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E-raamat: Manual of Definitive Surgical Trauma Care, Fifth Edition

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  • Formaat: 464 pages
  • Ilmumisaeg: 22-May-2019
  • Kirjastus: CRC Press
  • ISBN-13: 9781351012850
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Manual of Definitive Surgical Trauma Care, Fifth EditionSuurem pilt
  • Formaat: 464 pages
  • Ilmumisaeg: 22-May-2019
  • Kirjastus: CRC Press
  • ISBN-13: 9781351012850
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Developed for the International Association for Trauma Surgery and Intensive Care (IATSIC), the Manual of Definitive Surgical Trauma Care 5e is ideal for training all surgeons who encounter major surgical trauma on an infrequent basis.
This fifth edition had been revised and updated on the basis of new evidence-based information. The increasing role of non-operative management (NOM) has been recognised. With the increased need for humanitarian intervention, as well as military peacekeeping, the Military Module has been substantially updated and broadened to reflect recent conflict experience, and a new expanded section highlighting trauma management under austere conditions has been added.Written by faculty who teach the DSTC Course, this book  focuses on life-saving surgical techniques to use in challenging and unfamiliar incidents of trauma.
Video Contents xxv
Preface xxvii
Introduction xxxi
Injury Prevention xxxi
Training in the Initial Management of Severe Trauma xxxi
The DSTC™ Course xxxiii
The DATC™ Course xxxiii
Summary xxxiv
Board of Contributors xxxv
Acknowledgements xli
About the Author xliii
Part 1 TRAUMA SYSTEM AND COMMUNICATION PRINCIPLES
1(26)
1 Safe and Sustainable Trauma Care
3(8)
1.1 Introduction
3(1)
1.2 Safe Trauma Care
3(5)
1.2.1 Individual Factors
3(2)
1.2.2 Institutional Factors
5(1)
1.2.3 Performance Improvement Activities
5(1)
1.2.4 Regional Activities
6(1)
1.2.5 National Activities
6(1)
1.2.6 Global Activities
7(1)
1.3 Sustainable Trauma Care
8(1)
1.3.1 Workforce Development
8(1)
1.4 Conclusion
8(3)
2 Communication and Non-Technical Skills for Surgeons (NOTSS) in Major Trauma: The Role of Crew Resource Management (CRM)
11(6)
2.1 Overview
11(1)
2.1.1 The `Swiss Cheese' Theory
11(1)
2.2 Communication in the Trauma Setting
12(1)
2.2.1 Initial Handover
12(1)
2.2.2 Resuscitation and Ongoing Management
12(1)
2.3 Leadership in Trauma Care
13(2)
2.4 Potential Errors Related to Each Behavioural Theme
15(1)
2.5 Summary
15(2)
3 Pre-Hospital and Emergency Trauma Care
17(10)
3.1 Resuscitation in the Emergency Department and Pre-hospital Setting
17(1)
3.2 Management of Major Trauma
17(6)
3.2.1 Resuscitation
17(5)
3.2.2 Management of Penetrating Trauma
22(1)
3.3 Emergency Department Surgery
23(2)
3.3.1 Head Trauma
23(1)
3.3.2 Chest Trauma
23(1)
3.3.3 Abdominal Trauma
24(1)
3.3.4 Pelvic Trauma
24(1)
3.3.5 Long Bone Fractures
24(1)
3.3.6 Peripheral Vascular Injuries
25(1)
3.4 Summary
25(2)
Part 2 PHYSIOLOGY AND THE BODY'S RESPONSE TO TRAUMA
27(52)
4 Resuscitation Physiology
29(20)
4.1 Metabolic Response to Trauma
29(7)
4.1.1 Definition of Trauma
29(1)
4.1.2 Initiating Factors
29(1)
4.1.3 Immune Response
30(3)
4.1.4 Hormonal Mediators
33(1)
4.1.5 Effects of the Various Mediators
34(2)
4.1.6 The Anabolic Phase
36(1)
4.1.7 Clinical and Therapeutic Relevance
36(1)
4.2 Shock
36(13)
4.2.1 Definition of Shock
36(1)
4.2.2 Classification of Shock
36(4)
4.2.3 Measurements in Shock
40(1)
4.2.4 Endpoints in Shock Resuscitation
41(1)
4.2.5 Post-Shock and Multiple Organ Failure Syndromes
42(1)
4.2.6 Management of the Shocked Patient
43(3)
4.2.7 Prognosis in Shock
46(1)
4.2.8 Recommended Protocol for Shock
46(3)
5 Transfusion in Trauma
49(18)
5.1 Indications for Transfusion
49(1)
5.1.1 Oxygen-Carrying Capacity
49(1)
5.2 Transfusion Fluids
49(2)
5.2.1 Colloids
49(1)
5.2.2 Blood
49(1)
5.2.3 Component Therapy (Platelets, Fresh Frozen Plasma, Cryoprecipitate)
50(1)
5.3 Effects of Transfusing Blood and Blood Products
51(2)
5.3.1 Metabolic Effects
51(1)
5.3.2 Effects of Microaggregates
51(1)
5.3.3 Hyperkalaemia
51(1)
5.3.4 Coagulation Abnormalities
51(1)
5.3.5 Other Risks of Transfusion
52(1)
5.4 Current Best Transfusion Practice
53(6)
5.4.1 Initial Response
53(1)
5.4.2 Reduction in the Need for Transfusion
53(1)
5.4.3 Transfusion Thresholds
53(1)
5.4.4 Transfusion Ratios
54(1)
5.4.5 Adjuncts to Enhance Clotting
54(1)
5.4.6 Monitoring the Coagulation Status: Traditional and VHA
54(5)
5.5 Autotransfusion
59(1)
5.6 Red Blood Cell Substitutes
59(2)
5.6.1 Perfluorocarbons
60(1)
5.6.2 Haemoglobin Solutions
60(1)
5.6.3 Future Evolution
60(1)
5.7 Massive Haemorrhage/Massive Transfusion
61(1)
5.7.1 Definition
61(1)
5.7.2 Massive Transfusion Protocol (MTP)
61(1)
5.8 Haemostatic Adjuncts in Trauma
61(6)
5.8.1 Overview
61(2)
5.8.2 Tissue Adhesives
63(1)
5.8.3 Other Haemostatic Adjuncts
64(3)
6 Damage Control
67(12)
6.1 Introduction
67(1)
6.2 Damage Control Resuscitation
68(1)
6.3 Damage Control Surgery
68(9)
6.3.1 Stage 1: Patient Selection
69(1)
6.3.2 Stage 2: Operative Haemorrhage and Contamination Control
70(3)
6.3.3 Stage 3: Physiological Restoration in the ICU
73(2)
6.3.4 Stage 4: Definitive Surgery
75(1)
6.3.5 Stage 5: Abdominal Wall Closure
75(2)
6.3.6 Outcomes
77(1)
6.4 Damage Control Orthopaedics
77(2)
Part 3 ANATOMICAL AND ORGAN SYSTEM INJURY
79(178)
7 The Neck
81(10)
7.1 Overview
81(1)
7.2 Management Principles: Penetrating Cervical Injury
81(2)
7.2.1 Initial Assessment and Definitive Airway
81(1)
7.2.2 Control of Haemorrhage
82(1)
7.2.3 Injury Location
82(1)
7.2.4 Mechanism
83(1)
7.2.5 Frequency of Injury
83(1)
7.2.6 Use of Diagnostic Studies
83(1)
7.3 Management
83(1)
7.3.1 Mandatory versus Selective Neck Exploration
83(1)
7.3.2 Management Based on Anatomical Zones
84(1)
7.4 Access to the Neck
84(7)
7.4.1 Position
84(1)
7.4.2 Incision
84(1)
7.4.3 Surgical Access
85(1)
7.4.4 Priorities
86(1)
7.4.5 Midline Visceral Structures
87(1)
7.4.6 Root of the Neck
88(1)
7.4.7 Collar Incisions
88(1)
7.4.8 Vertebral Arteries
88(3)
8 The Chest
91(26)
8.1 Overview
91(1)
8.2 The Spectrum of Thoracic Injury
91(1)
8.2.1 Immediately Life-Threatening Injuries
91(1)
8.2.2 Potentially Life-Threatening Injuries
91(1)
8.3 Pathophysiology of Thoracic Injuries
92(1)
8.3.1 Paediatric Considerations
92(1)
8.4 Applied Surgical Anatomy of the Chest
93(2)
8.4.1 The Chest Wall
93(1)
8.4.2 The Chest Floor
93(1)
8.4.3 The Chest Contents
93(2)
8.5 Diagnosis
95(1)
8.6 Management of Specific Injuries
96(5)
8.6.1 Damage Control in the Chest
96(1)
8.6.2 Open Pneumothorax
96(1)
8.6.3 Tension Pneumothorax (Haemo/Pneumothorax)
96(1)
8.6.4 Massive Haemothorax
97(1)
8.6.5 Tracheobronchial Injuries
97(1)
8.6.6 Oesophageal Injuries
97(1)
8.6.7 Diaphragmatic Injuries
98(1)
8.6.8 Pulmonary Contusion
98(1)
8.6.9 Flail Chest
98(1)
8.6.10 Fixation of Multiple Fractures of Ribs
98(1)
8.6.11 Pulmonary Laceration
98(1)
8.6.12 Air Embolism
98(2)
8.6.13 Cardiac Injuries
100(1)
8.6.14 Injuries to the Great Vessels
101(1)
8.7 Chest Drainage
101(3)
8.7.1 Drain Insertion
101(3)
8.7.2 Drain Removal
104(1)
8.8 Surgical Approaches to the Thorax
104(3)
8.8.1 Anterolateral Thoracotomy
105(1)
8.8.2 Median Sternotomy
106(1)
8.8.3 The `Clamshell' Thoracotomy
107(1)
8.8.4 Posterolateral Thoracotomy
107(1)
8.8.5 `Trapdoor' Thoracotomy
107(1)
8.9 Emergency Department Thoracotomy
107(3)
8.9.1 History
107(1)
8.9.2 Objectives
108(1)
8.9.3 Indications and Contraindications
108(1)
8.9.4 Results
109(1)
8.9.5 When to Stop EDT
109(1)
8.9.6 Technique
109(1)
8.10 Surgical Procedures
110(2)
8.10.1 Pericardial Tamponade
110(1)
8.10.2 Cardiac Injury
110(1)
8.10.3 Pulmonary Haemorrhage
111(1)
8.10.4 Pulmonary Tractotomy
111(1)
8.10.5 Lobectomy or Pneumonectomy
111(1)
8.10.6 Thoracotomy with Aortic Cross-Clamping
112(1)
8.10.7 Aortic Injury
112(1)
8.10.8 Tracheobronchial Injury
112(1)
8.10.9 Oesophageal Injury
112(1)
8.11 Summary
112(1)
8.12 Anaesthesia for Thoracic Trauma
112(2)
8.12.1 Penetrating Thoracic Injury
112(1)
8.12.2 Blunt Thoracic Injury
113(1)
8.12.3 Anaesthetic Management of Thoracic Injury
114(1)
8.13 Anaesthetic Considerations
114(3)
9 The Abdomen
117(78)
9.1 The Trauma Laparotomy
117(16)
9.1.1 Overview
117(1)
9.1.1.1 Difficult Abdominal Injury Complexes
117(1)
9.1.1.2 The Retroperitoneum
118(1)
9.1.1.3 Non-Operative Management of Penetrating Abdominal Injury
118(1)
9.1.2 The Trauma Laparotomy
119(1)
9.1.2.1 Pre-Operative Adjuncts
119(1)
9.1.2.2 Draping
120(1)
9.1.2.3 Incision
121(1)
9.1.2.4 Initial Procedure
121(1)
9.1.2.5 Perform a Trauma Laparotomy
122(2)
9.1.2.6 Perform Definitive Packing
124(1)
9.1.2.7 Specific Routes of Access
125(2)
9.1.2.8 Specific Organ Techniques
127(1)
9.1.3 Closure of the Abdomen
128(1)
9.1.3.1 Principles of Abdominal Closure
128(1)
9.1.3.2 Choosing the Optimal Method of Closure
128(1)
9.1.3.3 Primary Closure
128(1)
9.1.4 Specific Tips and Tricks
129(1)
9.1.4.1 Headlight
129(1)
9.1.4.2 Stirrups and Lithotomy Position
129(1)
9.1.4.3 Table Tilt
129(1)
9.1.4.4 Be Flexible: Move!
130(1)
9.1.4.5 Aortic Compression Spoon
130(1)
9.1.4.6 Pericardial Window
130(1)
9.1.4.7 Washout
130(1)
9.1.4.8 Drains
130(1)
9.1.4.9 Stomas
131(1)
9.1.4.10 Temporary Closure
131(1)
9.1.4.11 Two Catheters: Bladder Injury
131(1)
9.1.4.12 Early Tracheostomy
131(1)
9.1.5 Briefing for Operating Room Scrub Nurses
132(1)
9.1.6 Summary
132(1)
9.2 Abdominal Vascular Injury
133(8)
9.2.1 Overview
133(1)
9.2.2 Retroperitoneal Haematoma
134(1)
9.2.2.1 Central Haematoma
134(1)
9.2.2.2 Lateral Haematoma
134(1)
9.2.2.3 Pelvic Haematoma
134(1)
9.2.3 Surgical Approach to Major Abdominal Vessels
135(1)
9.2.3.1 Incision
135(1)
9.2.3.2 Medial Visceral Rotation
135(1)
9.2.3.3 Coeliac Axis
136(1)
9.2.3.4 Superior Mesenteric Artery
136(1)
9.2.3.5 Inferior Mesenteric Artery
137(1)
9.2.3.6 Renal Arteries
137(1)
9.2.3.7 Iliac Vessels
137(1)
9.2.3.8 Inferior Vena Cava
137(2)
9.2.3.9 Portal Vein
139(1)
9.2.4 Shunting
139(2)
9.3 Bowel, Rectum, and Diaphragm
141(6)
9.3.1 Overview
141(1)
9.3.2 Diaphragm
141(2)
9.3.3 Stomach
143(1)
9.3.4 The Duodenum
143(1)
9.3.5 Small Bowel
143(1)
9.3.5.1 The Stable Patient
144(1)
9.3.5.2 The Unstable Patient
144(1)
9.3.6 Large Bowel
144(1)
9.3.6.1 The Stable Patient
145(1)
9.3.6.2 The Unstable Patient
145(1)
9.3.7 Rectum
145(1)
9.3.8 Mesentery
145(1)
9.3.9 Adjuncts
146(1)
9.3.9.1 Antibiotics
146(1)
9.4 The Liver and Biliary System
147(15)
9.4.1 Overview
147(2)
9.4.2 Resuscitation
149(1)
9.4.3 Diagnosis
149(1)
9.4.4 Liver Injury Scale
149(2)
9.4.5 Management
151(1)
9.4.5.1 Subcapsular Haematoma
151(1)
9.4.5.2 Non-Operative Management (NOM)
152(1)
9.4.5.3 Subcapsular Haematoma
153(1)
9.4.5.4 Operative (Surgical) Management
153(1)
9.4.6 Surgical Approach
153(1)
9.4.6.1 Incision
153(1)
9.4.6.2 Initial Actions
154(1)
9.4.6.3 Techniques for Temporary Control of Haemorrhage
154(3)
9.4.6.4 Mobilization of the Liver
157(1)
9.4.6.5 Hepatic Isolation
158(1)
9.4.7 Perihepatic Drainage
158(1)
9.4.8 Complications
159(1)
9.4.9 Injury to the Retrohepatic Vena Cava
160(1)
9.4.10 Injury to the Porta Hepatis
160(1)
9.4.11 Injury to the Bile Ducts and Gallbladder
160(1)
9.4.12 Anaesthetic Considerations
161(1)
9.5 Spleen
162(6)
9.5.1 Overview
162(1)
9.5.2 Anatomy
162(1)
9.5.3 Diagnosis
162(1)
9.5.3.1 Clinical
162(1)
9.5.3.2 Ultrasound
163(1)
9.5.3.3 Computed Tomography (CT) Scan
163(1)
9.5.4 Splenic Injury Scale
163(1)
9.5.5 Management
163(1)
9.5.5.1 Non-Operative Management
163(1)
9.5.5.2 Operative Management
163(1)
9.5.6 Surgical Approach
163(3)
9.5.6.1 Spleen Not Actively Bleeding
166(1)
9.5.6.2 Splenic Surface Bleed Only
166(1)
9.5.6.3 Minor Lacerations
166(1)
9.5.6.4 Splenic Tears
166(1)
9.5.6.5 Partial Splenectomy
166(1)
9.5.6.6 Mesh Wrap
166(1)
9.5.6.7 Splenectomy
166(1)
9.5.6.8 Drainage
167(1)
9.5.7 Outcome
167(1)
9.5.8 Opportunistic Post-Splenectomy Infection
167(1)
9.6 Pancreas
168(11)
9.6.1 Overview
168(1)
9.6.2 Anatomy
169(1)
9.6.3 Mechanisms of Injury
169(1)
9.6.3.1 Blunt Trauma
169(1)
9.6.3.2 Penetrating Trauma
169(1)
9.6.4 Diagnosis
169(1)
9.6.4.1 Clinical Evaluation
169(1)
9.6.4.2 Serum Amylase and Serum Lipase
169(1)
9.6.4.3 Ultrasound
170(1)
9.6.4.4 Diagnostic Peritoneal Lavage (DPL)
170(1)
9.6.4.5 Computed Tomography
170(1)
9.6.4.6 Endoscopic Retrograde Cholangiopancreatography
170(1)
9.6.4.7 Magnetic Resonance Cholangiopancreatography
170(1)
9.6.4.8 Intra-operative Pancreatography
170(1)
9.6.4.9 Operative Evaluation
171(1)
9.6.5 Pancreas Injury Scale
171(1)
9.6.6 Management
171(1)
9.6.6.1 Non-Operative Management
171(1)
9.6.6.2 Operative Management
172(1)
9.6.7 Surgical Approach
172(1)
9.6.7.1 Incision and Exploration
172(1)
9.6.7.2 Pancreatic Injury: Surgical Decision-Making
172(3)
9.6.8 Adjuncts
175(1)
9.6.8.1 Somatostatin and Its Analogues
175(1)
9.6.8.2 Nutritional Support
175(1)
9.6.9 Pancreatic Injury in Children
175(1)
9.6.10 Complications
175(1)
9.6.10.1 Early Complications
175(1)
9.6.10.2 Late Complications
176(1)
9.6.11 Summary of Evidence Based Guidelines
176(3)
9.7 The Duodenum
179(5)
9.7.1 Overview
179(1)
9.7.2 Mechanism of Injury
179(1)
9.7.2.1 Penetrating Trauma
179(1)
9.7.2.2 Blunt Trauma
179(1)
9.7.2.3 Paediatric Considerations
179(1)
9.7.3 Diagnosis
179(1)
9.7.3.1 Clinical Presentation
179(1)
9.7.3.2 Serum Amylase and Serum Lipase
180(1)
9.7.3.3 Diagnostic Peritoneal Lavage/Ultrasound
180(1)
9.7.3.4 Radiological Investigation
180(1)
9.7.3.5 Diagnostic Laparoscopy
180(1)
9.7.4 Duodenal Injury Scale
180(1)
9.7.5 Management
180(1)
9.7.6 Surgical Approach
181(1)
9.7.6.1 Intramural Haematoma
181(1)
9.7.6.2 Duodenal Laceration
182(1)
9.7.6.3 Repair of the Perforation
182(1)
9.7.6.4 Complete Transection of the Duodenum
182(1)
9.7.6.5 Duodenal Diversion
183(1)
9.7.6.6 Duodenal Diverticulation
183(1)
9.7.6.7 Triple Tube Decompression
183(1)
9.7.6.8 Pyloric Exclusion
183(1)
9.8 The Urogenital System
184(11)
9.8.1 Overview
184(1)
9.8.2 Renal Injuries
184(1)
9.8.2.1 Diagnosis
185(1)
9.8.2.2 Renal Injury Scale
185(1)
9.8.2.3 Management
185(2)
9.8.2.4 Surgical Approach
187(2)
9.8.2.5 Adjuncts
189(1)
9.8.2.6 Post-operative Care
190(1)
9.8.3 Ureteric Injuries
190(1)
9.8.3.1 Diagnosis
190(1)
9.8.3.2 Surgical Approach
190(1)
9.8.3.3 Complications
191(1)
9.8.4 Bladder Injuries
191(1)
9.8.4.1 Diagnosis
191(1)
9.8.4.2 Management
191(1)
9.8.4.3 Surgical Approach
191(1)
9.8.5 Urethral Injuries
192(1)
9.8.5.1 Diagnosis
192(1)
9.8.5.2 Management
192(1)
9.8.5.3 Ruptured Urethra
192(1)
9.8.6 Injury to the Scrotum
193(1)
9.8.6.1 Diagnosis
193(1)
9.8.6.2 Management
193(1)
9.8.7 Gynaecological Injury and Sexual Assault
193(1)
9.8.7.1 Management
193(1)
9.8.8 Injury of the Pregnant Uterus
194(1)
10 The Pelvis
195(14)
10.1 Anatomy
195(1)
10.2 Classification
196(4)
10.2.1 Tile's Classification
196(2)
10.2.2 Young and Burgess Classification
198(2)
10.3 Clinical Examination and Diagnosis
200(1)
10.4 Resuscitation
201(1)
10.4.1 Haemodynamically Normal Patients
201(1)
10.4.2 Haemodynamically Stable Patients (Transient Responders)
201(1)
10.4.3 Haemodynamically Unstable Patients (Non-Responders)
202(1)
10.5 External Fixation
202(1)
10.5.1 Iliac-Crest Route
202(1)
10.5.2 Supra-acetabular Route
203(1)
10.5.3 Pelvic C-clamp
203(1)
10.6 Laparotomy
203(1)
10.7 Extraperironeal Pelvic Packing
203(2)
10.7.1 Technique of Extraperitoneal Packing
204(1)
10.8 Associated Injuries
205(1)
10.8.1 Head Injuries
205(1)
10.8.2 Intra-abdominal Injuries
205(1)
10.8.3 Bladder and Urethral Injuries
205(1)
10.8.4 Urethral Injuries
205(1)
10.8.5 Anorecral Injuries
205(1)
10.8.6 Vaginal Injuries
206(1)
10.9 Open Pelvic Fractures
206(1)
10.9.1 Diagnosis
206(1)
10.9.2 Surgery
206(1)
10.10 Summary
206(3)
11 Extremity Trauma
209(14)
11.1 Overview
209(1)
11.2 Management of Severe Injury to the Extremity
209(1)
11.3 Management of Vascular Injury of the Extremity
210(1)
11.3.1 Chemical Vascular Injuries
211(1)
11.4 Crush Syndrome
211(2)
11.5 Management of Open Fractures
213(2)
11.5.1 Severity of Injury (Gustilo Classification)
213(1)
11.5.2 Sepsis and Antibiotics
213(1)
11.5.3 Venous Thromboembolism
214(1)
11.5.4 Timing of Skeletal Fixation in Polytrauma Patients
214(1)
11.6 Massive Limb Trauma: Life Versus Limb
215(2)
11.6.1 Scoring Systems
215(2)
11.7 Compartment Syndrome
217(1)
11.8 Fasciotomy
218(2)
11.8.1 Lower Leg Fasciotomy
218(1)
11.8.2 Upper Leg
219(1)
11.8.3 Upper and Lower Arm
219(1)
11.9 Complications of Major Limb Injury
220(1)
11.10 Summary
221(2)
12 Head Trauma
223(10)
12.1 Introduction
223(1)
12.2 Injury Patterns and Classification
223(1)
12.2.1 Severity
223(1)
12.2.2 Pathological Classification of TBI
223(1)
12.3 Measurable Physiological Parameters in TBI
224(1)
12.3.1 Mean Arterial Pressure
224(1)
12.3.2 Intracranial Pressure
224(1)
12.3.3 Cerebral Perfusion Pressure
225(1)
12.3.4 Cerebral Blood Flow
225(1)
12.4 Pathophysiology of Traumatic Brain Injury
225(1)
12.5 Management of TBI
225(1)
12.6 Cerebral Perfusion Pressure Threshold
225(1)
12.7 Intracranial Pressure Monitoring and Threshold
226(1)
12.7.1 ICP Monitoring Devices
226(1)
12.7.2 ICP Management - Do's and Don'ts
226(1)
12.8 Imaging
227(1)
12.9 Indications for Surgery
227(2)
12.9.1 Burr Holes and Emergency Craniotomy
227(2)
12.10 Adjuncts to Care
229(1)
12.10.1 Infection Prophylaxis
229(1)
12.10.2 Seizure Prophylaxis
229(1)
12.10.3 Nutrition
230(1)
12.10.4 Deep Vein Thrombosis Prophylaxis
230(1)
12.10.5 Steroids
230(1)
12.11 Paediatric Considerations
230(1)
12.12 Pearls and Pitfalls
230(1)
12.13 Summary
230(1)
12.14 Anaesthetic Considerations
231(2)
13 Burns
233(16)
13.1 Overview
233(1)
13.2 Burns Pathophysiology
233(1)
13.3 Anatomy
233(1)
13.4 Special Types of Burn
234(2)
13.4.1 Chemical Burns
234(1)
13.4.2 Electrical Injury
235(1)
13.5 Depth of the Burn
236(1)
13.5.1 Superficial Burn (Erythema)
236(1)
13.5.2 Superficial Partial Thickness
236(1)
13.5.3 Deep Partial Thickness
237(1)
13.5.4 `Indeterminate' Partial Thickness Burns
237(1)
13.5.5 Full Thickness
237(1)
13.6 Total Body Surface Area Burned
237(1)
13.7 Management
238(6)
13.7.1 Safe Retrieval
238(1)
13.7.2 First Aid
238(1)
13.7.3 Initial Management
239(2)
13.7.4 Escharotomy and Fasciotomy
241(1)
13.7.5 Definitive Management
242(2)
13.7.6 Assessing and Managing Airway Burns
244(1)
13.7.7 Tracheostomy
244(1)
13.8 Special Areas
244(1)
13.8.1 Face
244(1)
13.8.2 Hands
245(1)
13.8.3 Perineum
245(1)
13.8.4 Feet
245(1)
13.9 Adjuncts in Burn Care
245(2)
13.9.1 Nutrition in the Burned Patient
245(1)
13.9.2 Ulcer Prophylaxis
246(1)
13.9.3 Venous Thromboembolism Prophylaxis
246(1)
13.9.4 Vitamin C
246(1)
13.9.5 Antibiotics
246(1)
13.9.6 Other Adjuncts
247(1)
13.10 Summary
247(2)
14 Special Patient Situations
249(8)
14.1 Paediatric Trauma
249(3)
14.1.1 Introduction
249(1)
14.1.2 Injury Patterns
249(1)
14.1.3 Pre-Hospital
249(1)
14.1.4 Resuscitation Room
249(1)
14.1.5 Specific Organ Injury
250(1)
14.1.6 Analgesia
251(1)
14.2 Trauma in the Elderly
252(2)
14.2.1 Definition of `Older' and Susceptibility to Trauma
252(1)
14.2.2 Access to Trauma Care
252(1)
14.2.3 Physiology
252(1)
14.2.4 Multiple Medications - Polypharmacy
253(1)
14.2.5 Analgesia
253(1)
14.2.6 Decision to Operate
253(1)
14.2.7 Anaesthetic Considerations in the Elderly
254(1)
14.3 Trauma in Pregnancy
254(1)
14.3.1 Evaluation
254(1)
14.4 Non-Beneficial (Futile) Care
254(3)
Part 4 MODERN THERAPEUTIC AND DIAGNOSTIC TECHNOLOGY
257(18)
15 Minimal Access Surgery in Trauma
259(10)
15.1 Laparoscopy
259(2)
15.1.1 Screening Laparoscopy
259(1)
15.1.2 Diagnostic Laparoscopy
259(1)
15.1.3 Non-Therapeutic Laparoscopy
259(1)
15.1.4 Therapeutic Laparoscopy
259(1)
15.1.5 Technique
259(1)
15.1.6 Risks
260(1)
15.1.7 Applications
260(1)
15.2 Video-Assisted Thoracoscopic Surgery
261(1)
15.2.1 Technique
261(1)
15.2.2 Applications
262(1)
15.2.3 Summary
262(1)
15.3 Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA)
262(5)
15.3.1 Anatomy
262(1)
15.3.2 Physiology
263(1)
15.3.3 Insertion Technique
264(1)
15.3.4 Monitoring
264(1)
15.3.5 Total, Partial, and Intermittent Occlusion, and Targeted Blood Pressure
265(1)
15.3.6 Perioperative and Post-operative Care
265(1)
15.3.7 Indications
265(1)
15.3.8 Contraindications
266(1)
15.3.9 Complications
266(1)
15.3.10 Summary
266(1)
15.4 Anaesthetic Considerations
267(2)
16 Imaging in Trauma
269(6)
16.1 Introduction
269(1)
16.2 Radiation Doses and Protection from Radiation
269(1)
16.3 Principles of Trauma Imaging
270(1)
16.4 Pitfalls and Pearls
271(1)
16.5 Trauma Ultrasound
272(3)
16.5.1 Extended Focused Assessment by Sonography for Trauma
272(1)
16.5.2 Indications and Results
272(1)
16.5.3 Other Applications of Ultrasound in Trauma
273(1)
16.5.4 Training
273(1)
16.5.5 Summary
274(1)
Part 5 SPECIALISED ASPECTS OF TOTAL TRAUMA CARE
275(72)
17 Critical Care of the Trauma Patient
277(28)
17.1 Introduction
277(1)
17.2 Phases of ICU Care
277(3)
17.2.1 Resuscitative Phase (First 24 Hours Post-Injury)
277(1)
17.2.2 Early Life Support Phase (24-72 Hours Post-Injury)
278(1)
17.2.3 Prolonged Life Support (<72 Hours Post-Injury)
278(1)
17.2.4 Recovery Phase (Separation from the ICU)
279(1)
17.3 Extracorporeal Membrane Oxygenation
280(1)
17.3.1 Overview
280(1)
17.3.2 Modes of ECMO
280(1)
17.3.3 Exclusions
281(1)
17.4 Coagulopathy of Major Trauma
281(1)
17.4.1 Managemenr
282(1)
17.5 Hypothermia
282(1)
17.6 Multisystem Organ Dysfunction Syndrome (MODS)
283(1)
17.7 Systemic Inflammatory Response Syndrome
283(1)
17.8 Sepsis
284(1)
17.8.1 Definitions
284(1)
17.8.2 Surviving Sepsis Guidelines
284(1)
17.9 Antibiotics
284(7)
17.10 Abdominal Compartment Syndrome (ACS)
291(5)
17.10.1 Introduction
291(1)
17.10.2 Definition of ACS
292(1)
17.10.3 Pathophysiology
292(1)
17.10.4 Effect of Raised IAP on Individual Organ Function
292(2)
17.10.5 Measurement of IAP
294(1)
17.10.6 Management
295(1)
17.10.7 Surgery for Raised IAP
295(1)
17.10.8 Management Algorithm
296(1)
17.11 Acute Kidney Injury
296(1)
17.12 Metabolic Disturbances
296(1)
17.13 Nutritional Support
296(3)
17.13.1 Access for Enteral Nutrition
299(1)
17.14 Prophylaxis in the ICU
299(1)
17.14.1 Stress Ulceration
299(1)
17.14.2 Deep Venous Thrombosis and Pulmonary Embolus
299(1)
17.14.3 Tetanus Prophylaxis
300(1)
17.14.4 Line Sepsis
300(1)
17.15 Pain Control
300(1)
17.16 ICU Tertiary Survey
301(1)
17.16.1 Evaluation for Occult Injuries
301(1)
17.16.2 Assess Co-Morbid Conditions
301(1)
17.16.3 ICU Summary
301(1)
17.17 Family Contact and Support
302(3)
18 Trauma Anaesthesia
305(10)
18.1 Introduction
305(1)
18.2 Planning and Communicating
305(1)
18.3 Damage Control Resuscitation
305(3)
18.3.1 Limited Fluid Administration
306(1)
18.3.2 Targeting Coagulopathy
307(1)
18.3.3 Prevent and Treat Hypothermia
307(1)
18.4 Damage Control Surgery
308(2)
18.4.1 Anaesthetic Procedures
308(1)
18.4.2 Monitoring
309(1)
18.5 Anaesthesia Induction in Hypovolaemic Shock
310(3)
18.5.1 Introduction
310(1)
18.5.2 Drugs for Anaesthesia Induction
310(3)
18.6 Battlefield Anaesthesia
313(2)
18.6.1 Damage Control Anaesthesia in the Military Setting
313(1)
18.6.2 Battlefield Analgesia
313(2)
19 Psychology of Trauma
315(4)
19.1 What is Psychological Trauma?
315(1)
19.2 Reactions to Trauma
315(1)
19.3 Post-Traumatic Stress Disorder
315(1)
19.4 Trauma and ICU
315(1)
19.5 The Clinical Psychologist
316(3)
19.5.1 The Role of the Clinical Psychologist
316(1)
19.5.2 When to Call the Clinical Psychologist
317(2)
20 Physical and Rehabilitation Medicine P&RM
319(4)
20.1 Definition
319(1)
20.2 The Rehabilitation `Team'
319(1)
20.3 Rehabilitation Starts in ICU
319(1)
20.4 Outcomes-Based Rehabilitation (OBR)
320(1)
20.4.1 FIM/FAM Assessment
320(1)
20.4.2 Glasgow Outcome Scale
320(1)
20.4.3 Rancho Los Amigos Scale
320(1)
20.5 Summary
321(2)
21 Austere Environments
323(6)
21.1 Definition
323(1)
21.2 Overview
323(1)
21.3 Infrastructure
323(2)
21.3.1 Location
324(1)
21.3.2 Hospital Structures
324(1)
21.3.3 Health Protection of the Deployed Surgical Team
324(1)
21.4 Surgical Techniques to Have in Mind
325(1)
21.4.1 Bleeding Control
325(1)
21.4.2 Control of Contamination
325(1)
21.4.3 Treatment of War Wounds
325(1)
21.4.4 Amputations
325(1)
21.4.5 Stabilization of Fractures
326(1)
21.4.6 Obstetrics
326(1)
21.4.7 Anaesthesia
326(1)
21.5 Post-operative Care and Documentation
326(1)
21.6 Summary
326(3)
22 Military Environments
329(18)
22.1 Introduction
329(1)
22.2 Injury Patterns
329(2)
22.3 Emergency Medical Services Systems
331(2)
22.3.1 The Echelons of Medical Care
331(1)
22.3.2 Incident Management and Multiple Casualties
332(1)
22.4 Triage
333(2)
22.4.1 Source and Aim of Triage
333(1)
22.4.2 Forward Surgical Teams and Triage
334(1)
22.4.3 Forward Surgical Team Decision-Making
334(1)
22.4.4 Selection of Patients for Surgery
335(1)
22.5 Mass Casualties
335(1)
22.6 Evacuation
336(1)
22.7 Resuscitation
336(3)
22.7.1 Overview
336(1)
22.7.2 Damage Control Resuscitation
337(1)
22.7.3 Damage Control Surgery in the Military Setting
338(1)
22.8 Blast Injury
339(1)
22.8.1 Diagnosis and Management of Blast Injuries
339(1)
22.9 Battlefield Analgesia
340(1)
22.10 Battlefield Anaesthesia
340(2)
22.10.1 Induction of Anaesthesia
341(1)
22.10.2 Maintenance of Anaesthesia
342(1)
22.11 Critical Care
342(1)
22.12 Translating Military Experience to Civilian Trauma Care
342(1)
22.12.1 Leadership
342(1)
22.12.2 Front-End Processes
342(1)
22.12.3 Common Training
342(1)
22.12.4 Governance
343(1)
22.12.5 Rehabilitation Services
343(1)
22.12.6 Translational Research
343(1)
22.13 Summary
343(4)
Appendix A Trauma Systems
347(6)
A.1 Introduction
347(1)
A.2 The Inclusive Trauma System
347(1)
A.3 Components of an Inclusive Trauma System
347(2)
A.3.1 Administration
348(1)
A.3.2 Prevention
348(1)
A.3.3 Public Education
348(1)
A.4 Management of the Injured Patient within a System
349(1)
A.5 Steps in Organizing a System
349(1)
A.5.1 Public Support
349(1)
A.5.2 Legal Authority
349(1)
A.5.3 Establish Criteria for Optimal Care
349(1)
A.5.4 Designation of Trauma Centres
349(1)
A.5.5 System Evaluation
350(1)
A.6 Results and Studies
350(1)
A.6.1 Panel Review
350(1)
A.6.2 Registry Study
350(1)
A.6.3 Population-Based Studies
350(1)
A.7 Summary
350(3)
Appendix B Trauma Scores and Scoring Systems
353(32)
B.1 Introduction
353(1)
B.2 Physiological Scoring Systems
353(2)
B.2.1 Glasgow Coma Scale
353(1)
B.2.2 Paediatric Trauma Score
353(1)
B.2.3 Revised Trauma Score
354(1)
B.2.4 Acute Physiologic and Chronic Health Evaluation II
354(1)
B.3 Anatomical Scoring Systems
355(3)
B.3.1 Abbreviated Injury Scale
355(1)
B.3.2 The Injury Severity Score
356(1)
B.3.3 The New Injury Severity Score
356(1)
B.3.4 Anatomic Profile Score
356(1)
B.3.5 ICD-based Injury Severity Score
357(1)
B.3.6 Organ Injury Scaling System
357(1)
B.3.7 Penetrating Abdominal Trauma Index
357(1)
B.3.8 Revised Injury Severity Classification II
358(1)
B.4 Comorbidity Scoring Systems
358(2)
B.5 Outcome Analysis
360(2)
B.5.1 Functional Independence Measure and Functional Assessment Measure
360(1)
B.5.2 Glasgow Outcome Scale
360(1)
B.5.3 Major Trauma Outcome Study
360(2)
B.5.4 A Severity Characterization of Trauma
362(1)
B.6 Comparison of Trauma Scoring Systems
362(1)
B.7 Scaling System for Organ Specific Injuries
362(19)
B.8 Summary
381(4)
Appendix C The Definitive Surgical Trauma Care Course: The Definitive Anaesthetic Trauma Care Course: Course Requirements And Syllabus
385(4)
C.1 Background
385(1)
C.2 Course Development and Testing
386(1)
C.3 Course Details
386(2)
C.3.1 Ownership
386(1)
C.3.2 Mission Statement
386(1)
C.3.3 Application to Hold a Course
386(1)
C.3.4 Eligibility to Present
386(1)
C.3.4.1 Local Organizations
386(1)
C.3.4.2 National Organizations
386(1)
C.3.5 Course Materials and Overview
387(1)
C.3.6 Course Director
387(1)
C.3.7 Course Faculty
387(1)
C.3.8 Course Participants
387(1)
C.3.9 Practical Skill Stations
387(1)
C.3.10 Course Syllabus
387(1)
C.3.11 Course Certification
388(1)
C.4 IATSIC Recognition
388(1)
C.5 Course Information
388(1)
Appendix D Definitive Surgical Trauma Care™ Course - Core Surgical Skills
389(4)
D.1 The Neck
389(1)
D.2 The Chest
389(1)
D.3 The Abdominal Cavity
389(1)
D.4 The Liver
390(1)
D.5 The Spleen
390(1)
D.6 The Pancreas
390(1)
D.7 The Duodenum
390(1)
D.8 The Genitourinary System
390(1)
D.9 Abdominal Vascular Injuries
391(1)
D.10 Peripheral Vascular Injuries
391(1)
D.11 Insertion of Resuscitative Balloon Occlusion of the Aorta (REBOA) Catheter
391(2)
Appendix E Briefing for Operating Room Scrub Nurses
393(6)
E.1 Introduction
393(1)
E.2 Preparing the Operating Room
393(2)
E.2.1 Environment
393(1)
E.2.2 Blood Loss
393(1)
E.2.3 Instruments
394(1)
E.2.4 Cleaning
394(1)
E.2.5 Draping
394(1)
E.2.6 Adjuncts
395(1)
E.3 Surgical Procedure
395(1)
E.3.1 Instruments
395(1)
E.3.2 Special Instruments and Improvised Gadgets
396(1)
E.4 Abdominal Closure
396(1)
E.5 Instrument and Swab Count
397(1)
E.6 Medico-legal Aspects and Communication Skills
397(1)
E.7 Critical Incident Stress Issues
398(1)
E.8 Conclusion
398(1)
Index 399
Professor Ken Boffard is Professor of Surgery and Trauma Director at Milpark Hospital, Johannesburg, and until recently, Head of the Department of Surgery at Johannesburg Hospital and the University of the Witwatersrand. He was previously Head of the Johannesburg Hospital Trauma Unit. He qualified in Johannesburg, and trained in Surgery at the Birmingham Accident Hospital and Guys Hospital.



He is past President of the International Society of Surgery (ISS) in Switzerland, the International Association for Trauma Surgery and Intensive Care (IATSIC), and Chair of the IATSIC Education Committee. He is a Fellow of five Surgical Colleges, and has received Honorary Fellowships from the American College of Surgeons, Royal College of Surgeons of Thailand, College of Surgeons of Sri Lanka, and the Association of Surgeons of Great Britain and Ireland.



His passion is surgical education, and various aspects of trauma resuscitation, intensive care, and regional planning of Trauma Systems. His interests include flying (he is a licensed fixed wing and helicopter pilot), scuba diving, and aeromedical care. His research interests include coagulation, haemostasis and critical bleeding.



He is a Colonel in the South African Military Health Service.



He is a Freeman of the City of London by redemption, and an elected Liveryman of the Guild of Air Pilots of London.



He is married with two children.
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