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Manual of Definitive Surgical Trauma Care, Fourth Edition 4th New edition [Multiple-component retail product]

Edited by (BSc(Hons), FRCS, FRCPS, FCS(SA), Emeritus Professor, Department of Surgery, Milpark Hospital and University of the Witwatersrand, South Africa)
  • Formaat: Multiple-component retail product, 342 pages, kõrgus x laius: 246x189 mm, kaal: 839 g, No Color; 47 Line drawings, black and white; 122 Illustrations, black and white, Contains 1 Book and 1 CD-Audio
  • Ilmumisaeg: 16-Sep-2015
  • Kirjastus: Productivity Press
  • ISBN-10: 1498714870
  • ISBN-13: 9781498714877
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Manual of Definitive Surgical Trauma Care, Fourth Edition 4th New editionSuurem pilt
  • Formaat: Multiple-component retail product, 342 pages, kõrgus x laius: 246x189 mm, kaal: 839 g, No Color; 47 Line drawings, black and white; 122 Illustrations, black and white, Contains 1 Book and 1 CD-Audio
  • Ilmumisaeg: 16-Sep-2015
  • Kirjastus: Productivity Press
  • ISBN-10: 1498714870
  • ISBN-13: 9781498714877
Teised raamatud teemal:
Püsilink: https://www.kriso.ee/db/9781498714877.html
Märksõnad:
Few surgeons can both attain and sustain the necessary level of skill for decision making in major trauma without the necessary training. Surgical training in the technical aspects of surgical care of the trauma patient allows for the development of appropriate judgement and decision-making skills when treating traumatized patients with multiple injuries.



Developed for the International Association for Trauma Surgery and Intensive Care (IATSIC), the Manual of Definitive Surgical Trauma Care is ideal for training all surgeons who encounter major surgical trauma on an infrequent basis. It is designed to support general surgeons who, whether by choice or necessity, are confronted with major surgical injury but may not necessarily have the experience or expertise required.



This edition is updated to incorporate recent developments and covers every aspect of surgical trauma care covered by the Definitive Surgical Trauma Care (DSTC) course. It provides additional emphasis on anaesthesia and military components, reflecting changes in worldwide surgical trauma experience.



Written by faculty who teach the DSTC Course, this book will give you the confidence to focus on life-saving surgical techniques when faced with challenging and unfamiliar incidents of trauma.

Arvustused

"This book differs in scope and intended audience from the popular Advanced Trauma Life Support Course promulgated by the American College of Surgeons. This manual is intended for surgeons or anesthesiologists and includes far more physiology and procedural information than the more general ATLS curriculum." - David J. Dries, MD(University of Minnesota Medical School), Doody Enterprises



"[ I]t should be kept in the emergency departments and theatres of all hospitals that deal with major trauma. It describes damage control surgery for major trauma and has helped me understand the needs of other specialties in the management of these patients. This book fills a gap in the market [ and] should be recommended reading for all general surgeons and emergency department consultants." Citation, BMA Medical Book Awards 2012

Preface xxiii
Introduction xxv
Injury Prevention
xxv
Surgical Safety
xxv
Training in the Management of Severe Trauma
xxvi
The DSTC Course
xxvii
Summary
xxviii
References
xxviii
Contributors xxix
About the Editor xxxiii
Part 1 Trauma System And Communication Principles 1(14)
1 Overview
3(9)
1.1 Resuscitation in the Emergency Department
3(1)
1.2 Management of Major Trauma
3(5)
1.2.1 Resuscitation
3(4)
1.2.2 Management of Penetrating Trauma
7(1)
1.3 Emergency Department Surgery
8(3)
1.3.1 Craniofacial Injuries
9(1)
1.3.2 Chest Trauma
9(1)
1.3.3 Abdominal Trauma
10(1)
1.3.4 Pelvic Trauma
10(1)
1.3.5 Long Bone Fractures
10(1)
1.3.6 Peripheral Vascular Injuries
10(1)
1.4 Summary
11(1)
2 Communication and Non-technical Skills in Major Trauma
12(3)
2.1 Overview
12(1)
2.2 Communication in the Trauma Setting
12(1)
2.3 Leadership in Trauma Care
13(1)
2.4 Communication in Damage Control
13(2)
Part 2 Physiology And The Body's Response To Trauma 15(58)
3 Resuscitation Physiology
17(24)
3.1 Metabolic Response to Trauma
17(7)
3.1.1 Definition of Trauma
17(1)
3.1.2 Initiating Factors
17(1)
3.1.3 Immune Response
18(3)
3.1.4 Hormonal Mediators
21(1)
3.1.5 Effects of the Various Mediators
22(2)
3.1.6 Anabolic Phase
24(1)
3.1.7 Clinical and Therapeutic Relevance
24(1)
3.2 Shock
24(17)
3.2.1 Definition of Shock
24(1)
3.2.2 Classification of Shock
25(3)
3.2.3 Measurements in Shock
28(4)
3.2.4 Endpoints in Shock Resuscitation
32(1)
3.2.5 Post-shock and Multiple Organ Failure Syndromes
33(1)
3.2.6 Management of the Shocked Patient
33(5)
3.2.7 Prognosis in Shock
38(1)
3.2.8 Recommended Protocol for Shock
38(3)
4 Transfusion in Trauma
41(15)
4.1 Indications for Transfusion
41(1)
4.2 Transfusion Fluids
41(2)
4.2.1 Colloids
41(1)
4.2.2 Fresh Whole Blood
41(1)
4.2.3 Packed Red Blood Cells
42(1)
4.2.4 Component Therapy (Platelets, Fresh Frozen Plasma, Cryoprecipitate)
42(1)
4.3 Effects of Transfusing Blood and Blood Products
43(2)
4.3.1 Metabolic Effects
43(1)
4.3.2 Effects of Microaggregates
43(1)
4.3.3 Hyperkalaemia
43(1)
4.3.4 Coagulation Abnormalities
43(1)
4.3.5 Other Risks of Transfusion
44(1)
4.4 Current Best Transfusion Practice
45(5)
4.4.1 Initial Response
45(1)
4.4.2 Reduction in the Need for Transfusion
45(1)
4.4.3 Transfusion Thresholds
46(1)
4.4.4 Transfusion Ratios
46(1)
4.4.5 Adjuncts to Enhance Clotting
46(1)
4.4.6 Monitoring the Coagulation Status
47(3)
4.5 Autotransfusion
50(1)
4.6 Red Blood Cell Substitutes
51(1)
4.6.1 Perfluorocarbons
51(1)
4.6.2 Haemoglobin Solutions
51(1)
4.7 Massive Haemorrhage/Massive Transfusion
52(4)
4.7.1 Definition
52(1)
4.7.2 Protocol
52(4)
5 Damage Control Surgery
56(9)
5.1 Introduction
56(1)
5.2 Damage Control Resuscitation (DCR)
57(1)
5.3 Damage Control Surgery (DCS)
57(8)
5.3.1 Stage 1: Patient Selection
57(1)
5.3.2 Stage 2: Operative Haemorrhage and Contamination Control
58(2)
5.3.3 Stage 3: Physiological Restoration in the Intensive Care Unit
60(2)
5.3.4 Stage 4: Definitive Surgery
62(1)
5.3.5 Stage 5: Abdominal Wall Closure
62(1)
5.3.6 Outcomes
63(2)
6 The Neck
65(8)
6.1 Overview
65(1)
6.2 Management Principles
65(3)
6.2.1 Initial Assessment
65(2)
6.2.2 Use of Diagnostic Studies
67(1)
6.3 Treatment
68(2)
6.3.1 Mandatory versus Selective Neck Exploration
68(1)
6.3.2 Treatment Based on Anatomical Zones
68(2)
6.3.3 Rules
70(1)
6.4 Access to the Neck
70(5)
6.4.1 Incision
70(1)
6.4.2 Carotid Artery
70(1)
6.4.3 Midline Visceral Structures
70(1)
6.4.4 Root of the Neck
71(1)
6.4.5 Collar Incisions
72(1)
6.4.6 Vertebral Arteries
72(1)
Part 3 Physiology And The Body's Response To Trauma 73(164)
7 The Chest
75(23)
7.1 Overview
75(13)
7.1.1 Introduction: Scope of the Problem
75(1)
7.1.2 Spectrum of Thoracic Injury
75(1)
7.1.3 Pathophysiology of Thoracic Injuries
76(1)
7.1.4 Paediatric Considerations
76(1)
7.1.5 Applied Surgical Anatomy of the Chest
77(2)
7.1.6 Diagnosis
79(1)
7.1.7 Management
79(9)
7.2 Emergency Department Thoracotomy
88(2)
7.2.1 History
88(1)
7.2.2 Objectives
89(1)
7.2.3 Indications and Contraindications
89(1)
7.2.4 Results
89(1)
7.2.5 When to Stop Emergency Department Thoracotomy
90(1)
7.2.6 Conclusion
90(1)
7.3 Surgical Approaches to the Thorax
90(3)
7.3.1 Anterolateral Thoracotomy
91(1)
7.3.2 Median Sternotomy
92(1)
7.3.3 'Clamshell' Thoracotomy
92(1)
7.3.4 Posterolateral Thoracotomy
92(1)
7.3.5 'Trapdoor' Thoracotomy
93(1)
7.4 Emergency Department Thoracotomy Technique
93(2)
7.4.1 Requirements
93(1)
7.4.2 Approach
93(1)
7.4.3 Emergency Procedures
94(1)
7.5 Definitive Procedures
95(1)
7.5.1 Pericardial Tamp onade
95(1)
7.5.2 Myocardial Laceration
95(1)
7.5.3 Hilar Clamping
95(1)
7.5.4 Lobectomy or Pneumonectomy
95(1)
7.5.5 Pulmonary Tractotomy
95(1)
7.5.6 Aortic Injury
96(1)
7.5.7 Oesophageal Injury
96(1)
7.5.8 Tracheobronchial Injury
96(1)
7.6 Summary
96(2)
8 The Abdomen
98(11)
8.1 Trauma Laparotomy
98(11)
8.1.1 Overview
98(2)
8.1.1.1 Difficult Abdominal Injury Complexes
98(1)
8.1.1.2 Retroperitoneum
99(1)
8.1.1.3 Non-operative Management of Penetrating Abdominal Injury
99(1)
8.1.2 Trauma Laparotomy
100(5)
8.1.2.1 Pre-operative Adjuncts
100(1)
8.1.2.2 Draping
101(1)
8.1.2.3 Incision
101(1)
8.1.2.4 Procedure
102(1)
8.1.2.5 Retroperitoneum
103(2)
8.1.3 Closure of the Abdomen
105(1)
8.1.3.1 Principles of Abdominal Closure
105(1)
8.1.3.2 Choosing the Optimal Method of Closure
105(1)
8.1.3.3 Primary Closure
106(1)
8.1.4 Haemostatic Adjuncts in Trauma
106(2)
8.1.4.1 Overview
106(1)
8.1.4.2 Other Haemostatic Adjuncts
107(1)
8.1.4.3 Specific Applications
108(1)
8.1.5 Briefing for Operating Room Scrub Nurses
108(1)
8.1.6 Summary
108(1)
8.2 Bowel and Diaphragm
109(6)
8.2.1 Overview
109(1)
8.2.1.1 'Two hands, but four eyes'
109(1)
8.2.2 Diaphragm
110(1)
8.2.3 Stomach
110(1)
8.2.3.1 Pitfall
111(1)
8.2.4 The Duodenum
111(1)
8.2.5 Small Bowel
111(1)
8.2.5.1 The Stable Patient
111(1)
8.2.5.2 The Unstable Patient
111(1)
8.2.6 Large Bowel
112(1)
8.2.6.1 The Stable Patient
112(1)
8.2.6.2 The Unstable Patient
112(1)
8.2.6.3 Pitfall
113(1)
8.2.7 Rectum
113(1)
8.2.7.1 Pitfall
114(1)
8.2.8 Mesentery
114(1)
8.2.9 Adjuncts
114(1)
8.2.9.1 Antibiotics
114(1)
8.3 Liver and Biliary System
115(13)
8.3.1 Overview
115(1)
8.3.2 Resuscitation
116(1)
8.3.3 Diagnosis
116(1)
8.3.4 Liver Injury Scale
117(1)
8.3.5 Management
118(1)
8.3.5.1 Non-operative Management (NOM)
119(1)
8.3.5.2 Operative (Surgical) Management
119(1)
8.3.6 Surgical Approach
119(6)
8.3.6.1 Incision
119(1)
8.3.6.2 Initial Actions
120(1)
8.3.6.3 Techniques for Temporary Control of Haemorrhage
120(4)
8.3.6.4 Mobilization of the Liver
124(1)
8.3.6.5 Perihepatic Drainage
124(1)
8.3.6.6 Subcapsular Haematoma
124(1)
8.3.7 Complications
125(1)
8.3.8 Injury to the Retrohepatic Vena Cava
126(1)
8.3.9 Injury to the Porta Hepatis
127(1)
8.3.10 Injury to the Bile Ducts and Gallbladder
127(1)
8.4 Spleen
128(5)
8.4.1 Overview
128(1)
8.4.2 Anatomy
128(1)
8.4.3 Diagnosis
129(1)
8.4.3.1 Clinical
129(1)
8.4.3.2 Computed Tomography (CT) Scan
129(1)
8.4.3.3 Ultrasound
129(1)
8.4.4 Splenic Injury Scale
129(1)
8.4.5 Management
129(2)
8.4.5.1 Non-operative Management
129(2)
8.4.5.2 Operative Management
131(1)
8.4.6 Surgical Approach
131(1)
8.4.7 Complications
132(1)
8.4.8 Outcome
132(1)
8.5 Pancreas
133(11)
8.5.1 Overview
133(1)
8.5.2 Anatomy
134(1)
8.5.3 Mechanisms of Injury
134(1)
8.5.3.1 Blunt Trauma
134(1)
8.5.3.2 Penetrating Trauma
134(1)
8.5.4 Diagnosis
134(2)
8.5.4.1 Clinical Evaluation
134(1)
8.5.4.2 Serum Amylase and Serum Lipase
135(1)
8.5.4.3 Ultrasound
135(1)
8.5.4.4 Diagnostic Peritoneal Lavage (DPL)
135(1)
8.5.4.5 Computed Tomography
135(1)
8.5.4.6 Endoscopic Retrograde Cholangiopancreatography (ERCP)
135(1)
8.5.4.7 Magnetic Resonance Cholangiopancreatography (MRCP)
135(1)
8.5.4.8 Intraoperative Pancreatography
136(1)
8.5.4.9 Operative Evaluation
136(1)
8.5.5 Pancreas Injury Scale
136(1)
8.5.6 Management
137(1)
8.5.6.1 Non-operative Management
137(1)
8.5.6.2 Operative Management
137(1)
8.5.7 Surgical Approach
137(4)
8.5.7.1 Incision and Exploration
137(1)
8.5.7.2 Pancreatic Injury: Surgical Decision Making
138(3)
8.5.8 Adjuncts
141(1)
8.5.8.1 Somatostatin and Its Analogues
141(1)
8.5.8.2 Nutritional Support
141(1)
8.5.9 Pancreatic Injury in Children
141(1)
8.5.10 Complications
141(1)
8.5.10.1 Early Complications
141(1)
8.5.10.2 Late Complications
142(1)
8.5.11 Summary of Evidence-based Guidelines
142(2)
8.6 Duodenum
144(7)
8.6.1 Overview
144(1)
8.6.2 Mechanism of Injury
144(1)
8.6.2.1 Penetrating Trauma
144(1)
8.6.2.2 Blunt Trauma
145(1)
8.6.2.3 Paediatric Considerations
145(1)
8.6.3 Diagnosis
145(1)
8.6.3.1 Clinical Presentation
145(1)
8.6.3.2 Serum Amylase
145(1)
8.6.3.3 Diagnostic Peritoneal Lavage/Ultrasound
145(1)
8.6.3.4 Radiological Investigation
145(1)
8.6.3.5 Diagnostic Laparoscopy
146(1)
8.6.3.6 Exploratory Laparotomy
146(1)
8.6.4 Duodenal Injury Scale
146(1)
8.6.5 Management
146(1)
8.6.6 Surgical Approach
147(4)
8.6.6.1 Intramural Haematoma
147(1)
8.6.6.2 Duodenal Laceration
147(1)
8.6.6.3 Repair of the Perforation
148(1)
8.6.6.4 Complete Transection of the Duodenum
148(1)
8.6.6.5 Duodenal Diversion
148(1)
8.6.6.6 Duodenal Diverticulation
148(1)
8.6.6.7 Triple-Tube Decompression
149(1)
8.6.6.8 Pyloric Exclusion
149(1)
8.6.6.9 Pancreaticoduodenectomy (Whipple Procedure)
149(1)
8.6.6.10 Specific Injuries
149(2)
8.7 Abdominal Vascular Injury
151(6)
8.7.1 Overview
151(1)
8.7.2 Injuries of the Aorta and Vena Cava
151(1)
8.7.3 Retroperitoneal Haematoma
151(1)
8.7.3.1 Central Haematoma
151(1)
8.7.3.2 Lateral Haematoma
152(1)
8.7.3.3 Pelvic Haematoma
152(1)
8.7.4 Surgical Approach
152(4)
8.7.4.1 Incision
152(1)
8.7.4.2 Aorta
152(1)
8.7.4.3 Coeliac Axis
153(1)
8.7.4.4 Superior Mesenteric Artery
153(1)
8.7.4.5 Inferior Mesenteric Artery
154(1)
8.7.4.6 Renal Arteries
154(1)
8.7.4.7 Iliac Vessels
154(1)
8.7.4.8 Inferior Vena Cava (IVC)
154(1)
8.7.4.9 Portal Vein
155(1)
8.7.5 Shunting
156(1)
8.8 Urogenital System
157(10)
8.8.1 Overview
157(1)
8.8.2 Renal Injuries
157(4)
8.8.2.1 Diagnosis
157(1)
8.8.2.2 Renal Injury Scale
158(1)
8.8.2.3 Management
158(1)
8.8.2.4 Surgical Approach
159(2)
8.8.2.5 Adjuncts
161(1)
8.8.2.6 Post-operative Care
161(1)
8.8.3 Ureteric Injuries
161(1)
8.8.3.1 Diagnosis
161(1)
8.8.3.2 Surgical Approach
161(1)
8.8.3.3 Complications
162(1)
8.8.4 Bladder Injuries
162(1)
8.8.4.1 Diagnosis
162(1)
8.8.4.2 Management
163(1)
8.8.4.3 Surgical Approach
163(1)
8.8.5 Urethral Injuries
163(1)
8.8.5.1 Diagnosis
163(1)
8.8.5.2 Management
163(1)
8.8.5.3 Ruptured Urethra
164(1)
8.8.6 Injury to the Scrotum
164(1)
8.8.6.1 Diagnosis
164(1)
8.8.6.2 Management
164(1)
8.8.7 Gynaecological Injury and Sexual Assault
165(2)
8.8.7.1 Management
165(1)
8.8.8 Injury of the Pregnant Uterus
165(2)
9 The Pelvis
167(8)
9.1 Introduction
167(1)
9.2 Anatomy
167(1)
9.3 Classification
168(1)
9.3.1 Type A
168(1)
9.3.2 Type B
168(1)
9.3.3 Type C
168(1)
9.4 Clinical Examination and Diagnosis
169(1)
9.5 Resuscitation
169(2)
9.5.1 Haemodynamically Normal Patients
170(1)
9.5.2 Haemodynamically Stable Patients
170(1)
9.5.3 Haemodynamically Unstable Patients
170(1)
9.5.4 Laparotomy
170(1)
9.6 Pelvic Packing
171(1)
9.6.1 Technique of Extraperitoneal Packing
171(1)
9.7 Associated Injuries
172(1)
9.7.1 Head Injuries
172(1)
9.7.2 Intra-abdominal Injuries
172(1)
9.7.3 Bladder Injuries
172(1)
9.7.4 Urethral Injuries
172(1)
9.7.5 Anorectal Injuries
172(1)
9.8 Compound Pelvic Injuries
172(1)
9.8.1 Diagnosis
173(1)
9.8.2 Surgery
173(1)
9.9 Summary
173(2)
10 Extremity Trauma
175(12)
10.1 Overview
175(1)
10.2 Management of Severe Injury to the Extremity
175(1)
10.2.1 Life-saving Measures
175(1)
10.2.2 Limb-saving Measures
175(1)
10.3 Management of Vascular Injury of the Extremity
176(1)
10.3.1 Chemical Vascular Injuries
177(1)
10.4 Crush Syndrome
177(1)
10.5 Management of Open Fractures
177(3)
10.5.1 Severity of Injury (Gustilo Classification)
178(1)
10.5.2 Sepsis and Antibiotics
178(1)
10.5.3 Venous Thromboembolism
179(1)
10.5.4 Timing of Skeletal Fixation in Polytrauma Patients
179(1)
10.6 Massive Limb Trauma: Life versus Limb
180(3)
10.6.1 Scoring Systems
180(3)
10.7 Compartment Syndrome
183(1)
10.7.1 Measurement
183(1)
10.7.2 Technique
183(1)
10.8 Fasciotomy
184(1)
10.8.1 Four-compartment Fasciotomy
184(1)
10.8.2 Fibulectomy
184(1)
10.9 Complications of Major Limb Injury
184(1)
10.10 Summary
185(2)
11 Head Trauma
187(8)
11.1 Introduction
187(1)
11.2 Injury Patterns and Classification
187(1)
11.3 Measurable Physiological Parameters of Brain Function
188(1)
11.3.1 Mean Arterial Pressure (MAP)
188(1)
11.3.2 Intracranial Pressure (ICP)
188(1)
11.3.3 Cerebral Perfusion Pressure (CPP)
188(1)
11.3.4 Cerebral Blood Flow (CBF)
188(1)
11.4 Pathophysiology of Traumatic Brain Injury (TBI)
188(1)
11.5 Initial Management of TBI
189(1)
11.6 Cerebral Perfusion Threshold
189(1)
11.7 Intracranial Pressure (ICP) Threshold and Indications for Monitoring
189(1)
11.7.1 ICP Management - Dos and Don'ts
189(1)
11.7.2 ICP Monitoring Devices and Application
190(1)
11.7.3 Treatment Thresholds
190(1)
11.8 Imaging
190(1)
11.9 Indications for Surgery
191(1)
11.9.1 Burr Holes and Emergency Craniotomy
191(1)
11.10 Adjuncts to Care
192(1)
11.10.1 Infection Prophylaxis
192(1)
11.10.2 Antiseizure Prophylaxis
192(1)
11.10.3 Nutrition
193(1)
11.10.4 Deep Vein Thrombosis Prophylaxis
193(1)
11.10.5 Steroids
193(1)
11.11 Paediatric Considerations
193(1)
11.12 Pearls and Pitfalls
193(1)
11.13 Summary
193(2)
11.12 Burns
195
11.13 Summary
193(2)
12 Burns
195(11)
12.1 Overview
195(1)
12.2 Anatomy
195(1)
12.3 Depth of the Burn
196(1)
12.3.1 Superficial Burn (Erythema)
196(1)
12.3.2 Superficial Partial Thickness
196(1)
12.3.3 Deep Partial Thickness
196(1)
12.3.4 'Indeterminate' Partial Thickness Burns
197(1)
12.3.5 Full Thickness
197(1)
12.4 Total Body Surface Area (TBSA) Burned
197(1)
12.5 Management
198(4)
12.5.1 Safe Retrieval
198(1)
12.5.2 First Aid
198(1)
12.5.3 Emergency Department
198(2)
12.5.4 Definitive Management
200(2)
12.6 Special Areas
202(1)
12.6.1 Face
202(1)
12.6.2 Hands
202(1)
12.6.3 Perineum
203(1)
12.6.4 Feet
203(1)
12.7 Adjuncts in Burn Care
203(1)
12.7.1 Nutrition in the Burned Patient
203(1)
12.7.2 Paediatric Burn Nutrition
204(1)
12.7.3 Ulcer Prophylaxis
204(1)
12.7.4 Venous Thromboembolism Prophylaxis
204(1)
12.7.5 Antibiotics
204(1)
12.8 Criteria for Transfer
204(1)
12.9 Summary
204(2)
13 Special Patient Situations
206(7)
13.1 Paediatrics
206(2)
13.1.1 Introduction
206(1)
13.1.2 Injury Patterns
206(1)
13.1.3 Pre-hospital
206(1)
13.1.4 Resuscitation Room
206(1)
13.1.5 Specific Organ Injury
207(1)
13.1.6 Analgesia
208(1)
13.2 The Elderly
208(3)
13.2.1 Definition of 'Older' and Susceptibility to Trauma
208(1)
13.2.2 Physiology
209(1)
13.2.3 Influence of Co-morbid Conditions
210(1)
13.2.4 Multiple Medications - Polypharmacy
210(1)
13.2.5 Analgesia
210(1)
13.2.6 Decision to Operate
210(1)
13.2.7 Outcome
210(1)
13.3 Futile Care
211(2)
14 Critical Care of the Trauma Patient
213(24)
14.1 Introduction
213(1)
14.2 Goals of Trauma Intensive Care Unit (ICU) Care
213(1)
14.3 Phases of ICU Care
213(3)
14.3.1 Resuscitative Phase (First 24 Hours Post-Injury)
213(1)
14.3.2 Early Life Support Phase (24-72 Hours Post-injury)
214(1)
14.3.3 Prolonged Life Support (>72 Hours Post-injury)
215(1)
14.3.4 Recovery Phase (Separation from the ICU)
216(1)
14.4 Hypothermia
216(1)
14.4.1 Re-warming
216(1)
14.5 Systemic Inflammatory Response Syndrome
216(1)
14.6 Multisystem Organ Dysfunction Syndrome (MODS) or Multiple Organ Failure (MOF)
217(1)
14.7 Coagulopathy of Major Trauma
217(1)
14.7.1 Management
218(1)
14.8 Recognition and Treatment of Raised Intracranial Pressure
218(1)
14.9 Recognition of Acute Renal Failure (ARF) and Acute Kidney Injury (AKI)
218(1)
14.10 Evaluation of Metabolic Disturbances
219(1)
14.11 Pain Control/Sedation/Delirium
219(1)
14.12 Family Contact and Support
220(1)
14.13 ICU Tertiary Survey
220(1)
14.13.1 Evaluation for Occult Injuries
220(1)
14.13.2 Assess Co-morbid Conditions
220(1)
14.14 Nutritional Support
220(2)
14.14.1 Overview
220(1)
14.14.2 Choosing Nutritional Formula
221(1)
14.14.3 Initiation for Enteral or Parenteral Nutrition
222(1)
14.14.4 Gut Access for Enteral Nutrition
222(1)
14.15 Preventive Measures in the ICU
222(2)
14.15.1 Stress Ulceration
222(1)
14.15.2 Deep Venous Thrombosis and Pulmonary Embolus
223(1)
14.15.3 Infection
223(1)
14.16 Antibiotics
224(1)
14.16.1 Ventilator-associated Pneumonia (VAP) Diagnosis
224(1)
14.16.2 VAP Treatment
224(1)
14.17 Respiratory Support
224(1)
14.18 Surviving Sepsis Guidelines
225(2)
14.19 Abdominal Compartment Syndrome (ACS)
227(6)
14.19.1 Introduction
227(1)
14.19.2 Definition of ACS
227(1)
14.19.3 Pathophysiology
228(1)
14.19.4 Causes of Raised IAP
229(1)
14.19.5 Effect of Raised IAP on Individual Organ Function
229(1)
14.19.6 Measurement of IAP
230(1)
14.19.7 Treatment
230(1)
14.19.8 Surgery for Raised IAP
231(1)
14.19.9 Management Algorithm
231(2)
14.19.10 World Society of the Abdominal Compartment Syndrome
233(1)
14.20 Organ Donation
233(4)
Part 4 Diagnostic And Therapeutic Technology 237(14)
15 Minimally Invasive Surgery in Trauma
239(4)
15.1 Technique
239(1)
15.2 Thoracic Injury
239(1)
15.3 Diaphragmatic Injury
239(1)
15.4 Abdominal Injury
240(1)
15.4.1 Screening for Intra-abdominal Injury
240(1)
15.4.2 Splenic Injury
240(1)
15.4.3 Liver Injury
240(1)
15.4.4 Bowel Injury
240(1)
15.5 After Non-operative Management
240(1)
15.6 Risks of Laparoscopy in Trauma
240(1)
15.7 Summary
241(2)
16 Radiology in Trauma
243(3)
16.1 Introduction
243(1)
16.2 Radiation Doses and Protection from Radiation
243(1)
16.3 Pelvic Fractures
243(1)
16.4 Blunt Splenic Injuries
244(1)
16.5 Liver Injuries
244(1)
16.6 Aortic Rupture and Injury to Middle-sized Arteries
244(2)
17 Ultrasound in Trauma
246(2)
17.1 Applications of Ultrasound in Trauma - Introduction
246(1)
17.2 Extended Focussed Assessment by Sonography for Trauma (E-FAST)
246(1)
17.2.1 Indications and Results
247(1)
17.3 Other Applications of Ultrasound in Trauma
247(1)
17.4 Training and Pitfalls
248(5)
17.4.1 Training
248(1)
17.4.2 Pitfalls
248(1)
17.5 Summary
248(3)
Part 5 Aspects Of Specialized Care 251(32)
18 Austere or Military Environments
253(18)
18.1 Introduction
253(1)
18.1.1 Health Protection of the Deployed Surgical Team
253(1)
18.1.2 Recent Advances in Combat Military Care
254(1)
18.2 Injury Patterns
254(2)
18.3 Emergency Medical Services Systems
256(1)
18.3.1 Incident Management and Multiple Casualties
256(1)
18.4 Triage
257(2)
18.4.1 Forward Surgical Teams and Triage
258(1)
18.5 Mass Casualties
259(1)
18.6 Evacuation
260(1)
18.6.1 Forward Surgical Teams
260(1)
18.7 Resuscitation
261(2)
18.7.1 Overview
261(1)
18.7.2 Damage Control Resuscitation
261(2)
18.7.3 Damage Control Surgery in the Military Setting
263(1)
18.8 Blast Injury
263(1)
18.8.1 Diagnosis and Management of Primary Blast Injuries
264(1)
18.9 Battlefield Analgesia
264(1)
18.10 Battlefield Anaesthesia
265(2)
18.10.1 Induction of Anaesthesia
265(1)
18.10.2 Maintenance of Anaesthesia
266(1)
18.10.3 Damage Control Anaesthesia in the Military Setting
267(1)
18.11 Critical Care
267(1)
18.12 Translating Military Experience to Civilian Trauma Care
267(1)
18.12.1 Leadership
267(1)
18.12.2 Front-end Processes
267(1)
18.12.3 Common Training
267(1)
18.12.4 Governance
267(1)
18.12.5 Rehabilitation Services
267(1)
18.12.6 Translational Research
267(1)
18.13 Summary
268(3)
19 Trauma Anaesthesia
271(12)
19.1 Introduction
271(1)
19.2 Preparation for Damage Control
271(1)
19.2.1 Introduction
271(1)
19.2.2 Planning and Communicating
271(1)
19.3 Damage Control Resuscitation (DCR)
271(4)
19.3.1 Limited Fluid Administration
272(1)
19.3.2 Permissive Hypotension
273(1)
19.3.3 Targeting Coagulopathy
273(1)
19.3.4 Prevent and Treat Hypothermia
274(1)
19.3.5 Key Messages
274(1)
19.4 Damage Control Surgery
275(1)
19.4.1 Anaesthetic Procedures
275(1)
19.4.2 Monitoring
276(1)
19.5 Anaesthesia Induction in Hypovolaemic Shock
276(3)
19.5.1 Introduction
276(1)
19.5.2 Drugs for Anaesthesia Induction
277(2)
19.6 Battlefield Anaesthesia
279(6)
19.6.1 Damage Control Anaesthesia in the Military Setting
280(1)
19.6.2 Battlefield Analgesia
280(3)
Appendices 283(45)
Appendix A Trauma Systems
285(4)
A.1 Introduction
285(1)
A.2 Inclusive Trauma System
285(1)
A.3 Components of an Inclusive Trauma System
286(1)
A.3.1 Administration
286(1)
A.3.2 Prevention
286(1)
A.3.3 Public Education
286(1)
A.4 Management of the Injured Patient within a System
287(1)
A.5 Steps in Organizing a System
287(1)
A.5.1 Public Support
287(1)
A.5.2 Legal Authority
287(1)
A.5.3 Establish Criteria for Optimal Care
287(1)
A.5.4 Designation of Trauma Centres
287(1)
A.5.5 System Evaluation
288(1)
A.6 Results and Studies
288(1)
A.6.1 Panel Review
288(1)
A.6.2 Registry Study
288(1)
A.6.3 Population-based Studies
288(1)
A.7 Summary
288(1)
Appendix B Trauma Scores and Scoring Systems
289(26)
B.1 Introduction
289(1)
B.2 Physiological Scoring Systems
289(1)
B.2.1 Glasgow Coma Scale (GCS)
289(1)
B.2.2 Paediatric Trauma Score (PTS)
289(1)
B.2.3 Revised Trauma Score (RTS)
289(1)
B.2.4 Acute Physiologic and Chronic Health Evaluation II: APACHE II
290(1)
B.3 Anatomical Scoring Systems
290(4)
B.3.1 Abbreviated Injury Scale (AIS)
290(2)
B.3.2 The Injury Severity Score (ISS)
292(1)
B.3.3 The New Injury Severity Score (NISS)
292(1)
B.3.4 Anatomic Profile (AP)
292(1)
B.3.5 ICD-based Injury Severity Score (ICISS)
293(1)
B.3.6 Organ Injury Scaling System
293(1)
B.3.7 Penetrating Abdominal Trauma Index (PATI)
293(1)
B.3.8 Revised Injury Severity Classification (RISC) II
293(1)
B.4 Co-morbidity Scoring Systems
294(1)
B.5 Outcome Analysis
294(3)
B.5.1 Functional Independence Measure (FIM) and Functional Assessment Measure (FAM)/FIM + FAM
294(1)
B.5.2 Glasgow Outcome Scale (GOS)
294(1)
B.5.3 Major Trauma Outcome Study (MTOS)
295(2)
B.5.4 A Severity Characterization of Trauma (ASCOT)
297(1)
B.6 Trauma Scoring Systems
297(1)
B.7 Scaling System for Organ-Specific Injuries
297(16)
B.8 Summary
313(2)
Appendix C The Definitive Surgical Trauma Care Course: Course Requirements and Syllabus
315(4)
C.1 Background
315(1)
C.2 Course Development and Testing
315(1)
C.3 Course Details
316(1)
C.3.1 Ownership
316(1)
C.3.2 Mission Statement
316(1)
C.3.3 Application to Hold a Course
316(1)
C.3.4 Eligibility to Present
316(1)
C.3.5 Course Materials and Overview
316(1)
C.3.6 Course Director
317(1)
C.3.7 Course Faculty
317(1)
C.3.8 Course Participants
317(1)
C.3.9 Practical Skill Stations
317(1)
C.3.10 Course Syllabus
317(1)
C.3.11 Course Certification
317(1)
C.4 IATSIC Recognition
317(1)
C.5 Course Information
318(1)
Appendix D Definitive Surgical Trauma Care Course - Core Surgical Skills
319(3)
D.1 The Neck
319(1)
D.2 The Chest
319(1)
D.3 The Abdominal Cavity
319(1)
D.4 The Liver
320(1)
D.5 The Spleen
320(1)
D.6 The Pancreas
320(1)
D.7 The Duodenum
320(1)
D.8 The Genitourinary System
320(1)
D.9 Abdominal Vascular Injuries
321(1)
D.10 Peripheral Vascular Injuries
321(1)
Appendix E Briefing for Operating Room Scrub Nurses
322(6)
E.1 Introduction
322(1)
E.2 Preparing the Operating Room
322(2)
E.2.1 Environment
322(1)
E.2.2 Blood Loss
322(1)
E.2.3 Instruments
323(1)
E.2.4 Cleaning
323(1)
E.2.5 Draping
323(1)
E.2.6 Adjuncts
323(1)
E.3 Surgical Procedure
324(1)
E.3.1 Instruments
324(1)
E.3.2 Special Instruments and Improvised Gadgets
325(1)
E.4 Abdominal Closure
325(1)
E.5 Instrument and Swab Count
326(1)
E.6 Medicolegal Aspects and Communication Skills
326(1)
E.7 Critical Incident Stress Issues
326(1)
E.8 Conclusion
326(2)
Index 328
Edited by





Kenneth D. Boffard, BSc(Hons), FRCS, FRCPS, FCS(SA), Emeritus Professor, Department of Surgery, Milpark Hospital and University of the Witwatersrand, South Africa