-OIS).
Contains such a wealth of operative photographs and line drawings, both in the printed version and many more in the electronic version, that it could be considered an Atlas of Trauma Surgery.
An eBook version is included with purchase. The eBook allows you to access all of the text, figures and references, with the ability to search, customize your content, make notes and highlights, and have content read aloud.

Cover image
Title page
Table of Contents
Copyright
Contributors
Preface
Foreword
List of Illustrations
List of Tables
Trauma Systems
Development of trauma systems
Modern trauma system development
Are trauma systems effective?
What are the current problems?
Solutions
Suggested readings
Trauma center organization and verification for current therapy of trauma and surgical critical care
Trauma system and trauma center organization
Trauma performance improvement process
Trauma center verification
Suggested readings
Injury severity scoring: Its definition and practical application
Injury description and scoring: Conceptual background
Testing a test: Statistical measures of predictive accuracy and power
Measuring anatomic injury
Measuring physiologic injury
Measuring physiologic reserve and comorbidity risk
More powerful predictions: Combining several types of information
Statistical considerations
Improved prediction in trauma scoring
Machine learning approaches to risk prediction
Conclusions
Suggested readings
Role of alcohol and other drugs in trauma
Epidemiology
Effects of alcohol and drugs on management and outcome
Alcohol and injury recidivism
Withdrawal syndromes: Prophylaxis and treatment
Definition of alcohol and drug problems
Rationale for brief alcohol interventions in trauma centers
Treatment of marijuana dependence
Marijuana/cannabis-specific issues
Opioid-specific issues
Summary
Key points
Suggested readings and additional resources
Injury prevention: An evidence-based public health approach
Public health approach to injury prevention
Evidence-based prevention programs for specific mechanisms of injury
Conclusions
Suggested readings
Lessons learned in military trauma in Colombia
Knowing the primary enemy
Knowing the secondary enemy
Strategic plan for medical care
Results of the strategy
Conclusions
Suggested readings
Trauma scoring
Anatomic scoring systems
Physiologic scoring systems
Risk-adjustment scoring systems
Scoring systems evaluation
Summary
Suggested readings
Simulation-based training for combat surgery
Introduction
State of the art in simulation-based combat surgical training
Training gaps
Simulators
Next-generation simulation-based training
Suggested readings
Prehospital Trauma Care
Prehospital trauma care: Influence of emergency medical services on trauma center patient outcomes
Golden hour or golden opportunity?
Prehospital fluids
Chest decompression
Early hemorrhage control
Conclusion
Suggested readings
Field triage in the military arena
Historical perspective
Triage scoring system
Triage in the age of COVID-19
Field triage in the military
Rapid transfer of mass casualties from scene to facility
General principles of triage
Most commonly used triage systems in the world
Discussion
Conclusion
Suggested readings
Trauma systems on the battlefield
History of battlefield trauma systems
Creating a 21st-century joint trauma system
Organization of battlefield trauma care
Improvements in CCC in the 21st century
Trauma system development for noncombat military settings
Toward a national trauma system
Future directions
Suggested readings
Field triage in the civilian arena
History and evolution of trauma triage systems
Mass casualty triage
Summary
Suggested readings
En route care
Introduction
Development of critical care air transport teams
CCAT mission profile
CCAT team composition
CCAT training requirements
Situational awareness and environmental considerations
CCAT equipment
CCAT success
Tactical critical care evacuation team
Future considerations
Conclusion
Suggested readings
Prehospital airway management: Intubation, devices, and controversies
Introduction
Diagnosis
Assessing the airway
Management
Controversies in prehospital intubation
Conclusions and algorithm
Suggested readings
Prehospital fluid resuscitation: What type, how much, and controversies
Overview
Epidemiology
Diagnosis and management
Resuscitation fluids
Adjuncts
Resuscitation targets
Morbidity and complications
Summary
Suggested readings
Mass casualty events: The role of hospitals and trauma systems
Introduction
Definitions
Injury severity distribution
Managing the scene
The ED in an MCI
Beyond immediate care
The hospital in an MCE
Command structure
The ongoing MCI
Staff well-being
The COVID-19 pandemic from the mass casualty perspective
Suggested readings
Injuries from explosives
Incidence
Mechanisms of injury and diagnosis
Anatomic location of injury
Morbidity and mortality
Surgical management
Injury severity scoring
Conclusion
Suggested readings
Prehospital care of biologic agent–induced injuries
Anthrax
Smallpox
Plague
Botulism
Tularemia
Other agents
Summary
Suggested readings
Wound ballistics: What every trauma surgeon should know
Ballistics theory
Handguns
Hunting rifles
Military service rifles
Shotguns
Nonlethal ammunition
Protective vests and armored plates
Landmines and improvised explosive devices
Wound exploration and bullet removal
Suggested readings
Common prehospital complications and pitfalls in the trauma patient
Incidence
Airway
Breathing
Circulation
Disability
Transport
Comorbid conditions
Conclusion
Suggested readings
Initial Assessment and Resuscitation
Airway management: What every trauma surgeon should know, from intubation to cricothyroidotomy
Airway anatomy
Assessing the airway
Controlling the airway
Documentation of proper endotracheal tube placement
Combitube
Endotracheal intubation
Surgical airway
Summary
Suggested readings
Resuscitation fluids
Choice of fluids
Blood products
Resuscitation strategies
Complications of resuscitation
readings
REBOA: Resuscitative endovascular balloon occlusion of the aorta
Training
Indications
Technique
Discussion
Conclusion
Suggested readings
Resuscitative thoracotomy
Historical perspective
Objectives
Physiology
Indications
Techniques for cardiac injury repair
Results
Suggested readings
Focused assessment with sonography for the trauma patient
Introduction
Brief history of the ultrasound and FAST
FAST training evolution
Principles of ultrasound
Using FAST
FAST technique
Extended FAST for thoracic trauma ultrasound
FAST algorithm
FAST scoring systems
Pediatric FAST
Pitfalls and limitations of FAST and E-FAST
Utility of FAST and E-FAST in the prehospital environment
Fast: Facts and evidence
Future of FAST
Suggested readings
Role of radiology in initial trauma evaluation
Radiography
Ultrasound
Computed tomography
Magnetic resonance imaging
Management of iodine allergies
Skull and brain
Spine
Face
Vascular injuries
Nonvascular chest/thorax
Cardiac injuries
Diaphragmatic injuries
Focused abdominal sonogram for trauma
Free fluid
Free air
Gastrointestinal tract
Mesenteric injuries
Solid organ injuries (liver, spleen, and kidneys)
Collecting system
Urethra
Retroperitoneal injuries
Bones other than spine
Abdominal wall injuries
Shock
Resuscitation effects
Abdominal compartment syndrome
Suggested readings
Interventional radiology: Diagnostic and therapeutic roles
Computed tomography angiography
Transcatheter angiography
Pitfalls for the interventionalist
Solid organ injury
Pelvic trauma
IVC filter placement for prophylactic embolic protection
Interventional radiology response time
Concluding discussion
Suggested readings
Interventional radiology management during intermediate and long-term phases of trauma care
Nonacute vascular interventions
Venous thromboembolism
Inferior vena cava filter
Pulmonary embolism
Drainage procedures
Enteric procedures
Lymphatic interventions
Suggested readings
Endpoints of resuscitation
Background
Clinical endpoints
Hemodynamic endpoints/targets
Dynamic endpoints
SVV/PPV
Metabolic endpoints
Summary
Suggested readings
Head and Central Nervous System Injuries
Traumatic brain injury: Pathophysiology, clinical diagnosis, and prehospital and emergency center care
Incidence
Pathophysiology
Clinical diagnosis
Imaging studies
Serum markers
Prognosis in TBI
Prehospital and emergency department management
Suggested readings
Traumatic brain injury: Imaging, operative and nonoperative care, and complications
Specialty collaboration
Initial management
Imaging evaluation
Nonoperative care
Operative treatment
Surgical approaches
Surgical positioning
Conclusion
Suggested readings
Spinal cord injury, blunt and penetrating, neurogenic and spinal shock
Incidence
Classification of SCI
Evaluation and early intervention
Subacute management of spinal cord injury
Suggested readings
Maxillofacial and Ocular Injuries
Maxillofacial trauma
Airway and breathing
Circulation and control of hemorrhage
Epistaxis
History and physical examination
General concepts for laceration repair
Facial fractures
Conclusions
Suggested readings
Trauma to the eye and orbit
Ocular trauma terminology
Incidence
Mechanism of injury
Diagnosis
Anatomic location of injury and injury grading—ocular trauma classification group
Medical and surgical management
Conclusions and algorithm
Suggested readings
Neck Injuries
Penetrating neck injuries
Anatomy of the neck
Initial evaluation
Aerodigestive injury
Soft tissue injury
Thoracic duct injury
Vascular injury in the neck
Treatment of carotid artery injuries
Conclusion
Suggested readings
Blunt cerebrovascular injuries
Signs and symptoms
Mechanisms of injury and screening criteria
Diagnostic imaging
Injury grading scale
Incidence of blunt cerebrovascular injuries
Antithrombotic treatment
Role of endovascular stents
Surgical management of blunt cerebrovascular injuries
Long-term follow-up and outcome
Conclusions
Suggested readings
Tracheal, laryngeal, and oropharyngeal injuries
Anatomy of upper airway
Pharyngeal injury
Larynx
Trachea
Examples of penetrating trauma to the cervical trachea—case presentations
Surgical management
Morbidity
Mortality
Suggested readings
Thoracic Injuries
Pertinent surgical anatomy of the thorax and mediastinum
Chest wall
Muscles of the chest wall
Intercostal space
Pleural space
Diaphragm
Pericardium
Heart
Hilum of the lung
Lung anatomy
Aorta, trachea, esophagus, and thoracic duct
Suggested readings
Thoracic wall injuries: Ribs, sternal and scapular fractures, and hemothoraces and pneumothoraces
Incidence
Mechanism of injury
Vulnerable populations
Diagnosis
Chest wall organ injury grading
Management of specific injuries of the chest wall
Complications of hemopneumothorax
Complications of bony injuries
Conclusions
Suggested readings
Diagnostic and therapeutic roles of bronchoscopy and video-assisted thoracoscopy in the management of thoracic trauma
Incidence
Diagnostic and therapeutic roles of vats in chest trauma
Basic technique of vats
Diagnostic and therapeutic applications of vats
Diagnostic and therapeutic role of bronchoscopy
Conclusion
Suggested readings
Pulmonary contusion and flail chest
Incidence
Mechanisms of injury
Management of lung injury
Anatomic location of injury and injury grading
Management
Extracorporeal membrane oxygenation
Mortality
Conclusions
Suggested readings
Operative treatment of chest wall injury
Indications for operative therapy
Outcomes
Sternal fractures
Conclusions
Suggested readings
Tracheal and tracheobronchial tree injuries
Incidence and mechanisms of injury
Diagnosis
Management
Outcomes
Operative management of pulmonary injuries: Lung-sparing and formal resections
Incidence
Incidence of patients actually requiring thoracotomy
Etiology
Latest literature—operative management and predictors of outcome
Classification
Diagnosis
Associated injuries
Anatomic location of injury
Management
Surgical techniques of repair and resection
Prognostic factors and outcomes
Morbidity
Mortality
Conclusions
Suggested readings
Complications of pulmonary and pleural injury
Pulmonary complications
Pleural complications
Suggested readings
Cardiac injuries
Penetrating cardiac injuries
Latest literature—operative management and predictors of outcome
Blunt cardiac injury
Conclusion
Suggested readings
Thoracic vascular injury
Incidence
Mechanism of injury
Diagnosis
American association for the surgery of trauma, organ injury scale
Surgical management
Morbidity and management complications
Mortality
Conclusions
Suggested readings
Thoracic aortic injury
Epidemiology and incidence
Mechanism
Classification
Initial evaluation and diagnosis
Management and operative decision making
Medical management
Endovascular operative management
Open operative management
Conclusion
Suggested readings
Esophageal injuries: Principles of management
Incidence
Diagnosis
Surgical treatment
Cervical esophagus
Thoracic esophagus
Abdominal esophagus
Unifying principles of management
Devastating injuries
Use of esophageal stents
Management of complications
Conclusions
Suggested readings
Abdominal Injuries
Diaphragmatic injury
Embryology, anatomy, and physiology
Incidence of diaphragmatic injuries
Mechanism and location of injury
Severity of injury
Diagnosis of diaphragmatic rupture after blunt injury
Diagnosis of diaphragmatic injury after penetration wound
Management of diaphragmatic injury
Laparoscopic repair
Mortality
Morbidity
Combined diaphragmatic and chest wall injury
Combined chest wall and abdominal defect with diaphragmatic rupture
Suggested readings
Surgical anatomy of the abdomen and retroperitoneum
Making the incision
Exploring the abdomen
Exploring the retroperitoneum
Future challenges
Summary
Suggested readings
Diagnostic peritoneal lavage and laparoscopy in the evaluation of abdominal trauma
Diagnostic peritoneal lavage
Diagnostic laparoscopy
Suggested readings
Nonoperative management of blunt and penetrating abdominal injuries
Blunt abdominal injury
Conclusions
Key surgical therapy points
Penetrating abdominal injury
Key surgical therapy points
Suggested readings
Gastric injuries
Incidence
Mechanism of injury
Diagnosis
Surgical management
Mortality
Morbidity
Key points
Conclusion
Suggested readings
Small bowel injury
History
Incidence
Mechanism of injury
Diagnosis
Injury grading
Surgical management
Complications
Mortality
Conclusions
Suggested readings
Duodenal injuries
Determinants of outcome
Anatomy and physiology
Diagnostic adjuvants
Treatment
Duodenal hematoma
Suggested readings
Pancreatic injuries and pancreaticoduodenectomy
Anatomy
Physiology
Diagnosis
Classification of pancreatic injuries
Surgical management of pancreatic injuries
Pancreatic injury in children
Morbidity and complications management
Conclusions
Suggested readings
Liver injury
Incidence
Mechanism of injury
Diagnosis
Liver anatomy
Management
Contrast “blush” on computed tomography
Morbidity and complications management
Mortality
Conclusions and management algorithm
Suggested readings
Splenic injuries
Incidence and mechanism of injury
Diagnosis
Management
Morbidity and complications of management
Mortality
Conclusions and algorithm
Acknowledgment
Suggested readings
Abdominal vascular injury
Pathophysiology
Diagnosis
Initial management and resuscitation
Operation
Zone 1, midline supramesocolic
Zone 1, midline inframesocolic
Zone 2, lateral perirenal
Zone 3, lateral pelvic
Zone 4, porta hepatis/retrohepatic vena cava
Retrohepatic vena cava
Complications
Summary
Suggested readings
Colon and rectal injuries
Incidence and mechanism of injury
Diagnosis
Anatomic location of injury and injury grading
Surgical management
Morbidity and complications management
Mortality
Conclusions and management algorithm
Suggested readings
Genitourinary tract injuries
Kidney trauma
Ureteral trauma
Bladder trauma
Urethral trauma
Suggested readings
Gynecologic injuries: Trauma to uterus, ovaries, and female genitalia
Anatomy
Incidence
Mechanism of injury
Evaluation and surgical management
Morbidity and mortality
Conclusion
Suggested readings
Special Issues in Major Torso Trauma
Multidisciplinary management of pelvic fractures: Operative and nonoperative management
Incidence
Anatomic considerations
Mechanism of injury
Diagnosis
Anatomic location of injury and injury grading
Management
Temporary hemostasis
Definitive hemostasis
Morbidity and long-term outcomes
Conclusions and algorithm (Fig. 11)
Suggested readings
Current concepts in the diagnosis and management of hemorrhagic shock
Epidemiology
Pathophysiology of hemorrhagic shock
Differences between clinical shock and animal models
Diagnosis of shock
Management of hemorrhagic shock
New therapeutic possibilities
Conclusion
Suggested readings
Exsanguination: Reliable models to indicate damage control
History
Metabolic failure
Models for damage control
Patient selection
Technique of damage control
Conclusions
Suggested readings
Damage control resuscitation: An evidence-based report
Evidence classification
Prehospital damage control resuscitation
Hospital-based DCR (Table 2)
Future trends in DCR
Newer strategies from the use of blood and blood products: Lessons learned from recent wars
World War II
Reactions to, and complications of, blood and plasma transfusions
Korean conflict
Vietnam
Current blood transfusion practices
Conclusion
Suggested readings
Surgical techniques for damage control operations for abdominal, thoracic, pelvic, and extremity trauma
The lethal triad
Initial resuscitation
Phase 1: The damage control operation
Phase 2: Resuscitation in the intensive care unit
Phase 3: Definitive operative management
Summary
Suggested readings
Abdominal compartment syndrome, damage control, and the open abdomen
Abdominal compartment syndrome
Damage control
Special considerations: Nutrition support
Outcomes and complications of open abdomen
Conclusion
Acknowledgment
Suggested readings
Torso trauma on the modern battlefield
Introduction to combat torso trauma
Incidence and epidemiology of combat torso trauma
Noncompressible torso hemorrhage: Defining the problem
Mechanisms of combat torso injuries
Initial evaluation
Advanced resuscitative care
Operative intervention
Austere management of NCTH: Perioperative considerations and issues
Future directions
Suggested readings
Peripheral Vascular Injury
Vascular anatomy of the extremities
Vascular anatomy of the upper extremity
Vascular anatomy of the lower extremity
Suggested readings
Diagnosis of vascular trauma
Diagnosis
Hard and soft signs of vascular injury
Additional ancillary tests
Specific areas of injury
Suggested readings
Penetrating carotid artery injuries
Historical perspective
Incidence and mechanism of injury
Anatomy
Diagnosis
Anatomic location of injury
Surgical management
Shunts as adjuncts during repairs of internal and common carotid injuries: Their effect on neurologic outcomes
Outcomes and mortality
Morbidity
Conclusion
Suggested readings
Penetrating extracranial vertebral artery injuries
Background
Incidence
Mechanism of injury
Anatomic segment of injury
Diagnosis and management
Complications
Associated injuries
Operative management
Conclusion
Suggested readings
Subclavian vessel injuries: Difficult anatomy and difficult territory
Historical perspective
Anatomy
Incidence
Clinical presentation
Diagnosis
Surgical management
Morbidity
Outcomes and mortality
Conclusions
Suggested readings
Operative exposure and management of axillary vessel injuries
Historical perspective
Incidence and mechanism of injury
Anatomy
Diagnosis
Surgical management
Outcomes and mortality
Conclusions
Suggested readings
Brachial vessel injuries: High morbidity and low mortality injuries
Historical perspective
Incidence and mechanism of injury
Anatomy
Diagnosis
Anatomic location of injury
Surgical management
Outcomes and mortality
Morbidity
Conclusions
Suggested readings
Iliac vessel injuries: Difficult injuries and dif ficult management problems
Historical perspective
Incidence
Anatomy
Clinical presentation
Diagnosis
Surgical management
Morbidity and mortality
Conclusions
Suggested readings
Femoral vessel injuries: High mortality and low morbidity injuries
Anatomy
Incidence and mechanism of injury
Clinical presentation
Diagnosis
Surgical management
Endovascular management
Venous injuries
Outcomes
Conclusion
Suggested readings
Popliteal vessel injuries: Complex anatomy and high amputation rates
Historical perspective
Anatomy
Incidence
Clinical presentation
Diagnosis
Management
Latest literature—operative management and predictors of outcome
Morbidity
Outcomes and mortality
Conclusion
Suggested readings
Shank vessel injuries: The forgotten vascular injuries
Historical perspective
Incidence and mechanism of injury
Anatomy
Diagnosis
Anatomic location of injury
Surgical management
Outcomes and mortality
Morbidity
Conclusions
Suggested readings
Penetrating arteriovenous fistulas: Uncommon and challenging entities
Incidence
Clinical presentation
Mechanism of injury
Anatomic location of injury
Diagnosis and management
Associated injuries
Cardiac failure of AVFs
Operative management and discussion
Conclusions
Temporary vascular shunts
Definition
Historical perspective
Indications for temporary vascular shunts
Available shunts
Operative technique
Outcomes
Practical points in conclusion
Suggested readings
Musculoskeletal and Peripheral Central Nervous System Injuries
Upper extremity fractures: Orthopedic management
Open fractures
Dislocations
Gunshot wounds
Compartment syndrome
Imaging studies
Injuries to the shoulder girdle and humerus
Elbow
Forearm fractures
Suggested readings
Lower extremity and degloving injury
Vascular assessment and radiologic evaluation
Fractures
Early care of musculoskeletal injuries
Open fractures
Compartment syndrome
Degloving injuries
Mangled extremities: Delayed amputation
Suggested readings
Cervical, thoracic, and lumbar spine fractures
Cervical spine trauma
Thoracic and lumbar spine trauma
Neurologic injury
Suggested readings
Pelvic fractures
Anatomy
Imaging
Classification
Initial assessment/treatment
Definitive treatment
Outcomes
Summary
Suggested readings
Wrist and hand fractures: Orthopaedic management
Distal radius fractures
Dislocations of the wrist
Carpal fractures
Metacarpal and phalangeal injuries
Suggested readings
Scapulothoracic dissociation and degloving injuries of the extremities
Scapulothoracic dissociation
Degloving injuries of the extremities
Acknowledgment
Suggested readings
Extremity replantation: Indications and timing
History
Microsurgical centers
Transportation
Evaluation of the amputated part
Indications
Contraindications
Surgical management
Postoperative care
Replantation of various other parts
Suggested readings
Special Issues and Situations in Trauma Management
Flap reconstruction in the management of complex musculoskeletal injuries
Approach to wound evaluation
Wound debridement/preparation
Timing of flap reconstruction
Approach to reconstructive evaluation
Flap categorization and considerations
Surgical management
Conclusion
Acknowledgment
Suggested readings
What every surgeon should know about the traumatic airway
Initial assessment
Airway control methods
Interventional support
Facial and airway trauma
Airway management of a facial and pharyngeal injury
Penetrating vs. blunt trauma
Airway management
American society of anesthesiologists difficult airway algorithm modification for trauma
Overview of intubation techniques
Common intubation anesthetics
Summary
Suggested readings
Pediatric trauma
Incidence of pediatric trauma
Mechanisms of pediatric trauma
Initial assessment, stabilization, and management of the injured child
Management of specific injuries
Suggested readings
Trauma in pregnancy
Epidemiology
Mechanism of injury
Physiologic alterations of pregnancy
Initial evaluation
Surgical management
Morbidity and complications
Mortality
Conclusions
Suggested readings
Trauma in our “elders”
Physiologic changes
“geriatric giants”
Epidemiology
Prehospital assessment and trauma triage
Initial trauma evaluation
Special considerations on common injuries
Aftercare and palliative care
Conclusion
Suggested readings
Burns
Incidence
Mechanism of injury
Pathophysiology
Grading of burn wound depth
Resuscitation priorities
Morbidity and complications management
Transportation and transfer
Mortality and morbidity
Acknowledgment
Suggested readings
Soft tissue infections
Incidence
Mechanism of injury
Diagnosis
Surgical management
Pharmacologic therapy
Hyperbaric oxygen
Mortality, morbidity, and complications management
Conclusions
Suggested readings
Common errors in trauma care
Missed diaphragmatic injury
Failure to recognize extremity compartment syndrome
Abdominal compartment syndrome
The myth of mandatory colostomy
Delayed damage control laparotomy
Missed hollow viscus injury
Failure to perform tertiary survey
Futile resuscitative thoracotomy
Summary
Suggested readings
Combat trauma care: Lessons learned from recent combat operations
Overview of modern forward trauma care
Battlefield injuries
Prehospital and en route care
Prolonged field care and advanced resuscitative care
Triage and immediate care
Damage control resuscitation and massive transfusion
Combat surgery
Austere resuscitative and surgical care teams
Postoperative care and evacuation
Coordination and quality improvement initiatives
Conclusion
Suggested readings
Danger associated molecular patterns, complements, and other novel biomarkers in trauma patient management
Pathophysiology of systemic inflammatory response syndrome and multiorgan failure
Targeting damps in trauma
Targeting complement in traumatic injury
Implications for therapy
Prospective biomarkers
Importance of the time of intervention
Conclusion
Acknowledgments
Suggested readings
Microbiome and trauma
Evaluation of the community structure, membership, and function of the microbiota using next-generation technology
The microbiota, the immune system, and the emergence of pathobiota
The effects of traumatic injury and critical illness on the microbiota
The effect of trauma care on the microbiome
Microbiota-directed therapy in the trauma patient
Suggested readings
Genomics of profound shock and trauma
The human genome
Genetic divergence
Identifying the genetic basis of disease
Multiple-organ dysfunction and failure
The “genomic storm,” chronic critical illness, and individualized medicine
Summary
Suggested readings
Critical Care I: Management of Organ Failures and Techniques for Support
Cardiac hemodynamics: Pulmonary artery catheter and the meaning of its readings
History of controversy
Pulmonary artery catheter use and insertion: What it is and how it works
Interpretation: What does it measure and what does it mean?
Alternatives to the pulmonary artery catheter
Summary
Suggested readings
Oxygen transport
Energy generation in the cell
Microcirculation and oxygen delivery
Putting it all together: Measuring cellular oxygen consumption and extraction in patients
Conclusion
Suggested readings
Pharmacologic support of cardiac failure
Pathophysiology
Treatment
Special considerations
Summary
Suggested readings
Diagnosis and management of cardiac dysrhythmias
Incidence and risk factors
Bradyarrhythmias
Tachyarrhythmias
Conclusion
Suggested readings
Fundamentals of mechanical ventilation
Key points
Noninvasive ventilation
Pressure support ventilation
Heliox
Modes of mechanical ventilation
Monitoring
Invasive hemodynamic monitoring
Pulmonary artery catheterization
Clinical use of the pulmonary artery catheter
Liberation from mechanical ventilation
Special airway considerations
Suggested readings
Advanced techniques in mechanical ventilation
Key points
Impaired oxygenation in acute respiratory distress syndrome (ARDS)
Alternatives to conventional mechanical ventilation
Pharmacotherapy
Unconventional methods of ventilation
Special considerations: Respiratory management strategies in severe COVID-19
The future
Suggested readings
Acute kidney injury and renal replacement therapy in the surgical intensive care unit
Diagnosis
Sodium handling in AKI
Classifying AKI by cause and sodium handling
Prevention of acute kidney injury
Management of acute kidney injury
Renal replacement therapy
Long-term outcomes
Summary
Suggested readings
Management of coagulation disorders in the surgical intensive care unit
Incidence and mechanism of disease
Diagnosis
Management
Conclusions
Suggested readings
Management of endocrine disorders in the surgical intensive care unit
The neuroendocrine axis
Central nervous system problems
Abnormalities in thyroid response
Abnormalities of adrenal function
Glucose abnormalities
Other endocrine contributions: Procalcitonin
Summary
Suggested readings
Transfusion: Management of blood and blood products in trauma
Incidence: Who needs blood transfusion in trauma?
Massive transfusion
Blood transfusion components
Goal-directed hemostatic resuscitation after foundation ratio
Prehospital plasma resuscitation
Restrictive transfusion strategies in trauma
Risks of blood transfusion
Blood transfusion and mortality
Blood transfusion and infection
Potential mechanisms for transfusion-associated adverse outcome
Management of complications related to blood transfusion
Conclusions
Suggested readings
Critical Care II: Special Issues and Treatments
Thromboelastography: Techniques and uses
History of thromboelastography
ROTEM and TEG mechanics
Identification and treatment of trauma induced coagulopathy (TIC) using TEG and ROTEM
Coagulopathy following traumatic injury
Hyperfibrinolysis
Use of TEG and ROTEM to diagnose prothrombotic states
Fibrinolysis shutdown
Conclusions
Suggested readings
Acute respiratory distress syndrome
Definition, presentation, and clinical diagnosis
Epidemiology
Pathophysiology
Therapy and supportive measures
Conclusion
Suggested readings
The evolving epidemiology of multiple organ failure
Evolving epidemiology and proposed pathobiology of MOF
Most recent PICS-CCI paradigm
Validation of PICS-CCI paradigm
Acknowledgments
Suggested readings
Sepsis, septic shock, and its treatment
Definition of sepsis: The most recent changes
Diagnosis
Procalcitonin
Lactate production in sepsis
Normal extraction ratio and elevated lactate
The microcirculation as it applies to sepsis and septic shock
Treatment
The patient with intra-abdominal sepsis requiring surgery for source control
Optimal targets in the septic patient
Volume expansion
Ventriculo-arterial coupling
Resuscitation fluid
Inotropic and vasopressor support
Blood transfusion
Conclusion
Suggested readings
The immunology of trauma
Danger (damage)-associated molecular patterns
Cytokine response
Cell-mediated response
Leukocyte recruitment
Proteases and reactive oxygen species
Complement, kinins, and coagulation
Platelets, coagulation, and the immune response
Immune regulation
Acute phase reaction
Systemic inflammatory response syndrome
Compensatory anti-inflammatory response syndrome
Mixed antagonist response syndrome
Two-hit model
Persistent inflammation, immunosuppression, and catabolism syndrome
Immune response and nutrition
Amino acids
Cofactors and micronutrients
Summary
Suggested readings
Overview of infectious diseases in trauma patients
Determinants of infection
Prevention of infection
Diagnosis of infection
Treatment of infection
Summary
Suggested readings
Nosocomial pneumonia
Incidence, morbidity, and mortality
Risk factors and preventive measures
Diagnosis
Management
Suggested readings
Antibiotic use in the intensive care unit: The old and the new
Pharmacokinetics and pharmacodynamics
Antibiotic prophylaxis
Principles of antimicrobial therapy
Spectra of antibiotic activity
Antibiotic toxicities
Suggested readings
Fungal colonization and infection during critical illness
Key points
History and prevalence
Predictors for fungal infections
Pathogenic organisms
Principles of therapy
Summary
Suggested readings
Preoperative and postoperative nutritional support: Strategies for enteral and parenteral therapies
Metabolic stress and malnutrition
Assessment of nutritional status and risk
Perioperative nutrition
Nutritional support challenges and controversies
Technical aspects of parenteral and enteral access
Morbidity and complications management
Summary
Key points
Suggested readings
Venous thromboembolic events: Diagnosis, treatment, and filters as adjuncts
Incidence
Pathophysiology
Prevention
Diagnosis
Management
Treatment
Morbidity and complications management
Socioeconomic cost of VTE
Conclusions
Suggested readings
Hypothermia and trauma
Accidental vs. induced hypothermia
Detrimental effects of hypothermia
Effects on other organs
Management
Conclusions
Suggested readings
Surgical procedures in the surgical intensive care unit
Historical perspective
Surgical procedures
Special consideration in patients with COVID-19
Conclusion
Suggested readings
Anesthesia in the critical care unit and pain management
Sedatives in the ICU
Assessment and monitoring of sedation and delirium
Analgesia and pain management in the ICU
Assessing and monitoring pain control in the ICU
Common pharmacologic agents in the ICU
Conclusion
Suggested readings
Anesthesia adjuncts in the management of pain in trauma patients: New blocks and other techniques to combat the opioid epidemic
Physiology of pain
Multimodal pain modalities
Regional anesthesia and analgesia —novel regional anesthetic techniques
Summary
Suggested readings
Extracorporeal membrane oxygenation for acute cardiopulmonary failure
History
Components of an ECMO team
Patient selection
Indications
Contraindications to ECMO
Cannulation
Technical aspects of the ECMO circuit
Critical aspects of patient management
Weaning
Decannulation
Expected outcomes
Future directions and controversies
Conclusion
Suggested readings
Rehabilitation and Quality of Life After Trauma and Other Issues
Surgery during global pandemics: Focus on prioritization and resource allocation
The importance of “flattening the curve”
Notable pandemics since the early 1900s: The argument for ongoing vigilance
Impact of pandemic phase on surgical practice and services
Preparation, mitigation, and blind spots
Oxygenation and ventilation: An overview
Vaccinations, pharmaceutical interventions, and diagnostic testing
Protecting, supporting, and training health care workers
Follow-up care (telehealth)
End-of-life decisions and cardiopulmonary resuscitation for the clinician
Modern public health “weaponry” against pandemic: Technological assistance and artificial intelligence
Health equity and ethical considerations
Conclusion
Suggested readings
Diagnostic management of brain death in the intensive care unit and organ donation
Brain death
Catastrophic brain injury guidelines and donor management
Conclusion
Suggested readings
Palliative care in the trauma intensive care unit
What is palliative care in the intensive care unit?
When to start palliative care in the intensive care unit
Communication and shared decision making
Withholding and withdrawal of life support
Pain and symptom management
Family and bereavement support
Conclusion
Suggested readings
Trauma rehabilitation
Overview
Trauma rehabilitation team
Assessment of patients with spinal cord injury
Assessment of patients with traumatic brain injury
Assessment of patients with peripheral nerve injury
Assessment of patients with multiple orthopedic injuries: The polytrauma patient
Levels of care after acute trauma hospital stay
Conclusion
Suggested readings
Trauma outcomes
Trauma performance improvement and patient safety programs
Trauma registries
Trauma quality improvement program
Outcomes
Other related outcomes
Conclusion
Suggested readings
Index

Life Sciences

Physical Sciences & Engineering

Social Sciences & Humanities

Health

Current Therapy of Trauma and Surgical Critical Care

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Juan A. Asensio