Ebook Acute care surgery

Contents of the book Acute care surgery referred to the content you: Acute care surgery fundamental principles, trauma, emergency, non-trauma, surgery evaluation and management, surgical critical care, special topics

ACUTE CARE SURGERY Editors L.D Britt, MD, MPH, FACS, FCCM, FRCSEng (Hon), FRCSEd (Hon), FWACS (Hon), FRCSI (Hon) Brickhouse Professor and Chairman Department of Surgery Eastern Virginia Medical School Norfolk, Virginia Philip S Barie, MD, MBA, FIDSA, FCCM, FACS Surgeon and Professor of Surgery Department of Surgery Weill Cornell Medical College New York, New York Andrew B Peitzman, MD, FACS Gregory J Jurkovich, MD, FACS Mark M Ravitch Professor and Vice-Chair Chief, Division of General Surgery UPMC-Presbyterian Pittsburgh, Pennsylvania Chief of Surgery Denver Health Bruce M Rockwell Distinguished Chair of Trauma Professor and Vice-Chairman University of Colorado School of Medicine Denver, Colorado New illustrations by BodyScientific International, LLC Britt_FM.indd i 3/9/2012 9:03:05 PM Acquisitions Editor: Brian Brown Product Manager: Brendan Huffman Production Manager: Alicia Jackson Senior Manufacturing Manager: Benjamin Rivera Marketing Manager: Lisa Lawrence Design Coordinator: Holly McLaughlin Production Service: SPi Global Copyright © 2012 by LIPPINCOTT WILLIAMS & WILKINS, a WOLTERS KLUWER business Two Commerce Square 2001 Market Street Philadelphia, PA 19103 USA LWW.com All rights reserved This book is protected by copyright No part of this book may be reproduced in any form by any means, including photocopying, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews Materials appearing in this book prepared by individuals as part of their official duties as U.S government employees are not covered by the above-mentioned copyright Printed in China Library of Congress Cataloging-in-Publication Data Acute care surgery / [edited by] L.D Britt, Andrew B Peitzman — 1st ed p ; cm Includes bibliographical references ISBN 978-1-60831-428-7 (hardback) I Britt, L D II Peitzman, Andrew B [DNLM: Emergency Treatment—methods Surgical Procedures, Operative—methods Wounds and Injuries—surgery WO 700] 617.9—dc23 2011045998 Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication Application of the information in a particular situation remains the professional responsibility of the practitioner The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with current recommendations and practice at the time of publication However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions This is particularly important when the recommended agent is a new or infrequently employed drug Some drugs and medical devices presented in the publication have Food and Drug Administration (FDA) clearance for limited use in restricted research settings It is the responsibility of the health care provider to ascertain the FDA status of each drug or device planned for use in their clinical practice To purchase additional copies of this book, call our customer service department at (800) 638-3030 or fax orders to (301) 223-2320 International customers should call (301) 223-2300 Visit Lippincott Williams & Wilkins on the Internet: at LWW.com Lippincott Williams & Wilkins customer service representatives are available from 8:30 am to pm, EST 10 Britt_FM.indd ii 3/9/2012 9:03:06 PM CONTENTS Preface v Contributors vi Introduction xiv SECTION 1: FUNDAMENTAL PRINCIPLES Acute Care Surgery: General Principles 19 SECTION 2: TRAUMA 20 L.D Britt Training in Acute Care Surgery 23 Gregory J Jurkovich Pathophysiology of Acute Illness and Injury 29 Timothy R Billiar and Marcus K Hoffman Shock States in Acute Care Surgery 34 Jeremy M Hsu and Ronald V Maier Basic Operative Techniques in Trauma and Acute Care Surgery 47 Damage Control Management/Open Abdomen 66 21 Airway Management 79 Matthew Keith Whalin, Carla Irene Haack, Timothy G Buchman, and Paul S Garcia Preoperative Preparation of the Emergency General Surgery Patient 92 22 23 10 11 Hematologic Abnormalities, Coagulopathy, and Transfusion Therapy 127 24 25 26 27 28 Abdominal Trauma 358 Juan Asensio, Aurelio Rodriguez, Graciela Bauza, T Vu, F Mazzini, F Herrerias, and Andrew B Peitzman 29 Genitourinary Trauma 397 Bradley A Erickson and Jack W McAninch 30 Acute Care Surgery: Skeletal and Soft-Tissue Injury 414 Nutrition in Acute Care Surgery 149 Gustavo X Cordero, Gary S Gruen, Peter A Siska, and Ivan S Tarkin Sepsis 160 Antibiotic Use and Misuse 169 31 32 18 Burns 438 Basil A Pruitt Jr and Richard L Gamelli Acute Care Surgery in Special Populations 206 SECTION 3: EMERGENCY (NON-TRAUMA) SURGERY: EVALUATION AND MANAGEMENT 33 Evaluation of the Acute Abdomen 471 Prehospital Trauma Care 219 Greta L Piper, Matthew R Rosengart, Andrew B Peitzman, and Raquel Forsythe Norman E Mcswain Jr 17 Extremity Vascular Injuries 426 David V Feliciano Pain Management 195 C William Schwab, Daniel J Grabo, Edgargo S Salcedo, and Michael L Nance 16 Chest Injury 341 Amy N Hildreth and J Wayne Meredith Lena M Napolitano Sharon Henry 15 Blunt and Penetrating Neck Injury 329 Joseph Dubose and Thomas M Scalea Philip S Barie and Vanessa P Ho 14 Ophthalmic Injury 318 Francis L Counselman and Shannon M MCCole Todd W Costantini, Mike Krzyzaniak, and Raul Coimbra 13 Spinal Column and Spinal Cord Injury 304 Khalid M Abbed and Kimberly A Davis Juan B Ochoa and Jean Nickleach 12 Maxillofacial Injuries 295 Nathaniel MCquay Jr and Daniel Lader Diagnostic Imaging in Acute Care Surgery 104 Behroze A Vachha, Leo L Tsai, Karen S Lee, and Marc A Camacho Traumatic Brain Injury 285 Peter B Letarte Krista Turner and Frederick Moore Initial Evaluation of the Trauma Patient 266 Leslie Kobayashi, Raul Coimbra and David B Hoyt Brett H Waibel and Michael F Rotondo The Evolution of Trauma Care in the United States 259 Donald D Trunkey Rao R Ivatury Recovery and Rehabilitation 253 Robert D Winfield and Lawrence Lottenberg Disaster Preparedness and Mass Casualty Management 234 34 Acute Gastrointestinal Hemorrhage 482 Leonard J Weireter Jr 35 Christopher J Carlson and Grant E O’Keefe Injury Prevention 244 Inflammatory Conditions of the Gastrointestinal Tract 494 Jennifer C Roberts and Karen J Brasel Matthew Schuchert, Vaishali Schuchert, and Brian Zuckerbraun iii Britt_FM.indd iii 3/9/2012 9:03:06 PM iv Contents 36 Intestinal Obstruction and Dysmotility 51 Syndromes 527 Louis H Alarcon 52 37 Appendicitis 538 D Patrick Bryant and Heidi Frankel 53 54 55 56 Reconstruction 578 The Immunocompromised Patient 738 Uroghupatei P Iyegha and Gregory J Beilman 57 42 Abdominal Wall Hernias: Emergencies and Timothy C Fabian and Martin A Croce Thromboembolic Disease 732 Elliott R Haut and Edward E Cornwell 41 Anorectal Abscess and Inflammatory Processes 574 Herand Abcarian Nosocomial Infections 718 Pamela A Lipsett 40 Gastrointestinal Tract Foreign Bodies 565 Robert A Izenberg, Robert C Mackersie Hypothermia: Treatment and Therapeutic Uses 707 Matthew C Byrnes and Greg J Beilman 39 Cholecystitis, Cholangitis, and Jaundice 554 Umut Sarpel and H Leon Pachter Acute Kidney Injury 694 Soumitra R Eachempati, Frank Liu, and Philip S Barie 38 Acute Pancreatitis 544 Patricio Polanco and Steven J Hughes Acute Liver Failure and Portal Hypertension 685 Deanna Blisard and Michael E De Vera Support of the Organ Donor 750 David M Kashmer, Suzanne A Fidler, and Michael D Pasquale 58 Palliative Care 762 Ronald M Stewart 43 Surgical Infections of Skin and Soft Tissue 589 Vanessa P Ho, Soumitra R Eachempati, and Philip S Barie 44 Obstetric and Gynecologic Emergencies 605 David Streitman and W Allen Hogge 45 Nontraumatic Vascular Emergencies 614 SECTION 5: SPECIAL TOPICS 59 Brian L Chen, Jarrod D Day, Babatunde H Almaroof, Sadaf S Ahanchi, and Jean M Panneton EMTALA and Other Principles Affecting the Acute Care Surgeon 769 Kenneth L Mattox 60 Informed Surgical Consent 773 SECTION 4: SURGICAL CRITICAL CARE 46 Intensive Care Unit: The Essentials—Including Assessment of Severity of Critical Illness 629 David G Jacobs 61 Advance Medical Directives 785 Grace S Rozycki and William R Sexson 62 Acute Care Surgery, Ethics, and the Law 793 Charles E Lucas and Anna M Ledgerwood Mayur B Patel and Addison K May 47 Acute Respiratory Dysfunction 636 63 Scoring Systems for Injury and Emergency General Surgery 800 Giana Hystad Davidson and Eileen Bulger 48 Multiple Organ Dysfunction Syndrome 644 Philip S Barie and Fredric M Pieracci 49 Mechanical Ventilator Support 657 Marc J Shapiro and Brian M Hall Shawn Nessen and John Fildes 64 Procedures 808 Amy J Goldberg and Abhijit S Pathak Index 817 50 Cardiovascular Failure and Circulatory Support—Monitoring and Essential Adjuncts 669 John A Morris, Mickey Ott, Fitzgerald J Casimir, Walter K Clair, and Mark Glazer Britt_FM.indd iv 3/9/2012 9:03:06 PM PREFACE We are firmly committed to the tridisciplinary specialty— acute care surgery, which encompasses trauma, critical care, and emergency general surgery This comprehensive textbook represents innumerable hours of dedication and sacrifice by us and the editors of this new edition along with the many accomplished contributors, who are recognized leaders in their respective areas of interest The full spectrum of acute care surgery is expertly addressed in the 64 chapters included in this book, with each chapter highlighting cutting-edge advances in the field and underscoring state-of-the-art management paradigms In an effort to create the most definitive reference on acute care surgery, we have emphasized an evidence-based approach for all content included Also, notable controversies are discussed in detail often accompanied by data-driven resolution Perhaps the most pivotal point in the process was the working retreat that we had in a makeshift conference room where we essentially had a marathon and critically reviewed each chapter for accuracy, relevance, and style This process continued on an almost weekly basis until a consensus of high-level satisfaction was achieved for each chapter Without hesitation or trepidation, we are dedicating this book to all the authors, whose tireless efforts contributed to the success of Acute Care Surgery In addition, we graciously thank our family and friends for allowing us to spend some of our “free time” diligently working on this important project v Britt_FM.indd v 3/9/2012 9:03:06 PM CONTRIBUTORS Khalid M Abbed, MD Greg J Beilman, MD Chief Yale Spine Institute Director Minimally Invasive Spine Surgery Director Oncologic Spine Surgery New Haven, Connecticut Professor and Vice Chair Department of Surgery University of Minnesota Minneapolis, Minnesota Herand Abcarian, MD Professor Department of Surgery University of Illinois-Chicago Chairman Division of Colon and Rectal Surgery Department of Surgery John Stroger Hospital of Cook County Chicago, Illinois Sadaf S Ahanchi, MD Vascular Surgery Fellow Department of Surgery Eastern Virginia Medical School Norfolk, Virginia Babatunde H Alamaroof, MD Vascular Surgery Fellow Department of Surgery Eastern Virginia Medical School Norfolk, Virginia Louis H Alarcon, MD Associate Professor Department of Surgery and Critical Care Medicine Medical Director, Trauma Surgery University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania Juan Asensio, MD Professor Surgery Department of Surgery University of Miami Miller School of Medicine Director Trauma Clinical Research, Training and Community Affairs Department of Surgery University of Miami Miller School of Medicine Miami, Florida Timothy R Billiar, MD George Vance Foster Professor and Chair Department of Surgery University of Pittsburgh Pittsburgh, Pennsylvania Deanna Blisard, MD Assistant Professor Department of Critical Care Medicine University of Pittsburgh Medical Center Assistant Professor Department of Surgery University of Pittsburgh Medical Center Pittsburgh, Pennsylvania Karen J Brasel, MD, MPH Professor Department of Surgery Medical College of Wisconsin Milwaukee, Wisconsin L.D Britt, MD, MPH Brickhouse Professor and Chairman Department of Surgery Eastern Virginia Medical School Norfolk, Virginia D Patrick Bryant, MD Assistant Professor Department of Surgery Penn State University School of Medicine Attending Physician Division of Trauma and Critical Care Milton S Hershey Medical Center Hershey, Pennsylvania Timothy G Buchman, PhD, MD Director, Emory Center for Critical Care Professor of Surgery and Anesthesiology Emory University School of Medicine Atlanta, Georgia Philip S Barie, MD, MBA Eileen Bulger, MD Surgeon and Professor of Surgery Department of Surgery Weill Cornell Medical College New York, New York Professor Department of Surgery University of Washington Harborview Medical Center Seattle, Washington Graciela Bauza, MD Assistant Professor Department of Surgery University of Pittsburgh Medical Center Pittsburgh, Pennsylvania vi Britt_FM.indd vi 3/9/2012 9:03:06 PM Contributors Matthew C Byrnes, MD Todd Costantini, MD Assistant Professor Department of Surgery University of Minnesota Minneapolis, Minnesota Trauma Surgeon Department of Trauma North Memorial Medical Center Robbinsdale, Minnesota Clinical Fellow Division of Trauma Surgical Critical Care, and Burns University of California San Diego San Diego, California Marc A Camacho, MD, MS Section Chief Department of Emergency Radiology Beth Israel Deaconess Medical Center Instructor Department of Radiology Harvard Medical School Boston, Maryland Christopher J Carlson, MD Clinical Associate Professor Division of Gastroenterology University of Washington School of Medicine Attending Physician Harborview Medical Center Seattle, Washington Francis L Counselman, MD, CPE Professor and Chairman Department of Emergency Medicine Eastern Virginia Medical School Emergency Physicians of Tidewater Norfolk, Virginia Martin A Croce, MD Professor of Surgery Chief, Trauma and Critical Care Regional Medical Center at Memphis University of Tennessee Health Science Center Memphis, Tennessee Giana Hystad Davidson, MD, MPH Research Fellow Department of Surgery University of Washington Harborview Medical Center Seattle, Washington Fitzgerald J Casimir, MD Kimberly A Davis, MD Instructor of Surgery Division of Trauma and Surgical Critical Care Vanderbilt University Medical Center Nashville, Tennessee Professor, Vice Chairman of Clinical Affairs Department of Surgery Yale University School of Medicine Trauma Medical Director Yale New Haven Hospital New Haven, Connecticut Brian L Chen, MD Vascular Surgery Fellow Department of Surgery Eastern Virginia Medical School Norfolk, Virginia Walter K Clair, MD, MPH Assistant Professor Department of Medicine Vanderbilt University Medical Center Medical Director Department of Cardiac Electrophysiology Vanderbilt Heart and Vascular Institute Nashville, Tennessee Jarrod D Day, MD Vascular Surgery Fellow Department of Surgery Eastern Virginia Medical School Norfolk, Virginia Michael E de Vera, MD Professor of Surgery Chief of Transplant Director, LLU Transplantation Institute Loma Linda University Loma Linda, California Raul Coimbra, MD, PhD Joseph DuBose, MD The Monroe E Trout Professor of Surgery Chief Division of Trauma, Surgical Critical Care, and Burn University of California San Diego Executive Vice-Chairman Department of Surgery University of California San Diego San Diego, California Assistant Professor Department of Surgery University of Maryland Medical System, R Adams Cowley Shock Trauma Center Director of Physician Education Baltimore C-STARS United States Air Force Baltimore, Maryland Gustavo X Cordero, MD Soumitra R Eachempati, MD Orthopaedic Trauma Surgery Fellow Department of Orthopaedic Surgery University of Pittsburgh Medical Center Pittsburgh, Pennsylvania Professor of Surgery and Public Health Departments of Surgery and Public Health Weill Cornell Medical College Director, Surgical ICU and Chief, Trauma Services Department of Surgery New York Weill Cornell Center New York, New York Edward E Cornwell III, MD LaSalle D Leffall, Jr Professor & Chairman of Surgery Department of Surgery Howard University College of Medicine Washington, District of Columbia Britt_FM.indd vii vii 3/9/2012 9:03:06 PM viii Contributors Bradley A Erickson, MD Amy J Goldberg, MD Assistant Professor Department of Urology University of Iowa College of Medicine Iowa City, Iowa Professor of Surgery Chief of Trauma/Surgical Critical care Department of Surgery Temple University School of Medicine Philadelphia, Pennsylvania Timothy C Fabian, MD Harwell Wilson Alumni Professor and Chairman Department of Surgery University of Tennessee Health Science Center Memphis, Tennessee David V Feliciano, MD Attending Surgeon Atlanta Medical Center Professor of Surgery Mercer University School of Medicine Atlanta, Georgia Suzanne A Fidler, MD, JD, CPHRM Senior Director of Risk Management and Patient Safety Department of Risk Management Desert Regional Medical Center Palm Springs, California John Fildes, MD Professor Department of Surgery University of Nevada School of Medicine Medical Director & Chair Department of Trauma University Medical Center of Southern Nevada Las Vegas, Nevada Raquel Forsythe, MD Assistant Professor Department of Surgery and Critical Care Medicine University of Pittsburgh Medical School Pittsburgh, Pennsylvania Heidi Frankel, MD Professor of Surgery Department of Surgery University of Maryland Shock Trauma Center Baltimore, Maryland Richard L Gamelli, MD Robert J Freeark Professor of Surgery Loyola University Medical Center Maywood, Illinois Paul S García, MD, PhD Assistant Professor Department of Anesthesiology Emory University School of Medicine Atlanta, Georgia Staff Physician Anesthesiology Department Atlanta VA Medical Center Decatur, Georgia Mark Glazer, MD Assistant Professor Department of Medicine/Cardiovascular Vanderbilt University Medical Center Attending Physician Division of Cardiology Vanderbilt University Medical Center Nashville, Tennessee Britt_FM.indd viii Daniel Grabo, MD Instuctor in Surgery Division of Traumatology, Surgical Critical Care and Emergency Surgery Department of Surgery University of Pennsylvania School of Medicine Philadelphia, Pennsylvania Gary S Gruen MD Professor Department of Orthopaedic Surgery University of Pittsburgh Scholl of Medicine Attending Physician University of Pittsburgh Medical Center Pittsburgh, Pennsylvania Carla Irene Haack, MD Assistant Professor Department of Surgery Emory University School of Medicine Atlanta, Georgia Brian M Hall, MD Assistant Professor of Surgery Department of Surgery Stony Brook University School of Medicine Stony Brook, New York Elliott R Haut, MD Associate Professor Departments of Surgery, Anesthesiology/Critical Care Medicine, and Emergency Medicine The Johns Hopkins University School of Medicine Baltimore, Maryland Sharon Henry MD Anne Scalea Professor of Trauma University of Maryland School of Medicine Baltimore, Maryland F Herrerias, MD International Visiting Scholar/Research Fellow Department of Surgery Division of Trauma and Surgical Critical Care University of Miami Miami, Florida Fernando Herrerías González, MD Attending Physician Department of General and Digestive Surgery Hospital Universitari Arnau de Vilanova Lleida, Spain Amy N Hildreth, MD Assistant Professor Department of Surgery Wake Forest University School of Medicine Winston-Salem, North Carolina 3/9/2012 9:03:06 PM Contributors Vanessa P Ho, MD, MH Robert A Izenberg, MD, CAPT MC USN Department of Surgery Weill Cornell Medical College New York, New York General Surgery Resident Department of Surgery University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania Assistant Professor of Surgery Department of Surgery F Edward Hebert School of Medicine Uniformed Services University of the Health Sciences Bethesda, Maryland Attending Surgeon Department of Surgery Naval Medical Center San Diego, California W Allen Hogge, MD, MA David G Jacobs, MD Professor and Chair Department of Obstetrics, Gynecology & Reproductive Science University of Pittsburgh/Magee-Womens Hospital Pittsburgh, Pennsylvania Professor Department of Surgery University of North Carolina School of Medicine Chapel Hill, North Carolina Associate Medical Director F.H “Sammy” Ross Trauma Institute Carolinas Medical Center Charlotte, North Carolina Marcus K Hoffman, MD David B Hoyt, MD Executive Director American College of Surgeons Chicago, Illinois Jeremy M Hsu, B.Pharm, MBBS Clinical Lecturer Department of Surgery University of Sydney Sydney, New South Wales, Australia Consultant Surgeon Department of Surgery Westmead Hospital Westmead, New South Wales, Australia Steven Hughes, MD Associate Professor and Chief General Surgery, University of Florida Gainesville, Florida Maureen B Huhmann, DCN, RD, CSO Adjunct Assistant Professor Department of Nutritional Sciences University of Medicine and Dentistry of New Jersey Newark, New Jersey Rao R Ivatury, MD Professor Department of Surgery Virginia Commonwealth University Chair Division of Trauma, Critical Care and Emergency Surgery Department of Surgery VCU Medical Center Richmond, Virginia Uroghupatei P Iyegha, MD Surgery Resident Department of Surgery University of Minnesota Minneapolis, Minnesota Britt_FM.indd ix ix Gregory J Jurkovich, MD Chief of Surgery Denver Health Bruce M Rockwell Distinguished Chair of Trauma Professor and Vice-Chairman University of Colorado School of Medicine Denver, Colorado David M Kashmer, MD, MBA Section Chief Trauma & Acute Care Surgery Guthrie Health System Center Valley, Pennsylvania Leslie Kobayashi, MD Assistant Clinical Professor of Surgery Department of Surgery, Division of Trauma, Surgical Critical Care, and Burns University of California San Diego San Diego, California Michael Krzyzaniak, MD Research Fellow Division of Trauma Surgical Critical Care, and Burns University of California San Diego San Diego, California Daniel Lader, DDS Attending Surgeon Oral and Maxillofacial Surgery St Luke’s Hospital and Health Network Bethlehem, Pennsylvania Anna M Ledgerwood, MD Professor Department of Surgery Wayne State University School of Medicine Medical Director Trauma Department Detroit Receiving Hospital Detroit, Michigan 3/9/2012 9:03:06 PM x Contributors Karen S Lee, MD Addison K May, MD Attending Radiologist Department of Radiology Beth Israel Deaconess Medical Center Harvard Medical School Boston, Massachusetts Professor Department of Surgery and Anesthesiology Vanderbilt University Medical Center Nashville, Tennessee Peter B Letarte, MD Chief of Neurological Surgery Department of Surgery Edward G Hines Veterans Hospital Hines, Illinois Pamela A Lipsett, MD, MHPE Warfield M Firor Professor of Surgery Program Director, General Surgery and Surgical Critical Care Co-Director of the Surgical Intensive Care Units Johns Hopkins Hospital Baltimore, Maryland Frank Liu, MD Assistant Professor Department of Medicine New York Presbyterian – Weill Cornell Center Nephrologist The Rogosin Institute New York, New York Lawrence Lottenberg, MD Associate Professor of Surgery and Anesthesiology Division of Acute Care Surgery Department of Surgery University of Florida College of Medicine Gaiensville, Florida Charles E Lucas, MD Professor Department of Surgery Wayne State University Senior Attending Department of Surgery Detroit Receiving Hospital Detroit, Michigan Robert C Mackersie, MD Professor of Surgery University of California, San Francisco San Francisco General Hospital San Francisco, California Ronald V Maier, MD Jane and Donald D Trunkey Professor and Vice-Chair Surgery University of Washington Surgeon-in-Chief Harborview Medical Center Seattle, Washington Kenneth L Mattox, MD Distinguished Service Professor Department of Surgery Baylor College of Medicine Chief of Staff/Chief of Surgery Ben Taub General Surgery Houston, Texas Britt_FM.indd x F Mazzini, MD International Visiting Scholar/Research Fellow Dewitt-Daughtry Family Department of Surgery University of Miami Miami, Florida Attending Physician Department of Surgery Hospital Italiano de Buenos Aires Buenos Aires, Argentina Jack W McAninch, MD Professor Department of Urology University of California San Francisco Chief of Urology Department of Urology San Francisco General Hospital San Francisco, California Shannon M McCole, MD Chairman and Residency Program Director Assistant Professor Department of Ophthalmology Eastern Virginia Medical School Norfolk, Virginia Nathaniel McQuay Jr, MD Assistant Professor of Surgery Johns Hopkins University Johns Hopkins Bayview Medical center Baltimore, Maryland Norman E McSwain Jr, MD Professor of Surgery, Tulane University Medical Director, PreHosptial Trauma Life Support (PHTLS) Trauma director, Spirit of Charity Trauma Center, ILH J Wayne Meredith, MD Professor and Chair Department of Surgery Wake Forest University School of Medicine Director Division of Surgical Sciences Wake Forest University School of Medicine Winston-Salem, North Carolina Frederick Moore, MD Professor Department of Surgery Chief, Division of Acute Care Surgery University of Florida Gainesville, Florida John A Morris Jr, MD Professor of Surgery and Biomedical Informatics Department of Surgery Vanderbilt University School of Medicine Nashville, Tennessee 3/9/2012 9:03:06 PM 814 Section 5: Special Topics Anesthesia The procedure can be performed with moderate to deep sedation with local anesthesia at the site of placement It can also be performed under general anesthesia, and this is the usual technique in patients undergoing concomitant tracheostomy Positioning The patient is placed in the supine position with the head of the bed elevated to about 30 degrees to prevent aspiration especially if performed with sedation and local anesthesia Operative Preparation The patient should be NPO for at least hours prior to the procedure Preoperative antibiotics such as a first-generation cephalosporin should be infused prior to skin incision to prevent infection at the insertion site An alternate antibiotic such as clindamycin to cover gram-positive organisms in penicillinallergic patients is given The sterile field should be prepared in the usual manner and should include the upper abdomen/ lower chest Procedure The procedure is performed utilizing a two-surgeon team with one surgeon performing the endoscopy and the other surgeon managing the abdominal wall portion of the procedure An esophagogastroduodenoscopy is performed using the standard technique When performing a percutaneous endoscopic gastrostomy (PEG) tube in conjunction with a tracheostomy, we find that PEG tube placement performed prior to the tracheostomy is technically easier since the existing endotracheal tube assists in passage of the endoscope During the endoscopy, the stomach is inspected and any gastric contents suctioned Any gastric outlet or duodenal obstruction is excluded (if using tube for feeding) as is any evidence of gastritis or ulcer Next, the stomach is insufflated using the air channel of the endoscope The OR lights are dimmed, and the abdominal wall is transilluminated using the endoscope light set at maximum intensity (many light sources have a transilluminate setting) The ideal location for placement of the PEG tube is two fingerbreadths below the left costal margin and two fingerbreadths to the left of the midline Finger pressure is applied at this location over the previously transilluminated region, and the anterior stomach is visualized endoscopically If transillumination is not achieved but finger pressure is visualized, one pass at insertion of the catheter may be attempted If both are not achieved, then a decision to aborting the procedure should be taken As finger pressure is applied and visualized endoscopically, location within the stomach is important since the tube should not be placed too close to the pylorus The site on the abdominal wall is then anesthetized using lidocaine Next, the catheter-over-the needle is then passed through the abdominal wall using a rapid insertion technique to avoid having the stomach fall away form the abdominal wall The endoscopist visualizes the placement of the needle while continuously insufflating air to ensure gastric distension and apposition of the stomach to the abdominal wall The endoscope snare is inserted through the endoscope at this time, and the needle is removed, leaving the catheter within the stomach A looped guidewire is then inserted through the catheter and into the stomach The endoscopist then snares the guidewire and pulls the entire endoscope with the snare/guidewire out of the mouth The catheter is then removed by threading it back over the guidewire At this time, a scalpel is used Britt_Chap64.indd 814 to make a horizontal incision measuring 0.5–1 cm in width at the guidewire insertion site on the abdominal wall, being careful not to cut the guidewire The PEG tube is then secured to the looped end of the guidewire exiting the mouth This is performed by passing the looped end of the guidewire through the loop of the PEG tube and then passing the PEG tube disk through the guidewire loop and pulling the entire tube through it The PEG tube is then lubricated, and the person at the abdominal wall then pulls the guidewire so the entire PEG tube goes through the mouth, esophagus, and stomach and exits at the incision site Meanwhile, the endoscopist reinserts the endoscope and follows the PEG tube as it is placed The internal disk should be snug against the gastric mucosa without undue tension, and the site is inspected for bleeding The guidewire is then cut at the tapered end of the PEG tube, and the external flange or bumper is then passed over the external portion of the PEG tube so that it sits on the abdominal wall without tension The level of the PEG tube at the skin should be noted and recorded in the operative note The endoscope is then withdrawn after desufflation of the stomach The external portion of the PEG tube is then cut, and the supplied adapter is secured and the tube placed to gravity drainage or capped The flange is secured to the skin using 2–0 nylon suture Postoperative Care A drain sponge or split gauze is used as a dressing over the flange We typically begin tube feeds on POD no The PEG tube insertion site should be cleaned daily FASCIOTOMY Indications Definitive compartment syndrome High-risk lower extremity vascular injury a Combined arterial and venous injury b Associated bone fracture or massive soft tissue destruction c Prolonged ischemia (>4–6 hours) prior to revascularization d Treatment of major artery or vein injury by ligation Positioning The patient is in the supine position with both lower extremities exposed Operative Preparation Circumferential sterile field preparation of the affected lower extremity Procedure The double-incision technique is a safer, more effective, and preferred approach since the overlying skin can prevent decompression despite release of the underlying fascia There are four compartments in the lower leg (distal to knee); when performing a fasciotomy, all four compartments must be decompressed The anterior and lateral compartments are decompressed through one incision on the lateral aspect of the leg A 15- to 20-cm incision that is centered over the fibula is created and taken down through the subcutaneous tissues A flap needs 2/29/2012 7:52:16 PM Chapter 64: Procedures to be created anteriorly (transversely) to expose the intermuscular septum A nick in the anterior compartment fascia is performed midway between the septum and the tibia Metzenbaum scissors are used to perform a longitudinal fasciotomy proximally and distally staying parallel to the septum The lateral compartment is then released in the same manner by staying posterior to the intermuscular septum, and the longitudinal fasciotomy is carried out proximally, being careful not to extend it beyond the fibular head since the peroneal nerve courses around it Likewise, the fasciotomy is carried out distally aiming for the lateral malleolus to avoid injury to the peroneal nerve that will run more anteriorly The medial incision is made two fingerbreadths posterior to the posterior medial margin of the tibia and is extended 15–20 cm The subcutaneous tissue is incised and care taken to avoid the saphenous vein This will expose the superficial posterior compartment fascia, a nick is made, and a longitudinal fasciotomy is carried out proximally and distally with Metzenbaum scissors To expose the deep posterior compartment, the superficial posterior compartment muscles need to be dissected free of the tibia This will expose the deep posterior compartment, which can then be released in the same manner Bleeding is controlled with electrocautery or sutures The two wounds are then dressed with Xeroform gauze Alternatively, some surgeons “shoelace” the incision with vessel loops secured to the wound edges with staples and apply gentle progressive traction over several days to facilitate closure Postoperative Care The fasciotomy sites are inspected daily; once the swelling has subsided, primary closure can be undertaken If swelling continues, a vacuum assist closure device can be used to facilitate closure and promote granulation tissue if skin grafting seems necessary INFERIOR VENA CAVA FILTER Indications originating in the pelvic or lower extremity veins IVC filters should be placed in patients who have a contraindication to anticoagulation, prophylactically in high-risk patients, and in patients who develop recurrent pulmonary emboli on therapeutic anticoagulation Contraindications to anticoagulation can include patients with recent trauma or surgery, recent history of a GI bleed or development of a GI bleed while on anticoagulation, or patients with intracranial bleed Prophylactic filters may be placed in patients who are at high risk for development of a deep vein thrombosis or pulmonary embolus In the trauma patient population, this includes patients with severe head injury, spinal cord injuries with neurologic deficits, and significant long bone and pelvic fractures Procedure IVC filters can be placed at the bedside, decreasing any risks from the transport of critically ill patients from the ICUs to the operating room or interventional suite Patients should have a venous duplex of both common femoral veins to assess patency Only on rare occasions is an IVC filter placed from the right internal jugular vein Bedside fluoroscopy or ultrasonography is necessary to ensure patency of the IVC, measure its diameter, and evaluate for a duplicated IVC The right common femoral vein is accessed via a percutaneous approach, and utilizing the Seldinger approach, the guidewire is passed into the IVC, the sheath is passed over the wire, and the appropriately sized filter is deployed The filter should be placed below the level of the right renal vein Retrievable Within the last several years, retrievable filters have gained popularity These filters are ideal for patients who are temporarily at high risk for pulmonary embolism and deep vein thrombosis or those who later become candidates for anticoagulation The benefit of the retrievable filter is to decrease the complications from filter placement, such as migration and filter or caval thrombosis SPECIAL TOPICS Inferior vena cava (IVC) filters are placed to decrease the risk of pulmonary embolism from a deep vein thrombus 815 Britt_Chap64.indd 815 2/29/2012 7:52:17 PM This page intentionally left blank Britt_Chap64.indd 816 2/29/2012 7:52:17 PM INDEX Note: Page numbers in italics indicate figures; those followed by t indicate tables A A severity characterization of trauma (ASCOT), 803–804 Abbreviated Injury Scale (AIS), 801 Abdomen, 209–210 Abdominal aorta, 58–59 Abdominal aortic aneurysm, 112 Abdominal compartment syndrome (ACS), 70, 96, 478–479, 578–579, 701 Abdominal sepsis, 166, 166t Abdominal trauma, 115–116, 115–116, 278, 278–279 abdominal compartment syndrome, 389–390 abdominal vascular injury, 58–59, 59–60 anatomic location, 385–386 exposure and incisions, 386 operative intervention, 386 surgical technique, 386–389 blunt trauma, 358–359 celiac axis injury, 59 damage control, 390 diagnostic and therapeutic laparoscopy, 63 diaphragmatic injury anatomy and physiology, 361–362 diagnosis, 362 incidence, 362 surgical management, 362–363 duodenal injury anatomy, 367 blunt duodenal rupture, 371–372 diagnosis, 368 intramural duodenal hematoma, 372 mechanism of, 368 morbidity, 371 mortality, 371 surgical management, 368–371 enteric injury colon, 58 small bowel, 56, 58 stomach, 56 exploratory laparotomy indications, 360–361 patient preparation, 361 gunshot wounds, 359 hepatic artery injury, 59 initial assessment, 358 liver injury anatomy, 378–379 complications, 382 diagnosis, 379 outcomes, 381–382 treatment, 379–381 minimally invasive surgery, 62–63 pancreas, 56 pancreatic injury anatomic location, 374 anatomy, 372–374 diagnosis, 374–375 mechanism of, 374 morbidity, 377–378 mortality, 377 pancreaticoduodenal injury, 377 physiology, 374 surgical management, 375–377 penetrating trauma, 359 physical examination, 359 portal venous injury, 59 retrohepatic vena caval injury, 59 retrohepatic venous injury, 59–62 retroperitoneal hematoma clinical presentation, 390 diagnosis, 390 morbidity and mortality, 391 traumatic retroperitoneal hematoma, 391 solid organ injury hepatic resection, 52–53 pancreatoduodenal complex, 53–56, 55 splenic injury anatomy and function, 382 diagnosis, 382–383 outcomes, 384 treatment, 383–384 stab wounds, 359–360 stomach and small bowel injury anatomy, 363, 365 colon and rectal injury, 364–365 diagnosis, 363–364 gastric injuries, 364 management, 365–366 pathophysiology, 363 surgical management, 364 thoracoscopy, 63–64 trauma laparotomy, 361 Abdominal vascular injury, 58–59, 59–60 anatomic location, 385–386 exposure and incisions, 386 operative intervention, 386 surgical technique, 386–389 Abdominal wall hernias AWR, 581–582 etiology abbreviated laparotomy, 578 abdominal compartment syndrome, 578–579 abdominal wall loss, 579 absorbable mesh, 579–580 complications, 580–581 mesenteric ischemia, 579 nonabsorbable mesh, 580 plastic closure, 579 severe intra-abdominal infection, 579 skin closure, 580 vacuum closure, 580 reconstruction methods anterior fascia and muscle, 585 anterior rectus fascia, 584–585 mesh types, 582–584 posterior rectus sheath, 585 prosthetic reconstruction, 582 skin flaps, 584 STSG removal, 584 wound closure, 585–586 Absolute neutrophil count (ANC), 742 Acquired immunodeficiency syndrome (AIDS), 738 ACS (see Abdominal compartment syndrome (ACS)) Acute abdomen acute appendicitis, 477 acute mesenteric ischemia, 477 acute pancreatitis, 477 angiography, 476 bowel obstruction, 478 clostridium difficile colitis, 478 colonoscopy/sigmoidoscopy, 477 computed tomography scan, 476 DPL, 476–477 endoscopy, 477 hepatobiliary imaging, 477 history, 471–473 IAH/ACS, 478–479 laboratory data, 475–476 laparoscopy, 477 magnetic resonance imaging, 476 ovarian/uterine pathology, 478 peptic ulcer disease, 478 physical exam, 473–475 unique populations bowel obstruction, 479 cholecystitis, 479 pregnancy, 479 PTLD, 480 Acute aortic dissection, 123 Acute appendicitis, 104, 106, 108 Acute care surgery advance directives blood transfusion, 796 DNR/DNI orders, 794 health care proxy, 794 informed consent, 795 refusal of consent, 795 blunt splenic injury splenectomy, 17 splenorrhaphy, 17–18 blunt trauma, 15 colon, 12 commonly encountered disease, 21t confidentiality, 797–798 core management principles definitive management, 1–2 early intervention, 1–2 end point–guided resuscitation, 1–2 expeditious initial assessment, 1, 2t damage control strategy, 14–15 diagnostic and imaging techniques computed tomography, 15–16, 16t focused abdominal sonography, 15 ethics and law, 793 ethics curriculum, 798 gallbladder, 13, 13t general principles compartment syndrome, 415–417 deep vein thrombosis, 417 initial care, 414 open fractures, 414–415 pulmonary embolism prevention, 417 vascular injury, 417 genitourinary system, 13–14 hemodynamically stable and unstable patient, 10–12 injuries, management of damage control orthopedics, 418 diaphyseal fractures, 419–420 extremity fractures, 417–418 periarticular fractures, 420 intestine, 20, 20t–21t intra-abdominal packing, 14–15 knee dislocations, 422–423 liver, 13, 13t, 19–20 lung and chest wall, 20 mangled lower extremity, 423–424 817 Britt_Index.indd 817 3/9/2012 3:49:02 PM 818 Index Acute care surgery (Continued) medical-industrial complex, 796–797 medical procedures, 798–799 nonoperative management, 17 pain management, 796 palliative care, 798 pancreas, 13 pelvic fractures classification, 421 clinical evaluation, 420–421 incidence, 420 radiographic evaluation, 421 treatment, 421–422 penetrating abdominal injuries, 10–12 physical examination, primary survey airway assessment/management, 4–5 breathing, circulation assessment, disability assessment/management, exposure/environmental control, retroperitoneal hematoma, 14 secondary survey, 5–6 small intestine, 12 spleen, 13, 16 stomach/duodenum, 12 surgeon and medical ethics, 793 surgical curriculum, 793–794 topography and clinical anatomy, 6–8 training American Association for the Surgery of Trauma, 24 clinical component, 23 curriculum, 23, 24t operative management principles, 24, 25t–26t technical procedure requirements, 24, 25t–26 trauma surgery, 26–27 training years, 797 trauma setting, unexpected finding, 796 unplanned encounter, 794 Acute cholecystitis, 804–805 Acute diverticulitis, 122 Acute epidural hematoma, 287 Acute illness and injury cardiovascular, 29 hematologic, 31–32 hepatic and metabolic, 32 injury mediator, 32 neurologic, 31 pulmonary, 29–31 renal, 31 Acute interstitial nephritis (AIN), 697 Acute kidney injury (AKI), 96 contrast nephropathy, 699–700 countercurrent multiplication, 694 etiologies of, 696 intrinsic, 695, 697 loop of Henle, 694 postrenal detection of, 697 prevention of, 697–699 prerenal azotemia, 695 prognosis of, 705 rhabdomyolysis, 699 RIFLE criteria, 695t treatment complications, 702–704 intrinsic and postrenal causes, 702 medication dosing, 704 oliguria, evaluation of, 701–702 prerenal etiology, 702 Acute liver failure (ALF) cardiovascular, 687 Britt_Index.indd 818 encephalopathy, 685–686 gastrointestinal/metabolic, 687 hematologic, 687 infection, 687 portal hypertension ascites, 690–691 hepatorenal syndrome, 392 upper GI bleeding, 688–690 renal failure, 687 respiratory, 687 transplantation and prognosis, 687–688 Acute lung injury (ALI), 95 Acute pancreatitis (AP), 120 ACS, 550 antibiotic prophylaxis, 550 biochemical markers, 546–547 cholecystectomy, 549–550 classification and prognosis of, 548–549 clinical findings, 546 contrast-enhanced computed tomography, 547 early phase interventions, 550 enteral nutrition, 550 epidemiology, 544 ERCP and sphincterotomy, 551 etiology and pathogenesis alcohol-induced pancreatitis, 544 autoimmune pancreatitis, 545 hereditary pancreatitis, 545 infectious agents, 545 mechanical etiology, 544 metabolic disorders, 544–545 pharmacologic agents, 544 EUS, 548 hemorrhage, 552 inflammatory process, 545 late-phase interventions, 551–552 medical approaches, 551 mild acute pancreatitis, 549 MRI/MRCP, 547 Acute Physiology and Chronic Health Evaluation (APACHE), 631 Acute renal dysfunction, 96 Acute respiratory distress syndrome (ARDS), 636 Acute respiratory dysfunction ARDS, 638–639 chest wall trauma, 639–640 fat embolism, 641 hemothorax, 639 inhalation injuries, 641 laryngotracheal trauma, 640 physiology hypoxemia, 636 perioperative and neurologic impairment, 636–637 shock, 637 ventilatory failure, 636 pneumothoraces, 639 pulmonary embolism, 640–641 special populations children, 637–638 elderly, 638 obesity, 638 pregnancy, 638 thoracostomy tube placement, 641–642 Acute subdural hematoma, 287 Acute traumatic aortic injury (ATAI), 113, 113 Acute traumatic coagulopathy, 135 Acute tubular necrosis (ATN), 695 Adult respiratory distress syndrome (ARDS), 659 Advance care planning advance medical directives barriers, 789 health care proxy, 789 living will, 787 myths and facts, 788 treatment decisions, 787 web sites, 789 history, 787 special circumstances decision-making, 790 end-of-life medical decisions, 790–791 terminology autonomy, 785 beneficence, 785–786 informed consent, 785 Advanced cerebral monitoring, 290 AeroEMS (AEMS), 224 Airway management, 329 airway adjuncts, 81–82 artificial airway, 79 awake intubation, 86–87 basics, 79 cervical spine precautions, 86 common devices, 79–80 definitions, 79 documentation, 84 endotracheal intubation, 82–84, 83 esophageal–tracheal combination tubes, 86 history, 79 invasive approaches open tracheostomy, 88 percutaneous tracheostomy, 88 tracheostomy, 87–88 laryngeal mask airway, 86 mask ventilation, 80–81, 80t pediatric considerations, 88, 89, 89t pharmacology and rapid sequence induction, 88–90 placement timing, 79–80 AIS (see Abbreviated Injury Scale (AIS)) AKI (see Acute kidney injury (AKI)) Alcohol, 248–249 ALF (see Acute liver failure (ALF)) ALI (see Acute lung injury (ALI)) Amebic colitis, 517–518 American College of Surgeons (ACS), 762, 794 American Medical Association (AMA), 797 American Medical Student Association (AMSA), 797 Aminoglycoside therapy, 177–178 Aminoglycosides, 182–183 Amrinone, 40 Analgesia, 94 Anatomic injury systems AIS, 801 anatomic profile, 802 ISS, 801–802 NISS, 802 Anatomic profile (AP), 802 ANC (see Absolute neutrophil count (ANC)) Anemia, 127 Angiography, 330–331 Anorectal abscess and inflammatory process acute anal fissure, 576 chronic anal fissure, 576 Crohn’s disease, 574 Fournier’s gangrene, 575–576 hemorrhoids, 576–577 high abscesses, 574 low abscesses, 574 pilondial cyst/abscess, 577 primary fistulotomy, 575 ANP (see Atrial natriuretic peptide (ANP)) Anterior cord syndrome, 311 Antibiotics antifungal therapy, 187t–189t, 190, 190t beta-lactam, 181 carbapenems, 182 empiric therapy 3/9/2012 3:49:02 PM Index antibiotic choice, 176, 178t optimization, 176–179, 178, 179t hepatic insufficiency, 185, 185t infection control, 169 infection evaluation, 175, 175t lipoglycopeptides cyclic lipopeptides, 182 polymyxins, 182 microbial ecology management, 180–181 monobactams, 181 pharmacodynamics, 170, 170–171 pharmacokinetics, 169–170, 170 prophylaxis, 171–175, 173t–174t central venous catheters, 186 invasive Candida infection, 186, 187t solid organ transplantation, 186, 188–189t protein synthesis inhibitors aminoglycosides, 182–183 cytotoxic antibiotics, 184 fluoroquinolones, 183–184 macrolide–lincosamide–streptogramin family, 183 tetracyclines, 183 trimethoprim–sulfamethoxazole, 184 renal insufficiency, 185, 185t therapy duration, 179–180 toxicities beta-lactam allergy, 184 nephrotoxicity, 184 ototoxicity, 184–185 “Red Man” syndrome, 184 Anticonvulsants, 291 Antidiuretic hormone (ADH), 751 Antimediator therapy, 652–653 Antiplatelet therapy, 674 Aortic injuries, 354–355 Aortic occlusion, 124 AP (see Acute pancreatitis (AP)) APACHE (see Acute Physiology and Chronic Health Evaluation (APACHE)) Appendicitis acute care surgeon, 542 anatomy, 538 appendiceal adenocarcinoid, 540 carcinoid, 540 diagnosis, 538–539 embryology, 538 epidemiology, 538 history, 538 immunosuppressed patients, 540 inflammatory bowel disease, 540 laboratory data, 539 mucocele/mucinous cystadenoma, 540 operative procedure, 540–542 pathophysiology, 538 pregnancy, 540 radiology, 539–540 ARDS (see Adult respiratory distress syndrome) Arrhythmias, 96 Arterial lactate, 42 Aspirin, 674 Asymptomatic bacteriuria (ASB), 724 ATAI (see Acute traumatic aortic injury (ATAI)) Atlantoaxial joint injuries, 307 ATN (see Acute tubular necrosis) Atrial natriuretic peptide (ANP), 700 Awake intubation, 86–87 Azotemia, 157 Aztreonam, 181 B BAC (see Blood alcohol concentration (BAC)) Backboard immobilization, 229 Barbiturate therapy, 289 Base defecit, 42 Britt_Index.indd 819 Bedside tracheostomy, 808–810 Bernoulli Theorem, 228, 228t Beta-blockade, 95–96 Beta blocker therapy, 674–675 Beta-lactam allergy, 184 Bilevel positive airway pressure (BIPAP), 638 Biliary tract disorders arterial anatomy, 554–55 biliary anatomy, 554 cardiac physiology, 555 CBD cholangitis, 559–560 choledocholithiasis, 558–559 cholangiography, 556 coagulation, 555 computed tomography, 556 gallbladder disorders acalculous cholecystitis, 557 acute cholecystitis, 557 asymptomatic cholelithiasis, 556 biliary colic, 556 emphysematous cholecystitis, 558 gallstone ileus, 558 gangrenous cholecystitis, 557 hydrops, 558 Mirizzi’s syndrome, 557 pregnancy, 558 immune system, 555 Biochemical markers, 36 BIPAP (see Bilevel positive airway pressure (BIPAP)) Bladder injury, 118 Bladder trauma epidemiology, 405–406 initial evaluation, 406 management, 406–408 pathophysiology, 406 Blast injuries, 232, 240 Blood alcohol concentration (BAC), 248 Blood pressure, 35 Blood transfusion coagulopathy, 142 delayed resuscitation, 142 hemorrhage control, 144 hemostatic resuscitation, 143 hypotensive resuscitation, 142 massive transfusion, 141–143 RBC efficacy, 144–145, 145 strategies, 142 Blunt and penetrating neck injury Blunt cardiac injuries, 353–354, 354–355 Blunt injuries angiography, 333 carotid injuries, 334–335 cerebrovacular injury management, 333–334 clinical presentation, 333 color flow doppler, 333 CT and oral contrast studies, 333 endoscopy, 333 epidemiology, 332 nonoperative management, 338 operative management, 338 plain radiographs, 333 vertebral arteries, 335, 337, 338 Blunt splenic injury splenectomy, 17 splenorrhaphy, 17–18 Blunt trauma acute care surgery, 15 blast force, 232 falls, 232 motorcycle collisions, 232 penetrating trauma, 232 vehicular collisions, 230–232 BMI (see Bowel and mesenteric injury (BMI)) 819 Bowel and mesenteric injury (BMI), 116 Brain death, 292 Brown-Sequard syndrome, 311 Burns epidemiology, 438–439 fluid administration compartment syndromes, 447 edema, 447 escharotomy incision, 446 hyperkalemia, 447 MLCK, 448 Rule of Ten, 445 TBSA, 443 inhalation injury airway management, 449 gastrointestinal responses and complications, 451 mechanical ventilation, 449–450 pathophysiology, 448 local effects, 439–441 organ system support neurological deficits, 451 pain control, 450–451 resuscitation priorities, 443 systemic response, 441–443 transportation and transfer, 465–466 wound care bitumen injury, 460 burn wound excision and grafting, 454–456 cold injury, 460 complications, 464–465 electric injury, 458–459 initial wound care, 451–452 mechanical injury, 462–463 monitoring, 464 nutritional support, 463–464 radiation injury, 461–462 skin substitutes, 456–458 TEN, 462 topical antimicrobial therapy, 452–453 Burst fractures, 307 C C1 fractures, 306–307 C2 fractures, 307 C-reactive protein (CRP), 161 CAP (see Community-acquired pneumonia (CAP)) Cardiogenic shock, 44, 275 Cardiovascular failure and circulatory support anticoagulation, 674 antiplatelet therapy, 674 arrhythmias, 678 aspirin, 674 beta blocker therapy, 674–675 CHF, 677–678 classification of, 672 clopidogrel, 674 ECMO, 676 evaluation of afterload determination, 670 contractility, 670 CVP, 669 EDVI, 670 lactate and base deficit, 670–671 mixed venous oxygen saturation, 670 oxygen delivery, 670 PAC, 669 PAOP, 669 preload determination, 669 transthoracic and transesophageal echocardiography, 670 extrinsic causes of adrenal insufficiency, 680 3/9/2012 3:49:02 PM 820 Index Cardiovascular failure and circulatory support (Continued) drug reactions, 680–682 fat embolism, 680 tension pneumothorax/hemothorax, 680 thyroid dysfunction, 680 fluid resuscitation, 671–672 IABP, 675–676 intrinsic cause of, 672 MAT, 679 myocardial infarction, 672, 674 pharmacologic support, 672 physiology, 669 postoperative bleeding, 674 postoperative MI, 674 PSVT, 679 ST elevation vs Non–ST elevation, 674 troponin leak, 676 Cardiovascular response, 34 Cardiovascular system, 29, 211 Carotid artery injury, 47–48, 48–49 Carotid injuries, 334–335 Cauda equina syndrome, 311 Cavitation, 230 CDC (see Center for Disease Control (CDC)) Celiac axis injury, 59 Cell wall–active agents beta-lactam antibiotics, 181 cyclic lipopeptides, 182 polymyxins, 182 Center for Disease Control (CDC), 801 Centers for Medicare and Medicaid Services (CMS), 780 Central cord syndrome, 311 Central venous catheters, 186 Central venous pressure (CVP), 669 Cephalosporins, 181 Cerebral perfusion pressure, 290 Cerebrovacular injury management, 288, 333–334 Cervical collar, 229 Cervical esophagus, 48, 49 Cervical fractures, 307, 308 Cervical spine management, 286 Chemical injuries, 321–322 Chest injury blunt, 353–354, 354–355 delayed thoracotomy indications, 344 esophageal injury, 352 flail chest, 347 great vessel injuries, 355–356 hemorrhage, 347–348 incision choice, 342, 343t, 344 initial assessment, 341 open chest wounds, 348 operation indication, 341–342 penetrating, 353 pleura and lungs empyema thoracis, 349 hemothorax, 348 pneumothorax, 348 pulmonary contusions, 349 pulmonary lacerations, 349 radiologic adjuncts, 341 rib fractures, 345–346 secondary survey, 341 sternal fractures, 346–347 thoracic damage control, 342, 344 thoracic duct injuries, 352–353 tracheobronchial injuries, 349–352 urgent thoracotomy, 342 Chest trauma, 114 damage-control procedures, 52 emergency department thoracotomy, 48–51, 51 intrathoracic bleeding control, 51–52 Britt_Index.indd 820 thoracic esophagus injury, 52 tracheobronchial injury, 52 Chest wall, 20 Chest x-ray, 274, 274–275 CHF, Congestive heart failure (CHF) Choledocholithiasis, 111 Chronic pulmonary disease, 95 CIN (see Contrast-induced nephropathy (CIN)) Cirrhotic patient, 100–101 Clindamycin, 183 Clopidogrel, 674 Clostridium difficile, 726–727 CME (see Continuing medical education (CME)) CMS (see Centers for Medicare and Medicaid Services (CMS)) CMV (see Cytomegalovirus (CMV)) Coagulopathy, 291 blood transfusion, 142 hypercoagulable states acute traumatic coagulopathy, 135 classification, 134 hemostatic resuscitation, 135 vs hemostatic testing, 137t treatment, 134 Colloids, 40 Colon, 12 Colony stimulating factors (CSFs), 742 Color flow doppler, 331–332 Community-acquired pneumonia (CAP), 718 Complex Crohn’s disease, 110 Compression fractures, 307 Computed tomography head features, 287 mild head injury, 286–287 timing, 287 ocular trauma imaging, 321 penetrating neck injuries, 332 Confusion Assessment Method for the Intensive Care Unit (CAM-ICU), 765 Congestive heart failure (CHF), 96 aortic regurgitation, 678 aortic stenosis, 678 medical treatments, 677 mitral regurgitation, 678 mitral stenosis, 678 right sided heart failure, 677 takotsubo cardiomyopathy, 677 tricuspid regurgitation, 678 uncontrolled hypertension, 677 valvular heart disease, 677–678 Conjunctival lacerations, 322 Continuing medical education (CME), 797 Continuous positive airway pressure (CPAP), 657 Continuous venovenous hemodialysis (CVVHD), 687 Contrast-induced nephropathy (CIN), 96, 700 Controlled hemorrhage, 228 Conus medullaris syndrome, 311 Cornea, 324–325 Corneal abrasion, 321 Corneal foreign body, 321 Corticosteroids, 164–165 CPAP (see Continuous positive airway pressure (CPAP)) CPK (see Creatine phosphokinase (CPK)) Creatine phosphokinase (CPK), 699 Cricothyroidotomy anesthesia, 810 indications, 810 positioning, 810 postoperative care, 810 preoperative preparation, 810 procedure, 810 Cricothyrotomy, 87 Critical illness polyneuropathy syndrome, 651 Crohn’s disease anastomosis, 505 enterocutaneous fistulae, 504 enteroenteral fistulae, 504 infliximab, 503 laparoscopic surgery, 505 pregnancy, 506 preoperative workup, 504 small intestine, 502–503 surgical therapy, 504 Cryoprecipitate transfusion, 140 Crystalloids, 40 CVP (see Central venous pressure (CVP)) CVVHD (see Continuous venovenous hemodialysis (CVVHD)) Cyclic lipopeptides, 182 Cytomegalovirus (CMV), 494, 740 Cytotoxic antibiotics, 184 D Damage control management abdominal sepsis, 74 complications, 73 definitive abdominal closure, 71–73, 72 definitive injury repair, 71 hemorrhage and contamination, 67–69, 68t history and evolution, 66 ICU resuscitation, 69–71 indications, 66–67, 66t open abdominal wounds, 71–73, 72 prehospital care/initial resuscitation, 67 sequence, 67 Daptomycin, 182 Decompressive craniectomy, 288 Deep vein thrombosis (DVT), 732 Definitive medical care, 237–238 Delayed thoracotomy, 344 Dentoalveolar injuries, 298–299, 299 Depressed skull fractures, 288 Diabetic foot infection antibiotic therapy, 592, 594 HBO therapy, 594 osteomyelitis, 595 Diabetic ketoacidosis (DKA), 97 Diagnostic imaging computed tomography, 109–125, 113–125 magnetic resonance imaging, 104–105, 107, 107t, 108–109 ultrasound, 104, 105–107 Diagnostic peritoneal aspiration (DPA), 278 Diagnostic peritoneal lavage (DPL), 476–477 anesthesia, 811 indications, 810–811 operative preparation, 811 postoperative care, 812 preoperative preparation and positioning, 811 procedure, 811–812 DIC (see Disseminated intravascular coagulation (DIC)) Direct laryngoscopy alternatives, 84–86 evaluation and performance, 82–84, 83 Direct medical control, 225 Disability, 279–280, 280t Disaster definition, 234 definitive medical care, 237–238 hospital response, 239–240 incident command, 236–237 phases, 235, 235t planning process, 235, 235–236, 236t recovery, 240t, 241–242, 242t 3/9/2012 3:49:02 PM Index specific injury patterns, 240–241, 240t surgical volunteerism, 242 triage, 238–239, 239t Disseminated intravascular coagulation (DIC), 161 Distributive shock, 44 Do not intubate (DNI), 794 Do not resuscitate (DNR), 794 Dobutamine, 40 Domestic violence, 250–251 Donation after cardiac death (DCD), 750 Donor management goals (DMGs), 760, 760t Dopamine, 40 Doripenem, 182 DPL (see Diagnostic peritoneal lavage (DPL)) Duodenum, 12 DVT (see Deep vein thrombosis (DVT)) E Ebstein-Barr virus (EBV), 747 EBV (see Ebstein-Barr virus (EBV)) EGD (see Esophagogastroduodenoscopy (EGD)) Elderly surgical patient abdomen, 209–210 aging physiologic changes cardiovascular system, 206 gastrointestinal system, 207 neurologic system, 207 pharmacology, 207 pulmonary system, 206 renal system, 206–207 clinical presentation, 207 ethical and end-of-life issues, 210–211 hernias, 210 perioperative management, 207–208 skin and soft tissue, 210 trauma, 208–209 vascular emergencies, 210 Elective surgical practice, informed consent exceptions medical emergencies, 776–777 therapeutic privilege, 777 foundation, 773–774 principles adequate physician disclosure, 774 patient competence, 774–775 patient understanding, 775 undue influence, absence of, 775–776 problems clinical trials, 778 CMS, 780 documentation phase, 779 hernia information sheet, 778–779 information retention, 777 practice-specific consent forms, 780 written materials, 777 Emergency department resuscitative thoracotomy (ED-RT), 341–342 Emergency Medical Treatment and Active Labor Act (EMTALA), 797 acute surgical emergency, 770 communication, 771 disaster situations, 772 document, 772 funding agency, 769 hospital emergency department, 770 immediate life-threatening emergency, 770 innovative dumping, 770 integrated collaborative network, 771 obligations and assumptions, 770–771 regional review process, 772 reversed dumping, 770 transfer centers, 772 trauma, 770 Britt_Index.indd 821 warranty work, 770 Emergency surgery patient operating room, 101, 101 primary survey identification and assessment, 92, 93t resuscitation, 92–94 secondary survey cardiovascular, 95–96, 95t endocrine, 97–98 gastrointestinal, 96 hematology, 96–97 infectious disease, 98, 98t neurology, 94 pulmonary, 95, 95t renal, 96 special patient populations cirrhotic patient, 100–101 morbidly obese patient, 98–99 pregnant patient, 98, 99t septic shock patients requiring emergency laparotomy, 99–100 Empiric antibiotic therapy antibiotic choice, 176, 178t optimization aminoglycoside therapy, 177–178 beta-lactam agents, 177 infections, 178–179 vancomycin, 177, 179t, 180t Empyema thoracis, 349 EMTALA (see Emergency Medical Treatment and Active Labor Act (EMTALA)) Encephalopathy, 685–686, 691–692 End-diastolic volume index (EDVI), 670 Endocrine shock, 45 Endoscopic retrograde cholangiopancreatography (ERCP), 544 Endoscopic Ultrasound (EUS), 548 Endoscopy, 333 Endotracheal intubation, 82–84, 83 Enteric injury colon, 58 small bowel, 56, 58 stomach, 56 Epinephrine, 40 ESBL (see Extended-spectrum beta-lactamase (ESBL)) Esophageal injury, 352 Esophageal perforation, 120 Esophageal–tracheal combination tubes, 86 Esophagogastroduodenoscopy (EGD), 689 Extended-spectrum beta-lactamase (ESBL), 719 Extremities, 279 Extremity trauma, 118 Extremity vascular injuries complications, 435 diagnosis arterial pressure index, 427 imaging studies, 427 physical examination, 427 emergency center, 427–428 endovascular stents, 428 epidemiology, 426 history, 426 nonoperative management, 428 operative management compartment syndromes and fasciotomies, 433–435 extra-anatomic bypass, 432–433 incisions, 428 lower extremity, 431–432 mangled extremity, 433 preliminary/concurrent fasciotomy, 428 preparation/draping, 428 proximal and distal vascular control, 428–429 soft tissue, 433 821 temporary intraluminal vascular shunts, 429 upper extremity, 429–431 pathophysiology, 426 postoperative care, 435 prognostic factors, 426 therapeutic embolization, 428 F Facial fracture, 302–303, 302t Facial nerve, 302 Fasciotomy indications, 814 operative preparation, 814 positioning, 814 postoperative care, 815 procedure, 814–815 Fat embolism syndrome (FES), 641 FES (see Fat embolism syndrome (FES)) FFA (see Free fatty acids (FFA)) FFP (see Fresh frozen plasma (FFP)) Fiberoptic intubation, 271 Flail chest, 274, 347 Flourescein staining, 320, 320 Fluid resuscitation, 163 assessment, 228 energy production, 227–228 field helmet removal, 229 fluid replacement physiology, 228 spinal immobilization, 229 transtracheal airway, 228–229 Fluid therapy, 39–40 Fluoroquinolones, 183–184 Free fatty acids (FFA), 699 Fresh frozen plasma (FFP), 137 G Gabapentin, 204 Gallbladder, 13, 13t Gangrenous cholecystitis, 111 Gastric tonometry, 42 Gastric varices (GV), 688 Gastroesophageal reflux disease (GERD), 494 Gastrointestinal (GI) hemorrhage definition, 482 diagnostic approach blood transfusion, 482 prognostic factors and scores, 483–484 upper gastrointestinal source, 483 epidemiology, 482 nonsurgical diagnostic modalities and interventions abdominal computed tomography angiography, 487 balloon endoscopy, 487 colonoscopy, 484–486 esophagogastroduodenoscopy, 484 intraoperative endoscopy, 487 obscure GI hemorrhage, 487 radionuclide scans, 486–487 visceral angiography and transcatheter treatment, 486 wireless capsule endoscopy, 487 surgical considerations and procedures aortoenteric fistulae, 490–491 colonic angiodysplasia, 491 colonic diverticular disease, 491 gastric and duodenal bleeding, 491 gastroesophageal varices, 489–490 ischemic colitis, 491–492 Meckel’s diverticulum, 492 peptic ulcer disease, 488–489 sinistral portal hypertension, 490 stress-related mucosal disease, 489 3/9/2012 3:49:02 PM 822 Index Gastrointestinal (GI) tract caustic injury, 497–498 colon amebic colitis, 517–518 anatomy/physiology, 510–511 bacterial enterocolitides, 516 C difficile, 514–516 cytomegalovirus colitis, 516–517 diagnostic imaging, 512 differential diagnosis, 512 infectious colitides, 514 inflammatory bowel disease, 519–521 ischemic colitis, 518–519 management, 512–514 pathophysiology, 511 symptoms/clinical manifestations, 511–512 colonic inflammation epiploic appendages, 521 neutropenic enterocolitis, 521 radiation proctitis, 521–522 esophageal perforation, 496–497 esophagitis bacterial etiologies, 494–495 candida esophagitis, 494 eosinophilic esophagitis, 495 GERD, 494 iatrogenic causes, 495 pill esophagitis, 495 radiation, 495 uncommon inflammatory disorders, 495 viral esophagitis, 494 stomach and small intestine Crohn’s disease, 502–506 duodenal diverticulum, 508–509 enterocutaneous fistula, 506–507 gastroduodenal perforation, 498–500 iatrogenic perforation, 502 infectious enteritis, 507–508 jejunoileal diverticula, 509 marginal ulcer, 500–502 Meckel’s diverticula, 509 small bowel diverticular disease, 508 Gastrointestinal intolerance, 157–158 Gastrointestinal system, 212 Gastrointestinal tract foreign bodies foreign body ingestion battery ingestions, 566 drug packets, 569 esophagogastroduodenoscopy, 566 Foley’s catheter extraction, 568 Glucagon, 568 management scheme, 566 oropharynx, 568 radiographic imaging, 566 Rapunzel syndrome, 568–569 foreign body insertion clinical management, 570–571 complications, 572 extraction methods, 571–572 rectal FB, 569, 569 surgical management, 572 transanal removal, 571 lower esophageal sphincter, 565 surgical intervention, 565 Genitourinary system, 13–14 Genitourinary trauma bladder trauma epidemiology, 405–406 initial evaluation, 406 management, 406–408 pathophysiology, 406 genital skin loss, 412 renal trauma epidemiology, 397 initial evaluation, 397 management, 397–402 Britt_Index.indd 822 pathophysiology, 397 ureteral trauma diagnosis, 402–404 epidemiology, 402 urethral trauma anatomy/epidemiology, 408 initial evaluation, 408–409 management, 409–410 pathophysiology, 408 GERD (see Gastroesophageal reflux disease (GERD)) GFR (see Glomerular filtration rate (GFR)) GI (see Gastrointestinal (GI) hemorrhage) Glasgow Coma Scale (GCS), 279, 280t, 651 Glasgow Coma Score (GCS), 800 Glide scope, 271 Glomerular filtration rate (GFR), 694 Glucose, 150 Glutamine, 158 Great vessel injuries, 355–356 GV (see Gastric varices (GV)) H HAP (see Hospital-acquired pneumonia (HAP)) Hazard vulnerability analysis (HVA), 235–236 HBO (see Hyperbaric oxygen (HBO)) Heart rate, 35 Hematologic abnormalities platelet disorders thrombocytopenia, 127–133 thrombocytosis, 133–134 red blood cell disorders, 127, 128t Hematologic system, 212 Hematopoietic cell transplantation, 743 Hemoperitoneum, 104, 107 Hemorrhage, 347–348 Hemorrhagic shock, 275, 275t Hemostatic resuscitation, 143 Hemothorax, 348 Heparin-induced thrombocytopenia (HIT), 130, 131t–133t Hepatic artery injury, 59 Hepatic insufficiency, 185, 185t Hepatic resection, 52–53 Hepatorenal syndrome (HRS), 687, 692 Hernias, 210 HIT (see Heparin-induced thrombocytopenia (HIT)) HIV (see Human immunodeficiency virus (HIV)) Homicide, 250 Hospital-acquired pneumonia (HAP), 718 HRS (see Hepatorenal syndrome (HRS)) Human immunodeficiency virus (HIV), 738 HVA (see Hazard vulnerability analysis (HVA)) Hydronephrosis, 104, 105 Hyperbaric oxygen (HBO), 594 Hypercoagulable states acute traumatic coagulopathy, 135 classification, 134 coagulopathies, 134–135 hemostatic resuscitation, 135 treatment, 134 Hyperglycemia, 97, 157, 291 Hyperosmolar therapy, 289 Hypertension, 95 Hypertonic saline, 289 Hypertriglyceridemia, 157 Hyperventilation, 289 Hypoglycemia, 291 Hypotensive resuscitation, 142 Hypothermia, 290 clinical considerations, 710–711 definitions and measurement, 707 physiology cardiovascular system, 709 coagulation, 709 gastrointestinal, 709 hypothalamus, 708 metabolic activity, 707 neurologic, 709 renal/electrolytes, 709 respiratory system, 709 prevalence and risk factors, 707 rewarming active, 711–714 afterdrop, 714 frostbite, 714 methods of, 711 passive, 711 therapeutic uses of drowning, 715 emergency preservation and resuscitation, 716 post–cardiac arrest conditions, 715 spinal cord injury, 715–716 TBI, 714–715 Hypothermic management, 314 Hypovolemic shock, 43, 43t, 119, 275 Hypoxemia, 636 I IABP (see Intraaortic balloon pump therapy (IABP)) IAH (see Intraabdominal hypertension (IAH)) IC (see Incident commander (IC)) ICISS (see International classification of disease injury severity score (ICISS)) ICS (see Incident command structure (ICS)) ICU (see Intensive care unit (ICU)) IED (see Improvised explosive device (IED)) IH (see Intracranial hypertension (IH)) Iliac artery aneurysms (IAAs), 617 Immunocompromised patient aging and malnutrition, 743–744 autoimmune disorders, 741–742 burns/critical illness, 744 CMV infection, 746 diabetes, 744 diagnosis, 744 fungal infection, 746 hematopoietic cell transplantation, 743 HIV/AIDS, 742–743, 747 immune system, 738 neutropenia, 742 operative considerations, 745 organ transplantation, 738–740 pneumocystis jiroveci, 746 polyoma (BK) virus, 746 postoperative management, 745–746 preoperative management, 744–745 profound immunosuppression vs relative immunosuppression, 738 rejection, 747 substance abuse, 744 surgical disease process gastrointestinal cytomegalovirus infection, 747–748 necrotizing soft tissue infection, 748 neutropenic enterocolitis, 747 PTLD, 747 Immunonutrition, 158 Improvised explosive device (IED), 229 Incident command structure (ICS), 236–237 Incident commander (IC), 237 Indirect medical control, 225 Infections of skin and soft tissue (SSTI) diabetic foot infection antibiotic therapy, 592, 594 HBO therapy, 594 3/9/2012 3:49:02 PM Index osteomyelitis, 595 MRSA, 589–591 NSTI diagnosis, 600 etiology, 599 microbiology, 599–600 treatment, 600–602 surgical site infection diagnosis and treatment, 598–599 epidemiology, 595–597 microbiology, 597 preoperative preparation, 598 uncomplicated infections, 589 Inferior vena cava (IVC) filter indications, 815 procedure, 815 retrievable, 815 Inflammatory response, 35 Informed surgical consent acute surgical practice blanket consent approach, 781 decision making, 781 emergency exemption, 780 emergency patients, 782 ICU, 780 patients physical and emotional state, 783 urgent surgery, 781 elective surgical practice exceptions, 776–777 foundation, 773–774 principles, 774–776 problems, 777–780 Infrahepatic vena cava, 59, 61 Inhalation injury airway management, 449 gastrointestinal responses and complications, 451 mechanical ventilation, 449–450 pathophysiology, 448 Injury prevention alcohol, 248–249 child car seat restraints, 248 classification, 245–246 domestic violence, 250–251 elderly patient, 249 evaluation, 247, 247 foundation of, 244–245, 245t–246t helmets, 249 homicide, 250 intentional, 249–250 safety belts and airbags, 248 scope of problem, 244, 245 suicide, 250 traffic regulations, 248 types of efforts, 246–247 unintentional, 247 Injury severity score (ISS), 801–802 Innominate vessel injury, 47, 48 Intensive care unit (ICU), 790–791 critical care system, 629 hyperosmolar therapy, 289 hypertonic saline, 289 hyperventilation, 289 intracranial pressure, 289 organ injury antibiotic stewardship programs, 634 cardiovascular risk management, 632–633 endocrine support, 633 nutritional provision, 633–634 renal management, 633 respiratory management, 632 sedation and delirium management, 632 transfusion practice, 633 peritonitis, 631 severity of illness, 631 therapeutic interventions, 629–631 Britt_Index.indd 823 International classification of disease injury severity score (ICISS), 804 Intestinal obstruction and dysmotility syndromes adhesive small-bowel obstruction, 531–532 adjunctive tests computed tomography, 529 radiographic modalities, 529–530 sigmoidoscopy, 530 bowel obstruction, 532 diagnosis and evaluation, 527 diagnostic studies laboratory studies, 528 plain radiographs, 528 hernia, 533 ileus, 535 inflammatory conditions, 533–534 intestinal obstruction, 532 malignant bowel obstruction, 534–535 mechanical obstruction, 531 partial colonic obstruction, 534 pathophysiology, 527 physical examination and initial management, 527–528 pseudo-obstruction, 535 strangulation and closed-loop obstruction, 533 surgery, determination of, 530–531 surgical adhesiolysis, 532 volvulus, 533 Intestine, 20, 20t–21t Intimate partner violence (IPV), 250–251 Intraabdominal hypertension (IAH), 478–479 Intraaortic balloon pump therapy (IABP), 675–676 Intracranial hypertension (IH), 685–686 Intracranial pressure, 289 Intraocular foreign body, 325 Invasive hemodynamic monitoring, 36–37, 36t–37t Invasive oxygen transport monitoring, 37–38, 38t IPV (see Intimate partner violence (IPV)) Ischemic bowel, in pregnancy, 108 Ischemic colitis, 518–519 Isoproterenol, 40 K Ketamine, 204 Kinetic energy, 229 King Laryngeal tube, 269 L Large bowel obstruction, 123 Laryngeal mask, 269 Laryngeal mask airway, 86 Laryngotracheal injuries clinical presentation, 337–338 epidemiology, 337 Laryngotracheal trauma, 640 Lens subluxation, 323, 323–324 Lid lacerations, 322–323 Linezolid, 183 Lipids, 150 Lipoglycopeptides cyclic lipopeptides, 179t, 182 polymyxins, 182 Liver, 13, 13t nonoperative management, 19 operative management, 19–20 LMWH (see Low molecular weight heparin (LMWH)) Long-term acute care facilities, 256 Low molecular weight heparin (LMWH), 732 Lung, 20 823 M MADD (see Mothers against drunk driving (MADD)) Magnetic resonance cholangiopancreatography (MRCP), 547 Magnetic resonance imaging (MRI), 287, 319t, 321, 547 Mandible fractures, 300, 300–301 Mass casualty definition, 234 definitive medical care, 237–238 hospital response, 239–240 incident command, 236–237 phases, 235, 235t planning process, 235, 235–236, 236t recovery, 240t, 241–242, 242t specific injury patterns, 240–241, 240t surgical volunteerism, 242 triage, 238–239, 239t Mass lesion, 287–288 Massive hemothorax, 273 Massive transfusion, 141–143 MAT (see Multifocal atrial tachycardia (MAT)) Maxillary fractures, 300, 300 Maxillofacial injury deficit and environment, 295–296 initial assessment airway, 295 breathing, 295 circulation, 295 secondary survey dentoalveolar injuries, 298–299, 299 facial fracture antibiotics, 302–303, 302t mandible fractures, 300, 300–301 maxillary fractures, 300, 300 nasal fractures, 301 nerve, 302 ocular injuries, 301–302 orbital fractures, 299–300 parotid gland injury, 302 soft tissue injuries, 297 zygoma fractures, 301 MCS (see Monte Carlo simulation (MCS)) Mechanical ventilator support delirium, 661 ECMO, 663, 665 endotracheal tube, 657 inhalational therapy, 665 modes of, 658–659 neuromuscular blockade, 661–663 noninvasive ventilation, 657 oxygenation heliox, 663 nitric oxide, 663 prone ventilation, 663 pharmacologic approach, 659–661 sedation and anxiety, 661 surfactant therapy and liquid ventilation, 665 VAP, 665–666 Meropenem, 182 Mesenteric ischemia, 125 Metronidazole, 184 MI (see Myocardial infarction (MI)) MIC (see Minimal inhibitory concentration (MIC)) Micronutrients, 150 Mild head injury, 286–287 Milrinone, 40 Minimal inhibitory concentration (MIC), 170 Minimally invasive surgery, 62–63 Mixed venous oxygen saturation (SvO2), 42 MLCK (see Myosin light chain kinase (MLCK)) MODS (see Multiple organ dysfunction syndrome (MODS)) MOF (see Multiple organ failure (MOF)) Monobactams, 181 3/9/2012 3:49:02 PM 824 Index Monte Carlo simulation (MCS), 176 Morbidly obese patient, 98–99 Mothers against drunk driving (MADD), 249 Motorcycle collisions, 232 Multifocal atrial tachycardia (MAT), 679 Multiple organ dysfunction syndrome (MODS), 700 epidemiology, 645–646 historical perspectives, 644–645 induced pluripotent stem cells, 654 management, 652–653 organ system manifestations cardiovascular failure, 650 diagnosis, 651–652 GCS, 651 gut-motor hypothesis, 651 hepatic dysfunction, 651 lung inflammation, 650 pathophysiology, 648–650 Multiple organ failure (MOF), 161 Musculoskeletal injuries, 282 Myocardial infarction (MI), 672, 674 Myosin light chain kinase (MLCK), 448 N NAFLD (see Nonalcoholic fatty liver disease (NAFLD)) Nasal fractures, 301 National Trauma Data Bank (NTDB), 735 NDD (see Neurologic determination of death (NDD)) Neck injuries blunt angiography, 333 carotid injuries, 334–335 cerebrovacular injury management, 333–334 clinical presentation, 333 color flow doppler, 333 CT and oral contrast studies, 333 endoscopy, 333 epidemiology, 332 nonoperative management, 338 operative management, 338 plain radiographs, 333 vertebral arteries, 335, 337, 338 laryngotracheal injuries clinical presentation, 337–338 epidemiology, 337 nonoperative management, 338 operative management, 338 penetrating airway management, 329 anatomical zones, 329 angiography, 330–331 color flow doppler, 331–332 computed tomography, 332 epidemiology, 329 esophageal studies, 332 hemorrhage initial control, 329 initial evaluation, 330, 331t laryngotracheal evaluation, 332 nervous system injuries, 330 operative vs nonoperative management, 332 protocolized approach, 330 pharyngoesophageal injuries, 338–339 Neck trauma carotid artery injury, 47–48, 48–49 cervical esophagus, 48, 49 innominate and subclavian vessel injury, 47, 48 venous injury, 48 vertebral artery injury, 48, 50 Necrotizing soft tissue infections (NSTIs), 599 diagnosis, 600 etiology, 599 Britt_Index.indd 824 microbiology, 599–600 treatment, 600–602 Nephrotoxicity, 184 Nervous system injuries, 330 Neurocognitive rehabilitation services, 255 Neurogenic shock, 275 Neurohumoral response, 34 Neurologic determination of death (NDD), 751 Neuromuscular blocking agents (NMBAs), 662 Neutropenia, 742 New Injury Severity Score (NISS), 802 NISS (see New Injury Severity Score (NISS)) Nitrogen balance, 149 Nitroglycerin, 42 Nitroprusside, 40 NMBAs (see Neuromuscular blocking agents (NMBAs)) Nonalcoholic fatty liver disease (NAFLD), 688 Nonoperative management, 314–315 Nonsteroidal anti-inflammatory drugs (NSAID), 200, 201t Nontraumatic vascular emergencies acute aortic dissection, 623 arterial ischemia etiologies of, 618t lower limb ischemia, 619–620 popliteal artery aneurysm, 620 upper extremity ischemia, 620 arterial rupture abdominal aortic aneurysms, 614–615 iliac artery, 617 peripheral artery, 617 thoracic aortic aneurysms, 615–617 visceral artery, 617–618 cerebrovascular ischemia carotid artery, 621 great vessels, 620–621 venous emergencies infected internal jugular vein thrombosis, 624 inferior vena cava obstruction, 625 lower extremity deep venous thrombosis, 624 mesenteric vein thrombosis, 624–625 phlegmasia alba/cerulea dolens, 624 portal vein thrombosis, 624 pulmonary embolism, 625 renal vein thrombosis, 625 septic phlebitis, 624 superficial vein thrombosis, 623–624 superior vena cava obstruction, 625 upper extremity deep vein thrombosis, 624 visceral ischemia mesenteric ischemia, 621–622 renovascular ischemia, 622–623 Norepinephrine, 40 Nosocomial infections catheter-related blood stream infection definitions, epidemiology, and risk factors, 722–723 prevention, 723 intra-abdominal infection, 725–726 nosocomial diarrhea, 726–727 pneumonia diagnosis, 719–721 epidemiology, 718 outcomes, 722 pathophysiology, 718–719 prevention, 719 treatment, 721–722 UTI definitions, epidemiology, and risk factors, 723–725 pathogenesis and microbiology, 725 prevention, 725 treatment, 725 NSAID (see Nonsteroidal anti-inflammatory drugs (NSAID)) NSTIs (see Necrotizing soft tissue infections (NSTIs)) NTDB (see National Trauma Data Bank (NTDB)) Nutrition acute surgical illness, 150–151 future aspects, 158 goals calculation, 152, 152t–154t, 154 macro and micronutrients, 154 health normal states, 149–150 immunonutrition, 158 intervention team, 152 intervention therapy, 152 anastomosis protection, 155 bowel sounds, 155 clear fluid diet, 155 enteral nutrition, 156 gastrostomy tubes, 156 jejunostomy tubes, 156 mechanisms, 154 nasoenteric feeding tubes, 156 nasogastric tube utilization, 155 oral intake, 155 total parenteral nutrition, 156 for obese patient, 158 side effects azotemia, 157 gastrointestinal intolerance, 157–158 glucose control, 157 hyperglycemia, 157 hypertriglyceridemia, 157 overfeeding, 156–157 starvation, 151–152 O Obese patient, 158 Obstetric and gynecologic emergencies anesthesia, 608 fetus, 608–609 gynecologic emergencies, 610 management, 613 maternal physiology acid/base, 605 cardiovascular, 605 metabolism, 605, 608 renal, 605 respiratory, 605 non–pregnancy-related conditions ovarian cysts, 612 ovarian torsion, 612 ruptured tuboovarian abscess, 612 vaginal bleeding, 613 postoperative management, 610 pregnancy-related emergencies ectopic pregnancy, 611 spontaneous abortion, 611–612 pregnant patients, 605 preoperative workup, 610 surgical and obstetric emergencies abdominal pain, 609–610 nontraumatic obstetric hemorrhage, 609 preterm birth, 610 trauma, 609 Obstructive shock, 43–44 Occipital condyle fractures, 306 Occupational therapy, 255 Ocular injuries, 301–302 Ocular trauma imaging radiographs, 320 OLT (see Orthotopic liver transplantation (OLT)) Omega fatty acid, 158 3/9/2012 3:49:02 PM Index Open chest wounds, 348 Open pneumothorax, 274 Open tracheostomy, 88 anesthesia, 808 indications, 808 operative preparation, 808 positioning, 808 postoperative care, 808 preoperative preparation, 808 procedure, 808 Open wounds, 277 Ophthalmic injury chemical injuries, 321–322 conjunctival lacerations, 322 cornea, 324–325 corneal abrasion, 321 corneal foreign body, 321 intraocular foreign body, 325 lens subluxation/dislocation, 323, 323–324 lid lacerations, 322–323 ocular trauma imaging computed tomography, 321 magnetic resonance imaging, 319t, 321 radiographs, 320 flourescein staining, 320, 320 history of, 318 ultrasound, 320–321 orbital wall fractures, 324 physical examination direct fundoscopic exam, 320 external exam, 318, 319 motility exam, 318, 319 pupils, 318 slit lamp examination, 318–319 tonometry, 320 visual acuity, 318, 319t retinal injury and vitreous hemorrage retinal commotio, 325 retinal holes/tears/detachment, 325–326 sclera/open globe, 324–325 traumatic hyphema, 323, 323 traumatic iridocyclitis, 324 traumatic optic neuropathy, 327–328 traumatic retrobulbar hemorrhage, 326–327, 327 Opioids, 201 Orbital fractures, 299–300 Orbital wall fractures, 324 Organ donation, 292 Organ donors acute care surgeon donation after death, 750–751 interventions, 757–758 pronouncement, 751 brain death, 751 DMGs, 760, 760t implementation, 754–755 medicolegal and ethical considerations,758–759 optimization, 751–754 organ recovery, 759–760 pathophysiology cold ischemia, 757 preservation solutions, 757t warm ischemia, 755 Organ procurement organizations (OPOs), 751 Organs transplanted per donor (OTPD), 751 Oropharyngeal airway, 269 Orthotopic liver transplantation (OLT), 687 Ototoxicity, 184–185 OTPD (see Organs transplanted per donor (OTPD)) Ovarian torsion, 104, 106 Overfeeding, 156–157 Oxazolidinones, 183 Britt_Index.indd 825 P PAA (see Popliteal artery aneurysm (PAA)) PAC (see Pulmonary artery catheter (PAC)) Pain management, 255–256 assessment, 197, 198–199 classification, 198 epidemiology and scope, 195–196, 196t, 197 paravertebral nerve blocks, 204 pathophysiology, 199, 199 physiology, 196, 197, 198 sciatic nerve block, 204 therapy education, 200 medication, 200, 200–204, 202, 202t–204t Palliative care CAM-ICU tool, 765 compassion fatigue, 765 covenant of care, 764 distributive justice, 764 ethical considerations curative/supportive care, 762–763 futile care, 763 practitioner beneficence, 763 history, 762 intensive care unit, 765, 766t legal aspects, 766–767 overconfidence, 764 PEACE Tool, 765 principles, 762 unbiased surgeon/intensivist, 765, 765t Pancreas, 13, 56 Pancreatic injury anatomic location, 374 anatomy, 372–374 diagnosis, 374–375 mechanism of, 374 morbidity, 377–378 mortality, 377 pancreaticoduodenal injury, 377 physiology, 374 surgical management, 375–377 Pancreatitis, 805–806 Pancreatoduodenal complex, 53–56, 55 PAOP (see Pulmonary artery occlusion pressure (PAOP)) Parenchymal lesions, 287–288 Parotid gland injury, 302 Paroxysmal supraventricular tachycardia (PSVT), 679 Patient-controlled analgesic (PCA), 203 Patient Self-Determination Act, 787 PCA (see Patient-controlled analgesic (PCA)) PCT (see Procalcitonin (PCT)) PE (see Pulmonary embolism (PE)) Pediatric airway, 272 Pediatric surgery anatomy, 214 fluid management, 214 hypovolemia and hemorrhage, 214–215, 214t–215t surgical emergencies, 215–217 trauma, 215 PEEP (see Positive end expiratory pressure (PEEP)) Pelvic inflammatory disease (PID), 612 Pelvic trauma, 117 Pelvis, 279 Penetrating abdominal injuries, 10–12 Penetrating neck injuries (PNI) airway management, 329 anatomical zones, 329 angiography, 330–331 color flow doppler, 331–332 computed tomography, 332 epidemiology, 329 esophageal studies, 332 825 hemorrhage initial control, 329 initial evaluation, 330, 331t laryngotracheal evaluation, 332 nervous system injuries, 330 operative vs nonoperative management, 332 protocolized approach, 330 Penetrating trauma, 232 Penicillins, 181 Percutaneous gastrostomy tube anesthesia, 814 contraindications, 813 indications, 813 operative preparation, 814 positioning, 814 postoperative care, 814 procedure, 814 Percutaneous tracheostomy, 88 Percutaneous transtracheal, 229 Peritonitis, 631, 725–726 Pharmacodynamics, 170, 170–171 Pharmacokinetics, 169–170, 170 Pharyngoesophageal injuries, 338–339 Phenylephrine, 40 Physiatry, 256 Physical therapy, 255 PIGN (see Postinfectious glomerulonephritis (PIGN)) Pilondial cyst/abscess, 577 Plain radiographs, 333 Platelet disorders thrombocytopenia, 127–133 thrombocytosis, 133–134 Platelet transfusion complications, 140 indications, 137–138 technical aspects, 138 Pleura and lungs empyema thoracis, 349 hemothorax, 348 pneumothorax, 348 pulmonary contusions, 349 pulmonary lacerations, 349 Pneumocystis jiroveci, 746 Pneumothoraces, 639 Pneumothorax, 348 PNI (see Penetrating neck injuries (PNI)) Polycythemia, 127 Polymyxins, 182 Popliteal artery aneurysm (PAA), 620 Portal venous injury, 59 Positive end expiratory pressure (PEEP), 70, 638, 659 Posterior cord syndrome, 311 Posterior fossa lesions, 288 Postinfectious glomerulonephritis (PIGN), 697 Posttransplant lymphoproliferative disorder (PTLD), 480, 747 Predisposition, insult, response, organ dysfunction (PIRO) system, 631 Pregnancy patient, 98, 99t normal physiologic changes cardiovascular system, 211 gastrointestinal system, 212 hematologic system, 212 intravascular volume, 211 pulmonary system, 211 renal system, 212 surgical emergencies, 213–214 trauma, 212, 212t Prehospital trauma care assessment and management initial assessment, 225–226 primary survey, 226–227 resuscitation phase, 227 safety, 225 situation, 225 3/9/2012 3:49:02 PM 826 Index Prehospital trauma care (Continued) blunt trauma blast force, 232 falls, 232 motorcycle collisions, 232 penetrating trauma, 232 vehicular collisions, 230–232 communication systems, 224 continuum of care, 219, 220t, 221 definitive care, 219, 220t, 227 designation protocols, 221, 221t education and surgical control, 223 EMS system, 223 EMT-basic, 223 EMT-intermediate, 223 EMT-paramedic, 223–224 history of, 222, 222t kinematics, 229–230 medical control, 225 principles and preferences, 219, 221t protocols vs standing orders, 224–225 rural trauma organization system, 220–221 shock and fluid resuscitation assessment, 228 energy production, 227–228 field helmet removal, 229 fluid replacement physiology, 228 spinal immobilization, 229 transtracheal airway, 228–229 steps of care, 219, 220t time management, 229 Primary blast injury, 240 Primary survey acute care surgery airway assessment/management, 4–5 breathing, circulation assessment, disability assessment/management, exposure/environmental control, identification and assessment, 92, 93t resuscitation airway and breathing, 92–93 circulation, 93–94 endpoints, 94 trauma patient assessment, 268 Principles of medical ethics autonomy, 785 beneficence communication, 785–786 informed decision making, 785 Procalcitonin (PCT), 161–162, 180 Protein balance, 149 Protein synthesis inhibitors aminoglycosides, 182–183 cytotoxic antibiotics, 184 fluoroquinolones, 183–184 macrolide–lincosamide–streptogramin family, 177t, 183 tetracyclines, 183 trimethoprim–sulfamethoxazole, 184 Protein turnover, 149 PSVT (see Paroxysmal supraventricular tachycardia (PSVT)) Psychiatric care, 256 PTLD (see Posttransplant lymphoproliferative disorder (PTLD)) Pulmonary artery catheter (PAC), 669 Pulmonary artery occlusion pressure (PAOP), 669 Pulmonary contusions, 349 Pulmonary embolism (PE), 734–735 Pulmonary lacerations, 349 Pulmonary response, 34–35 Pulmonary system, 211 Pulse oximetry, 36 Pyloroplasty techniques, 501 Britt_Index.indd 826 R Recovery and rehabilitation center of, 256 long-term acute care facilities, 256 multidisciplinary inpatient conference care for caregiver, 256 clinical dietitian, 255 neurocognitive rehabilitation services, 255 occupational therapy, 255 pain management, 255–256 physiatry, 256 physical therapy, 255 psychiatric care, 256 social work, 254–255 speech–language pathology, 255 outpatient and home-based, 257 patient admission, 253 skilled nursing facilities, 256 Red blood cell transfusion complication, 136–137 hemorrhagic shock, 136 indications, 136 technical aspects, 136 Red Man syndrome, 184 Redistributive shock, 275 Refeeding syndrome, 156–157 Renal failure, 31 Renal insufficiency, 185, 185t Renal pedicle, 61–62, 62 Renal replacement therapy (RRT), 694, 702–704 Renal response, 35 Renal system, 212 Renal trauma epidemiology, 397 initial evaluation, 397 management, 397–402 pathophysiology, 397 Resuscitation, 227, 276–277 Retinal commotio, 325 Retinal injury, 325 Retrograde intubation, 271 Retrohepatic vena caval injury, 59 Retrohepatic venous injury, 59–62 Retroperitoneal hematoma, 14 Revised Trauma Score (RTS), 800–801 Rewarming active, 711–714 afterdrop, 714 frostbite, 714 methods of, 711 passive, 711 Rhabdomyolysis, 699 Rib fractures, 345–346 Risk, injury, failure, loss, and end-stage renal failure criteria (RIFLE), 694 Roux-en-Y-gastric bypass (RYGB), 500, 502 RRT (see Renal replacement therapy (RRT)) RTS (see Revised Trauma Score (RTS)) Rural trauma organization system, 220–221 RYGB (see Roux-en-Y-gastric bypass (RYGB)) S SAPS (see Simplified acute physiology score (SAPS)) SCIP (see Surgical Care Improvement Project (SCIP)) Sclera, 324–325 Scoring systems emergency general surgery acute cholecystitis, 804–805 appendicitis, 806–807 diverticulitis, 806 pancreatitis, 805–806 small bowel obstruction, 806 injury AIS, 801 anatomic profile, 802 CDC, 801 field triage systems, 800 GCS, 800 ISS, 801–802 NISS, 802 pediatric trauma score, 801 RTS, 800–801 outcomes ASCOT, 803–804 ICISS, 804 TRISS methodology, 803 Secondary blast injury, 240 Secondary survey acute care surgery, 5–6 cardiovascular, 95–96, 95t endocrine, 97–98 gastrointestinal, 96 hematology, 96–97 infectious disease, 98, 98t neurology, 94 pulmonary, 95, 95t renal, 96 trauma patient assessment, 281–282 Sepsis, 98 abdominal sepsis, 166, 166t coagulation, 161 complement activation, 161 corticosteroids, 164–165 definition, 160 diagnosis, 161–162 early phase management, 162 fluid resuscitation, 163 glucose management, 164 inflammatory response, 160 microbial factors, 160 multiple organ failure, 161 oxygen delivery, 163 pathophysiology, 160 recombinant human activated protein C, 165 septic shock, 162 source control, 166–167 source control and antibiotics, 163–164, 164t supportive ICU care, 165–166 Sepsis-related organ failure assessment (SOFA), 651 Septic shock, 162 Shock cardiogenic, 44, 275 classification, 35, 35t distributive, 44 endocrine, 45 fluid therapy, 39–40 hemorrhagic, 275, 275t hypovolemic, 43, 43t, 275 invasive hemodynamic monitoring, 36–37, 36t–37t invasive oxygen transport monitoring, 37–38, 38t neurogenic, 275 obstructive, 43–44 pathogenesis and organ responses cardiovascular, 34 inflammatory, 35 neurohumoral, 34 pulmonary, 34–35 renal, 35 pharmacological support, 40–42, 42t physiologic monitoring biochemical markers, 36 blood pressure, 35 heart rate, 35 pulse oximetry, 36 3/9/2012 3:49:02 PM Index temperature, 36 urine output, 36 redistributive, 275 resuscitation, 42 assessment, 228 energy production, 227–228 field helmet removal, 229 fluid replacement physiology, 228 spinal immobilization, 229 transtracheal airway, 228–229 Simplified acute physiology score (SAPS), 631 SIRS (see Systemic inflammatory response syndrome (SIRS)) Skin and soft tissue, 210 SMA (see Superior mesenteric artery (SMA)) Small bowel obstruction, 109, 121 Small intestine, 12 Social work, 254–255 SOFA (see Sepsis-related organ failure assessment (SOFA)) Soft tissue injuries, 297 Solid organ injury hepatic resection, 52–53 pancreatoduodenal complex, 53–56, 55 Solid organ transplantation, 186, 188t–189t Special populations elderly surgical patient abdomen, 209–210 aging physiologic changes, 206–207 clinical presentation, 207 ethical and end-of-life issues, 210–211 hernias, 210 perioperative management, 207–208 skin and soft tissue, 210 trauma, 208–209 vascular emergencies, 210 pediatric surgery anatomy, 214 fluid management, 214 hypovolemia and hemorrhage, 214–215, 214t–215t surgical emergencies, 215–217 trauma, 215 pregnancy normal physiologic changes, 211–212 surgical emergencies, 213–214 trauma, 212, 212t Spinal column and spinal cord injury anterior cord syndrome, 311 atlantoaxial joint injuries, 307 bony and ligamentous anatomy, 304–305, 305 Brown-Sequard syndrome, 311 C2 fractures, 307 C1 fractures and transverse ligament injuries, 306–307 cauda equina syndrome, 311 central cord syndrome, 311 clearance, 311–314 clinical presentation, 311 complications, 315–316 conus medullaris syndrome, 311 mechanism, 309, 310–311 morphologic and functional changes, 309–311 occipital condyle fractures, 306 occipitoatlantal dislocation, 306 penetrating spine trauma, 315 physiology, 305–306 posterior cord syndrome, 311 severity/grading, 311 spinal instability, 306 subaxial cervical spine (C3-C7) burst fractures, 307 cervical fractures, 307, 308 compression fractures, 307 Britt_Index.indd 827 therapeutic interventions hypothermic management, 314 nonoperative management, 314–315 pharmacotherapy, 314 surgical management, 315 thoracic spine, 307, 309 thoracolumbar spine, 308–309, 310 Spinal immobilization, 229 Spinal instability, 306 Spleen, 13, 16, 53 Splenectomy, 17 Splenorrhaphy, 17–18 SSTI (see Infections of skin and soft tissue (SSTI)) Sternal fractures, 346–347 Steroids, 291 Stomach, 12 Stress dose steroids, 97–98 Subaxial cervical spine (C3-C7) burst fractures, 307 cervical fractures, 307, 308 compression fractures, 307 Subclavian vessel injury, 47, 48 Suicide, 250 Superficial vein thrombosis (SVT), 623–624 Superior mesenteric artery (SMA), 618 Superior mesenteric vessels, 59 Superior vena cava syndrome (SVCS), 625 Surgical Care Improvement Project (SCIP), 171 Surgical cricothyrotomy, 229 Surgical management cerebrovascular injury, 288 decompressive craniectomy, 288 depressed skull fractures, 288 mass lesion removal, 287–288 penetrating injuries, 288 Surgical prophylaxis, 98 Surviving Sepsis Campaign (SSC), 630 SVCS (see Superior vena cava syndrome (SVCS)) SVT (see Superficial vein thrombosis (SVT)) Systemic inflammatory response syndrome (SIRS), 644 T Takotsubo Cardiomyopathy, 677 TBI (see Traumatic brain injury (TBI)) TEE (see Transesophageal echocardiography (TEE)) Telavancin, 182 TEN (see Toxic epidermal necrolysis (TEN)) Tension pneumothorax, 273 Tertiary blast injury, 240 Tetracyclines, 183 Thoracic cavity, 277, 277–278 Thoracic damage control, 342, 344 Thoracic duct injuries, 352–353 Thoracic spine, 307, 309 Thoracolumbar spine, 308–309, 310 Thoracolumbar trauma, 118 Thoracoscopy, 63–64 Thrombocytopenia diagnostic evaluation, 129–130, 131t heparin-induced thrombocytopenia, 130–133, 131t, 133t treatment, 133 Thrombocytosis causes, 134t definition, 133 treatment, 134 Thromboelastography (TEG), 709–710 Thromboembolic disease diagnosis, 734 IVC fillters, 733 LWMH, 732 827 mechanical devices, 733 pulmonary embolism, 733 screening philosophy and quality, 735–736 treatment, 735 Thromboembolism prophylaxis, 97 Tigecycline, 183 TIPS (see Transjugular intrahepatic portosystemic shunt (TIPS)) Tonometry, 320 Total parenteral nutrition (TPN), 156 Toxic epidermal necrolysis (TEN), 462 TPN (see Total parenteral nutrition (TPN)) Tracheobronchial injuries, 349–352 Tracheostomy, 87–88, 228 Transesophageal echocardiography (TEE), 678 Transfusion therapy cryoprecipitate, 140 fresh frozen plasma, 137 platelet complications, 140 indications, 137–138 technical aspects, 138 red blood cell, 135–137 Transjugular intrahepatic portosystemic shunt (TIPS), 689 Transtracheal airway, 228–229 Trauma abdominal abdominal vascular injury, 58–59, 59–60 celiac axis injury, 59 diagnostic and therapeutic laparoscopy, 63 enteric injury, 56–58, 57 hepatic artery injury, 59 minimally invasive surgery, 62–63 pancreas, 56 portal venous injury, 59 retrohepatic vena caval injury, 59 retrohepatic venous injury, 59–62 solid organ injury, 52–56, 55 thoracoscopy, 63–64 blunt blast force, 232 falls, 232 motorcycle collisions, 232 penetrating trauma, 232 vehicular collisions, 230–232 chest damage-control procedures, 52 emergency department thoracotomy, 48–51, 51 intrathoracic bleeding control, 51–52 thoracic esophagus injury, 52 tracheobronchial injury, 52 damage control (abbreviated laparotomy), 64 elderly surgical patient, 208–209 extremity injuries, 64 neck carotid artery injury, 47–48, 48–49 cervical esophagus, 48, 49 innominate and subclavian vessel injury, 47, 48 venous injury, 48 vertebral artery injury, 48, 50 pediatric surgery, 215 pregnancy patient, 212, 212t in United States civil war deaths, 260t compartment syndromes, 263t Department of Defense, 264 elderly population, 262 lack of general surgeons, 262 military surgery and system, 259 on-call pay, surgeons, 261 rehabilitation, 262 rural surgeons, 263 shock concept, 259 3/9/2012 3:49:03 PM 828 Index Trauma (Continued) surgical coverage, 263 surgical hospitalists, 264–265 surgical mortality, 260t valetudinaria, 259 war wounds, 259 Trauma patient assessment age criteria, 267 airway basic adjuncts, 269, 269 definitive, 270, 271 fiberoptic intubation, 271 glide scope, 271 King Laryngeal tube, 269 laryngeal mask, 269 oropharyngeal, 269 pediatric, 272 retrograde intubation, 271 breathing chest x-ray, 274, 274–275 massive hemothorax, 273 open pneumothorax, 274 tension pneumothorax, 273 circulation abdominal trauma, 278, 278–279 cardiogenic shock, 275 extremities, 279 hemorrhagic shock, 275, 275t hypovolemic shock, 275 localizing blood loss, 277 pelvis, 279 redistributive shock, 275 resuscitation, 276–277 thoracic cavity, 277, 277–278 wounds, 277 clinical criteria, 267 disability, 279–280, 280t exposure, 280–281 mechanism criteria, 267 over and undertriage, 267 patient arrival, 268 primary survey, 268, 281 secondary survey, 281–282 triage concept, 266–267 Trauma team activations (TTAs), 266 Traumatic brain injury advanced cerebral monitoring, 290 anticonvulsants, 291 barbiturate therapy, 289 brain death, 292 cerebral perfusion pressure, 290 coagulopathy, 291 Britt_Index.indd 828 emergency department management airway and breathing, 285 circulation, 285 neurologic assessment, 286 penetrating injuries, 286 emergency radiologic studies cervical spine management, 286 computed tomography, head, 286–287 magnetic resonance imaging, 287 hyperglycemia, 291 hypoglycemia, 291 hypothermia, 290 intensive care unit management hyperosmolar therapy, 289 hypertonic saline, 289 hyperventilation, 289 intracranial pressure, 289 organ donation, 292 outcome prediction, 291–292 penetrating injury, 290 steroids, 291 surgical management cerebrovascular injury, 288 decompressive craniectomy, 288 depressed skull fractures, 288 mass lesion removal, 287–288 penetrating injuries, 288 systemic management, 291 thromboembolic events, 291 Traumatic brain injury (TBI), 714–715 Traumatic diaphragmatic injury, 115 Traumatic hyphema, 323, 323 Traumatic iridocyclitis, 324 Traumatic optic neuropathy, 327–328 Traumatic retrobulbar hemorrhage, 326–327, 327 Trimethoprim–Sulfamethoxazole (TMP–SMX), 184 Truncal vagotomy, 500 Tube thoracostomy anesthesia, 812 indications, 812 operative preparation, 812 positioning, 812 postoperative care, 813 procedure, 812–813 Uniform Anatomical Gift Act (UAGA), 758 United Network for Organ Sharing (UNOS), 750 Urethral trauma anatomy/epidemiology, 408 initial evaluation, 408–409 management, 409–410 pathophysiology, 408 Urgent thoracotomy, 342 Urinalysis (UA), 476 Urinary tract infection (UTI), 723 V Vancomycin, 177, 179t, 180t, 184 Vascular emergency, 210 Vasopressin, 40 Vehicular collisions, 230–232 Venous injury, 48 Venous thromboembolism (VTE), 732 Ventilation, 229 Ventilator-associated pneumonia, 665–666 Vertebral arteries, 335, 337, 338 Vertebral artery injury, 48, 50 Visual acuity, 318, 319t Visual Acuity Scale (VAS), 796 Vitreous hemorrage, 325–326 VTE (see Venous thromboembolism (VTE)) W World Health Association, 200 Wound care bitumen injury, 460 burn wound excision and grafting, 454–456 cold injury, 460, 461 complications, 464–465 electric injury, 458–459 initial wound care, 451–452 mechanical injury, 462–463 monitoring, 464 nutritional support, 463–464 radiation injury,461–462 skin substitutes, 456–458 TEN, 462 topical antimicrobial therapy, 452–453 Wounds, 277 U UA (see Urinalysis (UA)) Ultrasound, 104, 105–107 Uncontrolled hemorrhage, 228 Z Zygoma fractures, 301 3/9/2012 3:49:03 PM ... PRINCIPLES Acute Care Surgery: General Principles 19 SECTION 2: TRAUMA 20 L.D Britt Training in Acute Care Surgery 23 Gregory J Jurkovich Pathophysiology of Acute Illness... of Surgery Division Chief Acute Care Surgery (Trauma, Burn, Critical Care, Emergency Surgery) Director, Trauma and Surgical Critical Care Associate Chair Department of Surgery University of Michigan... Bradley A Erickson and Jack W McAninch 30 Acute Care Surgery: Skeletal and Soft-Tissue Injury 414 Nutrition in Acute Care Surgery 149 Gustavo X Cordero,