Trauma Intensive Care Pittsburgh Critical Care Medicine Series Published and Forthcoming Titles in the Pittsburgh Critical Care Medicine series Continuous Renal Replacement Therapy, edited by John A Kellum, Rinaldo Bellomo, and Claudio Ronco Renal and Metabolic Disorders, edited by John A Kellum and Jorge Cerdá Mechanical Ventilation, edited by John W Kreit Emergency Department Critical Care, edited by Donald Yealy and Clifton Callaway Trauma Intensive Care, edited by Samuel A Tisherman and Racquel Forsythe Abdominal Organ Transplant Patients, edited by Ali Al-Khafaji Infection and Sepsis, edited by Peter Linden Pediatric Intensive Care, edited by Scott Watson and Ann Thompson Cardiac Problems, edited by Thomas Smitherman ICU Procedures, by Scott Gunn and Holt Murray Trauma Intensive Care Edited by Samuel A Tisherman, MD, FACS, FCCM Professor Departments of Critical Care Medicine and Surgery University of Pittsburgh Medical Center Pittsburgh, Pennsylvania Raquel M Forsythe, MD Assistant Professor Departments of Surgery and Critical Care Medicine University of Pittsburgh Medical Center Pittsburgh, Pennsylvania 1 Oxford University Press is a department of the University of Oxford It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide Oxford New York Auckland Cape Town Dar es Salaam Hong Kong Karachi Kuala Lumpur Madrid Melbourne Mexico City Nairobi New Delhi Shanghai Taipei Toronto With offices in Argentina Austria Brazil Chile Czech Republic France Greece Guatemala Hungary Italy Japan Poland Portugal Singapore South Korea Switzerland Thailand Turkey Ukraine Vietnam Oxford is a registered trademark of Oxford University Press in the UK and certain other countries Published in the United States of America by Oxford University Press 198 Madison Avenue, New York, NY 10016 © Oxford University Press 2013 All rights reserved No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, by license, or under terms agreed with the appropriate reproduction rights organization Inquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above You must not circulate this work in any other form, and you must impose this same condition on any acquirer Library of Congress Cataloging-in-Publication Data Trauma intensive care / edited by Samuel A Tisherman, Raquel M Forsythe p ; cm.—(Pittsburgh critical care medicine series) Includes bibliographical references and index ISBN 978–0–19–977770–9 (alk paper)—ISBN 978–0–19–977780–8 (alk paper) I Tisherman, Samuel A II Forsythe, Raquel M III Series: Pittsburgh critical care medicine [DNLM: Wounds and Injuries—therapy Intensive Care—methods Intensive Care Units WO 700] LC Classification not assigned 617.1—dc23 2012049560 Printed in the United States of America on acid-free paper Series Preface v No place in the world is more closely identified with Critical Care Medicine than Pittsburgh In the late sixties, Peter Safar and Ake Grenvik pioneered the science and practice of critical care not just in Pittsburgh, but around the world Their multidisciplinary team approach became the standard for how ICU care is delivered in Pittsburgh to this day The Pittsburgh Critical Care Medicine series honors this tradition Edited and largely authored by University of Pittsburgh faculty, the content reflects best practice in critical care medicine The Pittsburgh model has been adopted by many programs around the world and local leaders are recognized as world leaders It is our hope that through this series of concise handbooks a small part of this tradition can be passed on to the many practitioners of critical care the world over John A Kellum Series Editor This page intentionally left blank The management of critically ill patients who have suffered multiple trauma can be challenging Optimal management requires rapidly assessing and resuscitating patients, establishing priorities of care, coordinating multiple diagnostic tests and therapeutic interventions, while minimizing complications, all with the goal of achieving the best possible functional outcome for the patient Most textbooks devoted to trauma care tend to thoroughly cover all of the topics related to management of trauma patients, including out-of-hospital care, initial assessment and resuscitation, and management of specific injuries The unique issues of management in the intensive care unit tend to be addressed in various ways, but typically not extensively There are currently no books solely devoted to the critical care management of trauma patients This book was developed for all healthcare professionals involved in managing trauma patients in the intensive care unit The topics are presented in a concise and practical fashion By its nature, trauma management must be multi-disciplinary The physicians involved include emergency physicians, trauma surgeons, and surgical subspecialists (e.g., neurosurgery, orthopedics, plastics), as well as physical medicine and rehabilitation specialists Fellows, residents, interns, and medical students also are typically involved Other professionals who are integral to management of critically ill trauma patients include nurses; respiratory, physical, and occupational therapists; social workers; and case managers This book was designed to be used by all healthcare professionals interested in the management of critically ill trauma patients Our hope is that the book will prove valuable at the bedside and will help improve the quality of trauma care and functional patient outcomes Samuel A Tisherman, MD, Raquel Forsythe, MD vii Preface This page intentionally left blank Contents Contributors xi Section 1: Structure Development of the Trauma Intensive Care Unit within Trauma Systems Deepika Mohan Injury Severity Scoring Systems Matthew Rosengart Section 2: Patient Management The Tertiary Survey: How to Avoid Missed Injuries 21 Samuel A Tisherman Monitors and Drains in Trauma Patients 33 Greta L Piper and Lewis J Kaplan Airway Management in the Intensive Care Unit 51 Lillian L Emlet Resuscitation from Hemorrhagic Shock 63 Benjamin R Reynolds and Gregory A Watson Massive Transfusions and Coagulopathy 73 Matthew D Neal, Lauren M McDaniel, and Raquel M Forsythe Ventilator Management of Trauma Patients 87 Matthew Benns, Babak Sarani, and Alain C Corcos Abdominal Trauma 97 Graciela Bauzá and Andrew B Peitzman 10 Soft Tissue Trauma and Rhabdomyolysis 115 Paula Ferrada 11 Orthopedic Trauma 119 Boris A Zelle, Peter A Siska, and Ivan S Tarkin 12 Traumatic Brain Injury: Assessment, Pathophysiology, and Management Ramesh Grandhi and David O Okonkwo 133 ... Development of the trauma intensive care unit within trauma systems Deepika Mohan The modern trauma intensive care unit (ICU) reflects the confluence of two trends: the development of inclusive trauma systems... Linden Pediatric Intensive Care, edited by Scott Watson and Ann Thompson Cardiac Problems, edited by Thomas Smitherman ICU Procedures, by Scott Gunn and Holt Murray Trauma Intensive Care Edited by... II Forsythe, Raquel M III Series: Pittsburgh critical care medicine [DNLM: Wounds and Injuries—therapy Intensive Care methods Intensive Care Units WO 700] LC Classification not assigned 617.1—dc23