Trauma , 7th edition new medical books

TRAUMA NOTICE Medicine is an ever-changing science As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy are required The authors and the publisher of this work have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards accepted at the time of publication However, in view of the possibility of human error or changes in medical sciences, neither the authors nor the publisher nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they disclaim all responsibility for any errors or omissions or for the results obtained from use of the information contained in this work Readers are encouraged to confirm the information contained herein with other sources For example and in particular, readers are advised to check the product information sheet included in the package of each drug they plan to administer to be certain that the information contained in this work is accurate and that changes have not been made in the recommended dose or in the contraindications for administration This recommendation is of particular importance in connection with new or infrequently used drugs TRAUMA Seventh Edition Editors Kenneth L Mattox, MD Distinguished Service Professor Baylor College of Medicine Michael E DeBakey Department of Surgery Chief of Staff Chief of Surgery Ben Taub General Hospital Houston, Texas Ernest E Moore, MD Professor and Vice Chairman Department of Surgery University of Colorado at Denver and Health Sciences Center Bruce M Rockwell Distinguished Chair of Trauma Surgery Rocky Mountain Regional Trauma Center Chief of Surgery Denver Health Medical Center Denver, Colorado David V Feliciano, MD Attending Surgeon, Atlanta Medical Center Atlanta, Georgia Attending Surgeon, Medical Center of Central Georgia Macon, Georgia Professor of Surgery Mercer University School of Medicine Macon, Georgia Adjunct Professor of Surgery Uniformed Services University of the Health Sciences Bethesda, Maryland New York Chicago San Francisco Lisbon London Madrid Mexico City Milan New Delhi San Juan Seoul Singapore Sydney Toronto Copyright © 2013 by The McGraw-Hill Companies, Inc All rights reserved Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher ISBN: 978-0-07-171784-7 MHID: 0-07-171784-6 The material in this eBook also appears in the print version of this title: ISBN: 978-0-07-166351-9, MHID: 0-07-166351-7 All trademarks are trademarks of their respective owners Rather than put a trademark symbol after every occurrence of a trademarked name, we use names in an editorial fashion only, and to the benefit 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the work is strictly prohibited Your right to use the work may be terminated if you fail to comply with these terms THE WORK IS PROVIDED “AS IS.” McGRAW-HILL AND ITS LICENSORS MAKE NO GUARANTEES OR WARRANTIES AS TO THE ACCURACY, ADEQUACY OR COMPLETENESS OF OR RESULTS TO BE OBTAINED FROM USING THE WORK, INCLUDING ANY INFORMATION THAT CAN BE ACCESSED THROUGH THE WORK VIA HYPERLINK OR OTHERWISE, AND EXPRESSLY DISCLAIM ANY WARRANTY, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE McGraw-Hill and its licensors not warrant or guarantee that the functions contained in the work will meet your requirements or that its operation will be uninterrupted or error free Neither McGraw-Hill nor its licensors shall be liable to you or anyone else for any inaccuracy, error or omission, regardless of cause, in the work or for any damages resulting therefrom McGraw-Hill has no responsibility for the content of any information accessed through the work Under no circumstances shall McGraw-Hill and/or its licensors be liable for any indirect, incidental, special, punitive, consequential or similar damages that result from the use of or inability to use the work, even if any of them has been advised of the possibility of such damages This limitation of liability shall apply to any claim or cause whatsoever whether such claim or cause arises in contract, tort or otherwise DEDICATION The editors of Trauma, Seventh Edition, gratefully dedicate this edition to our five unique “families”: our spouses, children, grandchildren, and extended families; our trainees, who now dot the globe—our lasting legacy; our medical schools and academic anchors; our organizations and associations; and our patients, who continue to teach us so very much This page intentionally left blank CONTENTS Contributors xi Preface xix SECTION TRAUMA OVERVIEW Kinematics John P Hunt, Alan B Marr, and Lance E Stuke Trauma Systems, Triage, and Transport 54 Raul Coimbra, David B Hoyt, and Vishal Bansal Epidemiology 18 Thomas J Esposito and Karen J Brasel Injury Prevention 36 Ronald V Maier and Charles Mock Injury Severity Scoring and Outcomes Research 77 Robert D Becher, J Wayne Meredith, and Patrick D Kilgo Acute Care Surgery 91 Gregory J Jurkovich SECTION GENERALIZED APPROACHES TO THE TRAUMATIZED PATIENT Prehospital Care 100 Jeffrey P Salomone and Joseph A Salomone III Disaster and Mass Casualty 123 Eric R Frykberg and William P Schecter Rural Trauma 140 Charles F Rinker II and Nels D Sanddal 10 Initial Assessment and Management 154 Panna A Codner and Karen J Brasel 11 Airway Management 167 Eric A Toschlog, Scott G Sagraves, and Michael F Rotondo 12 Management of Shock 189 Louis H Alarcon, Juan Carlos Puyana, and Andrew B Peitzman 13 Postinjury Hemotherapy and Hemostasis 216 Fredric M Pieracci, Jeffry L Kashuk, and Ernest E Moore 14 Emergency Department Thoracotomy 236 Clay Cothren Burlew and Ernest E Moore 15 Diagnostic and Interventional Radiology 251 Salvatore J.A Sclafani 16 Surgeon-Performed Ultrasound in Acute Care Surgery 301 Christopher J Dente and Grace S Rozycki 17 Principles of Anesthesia and Pain Management 322 Dirk Younker 18 Infections 330 Michael A West and Daniel Dante Yeh vii viii Contents SECTION MANAGEMENT OF SPECIFIC INJURIES 19 Injury to the Brain 356 Alexander F Post, Thomas Boro, and James M Ecklund 20 Eye 377 Petros E Carvounis and Yvonne I Chu 21 Face 395 Robert M Kellman 22 Neck 414 David V Feliciano and Gary A Vercruysse 23 Vertebrae and Spinal Cord 430 Maneesh Bawa and Reginald Fayssoux 24 Trauma Thoracotomy: Principles and Techniques 461 Kenneth L Mattox, Matthew J Wall, Jr., and Peter Tsai 25 Lung, Trachea, and Esophagus 468 Joseph A DuBose, James V O’Connor, and Thomas M Scalea 26 Heart and Thoracic Vascular Injuries 485 Matthew J Wall, Jr., Peter Tsai, and Kenneth L Mattox 27 Trauma Laparotomy: Principles and Techniques 512 Asher Hirshberg 28 Diaphragm 529 Kevin M Schuster and Kimberly A Davis 29 Liver and Biliary Tract 539 Timothy C Fabian and Tiffany K Bee 30 Injury to the Spleen 561 David H Wisner 31 Stomach and Small Bowel 581 Lawrence N Diebel 32 Duodenum and Pancreas 603 Walter L Biffl 33 Colon and Rectal Trauma 620 Demetrios Demetriades and Kenji Inaba 34 Abdominal Vascular Injury 632 Christopher J Dente and David V Feliciano 35 Pelvis 655 George C Velmahos 36 Genitourinary Trauma 669 Michael Coburn 37 Trauma in Pregnancy 709 M Margaret Knudson and Daniel Dante Yeh 38 Trauma Damage Control 725 Amy D Wyrzykowski and David V Feliciano 39 Upper Extremity 747 Nata Parnes, Peleg Ben-Galim, and David Netscher 40 Lower Extremity 783 Philip F Stahel, Wade R Smith, and David J Hak 41 Peripheral Vascular Injury 816 Michael J Sise and Steven R Shackford Contents SECTION SPECIFIC CHALLENGES IN TRAUMA 42 Alcohol and Drugs 850 Larry M Gentilello 43 The Pediatric Patient 859 David W Tuggle and Nathaniel S Kreykes 44 The Geriatric Patient 874 Jay A Yelon 45 Ethics of Acute Care Surgery 886 Laurence B McCullough 46 Social Violence 890 James W Davis 47 Wounds, Bites, and Stings 896 Charles A Adams, Jr., Daithi S Heffernan, and William G Cioffi 49 Temperature-Related Syndromes: Hyperthermia, Hypothermia, and Frostbite 938 David H Ahrenholz 50 Organ Procurement for Transplantation 944 Aditya K Kaza and Max B Mitchell 51 Rehabilitation 950 Paul F Pasquina, Caitlin L McAuliffe, and Kevin F Fitzpatrick 52 Modern Combat Casualty Care 964 Jay Johannigman, Peter Rhee, Donald Jenkins, and John B Holcomb 53 Genomics and Acute Care Surgery 991 Grant E O’Keefe and J Perren Cobb 48 Burns and Radiation 922 Jong O Lee and David N Herndon 54 Trauma, Medicine, and the Law 997 Kenneth L Mattox and Stacey A Mitchell SECTION MANAGEMENT OF COMPLICATIONS AFTER TRAUMA 55 Principles of Critical Care 1006 Raul Coimbra, Jay Doucet, and Vishal Bansal 56 Cardiovascular Failure 1041 Mary Margaret Wolfe and Fred Luchette 57 Respiratory Insufficiency 1055 Jeffrey L Johnson and James B Haenel 58 Gastrointestinal Failure 1073 Rosemary A Kozar and Frederick A Moore 59 Renal Failure 1084 Charles E Lucas, Michael T White, and Anna M Ledgerwood 60 Nutritional Support and Electrolyte Management 1100 Kenneth A Kudsk and Caitlin Curtis 61 Multiple Organ Failure 1128 Angela Sauaia, Frederick A Moore, and Ernest E Moore ix 1210 Index gastrointestinal failure (continued ) modified enteral formulas, 1079–1080 vs parenteral nutrition, 1079 probiotics and prebiotics, 1081–1082 prokinetic agents, 1081 serotonin antagonists, 1081 gut dysfunction to adverse patient outcome abdominal compartment syndrome, 1074 decreased gut mucosal immunity, 1077 gastric alkalinization, 1076 gastroesophageal reflux, 1075–1076 gastroparesis/duodenogastric reflux, 1076 gut edema, 1078 impaired gut absorptive capacity (GAC), 1077 impaired intestinal transit, 1077 impaired mucosal perfusion, 1076–1077 increased gut colonization, 1077–1078 increased gut permeability, 1077 multiple organ failure, 1073–1074 nonocclusive small bowel necrosis (NOBN), 1074–1075 in critically injured patients, 1074t strategies to improve analgesics and sedatives, 1079 gut-specific resuscitation, 1078–1079 nonocclusive bowel necrosis (NOBN), pathogenesis of, 1075f gastrointestinal injury, 581 gastrointestinal tract, damage control operations in, 729 gastrojejunostomy, 867 genitourinary trauma, 669 anatomy, 669–672 anterior urethral disruption, mechanism of, 681f bladder neck avulsion injury, 698f stress cystograms, 678f–679f blunt renal injury, staging computed tomography scans, 675f complications of, 700–701 consultation and interservice interaction, 702–705 damage control laparotomy, 705f principles, 701–702 Gerota’s fascial envelope, 690f grade V parenchymal injury, 684f gunshot wound to mons pubis region, 702f gunshot wound to penis, 701f injury grading and scoring systems, 672–673 intraperitoneal bladder injury from blunt trauma, 697f intraperitoneal bladder rupture, computed tomography (CT) cystogram, 680f intrarenal vascular anatomy, 670f manipulating flexible cystoscope, 699f medicolegal considerations, 706 nonoperative management bladder, 685–686 genital injuries, 687–688 kidney, 680–683 ureter, 683–685 urethra, 686–687 operative management bladder, 695–698 kidney, 688–693 penis, testis, and scrotum, 699–700 ureter, 693–695 urethra, 698–699 partial nephrectomy for, 691f pediatric renal trauma, 675–676 penetrating injury, algorithm for management, 705f penetrating renal injury, 685f, 686f penile fracture, 700f renal anatomy, 670f renal artery occlusion, 676f renal autotransplantation, 696f renal trauma clinical presentation/diagnosis, 673 bladder, 677 clinical presentation and evaluation, 673–674 external genitalia, 680 incidence and patterns of injury, 673 radiographic imaging, 674–675 ureteral injuries, 676–677 urethra, 677–680 organ injury scaling system, 673f surgical management, 689f, 692f, 693f retrograde urethrogram, technique of, 682f scrotal exploration and testicular repair, 704f stress cystogram, 677f subtotal penile amputation injury, 703f testicular rupture, 703f transureteroureterostomy, 696f ureter, 687f ureteral anatomy, 671f ureteral blood supply, 671f ureteral reconstruction, techniques, 694f ureteral reimplantation with psoas hitch, 695f urethra, 683f urethral disruption, 671f urologic injury scale, 672t wedge resection of injured parenchyma, 690f genome structure clinical practice, 995–996 definitions, 992 DNA sequence, 991 genetic basis for disease, 993 genetic risk factors, 994–995 sepsis/organ dysfunction, 995 pharmacogenomics, 994–995 trauma/burns, gene expression profiling, 993–994 typical gene, structure, 993f venous thrombosis, genetic causes, 994t geriatric fracture centers, 800 geriatric patient aging process, 874–875 end of life, 883 management of initial assessment, 877–878 triage, 876–877 organ function and aging cardiac, 875 endocrine, 875 functional reserve, 875–876 pulmonary, 875 renal system, 875 skin/soft tissue and musculoskeletal system, 875 organ system changes with aging in, 876t outcomes complications, 881 preexisting conditions (PECs), 881 resource utilization, 881–882 specific injuries abdominal injury, 879 burns, 879–880 critical care, 880–881 pelvic fractures, 879 penetrating trauma, 880 rib fractures, 878–879 traumatic brain injury, 878 strategies for improving outcomes medications, 882 specialists, 882–883 triage, 882 Glasgow Coma Scale (GCS), 61, 84, 140, 864 Glasgow Coma Score (GCS), 156 Glasgow Outcome Scale (GOS), 878 glenohumeral dislocation, 764–765, 765f global positioning satellite (GPS), 142 glomerular filtration rate (GFR), 875 Golgi apparatus, 902 graduated driver licensing (GDL), 42 greenstick fractures, 870 ground zero, 64 gunshot wounds, 763 gut dysfunction to adverse patient outcome abdominal compartment syndrome, 1074 decreased gut mucosal immunity, 1077 gastric alkalinization, 1076 gastroesophageal reflux, 1075–1076 gastroparesis/duodenogastric reflux, 1076 gut edema, 1078 Index impaired gut absorptive capacity (GAC), 1077 impaired intestinal transit, 1077 impaired mucosal perfusion, 1076–1077 increased gut colonization, 1077–1078 increased gut permeability, 1077 multiple organ failure, 1073–1074 nonocclusive small bowel necrosis (NOBN), 1074–1075 in critically injured patients, 1074t strategies to improve analgesics and sedatives, 1079 gut-specific resuscitation, 1078–1079 H Haddon Matrix of injury etiology, 37t motor vehicle crash incident, 19t Haddon’s Matrix, 41 Haemophilus influenzae type B vaccine, 868 hand, infection in, 763 Haplochlaena spp., 918 Harborview Injury Prevention and Research Center (HIPRC), 44 Harlem Hospital Injury Prevention Program (HHIPP), 47 head to neck ratio, 865 Health Insurance Portability and Accountability Act (HIPAA), 165 Health Resources and Services Administration (HRSA), 55 heart bypass, left, 1173f heart injuries bleeding control, temporary techniques, 490f blunt cardiac injury, 486 clinical presentation blunt cardiac injury, 487 cardiac enzymes, 488 echocardiography, 488 electrocardiography, 488 evaluation, 487–488 focused assessment with sonography for trauma (FAST), 488 penetrating cardiac injury, 487 pericardial injury, 487 subxiphoid pericardial window, 488–489 complex cardiac injuries, 491 coronary arteries, 491f dysrhythmias, 491t electrical injury, 487 follow-up, 492 iatrogenic cardiac injury, 486–487 incidence, 485 left anterior thoracotomy, 489f penetrating cardiac injury, 485–486 pericardium , transdiaphragmatic exploration, 489f traumatic heart diseases, etiology of, 486t treatment blunt cardiac injury, 490–491 penetrating injury, 489–490 heart rate variability (HRV), 159 helicopter EMS (HEMS), 104 helmet promotion, 44 hematoma, 610–611 associated with abdominal vascular injuries, 636 hemithorax, video-assisted thoracoscopic surgery (VATS), port placement, 474f hemodynamic monitoring, 1008, 1009t arterial pressure monitoring, 1008–1009 bioimpedance, 1010 blood transfusions, 1010–1011 central venous pressure monitoring, 1009 echocardiography, 1010 erythropoiesis-stimulating agents (ESAs), 1011 gastric tonometry, 1010 hemoglobin therapies, 1010 near-infrared spectroscopy (NIRS), 1010 pulmonary artery catheters, 1009–1010 hemorrhage, 616, 832, 837 hemostasis, 216 acute endogenous coagulopathy, pathways, 221f antifibrinolytics, 229 blood components, complications, 231–232 bloody vicious cycle, updated, 222f cell-based coagulation construct, 218 coagulation/anticoagulation/fibrinolysis, proteins involved, 219t factor XIIIa, 229–230 management controversies goal-directeded hemostasis, 225–228 hypotensive resuscitation, 223 preemptive blood components, 223–225 trauma, acute coagulopathy, 218–223 MT, literature addressing component transfusion ratios, 224t postinjury coagulopathy perspective, 217–218 postinjury hypercoagulability, 232 pre-injury antithrombotic agents, 230 antiplatelet therapy, 230–231 warfarin, 230 prothrombin complex concentrate (PCC), 230 recombinant factor VIIa (rVIIa), 228–229 red blood cell (RBC) transfusion, 216–217 resuscitation via thrombelastography, 228f thrombelastographic tracings, characteristic, 227f thrombelastography (TEG) instrument and tracing, 226f parameters, 227t hemotherapy, postinjury, 216 See also hemostasis heparin-induced thrombocytopenia, 839 hepatic artery, management of injury to, 647 hepatic balloon tamponade, 1179f hepatic injuries, nonoperative management of, 868 hepatorrhaphy, 1178f hexachlorophene solution, 905 Hibiclens®, 905 high-energy vs low-energy trauma, 747 high-pressure injection injuries, treatment of, 758 high-resolution real-time ultrasonography (US), 714 high-speed cine-radiography, high-speed motor vehicle injury with mesocolon avulsion, 621f high-velocity penetrating injuries, 620, 621f hilar, 1174f hip dislocation, management of, 793–795, 794f hip fractures geriatric fracture centers for, 800 management of, 795 rehabilitation of patients with, 799–800 Hosmer–Lemeshow (HL) statistic, 88 human bite wounds, 909–911 human immunodeficiency virus (HIV), 911 human rabies cases in the United States by exposure category, 913t clinical symptoms of, 911 reatment recommendations and estimates of the risk of, 912t hyperglycemia, 863 hyperthermia, 864, 941 exercise, 941 iatrogenic hyperthermia syndromes, 941–942 hypervolemia, 711 hypotension, 821 hypothermia, 141, 726–727, 727t, 826, 862, 903 cardiac function, 940 coagulation, 940 immunity, 940 localized, 940 management algorithm, 939f maneuvers to prevent, 636 and metabolic reserves, 940 primary accidental, 938–939 secondary metabolic, 939 therapeutic, 940 in trauma, 939 hypovolemia, 875, 882 hypoxia-induced factor (HIF), 899 I iliac artery, right common, 1192f immediate amputation, role of, 833 imminent demise futility, 886 immunosuppressant therapy, 944 incisional hernia, late closure of, 741–742 increased intracranial pressure (ICP), 864 1211 1212 Index infection, 330 antibiotic choice recommendations, 339t SIS/IDSA evidence-based guidelines, 341t, 342t antibiotic prophylaxis, evidence-based recommendations, 337t clinical pulmonary infection score (CPIS), 348t microbial contamination, 331f microbial factors, environmental factors, and host defenses, 331f microbiology, 333 marine trauma, 335–336 rabies, 334–335 tetanus, 335 pathogenesis, 330 environmental barriers, 330–331 host defense mechanisms, 332–333 microbial factors, 331–332 pathogenic microorganisms, region, 332t postinjury infections, diagnostic approach, 340f postsplenectomy vaccinations, recommendations, 350t post-traumatic empyema, bacteriology, 342t prevention blood transfusion, 338 double gloving, 337–338 general principles, 336 nutritional support, 338–339 prophylactic antibiotics, 336–337 supplemental oxygen, 338 surgical scrub, 337 suture material, 338 temperature control, 338 tracheostomy, 339 S aureus bone and joint infections, bacterial determinant, 343t septic joints/osteomyelitic bone infections, 343t septic shock/severe sepsis, infection control priorities, 347t surgical/trauma intensive care unit, nosocomial infections, 346t surgical wounds, classification, 336t trauma-related infections, 339 catheter-related bloodstream infection, 349 chronologic approach to prevention, recognition, and treatment, 344 Clostridium difficile diarrhea, 350 diagnosis, 339–340 empyema, 341–343 environmental pathogens, occupational exposure, 344 ICU and early postoperative period, 346–347 intra-abdominal infections, 340–341 operating room, 345–346 osteomyelitis/septic arthritis, 343 overwhelming postsplenectomy infection (OPSI), 351 postsplenectomy vaccinations, 350 resuscitation bay, 344–345 surgical site infection, after discharge, 351 surgical site infections, 349–350 urinary tract infections, 349 ventilator-associated pneumonia, 347–349 traumatic injuries, immunologic defects, 334t ventilator-associated pneumonia, 334t Vibrio vulnificus Wound Infections, 336t infection in hand, 763 inferior pancreatoduodenal artery, 607 infrahepatic inferior vena cava, management of injuries in, 642–643 inframesocolic region, management of injuries in exposure and vascular control, 641–642, 643–644 infrahepatic inferior vena cava, 642–643 infrarenal aorta, 642 infrarenal aorta, management of injuries in, 642 initial assessment and management, 154 airway maintenance, with cervical spine protection, 156–157 blood loss, 158t breathing, 157 chin lift/jaw thrust, airway, 157f circulation with hemorrhage control, 157–160 stop the bleeding, 158–160 definitive airway, indications, 156t definitive care, 164 disability, neurologic status, 160–161 documentation, medical record, 165 exposure and environmental control, 161 hospital phase, 155 initial fluid resuscitation, responses, 160t intraosseous puncture, demonstration, 160f prehospital phase, 154–155 preparatory phase, 154 primary survey, 155 catheters and tubes, 161 early transfer, decision, 162 geriatric patient, 155–156 monitoring, 161 obese patients, 156 pediatric patients, 155 pregnant women, 156 x-rays and diagnostic studies, 161–162 reevaluation, 164 secondary survey history, 162–163 physical examination abdomen, 164 chest, 163 head and face, 163 musculoskeletal and peripheral vascular system, 164 neck and spine, 163 neurologic assessment, 163 triage, 155 ventilation, 157 initial assessment, of geriatric patient airway, 877 breathing, 877 circulation, 877 disability, 877 exposure, 878 injuries confounding factors, analysis and interpretation, 28–29 death rates, 26f distribution by geographic location, 27–28 by nature and severity, 26–27 fatal falls, 30–31 fatally injured drivers with blood alcohol level, 30f firearm-related injuries, 30 gun control laws, positioning, 20f injury control, 19f patterns by age and gender, 20–23 by mechanism and intent, 23–26 traffic-related incidents, 29–30 injury coding, 77 injury control cube, 18 injury etiology, Haddon Matrix interactions of phases and factors, 37t injury prevention, 36 accomplishment, 38 components, 50t global initiatives, 49–50 importance, 36 intentional injuries, prevention strategies alcohol/firearms, roles of, 48–49 assaultive behavior, 46–47 community-based programs, 47 crisis intervention services, 48 domestic violence, 47 education programs, aimed at general public, 48 high risk of suicide, 48 reducing access to means of suicide, 48 school-based programs, 46–47 suicide, 47–48 scientific approach, 36 ethical issues, 39 historical development, 36–37 political issues, 39–40 practical considerations, 38–39 surgeon’s role, 51 unintentional injuries, prevention strategies, 40 alcohol, 41–42 clothing ignition, 43 distracted driving, 42–43 graduated drivers licensing systems, 42 helmet promotion, 44 Index helmets, 41 house fires, 43 motor vehicle, 40 prevention efforts, nationwide effectiveness, 46 residential safety, 43 safety-related vehicle design/occupant protection, 40–41 scalds, 43 Seattle bicycle helmet campaign, 44–45 speed limits, 41 transportation, 40 Washington State motorcycle helmet law, 45–46 injury prevention during pregnancy, 721–722 injury severity scores (ISSs), 58, 77, 142, 877 AIS components, 79t anatomic scoring systems, 79–83 combined scoring systems, 85–86 comorbidity scoring systems, 85 GCS components, descriptors, 84t ICISS vs actual mortality, 83f injury coding, 77–79 classification schemes, 78t injury severity scores, 80t–82t ISS vs actual mortality, 83f NISS vs actual mortality, 83f physiological scoring systems, 83–85 revised trauma score (RTS) variable breakpoints, 84t TRAIS and ICISS, 84f trauma outcomes research basics, 86 covariates, 86–87 critical variables, identifying, 86–87 database choices, 87–88, 87t injury coding/classification choices, 88 outcome/dependent variables, 86 predictor/independent variables, 86 risk adjustment approaches, analysis, 87 risk adjustment choices, 88 risk of outcome, 79 trauma severityerity codes, evaluation, 88 TRISS equation, 85t innominate artery injury, exposure and management, 1168f–1169f insect and bug bites, wounds caused by, 918–919 insulin-like growth factor-1 (IGF-1), 898 intensive care before reoperation, 737 intensive care unit (ICU), 61, 859, 870 length of stay (LOS), 77 surgeon-performed ultrasound, 315 central venous catheter, insertion, 316–317 common femoral vein, thrombosis, 317–318 educational model, 318–319 inferior venal caval filters (IVCF), insertion, 318 intraperitoneal fluid/blood, 316 pleural effusion, 316 intercellular adhesion molecule-1 (ICAM-1), 898 intercostal artery, controlling, 1167f International Classification of Diseases (ICD), 23, 77 International Classification of Diseases Injury Severity Score (ICISS), 79 ICD-9 codes, 83 International Classification of Disease Version (ICD-9) codes, 852 international normalization ratio (INR), 882 International Trauma Life Support (ITLS), 107 interpersonal violence, 722 interphalangeal joint dislocations, 768–769 intimate partner violence (IPV), 722, 890 intra-abdominal aorta, endovascular intervention in injury to, 648 intra-abdominal hypertension, clinical manifestations of, 734 intra-abdominal packing, damage control operations in, 731–732 intra-abdominal pressure abdominal perfusion pressure, 734–735 clinical and laboratory manifestations of increased, 734t definition, 734 measurement of, 734 intracranial hemorrhage, 877 intraoperative cholangiogram, 610 intraoperative cholangiopancreatogram, 610 intraoperative evaluation of duodenum and pancreas, 608 intraoperative metabolic failure, 733 intraparenchymal bleeding, 869 intraperitoneal injuries, 627 intrathoracic blood loss, 866 ionizing radiation, 137 ischemia, 819 ischemic neurolysis, 819 ISDN lines, 151 isolated ulnar injuries, 836 J Joint Commission on Accreditation of Healthcare Organizations (JCAHO), 890 joint injuries acromioclavicular dislocation, 764 carpal dislocations, 767–768 dislocation and fracture–dislocation of elbow, 766–767 glenohumeral dislocation, 764–765, 765f interphalangeal joint dislocations, 768–769 metacarpophalangeal dislocations, 768 scapulothoracic dissociation, 764, 764f sternoclavicular dislocation, 764 trauma to elbow, 765–766 jugular venous distension (JVD), 159 K Kaplan–Meier trauma, 939f killer T cells, 898 kinematics, anatomic considerations, abdominal injury, 10–11 brain and maxillofacial injury, 8–9 musculoskeletal injury, 11–12 prevention, 12–13 spine and whiplash injuries, 12 thoracic injury, 9–10 basic principles, blast injury and ionizing radiation, 5–6 elastic and inelastic collisions, 3–4 energy and work, impulse, Newton’s law, 2–3 penetrating trauma and ballistics, 4–5 biomaterials, properties elasticity, 6–7 strain, 6–7 stress, 6–7 Young’s modulus, 6–7 biomechanical mechanisms of injury, 6f blast injuries, 14–15 department of defense classification, 15t blunt abdominal trauma, shear strain, 10f blunt trauma mechanisms/ injury patterns falls, motor vehicle crashes, 7–8 pedestrian injuries, bronchial injury, injury mechanisms, 10f explosive blast, physical characteristics of, 5f fracture mechanics, 11f geriatrics, 14 motor vehicle crash scenarios, energy and momentum, 3f pediatrics, 13 pregnancy, 14 pressure-time relationship, 5f stress, strain, elastic modulus, plastic modulus, tensile strength and energy, 7f thoracic aorta injury, 10f velocity and kinetic energy characteristics of guns, 4t Yaw, tumble, deformation, and fragmentation, 5f Kleihauer–Betke (KB) test, 712–713 knee dislocations, 833 management of, 804–805 Kocher maneuvers, 1183f L Lactrodectus macrotans, 919 laparotomy, trauma, 512 abdomen, chest, and groins operative field for torso trauma, 514f abdominal closure at reoperation, 526t 1213 1214 Index laparotomy, trauma (continued ) Cattell–Braasch maneuver, 523f generic sequence, schematic depiction, 515f Kocher maneuver, 522f left upper quadrant to achieve temporary hemostasis, 519f Mattox maneuver, 521f operative profile, factors, 524t penetrating abdominal trauma, 520t peritoneal cavity, 517f principles core mission, 512 operative sequence, 514–515 preparation, 513–514 surgeons, 515–516 surgeon’s support envelope, 513 relaparotomy abdominal infection, 525 planned reoperation, 526 urgent reoperation for bleeding, 524–525 role of, 527–528 small bowel, evisceration of, 518f surgeon’s support envelope, 513t surgical intensive care unit, bedside, 526–527, 527f techniques/maneuvers achieving temporary hemostasis, 517–518 gaining access/exposure, 516–517 intra-abdominal bleeding, 521–522 medial visceral rotations, 520–521 operative profile, choosing, 522–524 peritoneal cavity, 518–520 temporary abdominal closure, 524 uncontrolled abdominal infection, relaparotomy, technical options, 525t laryngeal mask airway (LMA), 110 laryngoscope, 860 late closure of incisional hernia, 741–742 lateral parietal craniectomy, performing steps, 1150f, 1151f–1152f LC injuries, 658 left medial visceral mobilization, 637f leukocytes, 819 lidocaine, 906, 907t ligamentous injuries, management of, 805–806 limb salvage vs amputation, 791–792 procedure for, 787f limb-threatening ischemia, 821 liver anatomy, 1177f damage control operations in, 728–729 omental packing, 1179f packing, 1180f liver injury, 539 anatomy functional, 539–540 hepatic artery, 540 hepatic veins, 540 ligaments, 540 lobes, 539 portal vein, 540 diagnosis of diagnostic peritoneal lavage, 542–543 focused abdominal sonography for trauma, 543 hemodynamically stable patient, 543 hemodynamically unstable patient, 542 focused abdominal sonography for trauma (FAST) CT scanning, 543–544 laparoscopy, 544 incidence and classification, 540–541 initial management, 541–542 liver trauma, management of, 544 abscesses, 546 anatomic resection, 553 bilomas/bile leak, 546 blunt hepatic injury, follow-up CT scanning of, 547 devascularization, 546 direct venous repair, 552–553 drains, 554 hemobilia, 546 hemodynamically stable patient, 547 hemodynamically stable patient with blunt injury, 545 hemorrhage, 546 nonoperative blunt hepatic injury , complications of, 545–546 operative management, 547–548 with major liver injury, 547–548 with minor liver injury, 547–548 operative management, complications of abdominal compartment syndrome, 554 bilhemia, 554 biliary fistulae, 555 bleeding, 554 fistulae problems, 555 hemobilia, 554 hepatic necrosis, 555 penetrating injury, nonoperative management of, 547 resumption of activity, 547 retrohepatic vena cava/hepatic vein injury, 552 severe parenchymal injury, hemostatic maneuvers direct suture, 549 fibrin sealants and hemostatic devices, 551 finger fracture, 549 hepatic artery ligation, 551–552 hepatic transplantation, 552 omental packing, 549–550 packing, 549 penetrating tract, 550–551 resection, 551 systemic inflammatory response, 546 tamponade with containment, 553–554 unusual complications, 546–547 vena cava stenting, 553 local anesthetic overdose, symptoms of, 906t long bone fractures, 790–791 loop colostomy with diversion, 628f loss of pregnancy after trauma, risk factors for, 721t low- and middle-income countries (LMICs), 49 low-energy vs high-energy trauma, 747 lower extremity fractures and dislocations, management of acetabular fractures, 792–793, 793f femoral neck fractures, 795–797, 796f femoral shaft fractures, 800–801, 801f fractures of distal femur, 801–803, 802f, 803f hip dislocation, 793–795, 794f hip fractures, 795 knee dislocations, 804–805 ligamentous injuries, 805–806 patellar fractures, 803–804 subtrochanteric fractures, 798–799, 799f tibia fractures, 806–810 trochanteric fractures, 797–798, 798f soft tissue injuries to (See soft tissue injuries) lower extremity injuries associated injuries injury combinations, 786–787 joint dislocation, 787–788 nerve injuries, 786 vascular injuries, 785–786 casues of, 783 challenges and controversies limb salvage vs amputation, 791–792 long bone fractures, 790–791 replantation, 792 clinical assessment, 784–785 history of, 783–784 late complications of malunion, 812 nonunion, 812 sequelae of joint trauma, 812 mechanism of injury, 784 pathophysiology and biomechanics, 784 radiographic diagnostics, 785 lower extremity vascular injuries, 836 low-velocity gunshot wounds, 621f Loxosceles reclusa, 919 lungs injuries, 468 anterolateral thoracotomy incision, 471f complications chylothorax, 475–476 empyema, 475 lung abscesses, 475 persistent air leak/bronchopleural fistula, 475 pneumatocele/intraparenchymal hematoma, 475 pneumonia, 474 retained hemothorax, 474–475 Index CXR and CT demonstrating right-sided pulmonary contusion, 474f indications for operation, 470–471 mechanism of systemic air embolism, 509f operative techniques, 471–473 outcomes, 474 presentation and evaluation, 469–470 pulmonary tractotomy with exposed hemorrhage sources ligation, 472f sizeable anterior pneumothorax, 469f surgical exposure, 471 tracheal intubation, 472f video-assisted thoracoscopic surgery (VATS) techniques, 473–474 lung twist, 1174f M Major Trauma Outcome Study (MTOS), 58, 880 “mangled limb,” 789 mangled upper extremities, 777 mannitol, 864 marine animals, bites and stings by bee and wasp stings, 919 insect and bug bites, 918–919 marine invertebrates, 917–918 piranha attacks, 918 shark bites, 918 spider bites, 919 venomous fish, 918 marine invertebrates, wounds caused by, 917–918 mass casualty systems, 124, 127, 128 massive transfusion protocol (MTP), and damage control resuscitation, 636 maternal assessment, 712 matrix metalloproteinases (MMPs), 899 Mattox maneuver, for large central suprarenal retroperitoneal hematoma, 1186f maxillofacial injuries, maximum AIS (maxAIS), 79 medial mobilization of right-sided intraabdominal viscera, 641f median nerve block anesthesia, technique of, 907f median sternotomy with neck extension, 1061f technique for performing, 1060f Medicaid, 857 medically reasonable, meaning of, 887 medical screening exam (MSE), 147 meshed split-thickness skin graft, 740f mesocolon and pancreas, 606 metacarpal bones, fractures of, 775–776 metacarpophalangeal (MCP), 911 metacarpophalangeal dislocations, 768 Michigan Alcohol Screening Test (MAST) questionnaires, for detection of alcohol problems, 854 microaerophilic streptococci, 909 Micrurus euryxanthus, 914, 917 Micrurus fulvius, 917 Micrurus fulvius fulvius, 914 Micrurus fulvius tenere, 914 midline bleeds, 663f military antishock trousers (MAST) garment, 660 missile emboli, 820 Mobile Army Surgical Hospital (MASH), 58 Model Trauma Care System Plan, 56 “modicum of benefit” test, of beneficencebased clinical judgment, 887 monocyte chemoattractant protein-1 (MCP-1), 899 Morison’s pouch, 162 motor vehicle collisions (MVCs), rear-end impact, 12 motor vehicle crash incident death rates, 34f Haddon Matrix, 19t multidetector CT (MDCT), 609 multiple organ dysfunction syndrome (MODS), 333f multiple organ failure, 1128 concepts on pathogenesis, 1128–1130 Denver MOF dataset, 1137t Denver Postinjury Multiple Organ Failure Score, 1138t adverse outcomes, 1139t risk factors, 1139t epidemiology and clinical relevance, 1130–1131 immunoinflammatory response to trauma, 1132f interventions adrenal insufficiency/cortisol replacement therapy, 1142–1143 blood transfusions, judicious use of, 1141–1142 continuous renal replacement therapy (CRRT), 1144 fracture management, 1142 immunonutrition, 1143–1144 immunostimulating factors, 1144 insulin/glycemic control, 1143 protective lung ventilation, 1142 protective resuscitation techniques, 1139–1141 TLR-directed interventions, 1144 Marshall Multiple Organ Dysfunction Score, 1138t adverse outcomes, 1139t risk factors, 1139t MOF, definition, 1136 Denver MOF dataset, 1137t MOF classification, 1137–1139 MOF scores, 1137 receiver operating characteristic (ROC) curves, 1139 validation of current scores, 1136 MOF over time, temporal distribution of, 1130f pathogenesis of, 1129f pathophysiology abdominal compartment syndrome, 1134–1135 blood transfusions, 1135 complement system, 1133 cytokines, 1132–1133 heat shock proteins (HSPs), 1133 hormones, 1134 infections, 1135–1136 inflammatory, hormonal, and immune responses to trauma, 1131 oxidative stress, 1133–1134 PAMPS, alarmins, and DAMPS, 1133 role of gut, 1131 role of PMN, 1131–1132 secondary operation, 1136 toll-like receptors, 1133 postinjury multiple organ failure, historical perspective, 1129t ROC curves for ICU, 1141f mechanical ventilation, 1141f mortality, 1140f ventilator-free days, 1140f multiple organ failure (MOF) score, 881 muscle mass, 875 musculoskeletal effects, rehabilitation contractures, 951 disuse osteoporosis, 951 muscle atrophy and weakness, 950–951 prevention and treatment, 951 musculoskeletal injury, musculoskeletal trauma, 11 Mycobacterium tuberculosis, 134 myocardial dysfunction, 1044 amrinone and milrinone, 1046 dobutamine, 1046 dopamine, 1045–1046 epinephrine, 1046 intra-aortic balloon pump counterpulsation, 1047 nitrovasodilators, 1046–1047 norepinephrine, 1045 pharmacologic, 1044–1045 preload augmentation and rewarming, 1044 steroids, 1047 vasopressin, 1045 myocardial infarction, current treatment of, 1050–1051 N nasal packing for hemorrhage control, 1149f National Center for Injury Prevention and Control (NCIPC), 31 National Crime Victimization Survey (NCVS), 32 National Electronic Injury Surveillance System—All Injury Program (NEISS-AIP), 31 National Health Interview Survey (NHIS), 31 1215 1216 Index National Highway Traffic Safety Administration (NHTSA), 13, 37 National Hospital Discharge Survey (NHDS), 31 National Standard Curriculum (NSC), 101 National Trauma Data Bank (NTDB), 26, 84, 91 National Violent Death Reporting System (NVDRS), 29, 51 navicular fracture–dislocation and metatarsal, 811f neck, 414 anatomy of, 414–415, 1150f arteriography, duplex ultrasonography, color flow doppler, CTA, 419–420 asymptomatic patients computed tomography, 419 modest/moderate symptoms, 419f pellet wound, 420f physical examination, 419 Zone I, 418 Zone II, 418–419 BCVI, screening criteria, 422t blunt cerebrovascular injuries, treatment of, 421 imaging for screening, 422 incidence/screening, 422 injuries, types, 422 management, 422–423 carotid artery, principles of repair, 424t cervical esophagostomy, 426f endotracheal intubation into distal trachea, 417f esophagogram/esophagoscopy/CT, 420–421 esophagus, principles of repair, 425t Fogarty balloon catheter, 418f laryngoscopy/fiber-optic bronchoscopy/ CT, 421 left sternocleidomastoid muscle, sternal head, 426f operative management esophagus, 425 general principles/incisions, 423 injury to carotid artery, 423–424 internal jugular vein, injury, 425 neurological deficit, 424 repair, 424 trachea, 425–426 tracheoesophageal, trachea–carotid artery/esophagus–carotid artery, 426 vertebral artery, injury, 424–425 Zone III injuries, 424 overt symptoms/signs, algorithm for management, 416f patients management , symptoms/signs, 415–418 penetrating vascular injuries, 259 abdomen/pelvis CT, 271–276 cervical spine, computed tomography, 260–265 cervical spine, flexion/extension X-rays, 266–267 chest CT, 267–271 pelvis/acetabulum CT, 276–282 spine, conventional X-rays, 260–265 spine, magnetic resonance imaging, 266 thoracolumbar spine, computed tomography, 265–266 presentation, 415 trachea, principles of repair, 426t Zone II hematoma secondary to gunshot wound of carotid artery, 417f Zone III, 421 zones, 415, 415f neck incisions, alternate, 1153f needle decompression, 116 nerve agents, 135 nerve injuries in upper extremity, 760–763 neurogenic shock, 159 neurologic injury, 666 anterior cord syndrome, 437 Brown-Séquard syndrome, 437 cauda equina syndrome, 438 central cord syndrome, 437 cervical root syndrome, 437 classification, 436–437 conus medullaris syndrome, 438 location, 435 posterior cord syndrome, 437 primary and secondary, 435–436 neurologic injury in pregnancy, management of, 718–719 neuropraxic injury, 761 neurotmesis, 761 neutrophil phagocytic function, 874 neutrophils, 898 New Injury Severity Score (NISS), 66, 79 Newtonian mechanics, nightstick fracture, 772 nondestructive colon injuries, management of, 622 nonocclusive bowel necrosis (NOBN), pathogenesis of, 1075f nutritional therapy, 1100 abdominal trauma index, sepsis risk, 1104t acute renal failure (ARF), 1110–1111 anabolic agents, in trauma patients, 1125–1126 aspiration, 1119 calorie-to-nitrogen ratio, 1110 diet by Jones and Moore, 1117t diet progression, 1116–1117 drug–nutrient interactions, 1117–1118 electrolytes in total parenteral nutrition, 1115t endocrine response to stress/injury, 1100–1101 enteral (postpyloric) access, determining indicators, 1103 burn patients, 1103–1105 patients with closed head injury, 1103 enteral feeding access, 1115t complications of, 1118–1119 diet choice, 1116 patients requiring celiotomy, 1115–1116 enteral feeding, type of immune-enhancing diets, 1106 immunonutrition, 1106–1107 enteral formulation, medications incompatible, 1118t enteral nutrition, 1124–1125 enteral vs parenteral feeding, 1102–1103 estimating nutritional needs, 1107–1109 fat requirements, 1109–1110 FDA guidelines, parenteral vitamins, 1122t fluid/electrolytes electrolyte management in severely injured trauma patients, 1114–1115 magnesium, 1114 phosphorus, 1113–1114 potassium, 1113 sodium, 1112–1113 formula preparation components, 1121–1122 PN formulas, 1122–1123 gastrointestinal secretions, electrolyte composition, 1115t hepatic failure, 1112 institution of therapy, 1123 intravenous fat emulsions in the United States, 1121t mechanical complications, 1119–1120 monitoring therapy, 1125 morbid obesity, 1109 nitrogen balance, 1124t nutrient prescription, 1107 nutrition support, protocol, 1105f oral medications, sorbitol content, 1118t outcome with enteral feeding, 1107 overfeeding, complications of, 1108f parenteral feeding, 1120 access and monitoring, 1120–1121 parenteral nutrition, complications essential fatty acid deficiency (EFAD), 1124 glucose, 1123–1124 micronutrient deficiencies, 1124 pneumatosis intestinalis and necrosis, 1119 postinjury hypermetabolism, 1100 prokinetic agents, 1117 protein requirements, 1110 protocol for nutrition support, 1105f pulmonary failure, 1112 regular insulin administration, algorithm, 1124t starvation vs severe stress hypercatabolism, 1101t stress/sepsis, intermediary metabolism current issues, 1102 fat metabolism, 1102 glucose metabolism, 1101–1102 protein metabolism, 1101 TPN formulas, trauma patients, 1122t Index O on-call practice, 92 open abdomen operative techniques for combination closure, 736 open packing, 737 suture closure of skin, 735 temporary silos, 735 towel clips, 735 vacuum-assisted wound closure, 736–737 at reoperation, techniques for management of absorbable meshes, 739–741, 740f permanent meshes, 739 repeat application of silo, 739 vacuum-assisted fascial closure, 739 zipper closure, 739 open fractures, 789, 907–908 classification of, 789–790 open packing, 737 open pelvic fractures, 665–666 with anorectal injury, 629f open soft tissue injuries, treatment of, 754 operating room (OR), 65 operative techniques for open abdomen combination closure, 736 open packing, 737 suture closure of skin, 735 temporary silos, 735 towel clips, 735 vacuum-assisted wound closure, 736–737 opiod narcotics, 881 organ procurement and transplantation network (OPTN), 944 overtriage, 59 oxygen consumption, 216 P pancreas anatomy and physiology, 606 blood supply of, 606 CT scan of, 609 damage control operations in, 729–730 duct and acinar cells of, 607 and duodenum, anatomic relation of, 605 endocrine and exocrine cells, 607 functions of, 607–608 pancreatic antisecretory medication, 869 pancreatic fistula, 617 pancreatic injuries, 869 AAST Organ Injury Scale (OIS) for grade I, 613–614 grade II, 613–614 grade III, 614–616 grade IV and V, 616 blunt force to epigastrium, 608 diagnosis of, 608–610 history of, 603–605 pancreatic insufficiency, 617 pancreatic neck, division of, 1182f pancreaticoduodenal biliary anatomy, 1180f pancreatic pseudocyst, 617 pancreatic trauma algorithm for, 615 associated injuries in, 606t complications of, 616 late deaths in, 605 mortality by mechanism of injury, 604 timing of death following, 607t pancreatitis, 617 pancreatoduodenal vessels, 607 papaverine hydrochloride, 826 paper plan syndrome, 125 Parent Teachers Association (PTA), 44 Pasteurella multocida, 911 patellar fractures, management of, 803–804 pediatric airway airway failure, 183–184 anatomy, 182 equipment, 182 physiology, 182 spontaneous respirations, 184 technique, 182–183 Pediatric Glasgow Coma Scale, 864t pediatric patients child abuse, 871 diagnostic assessment of, 862–863 emergency department management and family relations, 871 epidemiology of injured child, 859 initial assessment and resuscitation of injured child, 859–860 airway management, 860–861 restoration of circulation, 861–862 vascular access, 861 laboratory studies, use of, 863 pediatric critical care, 870 rehabilitation of, 870 specific injuries, management of abdomen injuries, 867–869 blood vessel injuries, 869–870 cervical spine injuries, 864–866 head and central nervous system injuries, 863–864 skeletal system injuries, 870 thorax injuries, 866–867 Pediatric Rapid Sequence Intubation (RSI), 860t pediatric vascular access, 861t pelvic anatomy, 655 pelvic binders, 659–660, 659f, 660f pelvic bleeding management, 663f angiographic embolization, 661–663 external fixation, 660–661 hypotensive resuscitation, 659 military antishock trousers (MAST) garment, 660 pelvic binders, 659–660, 659f, 660f preperitoneal pelvic packing, 663–664 pelvic fracture algorithm for management of, 666f associated injuries, 665–666 definitive fixation of, 664–665 Tile classification of, 655–657, 656t Young–Burgess classification of, 657–658, 658t pelvic fractures, 879 in pregnancy, management of, 716–717 pelvic injuries (PI), 655 diagnosis of, 658–659 pelvic inlet and outlet films, 659 pelvic retroperitoneum, management of injuries in exposure and vascular control, 645 injuries to common or external iliac artery, 645–646 common or external iliac vein, 646 Penetrating Abdominal Trauma Index (PATI), 66 penetrating trauma, 633 of elderly people, 880 in pregnancy, management of, 718 penetrating truncal wounds, 634 penicillin, 868 pericardium, opening, 1062f permanent meshes, 739 petrolatum-impregnated dressing, 908 pfannenstiel incision, 664f phalanges, fractures of, 776–777 pharyngotracheal lumen (PtL) airway, 110 PHisoHex®, 905 phospholipid platelet-activating factor (PAF), 898 physiologic changes during pregnancy, 710–711, 710t physiologic futility, 886 pilon fractures, 808–809 piranha attacks, wounds caused by, 918 placental injury, 709 plain anteroposterior pelvic film, 658 planned reoperation, 733 platelet-derived growth factor (PDGF), 898 platelet plug, 897 P multocida, 911 pneumococcal vaccine, 868 pneumonia, 878, 881 pneumothorax, 861, 866 poisonous and nonpoisonous snakes, characteristics of, 915f policymakers decide, 151 polyamines, 902 polyvinyl alcohol sponges, 909 popliteal and tibial artery injuries, 839 popliteal arteries, exposure and repair, 1196f popliteal artery injuries behind knee, 1195f posterior exposure, 1197f popliteal/tibial artery injuries, exposure and repair, 1196f porta hepatis, management of injuries in exposure and vascular control, 646–647 injury to hepatic artery, 647 injury to portal vein, 647–648, 648t 1217 1218 Index portal vein, injuries to management, 647–648 survival with, 648t portal vein pancreatic neck, division of, 1182f positive-end expiratory pressure (PEEP), 14 posterior elbow dislocation, 765f, 766f postischemic neuropathic pain, 843 postoperative anticoagulation, 839 postoperative hemorrhage, 616–617 postsplenectomy immunization, 868 posttraumatic coagulopathy, 862 post-traumatic stress disorder (PTSD), 134 povidone–iodine solution, 905 Practice Management Guideline on chest trauma analgesia management, 878 prebiotics, 1081–1082 pregnancy evaluation of state of, 712–713 fetal outcome following trauma and, 721 injury prevention during, 721–722 management of injuries during blunt abdominal trauma, 716 cesarean section following trauma, 719–720 fetal injuries, 717–718 neurologic injury, 718–719 pelvic fractures, 716–717 penetrating trauma, 718 thermal injury, 719 thoracic trauma, 716 physiologic changes during, 710–711, 710t trauma in (See trauma in pregnancy) pregnancy-associated homicide, risk factors for, 710 pregnancy-induced hypervolemia, 711 prehospital care, 711 airway management, 109f assessment and management, 107 abdominal trauma, 117 airway management, 108–110 AMPLE history, 113–115 circulation, 110–111 disability, 111 exposure and environmental control, 112 fluid therapy, 112–113 head-to-toe survey, 115 musculoskeletal trauma, 117 primary survey, 108 resuscitation, 112 safety/standard precaution, 107 scalp wounds, 115 scene, 107 secondary survey, 113 situation, 107–108 spinal trauma, 117 supraglottic airways percutaneous transtracheal ventilation (PTV), 110 surgical cricothyroidotomy, 110 thoracic trauma, 116–117 traumatic brain injury, 115–116 traumatic cardiopulmonary arrest, 111 ventilatory support, 110 communications, 104 critical trauma patient, 113t emergency medical services system, 101 EMS personnel, 101–102 advanced, 102 education and certification, 102 emergency medical responder, 102 emergency medical technician, 102 international trauma life support (ITLS), 107 nurses, 102–103 paramedic, 102 physicians, 103 prehospital trauma life support (PHTLS) program, 107 trauma education, 107 EMS provider levels, 101t EMS unit, equipment, 104 field triage decision scheme, 114f–115f historical perspective, 100–101 medical control, 106 direct (on-line), 106–107 indirect (off-line/protocols), 106 performance improvement (PI) process care rendered, 106 system efficiency, 105–106 prehospital care overview, 112f prehospital trauma care, audit filters, 106t principles, 119t protocol for tourniquet application, 111f research and development, 119 spinal immobilization, indications, 118f system design, 103 advanced life support, 103–104 basic life support, 103 tiered response systems, 104 transport modalities ground units fixed-wing aircraft, 105 rotor-wing aircraft, 104–105 traumatic brain injury prehospital management, algorithm for, 116t triage, 117–119 prehospital fluid therapy, 113 Prehospital Index (PHI), 61 prehospital resuscitation, 635 Prehospital Trauma Life Support (PHTLS) program, 107 preoperative abdominal aortography, 635 presacral drainage, 627 present-on-admission (POA) Codes, 23 preterm labor risk after maternal trauma, 712–713 primary blast injury (PBI), 133 primary survey, 711–712 pringle maneuver, 1181f probiotics, 1081–1082 profunda femoral artery, 837 progressive sclerosis, 875 proteolytic enzymes, 607 proximal humerus, fractures of, 769–770 proximal internal carotid artery, interposition grafting for injury, 1155f proximal interphalangeal (PIP) joints, 911 proximal renal arteries, management of injuries to, 640 proximal tibia fractures, 806–807, 806f proximal ulna, fractures of, 771 Pseudomonas spp., 917 Pterois volitans, 918 pulmonary agents, 136 pulmonary hila, anatomy of left, 1065f right, 1066f pulmonary tractomy, 1064f pulse oximetry, 157 Pygocentrus nattereri, 918 pyloric exclusion, 730f, 1181f Q quality-adjusted life years (QALYs), 86 quality-of-life futility, 887, 889 R rabies prophylaxis, 911–912 schedule recommended in the United States after possible exposure to rabies, 913t treatment recommendations and estimates of the risk of, 912t radial artery injuries, 836 Radiation Emergency Assistance Center/ Training Site (REAC/TS), 138 radiation injuries, 931 absolute lymphocyte count on prognosis, 934t acute radiation syndrome, 933, 933t assessment, 934 decontamination, 934–935 human cell types, radiosensitivity of, 933t incidents, 932 local injuries, management of, 935 measuring exposure, 932 pathophysiology, 932–933 triage, 934 types of, 932t whole-body exposure, 933–934 whole-body injuries, management of, 935 radiographic examination, 714–716 radiological mass casualty events, 137–138 acute radiation syndrome (ARS), 137 contamination/exposure, 137 decontamination, 138 radius and ulna, fractures of, 773 RANGE intervention for trauma patients, guidelines for, 855 rapid resectional debridement technique, 729f rapid sequence intubation (RSI), 108, 860 rapid two-suture splenorrhaphy, 729f Receiver Operating Characteristic (ROC) curve, 88 Index recombinant activated factor VII and coagulopathy, 727 rectal injuries diagnosis of, 626–627 epidemiology of, 626 mortality and morbidity related to, 626 operative management of history of, 627 technical tips for, 627–628 Rectal Organ Injury Scale, 626t rectum anatomy, 626 recurrent (secondary) hemorrhage, 616–617 red blood cell (RBC) transfusion, 216 rehabilitation afferent nociception pathway, 955f cardiovascular effects aerobic capacity, 952 cardiac effects, 951 orthostatic hypotension, 951–952 prevention and treatment, 952 shift of body fluids, 951 venous thrombosis and pulmonary embolus, 952 common pain terminology, 955t gastrointestinal effects appetite and gastric transit time, 953 prevention/treatment, 953 immobility, effects, 950 integumentary system effects decubitus ulcers, 953 prevention/treatment, 953 interdisciplinary team care, functional improvement, 956 case managers and social work services, 957 engineers/AT specialists, 957 mental health professionals, 957 orthotists and prosthetists (O&P), 957 OTs, 956–957 peer support visitors, 957 physical medicine and rehabilitation (PM&R) specialists, 956 PTs, 956 SLPs, 957 vocational rehabilitation specialists, 957 musculoskeletal effects contractures, 951 disuse osteoporosis, 951 muscle atrophy and weakness, 950–951 prevention and treatment, 951 pain management, 954 background, 954 nonpharmacological, 956 pharmacological antidepressant medications, 956 antiseizure medications, 956 continuous infusion analgesia and anesthesia, 956 NSAIDs, 955–956 opioids, 955 sympathetic blockade, 956 terminology and pathophysiology, 954 treatment, 954–955 pulmonary effects lung volume and structural changes, 952 prevention and treatment, 952 Ranchos Los Amigos Scale, 959t trauma patients, unique complications of heterotopic ossification (HO), 953–954 spasticity, 954 traumatic brain injury classification, 959t traumatic injuries amputation, 961 burn injuries, 960–961 peripheral nerve injuries and complications, 961–962 spinal cord injury, 957–959 traumatic brain injury, 959–960 urinary system effects prevention and treatment, 953 urinary retention/stones/urinary tract infection, 952–953 renal failure, 1084 albumin-supplemented resuscitation, renal effects, 1090t colloid resuscitation, renal effects of fluid mobilization and renal changes, 1090–1091 vasopressor therapy and renal function, 1090 contrast-induced renal injury, 1096 crush injury and kidney, 1097 intraperitoneal pressure and kidney, 1097 nephrotoxic agents and ARF, 1097–1098 oliguria, differential diagnosis, 1097 renal replacement therapy (RRT), 1098 graded renal response to acute hypovolemia, 1086t hemorrhagic shock, 1086 kidney during operation after injury, 1086–1087 postoperative juxtamedullary and polyuria, 1087–1089 postoperative oliguria during extravascular fluid sequestration phase, 1089 impaired concentration after operation, 1088t kidney, components, 1085f mild to moderate hemorrhage causes, 1087f normal renal function, 1084–1086 oliguria, differential diagnosis, 1097t patient with extensive peritonitis, 1094f polyuria of acute sepsis, 1093f postresuscitative hypertension (PRH), 1091–1092, 1091t renal response to sepsis, 1092–1095 free water clearance, 1095 hypodynamic sepsis, 1094–1095 polyuria, 1093–1094 response to furosemide in early sequestration phase, 1089f restoration of PV, 1088f rifle criteria, 1095 renal trauma on renal function, 1095–1096 SCr and GFR correlation, 1096f serum creatinine to renal hemodynamic studies, 1091t serum creatinine value, 1095 renal perfusion, 875 renovascular injuries endovascular management of, 649 management of, 644 reoperation emergency, 737–738, 738t intensive care before, 737 routine, 738 repeat application of silo, 739 reperfusion injury, 819 replantation, 792 replantations of upper extremities, 777, 779–780, 779f reproductive system, changes in maternal, 711 Residency Review Committee (RRC), 94 respiratory distress syndrome (RDS), 866 respiratory insufficiency, 1055 acute lung injury, definitions of, 1057t acute respiratory distress syndrome, definitions of, 1057t ALI and ARDS, 1056 ARDS chest CT scan, 1061f clinical risk factors, 1058t Delphi definition, 1057t idealized static pressure–volume curve, 1062f ventilatory strategies, 1064t corticosteroids, 1068–1070 nutritional support, 1069–1070 definitions and limitations, 1056–1058 Denver Health SICU mechanical ventilation protocol, 1069f epidemiology and risk factors, 1058 extracorporeal life support (ECLS), 1068 fluid management/hemodynamic support, 1064 gas exchange, 1062 gut lymph hypothesis, 1060–1061 respiratory distress syndrome, acute, mediators/markers of, 1060–1061 hemodynamics, 1062 high-frequency modes of ventilation (HFV), 1066–1067 hypercapnic pulmonary failure, 1055–1056 hypoxic pulmonary failure, 1056 low-pressure pulmonary edema, 1063t Lung Injury Score, 1057t macrophages, 1059 management, 1063 mechanical ventilation, 1064 1219 1220 Index respiratory insufficiency (continued ) multiple lower extremity fractures., 1061f outcome, 1070 pathogenesis, neutrophils, 1059 pathology, 1058–1059 pathophysiology, 1061–1062 permissive hypercapnia, 1066 pharmacologic therapy, 1068 inhaled nitric oxide, 1068 positive end-expiratory pressure, 1065 presentation, 1062–1063 pressure-limited ventilatory support, 1065–1066 prone ventilation, 1066–1067 pulmonary edema, 1062 pulmonary endothelium, 1059–1060 pulmonary mechanics, 1062 risk factors, 1058 respiratory rate (RR), 83 respiratory system, changes in maternal, 711 resuscitation damage control, 636 emergency department, 635–636 prehospital, 635 Resuscitation Outcomes Consortium (ROC), 66 retained amputated fingertip, 758 retinal hemorrhage, 13 retroperitoneal bleeding, grade fracture, pelvic packing, 1175f–1176f retroperitoneal duodenal perforation, computed tomography (CT) finding of, 609 Revised Trauma Score (RTS), 84, 85 rib calcification, 875 rib fractures, 878–879 ribonucleic acid (RNA), 902 right scaphoid fracture, 774f road rash, 908 roux-en-Y duodenojejunostomy, 612, 613f rural trauma, 140 ambulance to local hospital, 142, 143f communications, 144 education/maintenance of skills, 146–147 environment, 140–141 epidemiology, 141–142 facilities, 145–146 global positioning satellite (GPS), 142 manpower, 143–144 resources and limitations, 142 discovery and access to system, 142–143 rural, definition, 141 telemedicine, 150–151 telepresence surgery, 151 transport systems, 145, 150 trauma systems, 151 treatment options damage control surgery, 148–149 definitive surgery, 148 local definitive care, 149 operative stabilization and transfer, 148 population shifts, 150 stabilization and transfer to definitive care, 147–148 wireless technology, 150 Rural Trauma Subcommittee, 143 S sacral trauma, 456 San Diego Trauma System, 68 saphenous vein interposition graft, for repair of brachial artery laceration, 840f saphenous vein panel interposition graft, 837, 839 scaphoid, fractures of, 773–774 scapula, fractures of, 769 scapulothoracic dissociation, 764, 764f, 833 injury, 833 screening and brief intervention (SBI), 41 Screening, Brief Intervention, and Referral to Treatment (SBIRT), 851 billing for, 857 Common Procedural Terminology (CPT) codes, 857 establishment of, 856–857 “Seat belt aorta,” 648 “secondary” abdominal compartment syndrome, 735 secondary survey, 712 sedative-hypnotics, 853 drugs, 853 Sellick maneuver See cricoid cartilage pressure septic shock, 204–206 serum osmolarity, 864 shaft of humerus, fractures of, 770 shaft of radius, fractures of, 772 shaft of ulna, fractures of, 772 shark bites, wounds caused by, 918 shock, 189, 624–625 afferent signals, 191 efferent signals cardiovascular response, 191–192 cellular effects, 193–195 immunologic/inflammatory response, 192–193 neuroendocrine response, 192 quantifying cellular hypoperfusion, 195–196 extracellular BEA and mortality, 196f forms of, 190t cardiogenic, 203–204 hypovolemic, 200–202 neurogenic, 202–203 obstructive, 206–207 septic, 204–206 traumatic, 207 hemorrhagic shock, rodent model, 191f mortality and serum lactate levels, 195f pathophysiology, 190–191 tissue hypoperfusion algorithm, 197f, 198f trauma patient, evaluation hypotensive resuscitation, 199–200 overview, 196–197 resuscitation fluids, 199 severe hemorrhage patients, vascular access, 197–199 trauma patient, resuscitation, 207 near-infrared spectroscopy, 208–212 hemorrhagic shock, 209–211 muscle oxidative metabolism measurement, 211–212 StO2, histogram of, 209f StO2 measurements, 208, 212f StO2, ROC curves, 210f Shock Index, 877 shoulder girdle region, imaging examinations for, 750t “single-shot” extremity arteriography, technique for, 822t single-vessel arterial injuries, 827 Sistrurus, 914 skeletal system, injuries to, 870 skin wheals and level of cross-section, position of, 908 small bowel See abdominal injuries smoke detectors, 43 Snakebite Severity Score (SSS), 915 snakebite wounds, 912–913 algorithm for the treatment of, 914f anaphylaxis, treatment for, 917t antivenin therapy for treatment of, 916–917 coral snake envenomation, 917 CroFab antibody, 916 crotalidae of North America and, 914t crotalid envenomation, assessment of, 914–915 definitive care for treatment of, 916 fasciotomy, 917 first aid for, 915–916 and identification of the snake, 913–914 poisonous and nonpoisonous snakes, characteristics of, 915f Snakebite Severity Score (SSS), 915 social violence community violence history of, 892 risk factors, 893 domestic violence diagnosis of, 891–892 incidence and prevalence of, 890–891 treatment and referral, documentation, and reporting, 892 elder abuse diagnosis of, 892 treatment and referral, 892 surgeon’s role in, 893 soft tissue injuries Hannover classification of, 788t to lower extremity, 788 soft tissue lacerations, 747 soft tissue wounds, 908 Solenopsis invicta, 918 Solenopsis richteri, 918 spider bites, wounds caused by, 919 Index spinal cord injury (SCI), 13, 27, 430 See also cervical spine injuries anatomy and biomechanics, 431–434 anatomy and physiology, 434–435 ASIA classification of neurologic deficit, 436f atlantoaxial subluxation, 452f Atlas fractures, 452f blood supply of, 435f causes of, 431f cervical spine Canadian cervical spine rules, 441f NEXUS low-risk criteria, 440f cervical vertebrae, 433f emergency room, evaluation, 438–439 epidemiology, 430–431 flexion–distraction subaxial cervical spine injury, 454f gunshot wounds, 457–458 Halo pin placement, 448f Halo ring apparatus, 448f Hangman’s fracture, 453f imaging, 439–441 ankylosing spondylitis, 440 cervical spine, clearing, 440–441 lateral cervical spine x-ray, analyzing, 439f lumbar vertebrae, 434f lumbosacral dissociation injury, CT, 457f lumbosacral spine, checklist for the diagnosis, 444t management, 444 spinal stability, 444–446 neurologic injury anterior cord syndrome, 437 Brown-Séquard syndrome, 437 cauda equina syndrome, 438 central cord syndrome, 437 cervical root syndrome, 437 classification, 436–437 conus medullaris syndrome, 438 location, 435 posterior cord syndrome, 437 primary and secondary, 435–436 nonoperative management, 447 cervical traction, 449 halo fixator, 447–449 spinal orthotics, 447 occipital condyle injuries, classification, 450f odontoid fractures, classification, 452f operative management goals of, 449–450 perioperative considerations, 449 spinal fractures, stabilization timing, 450 posterior ligamentous complex (PLC), 433 Power’s ratio, 451f prehospital care, 438 prophylaxis against deep vein thrombosis (DVT), 441 protocol for initial evaluation, 442t rule of 12’s, 451f spinal cord injury, patterns, 437f subaxial cervical spine injuries based on injury mechanism, 445f Subaxial Injury Classification (SLIC) Scale, 446t surgical decompression, timing, 443 therapeutic intervention decubitus ulcer, prevention, 441–442 oxygenation/hemodynamic parameters, maintenance of, 442 pharmacologic/cellular interventions, 442–443 thoracic/thoracolumbar spine, checklist for the diagnosis, 444t Thoracolumbar Injury Classification and Severity Score (TLICS), 446t thoracolumbar spine burst fracture of, 455f fracture-dislocation of, 457f traumatic spondylolisthesis, classification of, 453f upper cervical spine, midsagittal section, 432f spinal cord injury without radiographic abnormalities (SCIWORA), 13, 865 spleen, damage control operations in, 729 spleen injury, 561 algorithm for diagnosis and management, 569f arterial blood supply, 564f complications nonoperative management, 576–577 operative management, 577–578 computed tomographic findings, 567f diagrammatic representation, 568f, 571f grading systems, 567–568 guidelines for resource utilization, 572t historical perspective, 561–562 imaging and diagnostic peritoneal lavage, 566–567 initial evaluation and management, 565–566 injury scaling system, 568t ligaments, 563f mobilization of, 574f nonoperative management, 568 operative management, 573–576 partial splenectomy, depiction of, 562f pathophysiology of, 564 patient management, 572–573 patient selection, 568–572 postembolization view, 571f postsplenectomy infection, 578 splenic anatomy, 562–564 splenic function, 562 splenic tissue, autotransplantation of, 576f splenectomy, 868 splenic flexure of colon, 626f split-thickness skin graft donor, 908 Stab wounds and colon injuries, 620 Staphylococcus spp., 909, 911, 917 START triage system, 62 sternoclavicular dislocation, 764 stomach See abdominal injuries STOP THE BLEEDING!!!, 160 Streptococcus viridans, 909 strict futility, 886 subatmospheric sponge dressings, 909 subclavian and axillary vascular injuries, 834–836 subclavian artery, hemorrhage controlling, 1169f subclavian artery injury, 835 exposure and repair, 1170f–1171f subendothelial matrix collagen, 897 subtrochanteric femoral nonunion, salvage procedure of, 813 subtrochanteric fractures, management of, 798–799, 799f SUM intervention for trauma patients, guidelines for, 855 superficial femoral vascular injuries, 837–838 superior mesenteric artery management of injuries to, 639–640, 640f survival with injuries to, 640 supraclavicular subclavian injuries, 834 supracondylar humerus fracture, 836 suprarenal aorta, management of injuries to, 638, 639t Surgical Council on Resident Education (SCORE), 93 surgical intensive care unit (SICU), resuscitation in, 725 survivable vascular injuries, 817 S viridans, 911 Synanceia spp., 918 syndromic surveillance, 135 systemic inflammatory response syndrome (SIRS), 67, 333f, 898 systolic blood pressure (SBP), 83 T telemedicine, 150–151 telepresence surgery, 151 temporary silos, 735 tendons in distal extremity, treatment of injuries to extensor tendon, 754–755 flexor tendons and “spaghetti wrist,” 756–757 thumb extensor injury, 756 terrestrial animals, bites and stings by cat bites, 911 dog bites, 911 human bites, 909–911 rabies prophylaxis, 911–912 snakebites, 912–917 tetanus prophylaxis, 904t therapeutic anticoagulation, 877 thermal injuries, treatment of, 759–760 thermal injury in pregnancy, management of, 719 thigh fasciotomy, 831 1221 1222 Index thoracic duct anatomy, 1171f cross-clamping of, 1172f thoracic incision, options, 1058f–1059f thoracic (operative) procedure, 1057f thoracic spine injuries, 454–455 thoracic trauma damage control operations in, 728 in pregnancy, management of, 716 thoracic vascular injuries, 492 algorithm, 498f anteroposterior projection, 500f aortic isthmus flow analysis, 497f three-dimensional reconstruction, 496f aortogram demonstrating blunt chest trauma, 505f intimal tear and traumatic pseudoaneurysm, 504f azygos vein, 508f blunt injury, plain chest x-ray, 501f blunt thoracic aortic injury, 501t bullet in left groin, 495f bypass exclusion technique, 504f chest radiograph, 499f diagnostic studies, catheter arteriography, 499–500 emergency center evaluation chest radiography, 494 history, 493 physical examination, 493 etiology and pathophysiology, 492–493 groups of patients, 493t initial evaluation, prehospital management, 493 initial treatment and screening emergency center thoracotomy, 494 impulse therapy/beta-blockade, 495–496 intravenous access and fluid administration, 494–495 screening/planning CT scan, 496–499 tube thoracostomy, 494 innominate artery, blunt injury, 503f lateral chest x-ray, cardiac silhouette, 494f misdiagnosis by aortography, 499f multifactorial development, 506t patient classification, 493 penetrating wound, plain chest x-ray, 500f proximal innominate artery, 503f radiographic clues, 495t recommended incisions, 502t surgical repair, 501–503 damage control, 502–503 therapeutic approaches, management of, 505t thoracic aorta distal, multiplanar, 496f thoracic aortic anomalies, 492t treatment options endograft repair, 500–501 nonoperative management, 500 thoracolumbar spine injuries burst fractures, 455–456 compression fractures, 455 flexion–distraction injuries, 456 fracture–dislocations, 456 isolated injuries, 456 thoracotomy, traumatic incision algorithm, 464f indications, 462 minor therapeutic interventions, 462 patient positions/incisions, 462–463 specific injuries algorithm, 464f thoracic anatomy and physiology, 461 evaluation technology, 461–462 thoracic damage control, 463–464 thoracic incisions, 463f thoracic trauma, complications of, 466 thoracic trauma controversies cardiorrhaphy, pledgets, 465 chest tubes, clamping of, 465 CT scanning, 464–465 pericardiocentesis, 465 pleural cavity, needle decompression of, 465 subxyphoid pericardiotomy, 465 trap door thoracotomy, 465 trocar chest tubes, 465 timing of, 465–466 tube thoracostomy, 462 thorax, injuries to, 866–867 thrombocytopenia, 863 thrombosis of brachial artery, 841f Through the Brazilian Wilderness (1914), 918 tibia fractures, management of, 806–810 ankle injuries, 809–810 pilon fractures, 808–809 proximal, 806–807, 806f tibial shaft, 807–808, 809f tibial shaft fractures, 807–808, 809f tibial vessel injuries, 839 tick-borne encephalitis (TBE) viruses, 134 Tile classification of pelvic fracture, 655–657, 656t tissue coverage, role of, 829 tissue hypoperfusion, 877 tissue inhibitors of matrix metalloproteinases (TIMP-1), 899 total body surface area (TBSA), 879 trachea esophagus, combined injury repair, 1155f tracheobronchial injuries, 476 distal tracheal repair, intraoperative photograph of, 477f operative techniques, 477–478 outcomes, 478–479 presentation and evaluation, 476–477 tracheal injury, preoperative bronchoscopy, 476f tracheal stenosis, 479 tractotomy, 1178f traffic-related injury prevention, 46 transected ureter, repair, 1187f transesophageal ECHO (TEE), 867 transforming growth factor alpha (TGF-α), 899 transforming growth factor beta (TGF-β), 898 transplantation brain death declaration, 946–947 physiologic consequences, 947–948 brain death, defining, 946t donor management, 948 donor screening, 946 donor type, 945f organ donation and allocation, 944–946 contraindications, 946t organ procurement for, 944, 948–949 transscaphoid perilunate dislocation, 767f Trauma and Injury Severity Score (TRISS), 85 Trauma and Injury Severity Score Comorbidity (TRISSCOM), 85 trauma care, 890 trauma in pregnancy causes of, 709 epidemiology of, 709–710 initial assessment and management algorithm for, 713f fetal–placental unit, 712–714 maternal assessment, 712 prehospital care, 711 primary survey, 711–712 radiographic examination, 714–716 secondary survey, 712 ultrasonography, 714 trauma ostomy complications, 630 Trauma Quality Improvement Program (TQIP), 88 Trauma Score (TS), 61 trauma systems ACS Field Triage System, 62 age, comorbid disease, and environmental concerns, 60 anatomic criteria, 59 chain of custody, 1002 classic key points, 997–998 clothing, 1001 combination methods, 62 communications system, 57 components, 56 concepts, principles, and definitions consent, 998–1000 duty to treat, 998 CRAMS scale, 61 critical targets for future development, 75t definition of, 54 development, 55–56 disaster situations, 1002 emergency medical service system components, 55t errors/preventable death, definition of, 72–73 forensic/medical implications, 1000 forensic nursing, 1000 Glasgow Coma Scale (GCS), 61 histories, 54–55 Index human resources, 57 injury identification, classification, and grading, 1000–1001 injury, mechanism, 59 interacting with attorneys hospital bylaws, committees, credentialing, policies, 1002 professional liability, depositions, and testifying in court, 1002–1003 laboratory specimen collection, for law enforcement purposes, 1001–1002 law enforcement, 997 legal considerations, during mass casualty, 1002 limitations of, 73t medical direction, 57 outcome from transfer, 69–70 paramedic judgment, 60 performance analysis, 73–74 physiologic criteria, 59 prehospital, 57 prehospital index, 61 prehospital triage decision scheme, 63f problems and challenges, 74–75, 74t public information, education, and injury prevention, 56–57 quality improvement (QI), 71–72 regional trauma system development, 56f rehabilitation, 71 rural trauma, 151 simple triage and rapid treatment (START), 62 statewide trauma care system, criteria, 55t system evaluation, 71 transport mode , interfacility transfer, 70 trauma care system, diagram, 56f trauma center facilities, and leadership acute care, 71 Level I, 70–71 Level II, 71 Level III, 71 Level IV, 71 specialty trauma centers, 71 trauma index, 61 trauma triage criteria, uses, 60t trauma triage rule, 61–62 triage and transport, 57–58 triage guidelines, 65 field triage riage scores, 66–67 in-hospital, triage, 67–68 interhospital transfer, 68–69 criteria, 69 major trauma patient, 65–66 transfer agreement, 69 transfer methods, 69 transport modality, 69 transport team, 69 undertriage/overtriage, 68 triage principles, application, 62 disaster management, 64–65 mass casualties, 64 multiple casualties, 62–63 single patient, 62 triage, purpose/challenges of, 58–59 triage scoring method, 61 triage tools/decision making, components, 59 wounds from firearms, 1001 Trauma Systems Planning and Development Act, 55 trauma team, 142, 143 trauma team activation (TTA), 876 traumatic aortoiliac disease, endovascular management of, 649 traumatic brain injury (TBI), 26, 110, 356, 877, 878, 944 acute subdural hemorrhage, CT, 362f bilateral hemispheric decompressive craniectomy, CT of, 371f brain death determination, 374 coagulopathy/DVT prophylaxis, 373 concussion grading, 364t diffuse cerebral injuries blast traumatic brain injury, 366–367 child abuse/nonaccidental trauma, 367 concussion, 364 diffuse axonal injury, 364 extracranial vascular injury, 367 penetrating missile injury, 365–366 penetrating nonmissile injury, 364–365 epidemiology, 356 epidural hemorrhage, CT, 362f focal cerebral injuries, 361 cerebral contusions, 361 epidural hemorrhage, 361–362 intraparenchymal hemorrhage, 361 subarachnoid hemorrhage, 363 subdural hemorrhage, 362–363 Glasgow Coma Scale, 358, 358t for children, 358t Glasgow Outcome Score, 374t infection, 372–373 intracranial pressure assessment, 368 cerebral blood flow and metabolism, 369 cerebral perfusion pressure, 369 ICP monitoring, 368–369 intracranial pressure management analgesics and sedatives, 369–370 antiseizure prophylaxis, 372 barbiturates, 371–372 decompressive craniectomy, 371 hyperosmolar therapy, 370 hypertonic saline (HS), 370 hyperventilation, 370–371 hypothermia, 372 steroids, 372 left central sulcus, traumatic subarachnoid hemorrhage CT, 363f medical management, 367–368 blood pressure and oxygenation, 368 multiple sports-related concussions, 365t neurological examination, 357, 357t nutrition, 372 organ donation, 374 outcome, prognosis, 373–374 pathophysiology, 356 penetrating nail-gun injury, intraoperative picture of, 366f ping-pong skull fracture, CT bone windows, 359f pupillary response, 357–358 radiographic diagnosis, 359–361 radiographic evaluation angiography, 359 CT scan, 359 MRI, 359 plain x-rays, 358 SDH on CT/MRI, 363t single sports-related concussion, 365t skull fractures, 359 CT bone windows, 360f differential diagnosis, 360t systemic evaluation and resuscitation, 356–357 trauma to elbow, 765–766 triage guidelines, trauma, 65 field triage riage scores, 66–67 in-hospital, triage, 67–68 interhospital transfer, 68–69 criteria, 69 major trauma patient, 65–66 transfer agreement, 69 transfer methods, 69 transport modality, 69 transport team, 69 undertriage/overtriage, 68 trochanteric fractures, management of, 797–798, 798f tube thoracostomy, 1057f U ulnar nerve block anesthesia, technique of, 907f ultrasonography, 714 ultrasound examination of injured gravid patient, 717f ultrasound imaging essential principles, 304f maximizing accuracy, 306t scanning planes, 304t, 305f terminology, 302t–303t, 304t ultrasound physics, 301–302 undertriage, 58 unhealthy alcohol use, 851 upper extremities fractures and dislocations of, 778–779t injury-specific history of, 747–748 vs lower extremities, 777 nerve injuries in, 760–763 nerves and muscles of, 748–749t physical examination, 747–748 reconstructive requirements for, 754 replantations of, 777, 779–780 vascular injuries in, 760 x-ray examination, 750 upper extremity arterial injury, guideline for management of, 837f 1223 1224 Index upper extremity injuries classification of, 747–748 clinical presentations, 752–753t compartment syndrome, 751, 753f “fight bite” injuries of head of metacarpal bone, 751–752 joint injuries (See joint injuries) treatment chemical burns, 759 electrical injuries, 759 frostbite, 758–759 high-pressure injection injuries, 758 injuries to fingertip and nail bed, 757–758 injuries to tendons, 754–757 open soft tissue injuries and complex wounds, 754 thermal injuries, 759–760 upper extremity vascular injuries, 834 upper lateral retroperitoneum, management of injuries in exposure and vascular control, 643–644 renovascular injuries, 644 ureteral stenting, for urine leaks, 869 urinary bladder, coronal view, 308f urinary system effects, rehabilitation prevention and treatment, 953 urinary retention/stones/urinary tract infection, 952–953 uterine contraction pattern, assessment of, 712 V vac sponge, 909 V.A.C.® system, 909 vacuum-assisted closure, 741 vacuum-assisted fascial closure, 739 vacuum-assisted wound closure, 736–737 vaginal bleeding, 712 varus malunion of tibia shaft fracture, 809f vascular anastomoses, small, 1192f vascular cell adhesion molecule-1 (VCAM-1), 898 vascular injuries in upper extremity, 760 vascular injury by anatomic region brachial artery injuries, 836 common femoral vascular injuries, 837 forearm arterial injuries, 836 lower extremity vascular injuries, 836 popliteal and tibial artery injuries, 839 subclavian and axillary vascular injuries, 834–836 superficial femoral vascular injuries, 837–838 upper extremity vascular injuries, 834 clinical presentation, 820–821 complications and outcome, 839–840 damage control principles and techniques, 832 decision making in extremity arterial and venous repairs in stable patients, 828f diagnostic evaluation of, 823f arteriography, 822 of combined arterial and skeletal extremity trauma, 832–833 common management errors and pitfalls, 834 early postoperative management, 833–834 noninvasive evaluation, 822 physical examination, 821–822 practice recommendation for extremity vascular, 822–823 and principles of operative management, 826–832 and role of immediate amputation, 833 of vascular damage control, 832 epidemiology of, 817–818 extremity vascular trauma case presentations lower extremity, 842–846 upper extremity, 840–842 four-compartment calf fasciotomy checklist, 831f “hard” and “soft” signs of, 821t indications for arteriography in patients with, 822t lessons of war, 816–817 management of endovascular management, 823–824 endovascular repairs, 824 minimal vascular injury and nonoperative management, 823 operative, 824 preoperative preparation, 824–826 vascular trauma surgery, 824 pathophysiology of, 818–819 compartment syndrome, 819–820 missile emboli, 820 potential errors in the recognition, preoperative preparation, and operative management of, 817t preparation checklist for repair of, 825f prognostic factors, 820 vascular shunt, temporary, 1193f vasoconstriction, 834 vasodilatory shock See septic shock vein clamping, 837 vein injuries, exposure and repair, 1196f venomous fish, wounds caused by, 918 venous bypass, 1200f venous hypertension, 828 venous injuries azygos vein, 508 pulmonary veins, 507 subclavian veins, 508 thoracic vena cava, 507 venous repairs, 828–829 vertebral artery, injury control, 1056f vertical shear injuries, 658 vesicants, 136 Vietnam Vascular Registry, 816 violence, definition of, 890 visceral herniation, 867 vital functions for children, 862t volar fingertip injures, 757–758 vscular endothelial growth factor (VEGF), 899 W warfarin therapy, 882 warning signs, 48 war-related colorectal injuries, 628–629 recommendations for, 629 Web-Based Injury Statistics Query and Reporting System (WISQARS), 859 well-trained air medical crews, 110 Western Trauma Association (WTA), 92 World Health Organization (WHO), 49 wound closure, types of, 903 wound management, 629 wounds bites and stings, caused by (See bites and stings) clinical management of antibiotic usage for, 907–908 conditions requiring management in operating room, 905t decision-making for, 903–904 local anesthetics for, 905–907 operative issues and, 905 operative vs nonoperative, 904–905 subatmospheric sponge dressings, 909 wound closure, types of, 903 wound dressing, 908–909 dressing materials for, 910t dressing of, 908–909 subatmospheric sponge, 909 healing of algorithm for the treatment, 897f cytokines and growth factors, 900t–901t inflammatory phase, 897–898 migratory phase of, 899–900 normal aspect of, 896–897 phases of, 897t proliferative phase of, 900–902 remodeling phase of, 902 threats to infection-free, 904t technique for high-pressure syringe irrigation of, 906f tetanus characteristics, 904t Y Years of Potential Life Lost (YPLL), 850 Young–Burgess classification of pelvic fractures, 657–658, 658t Z zipper closure, 739 ... 745 1,4 10 855 985 1,4 70 850 935 1,3 40 73 140 540 255 390 1,1 50 370 345 425 Long guns/military weapons 0.243 Winchester 3,5 00 M-16 3,6 50 2,8 30 7.62 NATO 1,5 00 Uzi 3,7 70 AK47 1,7 25 1,1 85 1,5 35... Chapter 54: Trauma, Medicine, and the Law James V O’Connor, MD, FACS Trauma Medical Director CaroMont Health Gastonia, North Carolina Chapter 25: Lung, Trachea, and Esophagus Grant E O’Keefe, MD Professor... one copy of the work, you may not decompile, disassemble, reverse engineer, reproduce, modify, create derivative works based upon, transmit, distribute, disseminate, sell, publish or sublicense