Acute Care Surgery and Trauma Evidence Based Practice Edited by Stephen M Cohn Acute Care Surgery and Trauma: Evidence Based Practice Edited by Stephen M Cohn MD FACS Witten B Russ Professor of Surgery University of Texas Health Science Center San Antonio, Texas, USA © 2009 Informa UK Ltd First published in the United Kingdom in 2009 by Informa Healthcare, Telephone House, 69-77 Paul Street, London EC2A 4LQ Informa Healthcare is a trading division of Informa UK Ltd Registered Office: 37/41 Mortimer Street, London W1T 3JH Registered in England and Wales number 1072954 Tel: +44 (0)20 7017 5000 Fax: +44 (0)20 7017 6699 Website: www.informahealthcare.com All rights reserved No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of the publisher or in accordance with the provisions of the Copyright, Designs and Patents Act 1988 or under the terms of any licence permitting limited copying issued by the Copyright Licensing Agency, 90 Tottenham Court Road, London W1P 0LP Although every effort has been made to ensure that all owners of copyright material have been acknowledged in this publication, we would be glad to acknowledge in subsequent reprints or editions any omissions brought to our attention Although every effort has been made to ensure that drug doses and other information are presented accurately in this publication, the ultimate responsibility rests with the prescribing physician Neither the publishers nor the authors can be held responsible for errors or for any consequences arising from the use of information contained herein For detailed prescribing information or instructions on the use of any product or procedure discussed herein, please consult the prescribing information or instructional material issued by the manufacturer A CIP record for this book is available from the British Library Library of Congress Cataloging-in-Publication Data Data available on application ISBN-10: 420 07513 ISBN-13: 978 420 07513 Distributed in North and South America by Taylor & Francis 6000 Broken Sound Parkway, NW, (Suite 300) Boca Raton, FL 33487, USA Within Continental USA Tel: (800) 272 7737; Fax: (800) 374 3401 Outside Continental USA Tel: (561) 994 0555; Fax: (561) 361 6018 Email: orders@crcpress.com Book orders in the rest of the world Paul Abrahams Tel: +44 (0)20 7017 4036 Email: bookorders@informa.com Composition by Exeter Premedia Servies Private Ltd., Chennai, India Printed and bound in India by Replika Press Pvt Ltd Contents Contributors viii Preface xiv Foreword xvii Introduction xxi Section I – Trauma Evidence for Injury Prevention Strategies: From Private Practice to Public Policy Michelle A Price and Cynthia L.Villarreal Trauma Systems S Morad Hameed and Richard K Simons Evidence-Based Review of Trauma Outcomes 18 Michael M Badellino, John J Hong, and Michael D Pasquale Evidence-Based Surgery: Military Injury Outcomes 23 Brian J Eastridge Evidence-Based Surgery: Traumatized Airway 29 Edgar J Pierre and Amanda Saab Monitoring of the Trauma Patient 36 Eugene Y Fukudome and Marc A de Moya Resuscitation of the Trauma Patient 42 David R King Diagnosis of Injury in the Trauma Patient 46 Pedro G R Teixeira and Kenji Inaba An Evidence-Based Approach to Damage Control Laparotomy for Trauma 56 Bruce Crookes 10 Evidence-Based Surgery: Coagulopathy in the Trauma Patient 65 Joseph J DuBose and Peter M Rhee 11 Traumatic Brain Injury 72 Ara J Feinstein and Kenneth D Stahl 12 Spine and Spinal Cord Injuries 80 Yoram Klein and Shaul Sagiv iii iv Contents 13 Facial Injuries 86 Antonio Jorge V Forte, Renato da Silva Freitas and Joseph H Shin 14 Ocular Trauma: An Evidence-Based Approach to Evaluation and Management 92 Heidi I Becker and M Kelly Green 15 Neck Trauma 97 Marc A de Moya 16 Emergency Thoracotomy 102 Joseph J DuBose and Mark Gunst 17 Trauma to the Chest Wall 105 Joseph J DuBose and Lydia Lam 18 Evidence-Based Surgery: Injury to the Thoracic Great Vessels 115 Mark Cockburn 19 Evidence-Based Surgery: Cardiac Trauma 121 Dror Soffer and Edan Sarid 20 Injury to the Esophagus, Trachea, and Bronchus 125 Deborah L Mueller 21 An Evidence-Based Approach to Spleen Trauma: Management and Outcomes 131 Anne Saladyga and Robert Benjamin 22 Injury to the Liver 138 Alberto Garcia, Maria Fernanda Jimenez and Juan Carlos Puyana 23 Small Bowel and Colon Injuries 144 Daniel L Dent 24 Diaphragmatic Injuries 147 Fahim Habib 25 Pancreatic and Duodenal Trauma 153 Adrian W Ong and Elan Jeremitsky 26 Abdominal Vascular Trauma 160 Joseph E Glaser and Alexandra A MacLean 27 An Evidence-Based Approach to Pregnant Trauma Patients 165 Igor Jeroukhimov 28 Pelvic Fractures 172 Matthew O Dolich 29 An Evidence-Based Approach to Extremity Vascular Trauma 177 Terence O’Keeffe 30 Surgery of Upper Extremity 186 Howard Wang, Patrick Schaner and Sahar David 31 Lower Extremity Injury 194 Hany Bahouth and Doron Norman 32 Limb Salvage for the Mangled Extremity 199 Gabriel E Burkhardt and Todd E Rasmussen 33 Critical Questions in Support of the Burned Patient 207 Steven E Wolf Contents 34 Burn Wound Management 212 Joseph H Shin, Antonio Jorge V Forte and Renato Freitas 35 Inhalation Injury 218 Leopoldo C Cancio 36 Electrical, Cold, and Chemical Injuries 226 Stephanie A Savage 37 Evidence-Based Wound Care Management 233 David Sahar and Howard Wang 38 Viperidae Snakebite Envenomation 240 Steven Granger and Ronald Stewart 39 Evidence-Based Surgery: War Wounds 245 Lorne H Blackbourne 40 Evidence-Based Surgery: Pediatric Trauma 250 Gerald Gollin 41 An Evidence-Based Approach to Geriatric Trauma 258 Carl I Schulman 42 Rural Trauma 265 Burke Thompson 43 Reducing Patient Errors in Trauma Care 268 Kenneth D Stahl and Susan E Brien Section II – Emergency General Surgery 44 Small Bowel Surgery 278 Erik J Teicher, John J Hong, Michael M Badellino, and Michael D Pasquale 45 An Evidence-Based Approach to Upper GI Bleed Management 285 John G Schneider and Bruce A Crookes 46 Peptic Ulcer Disease 290 Wayne H Schwesinger 47 Enterocutaneous Fistula 299 Peter A Learn 48 Paraesophageal Hernia Repair 303 Omid Noormohammadi, Alicia Logue and Kent R Van Sickle 49 Appendicitis 307 Peter P Lopez and Amy De Rosa 50 Lower Gastrointestinal Bleeding 316 Steven D Schwaitzberg 51 Diverticular Disease of the Colon 322 Brent Izu and Akpofure Peter Ekeh 52 Large Bowel Obstruction 327 Jerry Lee Howard, John J Hong, Michael M Badellino, and Michael D Pasquale 53 Acute and Chronic Mesenteric Ischemia 333 Joshua B Alley v vi Contents 54 Ogilvie’s Syndrome and Colonic Volvulus 336 Raymond P Compton 55 Hemorrhoids 341 Clarence E Clark III 56 Anal Fissure, Fistula, and Abscess 345 W Brian Perry 57 Evidence-Based Surgery: Pilonidal Disease 348 Matthew J Eckert, Joel E Goldberg and Scott R Steele 58 Rectal Prolapse: Evidence-Based Outcomes 356 Scott R Steele and Joel E Goldberg 59 Evidence-Based Practice: Acute Cholecystitis 368 Juliane Bingener 60 Acute Cholangitis 374 Adrian W Ong and Charles F Cobb 61 Acute Pancreatitis 382 Stephen W Behrman 62 Pancreatic Pseudo-cysts 390 Olga N Tucker and Raul J Rosenthal 63 Liver Abscess 397 Andreas G Tzakis and Pararas Nikolaos 64 Diagnosis and Treatment of Variceal Hemorrhage due to Cirrhosis 406 Robert M Esterl Jr., Greg A Abrahamian and K Vincent Speeg 65 Gangrene of the Foot 415 Maureen K Sheehan 66 Acute Arterial Embolus 419 Ryan T Hagino 67 Ruptured Abdominal Aortic Aneurysm 423 Boulos Toursarkissian 68 Acute Aortic Dissection 427 V Seenu Reddy 69 Deep Venous Thrombosis 433 Paula K Shireman 70 Pulmonary Embolism 438 George C Velmahos 71 Necrotizing Soft Tissue Infections 443 Mark D Sawyer 72 Incarcerated Hernias 447 Steven Schwaitzberg 73 Surgical Endocrine Emergencies 451 Christopher Busken, Rebecca Coefield, Robert Kelly and Steven Brower Section III – Surgical Critical Care Problems 74 Evidence-Based Surgery: Bacteremia 457 Sapoora Manshaii and Greg J Beilman Contents 75 Prevention of Central Venous Catheter Infections 463 J Matthias Walz and Stephen O Heard 76 Ventilator-Associated Pneumonia 467 Aaron M Fields 77 Management of Acute Myocardial Infarction and Cardiogenic Shock 473 Antonio Hernandez 78 Perioperative Arrhythmias 480 Bipin K Ravindran and Mohan N Viswanathan 79 Feeds and Feeding Surgical Patients 486 Jayson D Aydelotte 80 Evidence-Based Surgery: Acute Lung Injury/Acute Respiratory Distress Syndrome 490 Juan J Blondet and Greg J Beilman 81 Acute Renal Failure 497 Teofilo Lama 82 Hyperglycemia 503 Balachundhar Subramaniam and Alan Lisbon 83 Abdominal Compartment Syndrome 509 James C Doherty 84 Agitation and Delirium in the ICU 514 Robert Chen 85 Malignant Hypertension: An Evidence-based Surgery Review 523 David S Owens and Marshall A Corson Appendix 533 Index 573 vii Contributors Robert Benjamin MD FACS Chief of Trauma Services William Beaumont Army Medical Center Department of Surgery El Paso, Texas, USA Greg A Abrahamian MD Assistant Professor of Surgery, Department of Surgery Transplant Center, University of Texas Health Science Center at San Antonio, Texas, USA Omid Noormohammadi, Alicia Logue MD University of Texas Health Science Center San Antonio, Texas, USA Bethesda MD Department of Surgery Madigan Army Medical Center, Tacoma Fort Lewis, Washington, USA Joshua B Alley MD Major USAF MC, Staff General Surgeon Wilford Hall Medical Center, Lackland AFB Texas Clinical Assistant Professor, Department of Surgery, University of Texas Health Science Center San Antonio, Texas, USA Juliane Bingener MD Department of Surgery, Mayo Clinic Rochester, Minnesota, USA COL Lorne H Blackbourne MD FACS U.S Army Institute of Surgical Research Fort Sam Houston San Antonio, Texas, USA Jayson D Aydelotte MD Director of Trauma, Department of Surgery Walter Reed Army Medical Center Washington, DC, USA Juan J Blondet MD Postdoctoral Fellow, Department of Surgery University of Minnesota Minneapolis, Minnesota, USA Michael M Badellino MD Associate Professor of Surgery Penn State College of Medicine Program Director, General Surgery Residency Lehigh Valley Health Network Allentown, Pennsylvania, USA Col W Brian Perry MD USAF MC Wilford Hall Medical Center, Lackland AFB San Antonio, Texas, USA Hany Bahouth MD BSC General and Trauma Surgeon, Director Acute Care Surgery, Rambam Health Campus Haifa, Israel Susan E Brien MD MEd CSPQ FRCSC CPE Associate Director, Professional Affairs, Royal College of Physicians and Surgeons of Canada Ottawa, Ontario, Canada Heidi I Becker MD Assistant Professor Department of Ophthalmology, University of Texas Health Science Center at San Antonio San Antonio, Texas, USA Steven Brower MD Division of General Surgery Memorial Health Medical Center Savannah, Georgia, USA Stephen W Behrman MD FACS Associate Professor of Surgery, Department of Surgery The University of Tennessee Health Science-Center Memphis, Tennessee, USA Gabriel E Burkhardt MD Capt USAF MC Vascular Surgery Resident, Wilford Hall United States Air Force Medical Center, Lackland Air Force Base The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA Greg J Beilman MD FACS Professor of Surgery, Department of Surgery University of Minnesota Minneapolis, Minnesota, USA Christopher Busken MD Division of General Surgery Memorial Health Medical Center Savannah, Georgia, USA viii Contributors Leopoldo C Cancio MD FACS Colonel, Medical Corps, U.S Army, U.S., Army Institute of Surgical Research, Fort Sam Houston San Antonio, Texas, USA Robert Chen MD FRCPC Attending Anaesthetist and Intensivist Assistant Professor St Michael’s Hospital, Department of Anaesthesia University of Toronto, Toronto, Canada, USA Clarence E Clark III MD Chief Resident, General Surgery Department of Surgery University of Texas Health Science Center San Antonio and Wilford Hall Medical Center San Antonio, Texas, USA Charles F Cobb MD Associate Professor of Surgery, Drexel University College of Medicine, Allegheny General Hospital Department of Surgery Pittsburgh, Pennsylvania, USA Mark Cockburn MD New Rochelle, New York, USA James C Doherty MD MPH Director of Trauma Surgery and Critical Care Advocate Christ Medical Center Oak Lawn, Illinois Clinical Assistant Professor of Surgery, University of Illinois College of Medicine, Chicago, Illinois, USA Matthew O Dolich MD FACS Associate Clinical Professor, Department of Surgery University of California, Irvine Orange, California, USA Joseph J DuBose MD Division of Acute Care Surgery, Trauma and Surgical Critical Care, Wilford Hall Medical Center Lackland AFB, Texas Clinical Instructor, Trauma and Surgical Critical Care Division of Trauma and Surgical Critical Care Los Angeles County, University of Southern California Hospital Los Angeles, California, USA COL Brian J Eastridge MD FACS Director, Joint Trauma System U.S Army Institute of Surgical Research Fort Sam Houston, San Antonio, Texas, USA Rebecca Coefield MD Division of General Surgery Memorial Health Medical Center Savannah, Georgia, USA Matthew J Eckert MD Department of Surgery, Madigan Army Medical Center Fort Lewis, Washington, USA Raymond P Compton MD FACS Paris Surgical Specialists, Chief of Surgery, Henry County Medical Center Paris, Tennessee, USA Akpofure Peter Ekeh MD Associate Professor Wright State University Department of Surgery, Boonshoft School of Medicine Dayton, Ohio, USA Marshall A Corson MD Associate Professor of Medicine Head, Section of Cardiology Medical Center Division of Cardiology University of Washington Medical Center Seattle, Washington, USA Bruce A Crookes MD FACS Assistant Professor of Surgery, Division of Trauma Burns and Critical Care, Department of Surgery University of Vermont College of Medicine Burlington, Vermont, USA Marc A de Moya MD FACS Assistant Professor of Surgery Harvard Medical School Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital Boston, Massachusetts, USA Robert M Esterl Jr MD Professor of Surgery, Department of Surgery Transplant Center, University of Texas Health Science Center at San Antonio, Texas, USA Ara J Feinstein MD MPH Ryder Trauma Center, Jackson Memorial Hospital Division of Trauma and Surgical Critical Care DeWitt Daughtry Family Department of Surgery Miami, Florida, USA Aaron M Fields MD Assistant Program Director Critical Care Fellowship, Staff Intensivist Staff Anesthesiologist, United States Air Force Wilford Hall Medical Center Lackland AFB, Texas, USA Amy P De Rosa DO Resident Surgeon MCRMC: Department of General Surgery Michigan State University East Larsing, Michigan, USA Antonio Jorge V Forte MD Resident Plastic Surgery, Section of Plastic Surgery Department of Surgery Yale University School of Medicine New Haven, Connecticut, USA Daniel L Dent MD Associate Professor, Division of Trauma and Emergency Surgery, University of Texas Health Science Center San Antonio, Texas, USA Renato Freitas MD PhD Adjunct Professor of Plastic Surgery Federal University of Parana Curitiba, Brazil ix 570 Appendix Clinical Questions Question Answer What are risk factors for development of ALI/ ARDS? What is appropriate ventilator management in ALI/ARDS? What are common causes of poor outcome in ALI/ARDS? Is there a risk of PEEP >10, FiO2 >0.5? Risk factors for ARDS/ALI include severe sepsis, multiple system trauma, massive blood transfusion, aspiration, and others Low tidal volume ventilation (VT 3.5 L/24 hour resuscitation, hypothermia, oliguria, anemia, base deficit, high GAP CO2 Intermittent IAP measurement via urinary bladder (B) with repeat measurements if IAH is present (C) There appears to be benefit in keeping APP ≥50–60 mmHg How should patients be screened for ACS/IAH? Is there a threshold level of IAP that mandates intervention? Are there any effective nonsurgical strategies for treating ACS/IAH? Is there a preferred technique for temporary abdominal closure? Is there a predictable time frame or preferred technique for definitive abdominal closure? Is there a role for abdominal decompression in the management of intracranial hypertension Grade of recommendation B B, C C Decompressive laparotomy (B), neuromuscular blockade (C), supine positioning (C), avoid overly zealous fluids (B), colloid or hypertonic crystalloid (C), percutaneous catheter drainage (C) No B, C No N/A Decompressive laparotomy should be considered in cases of refractory intracranial hypertension N/A B Abbreviations: ACS, abdominal compartment syndrome; APP, abdominal perfusion pressure; GAP CO2, gastric-to-arterial PCO2 difference IAH, intra-abdominal hypertension; IAP, intra-abdominal pressure; N/A, not available 572 Appendix Question Summary Question Answer How can sedation needs be assessed? How should sedation in the ICU be managed? What is the evidence for short-acting and non-GABA drugs for ICU sedation? What is the impact of delirium in ICU? Sedation requirements should be reexamined frequently using a sedation scale The use of a sedation protocol or daily interruption of sedation should be considered A A Propofol and dexmedetomidine should be reserved for ICU sedation where the duration is thought to be no more than 24–48 hours, propofol should be given at an infusion rate of no more that 4–5 mg/kg/hour Delirium is common It increases length and cost of stay and may lead to long-term cognitive dysfunction The rate of delirium is high and underdiagnosed Screen for delirium with a standardized exam or scale Treat delirium with environmental changes (risk factor reduction or elimination), then haloperidol There is an association with alcohol and trauma All trauma admissions should be screened for alcohol and alcoholism If alcoholism is identified, brief intervention is warranted No! Alcohol withdrawal should be treated with benzodiazepines in a symptom-driven approach Processed EEG is not ready for sedation assessment C How is delirium identified? How should delirium be treated? What is the impact of alcohol and trauma? Should benzodiazepines be given as prophylaxis for alcohol withdrawal? Is processed EEG an equivalent to the qualitative clinical assessment of sedation? Grade A A A A D Abbreviations: EEG, electroencephalogram; GABA, gamma-aminobutyric acid; ICU, intensive care unit Summary of Grade of Recommendations for Questions Regarding Malignant Hypertension Question Summary recommendation What is the optimal target BP for chronic therapy? How should preexisting hypertension be managed in the perioperative setting? Care guidelines recommend SBP 120 mmHg, or lower pressures with target organ dysfunction, should be treated aggressively to lower SBP to 110 mmHg for noncardiac surgeries and SBP >140 or DBP >90 mmHg following cardiac surgeries Agents shown to be most effective include sodium nitroprusside, nitroglycerin, labetalol, nicardipine, and fenoldopam Encephalopathy, hemorrhagic or ischemic CVA, myocardial ischemia and infarction, acute pulmonary edema, aortic dissection, acute renal failure, or anastamotic complications; these signs may be masked in the perioperative period and should be aggressively sought in patients with severe hypertension No pharmacologic agents have been shown to improve morbidity and mortality in hypertensive emergencies, but appear to be equally efficacious at lowering BP acutely Choice of therapy should be tailored to clinical context and patient condition What is the threshold for pharmacologic treatment of high BP acutely in ambulatory individuals? What are the clinical implications of APH? What are the best therapies for APH? What signs and symptoms suggest end organ compromise due to malignant hypertension? What are the best pharmacologic therapies for acute management of hypertension in the presence of complicating conditions? Grade B B C C C B C Abbreviations: APH, acute postoperative hypertension; BP, blood pressure; CVA, cerebrovascular accident; DBP, diastolic blood pressure; SBP, systolic blood pressure Index abdominal compartment syndrome, 509 abdominal decompression, 511–12 ACS/IAH screening, 510 definitive abdominal closure, 511–12 IAP threshold level, 510 nonsurgical strategies, 510–11 risk factors, 510 temporary abdominal closure, 511 treatment, 510 abdominal decompression role in intracranial hypertension, 511–12 abdominal operation enteral feeds, 486–7 abdominal perfusion pressure (APP), 510 abdominal septic complications, 144, 145 Abdominal Trauma Index, 144 abdominal vascular trauma evaluation and diagnosis, 160–1 color duplex doppler, 161 CTA, 161 MRA, 161 follow-up, 163 intraoperative management anticoagulation, 162–3 interventional endovascular techniques, 161–2 intraoperative placement of endovascular balloon, 162 SMV injuries, 162 outcomes, 163 role of thoracotomy, 161 ultrasonography/CT, 163 ACE-I therapy managment of MI, 476–7 acellular replacement dermis, 235 ACP (antivenin), 242 ACS-COT, acute airway trauma, 29 acute aortic dissection beta-blockade, 430 blood pressure management, 430 categories, 427–8 imaging modality, 428–9 role and timing of operative intervention, 429 role of D-dimer, 428 stent graft repair, 430 acute appendicitis, 307, 310 acute arterial embolus diagnosis of embolism, 420 embolic ischemia vs thrombotic ischemia, 419–20 initial thrombolysis prior to surgical revascularization, 420–1 perioperative anticoagulation, 420 acute cholangitis antibiotic strategy, 375 cholecystectomy after ES, 376 endoscopic decompression/PTBD, 375–6 methods, 374–5 role of MRCP, 376 acute cholecystitis, 372 anatomy and physiology, 368 clinical criteria, 368–9 discussion, 372 evaluation and diagnosis, 368–9 history and epidemiology, 368 management, 369–72 antibiotic therapy, 371 indications and outcomes for nonsurgical intervention, 370–1 laparoscopic cholecystectomy, 369 perioperative pain therapy, 371–2 postoperative drain placement, 371 timing of surgical intervention, 369–70 radionuclide scan, 369 acute diverticulitis, 322 acute fluid collections, 390 acute kidney injury (AKI), 498, 499 acute lower extremity compartment syndrome (ALECS), 182 acute lung injury, 490 causes of poor outcome, 492 risk factors, 491 risk of PEEP, 493 salvage therapies, 493–4 ventilator management low Vt ventilation, 491–2 PEEP and alveolar recruitment, 492 weaning protocols, 494 acute mesenteric ischemia (AMI), 333 CT angiography, 333 endovascular therapy, limited role of, 334 acute myocardial infarction cardiogenic shock, 477–8 diagnosis, 473–4 management, 474–7 non–ST-elevation MI, 477 acute pancreatic pseudo-cyst, 390 acute pancreatitis enteral nutrition, 385–6 gastric feeding, 386–7 inflammatory cascade alleviation, 387–8 prophylactic antibiotics, 384–5 role of ERCP, 383–4 scoring systems, 382–3 acute pilonidal disease, 348 acute postoperative hypertension (APH), 525 therapies, 525 acute pulmonary edema, 528 acute renal failure (ARF), 497 dopamine, ineffective as treatment, 499 epidemiology, 498 history, 497–8 573 574 Index acute renal failure (ARF) (Continued ) initial evaluation and diagnosis, 498 management higher risk surgical patients, 499 IHD vs CRRT, 500 impact in morbidity and mortality, 500 role of CRRT, 500 role of diuretics, dopamine and fenoldopam, 499 signs of AKI/ARF, 499 treatment modalities, 499–500 morbidity and mortality, 500 physiology, 498 prevention as treament nonpharmacologic approaches, 498 pharmacologic approaches, 498 risk of developing, 499 signs, 499 surgical patients, treatment modalities, 499 acute respiratory distress syndrome (ARDS), 220, 481 definition, 490 acute respiratory distress syndrome (ARMA), 220 Adaptation to Intensive Care Environment (ATICE), 515 Adaptation to the Intensive Care Environment, 515 adrenal crisis, 455 signs and symptoms, 455 symptoms, 455 treatment, 455 work-up, 455 adrenal insufficiency, 455 adult respiratory distress syndrome, 195, 511 Advanced Trauma Life Support (ATLS), 175, 188, 265 Agency for Healthcare Policy and Research (AHCPR), 494 agitation and delirium alcohol and trauma impact, 518 benzodiazepines for alcohol withdrawal, 518–19 delirium identification, 517–18 impact of delirium, 517 processed EEG, 519 sedation assessment, 515 sedation in ICU management, 515–17 short-acting and non-GABA drugs, 517 treatment of delirium, 518 AHRQ, 20 alcohol impact in ICU, trauma, 518 withdrawal, 519 ALI/ARDS causes of poor outcome in, 492 PEEP and, 492 risk factors, 491 risk of PEEP, 493 ventilator in, 491–2 weaning protocols for mechanical ventilation, 494 ALIVE study, 492 allogenic cultured skin, 215 Alvimopan, 280 amebic abscesses, 397 amebic liver abscesses, 399 amiodarone, 481 anal fissure antibiotics for perianal abscesses, 347 endorectal advancement flap for complex fistulas, 346–7 fibrin glue, plug, seton for complex fistulas, 346 fistulotomy for simple fistula-in-ano, 346 lateral internal sphincterotomy, 346 nonoperative medical therapies, 345–6 analgesia, in surgical ICU, 515 anastomosis, 144 angiographic embolization, 162 angiography, 116, 288, 317–18 ankle-brachial pressure index (ABI), 178 anterior cord syndrome, 81 anti-infective catheters, 465 antibiotics, 213–14 anticoagulants managment of MI, 476, 477 anticoagulation, 136, 478 antidiuretic hormone (ADH), 451 decreased secretion, 451 antihypertensive therapy, 116–17 antimicrobial resistance, 292 antimicrobials minimizing burn wound infection, 209 antiplatelet therapy managment of MI, 477 antipyretics, 453 antisecretory therapy, 291 aortic dissection, 528 apigraft, 215 appendicitis antibiotics, 310 appendectomy vs antibiotics, 312–13 clinical findings, 308 CT scan, 310–11 interval appendectomy, 312 laboratory test, 308 laparoscopic appendectomy, 309 pain medicine and diagnostic accuracy, 309 aspirin managment of MI, 476 Atlanta classification system, 390–1 atrial arrhythmias prevention, 480–2 treatment, 482–3 atrial fibrillation (AF), 480 anticoagulation, 483 AV-nodal blocking agent, avoiding, 482 prevention, 480–2 cardiac pacing, 482 intraoperative techniques, 481–2 treatment, 482 warfarin, 483 atrial tachyarrhythmias, 480 AUDIT, autografting, 215 autologous cultured skin, 215 autologous vein interposition graft, 200 aviation-based CRM, 273 baby aspirin, 476 bacteremia, 457 antibiotic therapy, avoiding, 459–60 diagnosis blood cultures, 457–8 PCR, 458 diagnosis of catheter-related, 458–9 empiric therapy, 459 prevention of catheter-related bloodstream infections, 460–1 protocol for diagnosis, 457–8 banding ligation, 287 barium esophagography, 128 beta-blockade, 430 beta-blocker therapy, 475 managment of MI, 477 beta-blockers, 259 bilayer matrix, 235 biobrane, 215 bleeding risks vs DVT recurrence, 435 Index blood cultures, 457 bloodstream infections, intravascular catheters, 458 see also catheter-related bloodstream infection (CRBSI) diagnosis, 458–9 blunt cardiac injury ECG monitoring, 122 echocardiography, 122 elimination, 121–2 management of foreign bodies, 123 role of pericardiocentesis, 122–3 role of pledgets, 123–4 blunt thoracic aortic injury beta-blockade and intravenous vasodilator therapy, 116–17 diagnosis, 115–16 endovascular treatment, 118–19 modality in minimal aortic injuries, 116–17 nonoperative management, 117 operative techniques, 117–18 botulinum toxin, 87, 345 bowel viability, intraoperative evaluation tools, 448–9 BP, optimal, 523–4 pharmacologic therapy, 524 bradyarrhythmias, 483 brain seizure activity, 74 bronchoalveolar lavage (BAL), 467 bronchopleural fistula, 109 Brown-Sequard syndrome, 81 burn care, 207 burn depth determination laser Doppler imaging, 208 burn flowsheet, 248 burn resuscitation Parkland and modified Brooke formulas, 207–8 burn wound debridement, 214–15 burn wound excision, 209 blood loss minimization, 209 debridement, 214–15 optimal time, 208 burn wound infection antibiotic treatment, 213–14 minimization, 209 excision and grafting/antimicrobials use, 209 burn wound management ancillary treatment to prevent keloids/scar contracture silicone sheeting/pressure garments, 215–16 choice of fluids for resuscitation, 213 definitive treatment and artificial skin autografting, 215 scar contracture/keloids prevention, 214–15 timing and technique for debridment, 214–15 use of systemic and topical antibiotics, 213–14 CAGE, calcium channel blockers, 345 carcinoid crisis, 451 carcinoid syndrome, 451 cardiac arrhythmias, 122 cardiac troponin I (cTnI), 121 cardiogenic shock, 577 cardiopulmonary bypass, 229 cardiopulmonary resuscitation (CPR), 102 cardiovascular disease cause of death in US, 473 catheter-directed thrombolysis, 435 catheter-related bacteremia, 458 catheter-related bloodstream infection (CRBSI) catheter bundles/intervention model, 464 prevention, 460 caustic ingestions, 229–30 575 CECT, 392 Centers for Disease Control and Prevention (CDC), 135 central cord syndrome, 81 central diabetes insipidus causes, 451 treatment, 451 central venous catheter infections, prevention of anti-infective catheters, 465 anti-infective catheters and antibiotic resistance, 465 behavioral interventions in reducing, 464 catheters placement, 464–5 education program, 464 method and site for intravascular catheter insertion, 463–4 cerebral perfusion pressure, 251 cerebrovascular accidents (CVAs), 528 chemical injuries agents to prevent, 230–1 endoscopy and caustic ingestion, 230 chest wall trauma imaging modalities, 105–6 pain control, 106–7 persistent air leaks, 108–9 pulmonary parenchymal hemorrhage control techniques, 107 retained hemothorax management, 109–10 ventilatory weaning modalities, 108 child safety seat, chronic mesenteric ischemia (CMI), 333 duplex ultrasound/CT angiography, 333 MRA, 334 open bypass or catheter-based endovascular intervention, 334 chronic therapy optimal target BP, 523–4 cirrhosis, 407 clamp-and-sew techniques, 118 CN poisoning, 222–3 hydroxocobalamin treatment, 222 coagulation, 107 coagulopathy factor VIIa, 67 and guide therapy, 68–9 massive transfusion protocols, 65 PRBCs:FFP ratio, 66 whole blood transfusion, 66 cold injuries hypothermia, 228–9 rewarming, 228–9 risk factors, 228 role of thrombolytics, 229 colloid resuscitation, 213 colonic neoplasia, 328 colonic stenting, 330 colonic volvulus, 338 colonoscopic decompression, 337 colonoscopy, 317, 318 color duplex doppler, 161 color flow Doppler imaging, 99 colostomy, 174 combat burn care advances, 247–8 combat damage control resuscitation, 247 combat-injured evacuation route, 246 combat vascular surgery temporary vascular shunt use, 247 comfort scale, 515 compartment syndrome, 189, 194 compensated shock/occult hypoperfusion, 36 computed tomographic pulmonary angiography (CTPA), 439 continuous renal replacement therapy, 248 576 Index continuous RRT (CRRT), 499 role of, 500 continuous veno-venous hemodialysis (CVVHD), 499–500 advantages over IHD, 500 contrast-enhanced abdominal computed tomography (CECT), 392 contrast-enhanced ultrasound (CEU), 134 conventional excisional surgery, 343 cooximetry, 223 coronary artery bypass grafting (CABG), 480 corticosteroids, adrenal crisis treatment, 455 cricothyroidotomy, 30 CRM, 273 crystalloid resuscitation, 213 CT scan, 250 CTA technology, 49, 161 cyborg prosthesis, 188 damage control, 84 damage control laparotomy decrease mortality rates, 57 intraoperative identification, 58 morbidity rate, 59–60 preoperative identification, 57–8 temporary closure of open abdomen, 59 termination, 59 damage control resuscitation, 24, 247 damage control techniques, 200 debridement, 242–3 deep venous thrombosis (DVT), 433 catheter-directed thrombolysis, 434 compression stockings, 435 graded compression stockings, 435 home therapy for venous thromboembolism, 434 home therapy with LMWH, 433 initial treatment for venous thromboembolism, 433–4 length of oral vitamin K antagonist treatment, 434–5 oral starting dose of vitamin K antagonists, 434 preventing recurrent, 434 definitive stabilization, 201, 202 delirium definition, 517–18 impact in ICU, 517 risk factors, 516 treatment of, 518 dermagraft, 215 dexmedetomidine, 517 diabetes affected population, 503 risk of heart disease/stroke, 503 of stress, 505 diagnosis of injury FAST in hemodynamically stable patients, 47 FAST in hemodynamically unstable patients, 47–8 pneumothorax detection, 48–9 role of CT-angiography, 49–50 routine pelvis plain films, 49 ultrasound in penetrating trauma patients, 48 diagnostic peritoneal aspirate, 48 diagnostic peritoneal lavage (DPL), 140, 167 diaphragmatic injuries classification system, 149 consequences of missed injuries, 150 diagnosis in blunt trauma, 148 diagnosis in penetrating trauma, 148–9 left vs right-sided injuries, 150 operative management approaches, 149 suture material/prosthesis for repair, 150 diverticular disease of colon dietary recommendations, 323–4 elective colectomy in younger patients, 323 indication for elective colectomy, 322–3 laparoscopic colectomy, 324–5 primary anastomosis, 324 domestic violence, control of, duodenal trauma diagnosis, 154, 156 pyloric exclusion in primary repair of duodenal perforation, 157 reliability of CT to diagnose blunt duodenal perforation, 156 treatment, 154 duodenography, 156 Early Management of Severe Trauma, 266 Eastern Association for the Surgery of Trauma (EAST), 138 echocardiography, 474 elective laparoscopic hernia repair, 304 electrical injuries cardiac evaluation, 227 upper arm fasciotomy, 227–8 electroencephalogram (EEG), 519 electroporation, 226 embolic therapy, 318 emergency department thoracotomy (EDT), 161 CPR for blunt trauma, 103 CPR for penetrating thoracic trauma, 102–3 extra-thoracic injuries, 103 institutional protocols, 103 pericardiotomy, 103–4 empiric coverage, 469 empiric therapy, 459 empyema, 109 encephalopathy, 527 endorectal advancement flap, 346–7 endoscopic banding ligation, 287 endoscopic decompression, 375 endoscopic retrograde cholangiopancreatography, 374, 393 endoscopic retrograde cholangiopancreatography (ERCP), 402 endoscopic retrograde cholangiopancreatography (ERCP), 153 endoscopy, 287, 293 endotracheal tube (ETT), 468 endovascular repair, 425 endovascular revascularization, 417 endovascular stent grafts, 118, 119 enteral nutrition, 385 enteral tube feedings, 486 after abdominal surgery, 487 glutamine as additive, 487 enterocutaneous fistula factors predicting mortality, 299–300 nutritional strategy TPN/enteral nutrition, 300 optimal timing for elective surgical intervention, 301 role of somatostatin, 300–1 surgical closure by resectional/nonresectional techniques, 301 VTACs increase risk, 300 envenomations, 240 epidural, 107 error categorization, 269 error-producing conditions (EPCs), 269 esmolol, 526 esophageal injuries diagnostic test, 128 incidence, 127 mechanism, 127 nonoperative management, 130 surgical management, 128 symptoms and signs, 127–8 Index esophagography, 98, 128 esophagography, 128, 129 evidence-based guidelines, 20 evidence-based outcome evaluations (EBOEs), 18 excision and grafting, 215 execution error, 269 explosion injuries, 246 external fixation, 195, 202 external hemorrhoids, 341 extracorporeal membrane oxygenation, 493 extracorporeal membrane oxygenation (ECMO), 493 extraperitoneal packing, 173 extremity injury, 204 extremity vascular trauma diagnosis, 177 endovascular treatment (stenting), 180 knee dislocation, 179–80 nonoperative management, 180 prophylactic fasciotomy, 182 tourniquets usage, 181 vascular shunts for damage control vascular surgery, 181 FabAV for treatment of pit viper envenomations, 242 facial injuries method and timing of closing and caring for facial lacerations, 86–7 surgical treatment of mandible fractures, 89–90 timing of facial fracture repair, 87–8 use of antibiotics for facial lacerations and fractures, 88–9 fasciotomy, 242 FAST, 168 FASTHUG paper, 515 feeds and feeding surgical patients enteral feeds, 487 feed stomach/small bowel, 487 glutamine, 487 immunonutrition, 487 TPN/tube feedings, 486 femur fractures, 253 fenoldopam, 526 fiber intake and risk of diverticulitis, 323–4 fiber optic laryngoscopy, 210 fibrin glue, 346 firearm injury, firearm safety, 3–4 fistula plug, 346 fistulotomy, 346 fluid resuscitation, 213, 223, 453 FOB, 220 focused abdominal sonography for trauma, 47 focused assessment with sonography in trauma (FAST), 172 fragmentation wounds CT scan, 246 frostbite, 228 gamma-aminobutyric acid (GABA) agonists, 517 gangrene of foot cardiac work-up, necessity of, 416 endovascular revascularization, 416–17 primary amputation, 417 vascular testing/imaging, 415–16 geriatric, 258 geriatric trauma appropriate withholding/withdrawing care, 261–2 beta-blockers, 259 effect of PECs, 259 injury prevention programs, 261 resuscitation and monitoring strategies, 260–1 triage guidelines, 259–60 warfarin use, 259 Glasgow Coma Scale, 88 glucose control benefits and side effects of, 504–5 perioperative, 504 decreasing variability, beneficial, 505–6 glutamine, 487 glyceryl trinitrate, 345 gun safety programs, gunshot wounds, 140 halofuginone, 230 HBO therapy, 445 HBOT, 223 head computed tomography, 73 head injuries, 251 heat and moisture exchangers (HME), 468 helical computed tomography (HCT), 116 Helicobacter pylori infection, 291 hemodialysis, 497–8 hemorrhoids classification, 341 conventional excisional surgery, 343 harmonic scalpel, bipolar diathermy, 342 management internal hemorrhoids, 341–2 symptomatic external hemorrhoids, 343–4 non-operative management strategy rubber band ligation, 342 open vs closed hemorrhoidectomy, 342 stapled hemorrhoidopexy, 342 hemostatic agents, 201–2 hemosuccus pancreaticus, 391 hepatic vein pressure gradient (HVPG), 407 hernias, need to repair, 449 high-frequency oscillatory ventilation, 209, 493 high-frequency percussive ventilation, 220 high-reliability theory, 271 high-voltage injuries, 227 high-volume hemofiltration, 499 Hinchey stages, 324 HROs, 271 human error, 269 human placental lactogen (hPL), 166 hydroxocobalamin treatment cyanide poisoning, 223 hyperbaric oxygen therapy, 222, 236, 444–5 hyperglycemia blood glucose variability and outcome, 505–6 cost savings, 506 perioperative glucose control, 504 prevention of glucose toxicity/insulin, 505 risk of death and degree of, 505 target blood glucose value with least adverse effects, 505 target glucose level in diabetics and nondiabetics, 504–5 TGC in surgical ICU, 503–4 hypertension, 523 risk for intraoperative hemodynamic instability, 524 treatment of β-adrenergic blockade, 453 hypertensive emergency, 524 hypertensive encephalopathy, 527 hypertensive urgency, 524 hyperthyroidism diagnosis of, 453 etiology, 451 hypertonic saline, 213 hypertrophic scars, 236, 237 577 578 Index hypoglycemia, 505 hypotensive resuscitation, 43 hypothermia, 228, 229 IAH/ACS fluid administration, 511 nonsurgical strategies for treating, 510 risk factors, 510 temporary abdominal closure techniques, 511 use of catheter decompression to reduce IAP, 511 iatrogenic injuries, 180 Ibutilide, 482 ICU sedation, short-acting and non-gaba drugs for, 516 II see inhalation injury ileus, 278 immunoglobulin therapy, 445 immunosuppressive therapy, 93 incarcerated hernia, 447 diagnosis, 447–8 GI contamination/infection repair options, 448 mortality, factors, 448 technical considerations for treating, 448 incarcerated hernias characteristics, 448 choices for repair, 448 elective repair, 449 intraoperative evaluation tools, 448–9 physical examination and imaging evaluations, 447–8 repair options, 448 incomplete spinal cord injuries, 81 inferior vena cava (IVC) filters effectiveness of, 440 inhalation injury, 218–19 cooximetry, 223 diagnostic procedures FOB, 220 imaging, 220 drugs and fluid management strategies fluid resuscitation, 221 inhaled heparin, 221 other drugs, 221–2 endotracheal intubation, 219–20 mechanical ventilation, 220–1 high-frequency percussive ventilation, 220 tracheostomy, 219–20 transfer to burn center, 223 treatment carbon monoxide, 222 cyanide, 222–3 methemoglobinemia, 223 types, 218–19 ventilation methods HFOV/HFPV, 209 inhaled heparin, 221 injury, injury control, injury prevention strategies benefit of primary belt laws, clinician counseling regarding firearm safety, 3–4 control of domestic violence, effectiveness of SBI for alcohol problems, 2–3 injury prevention counseling, Injury Severity Score (ISS), 105, 161, 266 integra, 215 intensive care unit, 514 intensive care unit (ICU), stress in, 514 intensive glucose management, 503 Leuven I trial, 503–4 intention error, 269 intermittent hemodialysis (IHD), 497 internal hemorrhoids, 341 intimate partner violence, intra-abdominal adhesions, 280 intra-abdominal hypertension (IAH), 509 diagnosis, measurement of IAP, 510 intracranial hypertension, 251 intracranial pressure (ICP), 88, 251 intrahepatic abscess, 397 intramedullary nailing, 195, 202 intraoperative glycemic control, beneficial effects of, 504 intrapleural fibrinolytics, 109 ISS, 260 Joint Theater Trauma System, 24 Kanavel’s sign, 187 Karydakis flap, 351 keloid/hypertrophic scar treatments, 236 intralesional steroid injection, 237 silicone gel/pressure therapy, 237 keloids/hypertrophic scars, 215 Kleihauer-Betke test, 167 knowledge-based errors, 269 labetalol, 526 lacerations repair, 190 laparoscopic appendectomy, 309 laparoscopic colon resection, 325 laparoscopic color duplex ultrasound (LDCU), 161 laparoscopic preperitoneal repair, 448 laparoscopy, 149 laparotomy, 103, 141 large bowel obstruction clinical presentation, 327 colon cancer, 327–8 diagnostic evaluation, 328–9 differential diagnosis, 328 hernias, 328 infrequent causes, 328 nonoperative approaches, 329–30 colonic stenting, 330 operative approaches, 329 outcomes, 330 large hemoperitoneum, 132 laser Doppler method, 208 lateral internal sphincterotomy, 346 Leapfrog group, 20 LeFort fractures, 30 Leuven I trial, 504 limb salvage, 200 cost of reconstruction and quality of life, 204–5 defined, 200 factors influence decision, 203 management strategies improve ischemia and reperfusion injury, 200–1 damage control techniques, 200 temporary vascular shunt, 200–1 vessel ligation, 200 mangled extremity severity scoring systems, 203–4 prehospital adjuncts, 201–2 topical hemostatic agent, 201–2 tourniquets, 201 skeletal reconstruction, 202 definitive stabilization, 202 external fixation, 202 soft tissue wound management strategies, 202–3 rotational flap/free tissue transfer, 203 Index skin grafts, 203 VAC therapy, 202 upper vs lower extremity injury, 201 limb salvage rates, 201 liver abscess causes of, 398 definition, 397–8 diagnosis imaging studies, 401 laboratory findings, 400 serologic tests, 400–1 stool examination, 400 differential diagnosis, 401–2 epidemiologic facts, 398 etiology and pathogens, 398–9 prognosis, 403 symptoms, 399–400 treatment modalities, 402–3 types, 397 liver injury angio-embolization as adjuvant therapy, 141 drainage techniques, 139–40 efficiency of NOM, 138–9 NOM in patients with GSW to liver, 140–1 routine CTs for follow-up, 139 low molecular weight heparin (LMWH), 433, 440 advantages, 433–4 managment of MI, 476 treatment of PE, 441 low-voltage electrical injuries, 227 lower airway and parenchymal injuries, 218–19 Lower Extremity Assessment Project (LEAP), 203 lower extremity injury amputation prediction method, 196 compartment pressure measurement method, 194–5 damage control orthopedic, 195–6 diagnosis of compartment syndrome, 194 long bone fracture stabilization, 196 role of antibiotics, 196 tourniquets, use of, 195 lower gastrointestinal bleeding colonoscopy, 317 criteria for surgical intervention, 318 diagnostic test, 317–18 embolic therapy, 318 MDCT, 317 scintigraphy, 317 TC-99 sulfur colloid injection vs TC-99-tagged red cells, 317 vasopressin therapy, drawbacks of, 318 magnetic resonance cholangiopancreatography (MRCP), 153 magnetic resonance imaging, 106, 149 magnetic retrograde cholangiopancreatography, 374 malignant hypertension acute postoperative hypertension, 525 acute pulmonary edema, 528 antihypertensive therapy, 524 aortic dissection, 528 encephalopathy, 527 hypertensive urgency, 524 myocardial ischemia, 528 pharmacologic agents in treatment of APH esmolol, 526 fenoldopam, 526 labetalol, 526 nicardipine, 526 nifedipine, 526–7 nitroglycerin, 526 sodium nitroprusside, 525–6 pharmacologic therapy, 524 signs and symptoms, 527 stroke, 528 mangled extremity, 200 mangled extremity severity scoring systems, 201, 204 manual in-line stabilization, 81 maxillomandibular fixation (MMF), 89 mechanical ventilation high-frequency percussive ventilation, 220 meglumine amidotrizoate, 282 mesenteric ischemic syndromes mesenteric venous thrombosis (MVT), 333 catheter-directed thrombolysis, 334 metabolic asphyxiation, 219, 222–3 methemoglobinemia, 223 methicillin-resistant Staphylococcus aureus (MRSA) pneumonia, 469 treatment and assessment, 470 percutaneous tracheotomy, 469–70 rate of incidence, 470 vancomycin, 469 military injury outcomes burn surgery, 25–6 colon surgery, 24–5 damage control resuscitation, 24 role of trauma system trauma systems, 23–4 vascular surgery, 25 minimal aortic injuries, 116–17 modified Kessler technique, 190 monitoring of trauma patient biochemical parameter, 37 geriatric patient, 38–9 heart rate and blood pressure, 36–7 local tissue perfusion, 38 pulmonary artery catheter, 37–8 morphine, 107 Motor Activity Assessment Scale (MAAS), 515 motor vehicle collisions, MRI, 83, 429 multidetector row helical CT (MDCT), 317 multiple organ dysfunction syndrome (MODS), 175 myocardial infarction (MI), 473 beta-blocker therapy intiation, 475 diagnosis, 473–4 mortality reduction, 475 right vs left ventricular infarction, 474 thrombolytic therapy, 475 troponin levels and, 474 myocardial ischemia, 528 nasotracheal intubation, 81 National Study on the Costs and Outcomes of Trauma (NSCOT), 12 near infrared spectroscopy (NIRS), 38 neck injuries, 31 neck trauma BCVI injuries, treatment of, 99–100 color flow Doppler, 99 esophagoscopy and swallow studies, 98 physical examination, 98 reliablity of CT scan, 98–9 risk factors for BCVI, 99 selective exploration, 99 necrotizing fasciitis, 443 diagnosis, 443 therapy, 443–4 necrotizing myositis, 444 579 580 Index necrotizing soft tissue infections (NSTI), 443 approach to initial resection, 444 definition, 443 hyperbaric oxygen therapy, 444–5 immunoglobulin therapy, 445 necrotizing fasciitis, 443–4 necrotizing myositis, 444 open biopsy, 444 standard for diagnosis in, 444 treatment, HBO therapy, 444–5 negative-pressure wound therapy, 202, 203, 234 neurogenic shock, 81, 82 NEXUS criteria, 252–3 NEXUS II, 251 nicardipine, 526 nitroglycerin, 526 nitroprusside, 528 NOMI vasodilator therapy, 334 noninvasive positive pressure entilation (NPPV), 108 nonocclusive mesenteric ischemia (NOMI), 333 nonoperative management failure, 132 nonsteroidal anti-inflammatory drug (NSAID), 94, 107 nontechnical skills (NTSs), 272 NSAIDs, 291, 292 nuclear medicine scan techniques, 148 nutrition in wound healing, 486 octreotide, 287 ocular trauma CT for detection of occult open globes, 95 enucleation for sympathetic ophthalmia, 93 NSAIDs for corneal abrasions, 94 patching for corneal abrasions, 93–4 prevention of secondary hemorrhage in hyphema, 94 prophylactic intraocular antibiotics for endophthalmitis, 94–5 steroids/orbital surgery for traumatic optic neuropathy, 92–3 surgery for hyphema, 94 Ogilvie’s syndrome history and pathogenesis, 336 neostigmine for treatment, 336–7 recurrence prevention, 338 role of colonoscopy, 337–8 one-way decision gates, 270 open pelvic fracture, 174 open reduction and internal fixation (ORIF), 89 opioid, 107 ostomy, 144 overwhelming postsplenectomy sepsis, 132 oxidative stress, 387 pancreatic abscess, 390, 391 pancreatic injuries, 254 pancreatic necrosis, 390 pancreatic pseudo-cysts CECT, 392–3 definition, 390–1 incidence, 391 incidence of complicated, 391–2 local complications, 390–1 surgical intervention, 393–4 therapeutic intervention, 393 timing of intervention, 392 pancreatic trauma detection, 154 diagnosis, 154 evaluation, 154, 155 feasibility of NOM of adult BPI, 155 feasibility of NOM of pediatric BPI, 155 operative management of ductal injuries, 156 prophylactic use of octreotide, 155 reliability of CT in detecting, 154–5 reliability of MRCP, 155 reliability of serum amylase, 154 routine versus selective use of ERCP, 154–5 treatment, 154 pancreatitis, 382–7 paraesophageal hernia classifications, 303 definition, 303 laparoscopic repair, 304–5 natural history, 304 nonsurgical/endoscopic management options, 305 recurrence rates for laparoscopically repaired, 304 repair, 303 surgical repair of asymptomatic, 303–4 Parkland formula, 213 patient-controlled analgesic (PCA), 107 pediatric trauma cervical spine injuries, clinical clearance of, 252–3 CT scan of head, 250–1 femur fractures management, 253–4 intramedullary rod placements, 253 pancreatic transection management, 254–5 distal pancreatectomy, 254 ERCP and ductal stenting, 254 role of hypertonic saline, 251–2 PEEP, 492 PEH see paraesophageal hernia pelvic fractures angiography and embolization, 172–3 extraperitoneal pelvic packing, 173 fecal diversion, 174–5 plain radiography, 175 recombinant activated factor VIIA, 173–4 pelvic sepsis, 145, 146 penetrating cardiac injury (PCI), 122 penetrating neck injuries, 97 peptic ulcer disease endoscopy, 293 etiologic distribution, 291 Helicobacter pylori infection, 291 initial approach, 292–3 management of perforated, 294–6 nonoperative management, 295 NSAID use, 291 pharmacotherapy, 293 reducing risk of NSAID-induced complications, 292 risk factors, 291–2 surgical management, 294, 295 therapy for H pylori– positive, 292 time trends of operations, 291 peptic ulcer perforation, 294–5 percutaneous drainage, 402 percutaneous versus surgical drainage, 402 pericardiotomy, 104 perimortem cesarean section, 168 phenoxybenzamine (POB), 454 pheochromocytoma, 453 diagnosis, 454 removal, 454–5 signs and symptoms, 453–4 surgical removal, 454 symptoms, 453–4 treatment, 454 pilonidal disease flap-based techniques, 351–2 importance of gluteal cleft shaving, 350 Index phenol injection, 352–3 role of antibiotics, 349–50 surgical drainage, 348–9 surgical treatment of cyst and sinus, 350–1 treatment of recurrent disease, 352 pit viper snakebite antibiotics, 243 antivenin administration, 241–2 antivenin choices, 242 dosing regimen for FabAV, 242 first aid, 240–1 surgical debridement/fasciotomies, 242–3 plan continuation bias, 270 platelet-activating factor, 387 platelet-activating factor (PAF), 387 pneumothorax, 105 polymerase chain reaction (PCR) assays, 458 polymorphic VT, 484 polyurethane cuff (PUC), 468 polyuria in acute trauma setting, 451 portal hypertension, 407 pathophysiology, 407 posterior cord syndrome, 81 postoperative ileus intra-abdominal adhesions, 280–3 adhesional SBO, 282 diagnosis of SBO, 282–3 techniques/agents to decrease, 281–2 management, 279–80 agents/techniques to improve duration, 279 chewing gum decrease duration, 279–80 selective opiate receptor inhibitors decrease duration, 280 Predictive Salvage Index, 196, 204 preexisting conditions (PECs), 259 pregnancy trauma anatomic and physiologic changes, 165 cardiovascular system, 165 endocrine system, 166 gastrointestinal system, 166 musculoskeletal system, 166 renal system, 166 reproductive system, 166 respiratory system, 166 assessment, 166 fetal monitoring, 167 Kleihauer-Betke (KB) test, 167 diagnostic considerations, 167 FAST, 168 fetal radiation exposure, 167 radiologic studies, 168 emergency cesarean section, 168 prehospital combat casualty care chitosan hemostatic wound dressings, 246 hypotensive resuscitation, 246 tension pneumothorax, 246 tourniquets, 245 premature ventricular complexes (PVC), 483 pressure garments, 216 pressure therapy, 237 primary amputation, 200 primary safety belt laws, procedure for prolapse and hemorrhoids, 343 propofol, 517 pseudo-cysts, 155 PTBD, 376 PUD see peptic ulcer disease pulmonary angiography (PA), 439 pulmonary artery catheter (PAC), 37 pulmonary embolism (PE), 438 CT angiography, 439 diagnosis, 439 (see also computed tomographic pulmonary angiography (CTPA)) heparin and compression devices, 439–40 IVC filters and mortality, 441 LMWH, 441 pathogenesis of, 438 prevention with LMWH, 440 risk factors, 438–9 treatment, 441 pulmonary hemorrhage, 107 pyloric exclusion (PE), 157 pyogenic hepatic abscesses, 397 pyogenic liver abscess empiric antibiotic therapy, 403 RBL, 342 recombinant activated factor VIIa, 173 rectal prolapse abdominal approaches, 359–60 abdominal/perineal approaches, 358–9 laparoscopy, 360–1 preoperative constipation, 362–3 preoperative evaluation, 357–8 preoperative fecal incontinence, 361–2 treatment of recurrent, 363–4 renal replacement therapy (RRT), 498 replantation capability, 188 resuscitation blood/blood products as resuscitation fluid, 43–4 fluid resuscitation requirement, 43 hypotensive resuscitation, 43 termination of fluid resuscitation, 43 type of fluid, 42–3 vasoactive drugs, 44 resuscitative thoracotomy, 24 Richmond Agitation Sedation Scale (RASS), 515 RIFLE, 498 Rolando fracture, 191 rotational flap/free tissue transfer, 203 rubber band ligation, 342 rule-based errors, 269 ruptured abdominal aortic aneurysm abdominal compartment syndrome, 425 anticoagulation, 425 endovascular repair, 424–5 mortality, 423–4 resuscitation goals, 423 sigmoidoscopy, 425 rural trauma higher mortality rates, 265–6 mode of transportation, 265 roles of physicians, 266 system development and trauma centers, 266–7 scintigraphy, 317 scoring systems, 204, 383 secondary amputation, 200 Sedation Agitation Scale (SAS), 515 sedation in ICU, 515–17 selective vessel ligation, 200 seprafilm, 281 sepsis, 174 sequential compression devices (SCD), 440 seton, 346 severe pancreatitis, 384 shock, 36, 43 Sickness Impact Profile, 204 581 582 Index silicon gel sheeting, 215–16, 237 silver sulfadiazine, 214 skill-based errors, 269 skin antisepsis, 463 skin grafts, 203 small bowel and colon injuries anastomosis/ostomy, 144 antibiotics, duration of, 145 colon anastomosis, 144 hand-sewn anastomosis vs stapled anastomosis, 145 presacral drains, 145–6 smoke alarm, Society of Critical Care Medicine (SCCM), 514 sodium nitroprusside, 525 soft tissue war wound management wound VAC negative-pressure dressings, 247 sotalol, 481 spinal shock, 81 spine and spinal cord injuries airway management, 81 clinical clearance of cervical spine, 82 high-dose corticosteroids, 83 imaging modality of choice of spine, 82 impact of airway maneuvers, 81 neurological assessment, 80 pathophysiology, 80 surgical intervention, 84 tracheal intubation, 81–2 breathing and circulation, 82 diagnostic options, 82 spleen, 132 spleen trauma angiography candidates and embolization failure, 133–4 imaging studies, 134–5 management of patients with special circumstances, 136 nonoperative management, 132 patients for nonoperative management, 132–3 prevention of OPSS, 135 resume activities, 135–6 splenic parenchyma necrosis, 134 spontaneous breathing trials (SBTs), 108 stapled hemorroidopexy, 343 steroids, 230–1 surgical drainage, 402 surgical sphincterotomy, 346 sympathetic ophthalmia, 93 systemic inflammatory response syndrome (SIRS), 500 target lesion, 310 temporary vascular shunt, 200 thoracic great vessels injury thoracoscopy, 149 thoracotomy, 161 thrombolytic therapy, 475 contraindications in case of surgery, 475 thrombolytics, 229 thyroid storm, 451 diagnosis, 453 management, 453 surgery in, 453 surgical management, 453 treatment, 453 topical thrombin/fibrin sealant, 209 total parenteral nutrition, 300, 385 totally extraperitoneal laparoscopic repairs (TEP), 448 tourniquets, 201 decrease bleeding, 209 tracheal gas insufflation, 493 Tracheal gas insufflation (TGI), 493 tracheobronchial injuries, 106 tracheobronchial injuries diagnostic test, 126 incidence, 125 mechanism, 125 nonoperative management, 126–7 surgical management, 126 symptoms and signs, 126 tracheostomy, 219–20 transabdominal laparoscopic repairs (TAP), 448 TransCyte, 215 transesophageal echocardiography, 116, 429 transthoracic echocardiography (TTE), 122 trauma, 8, 165 and risk factors of PE, 439 Trauma and Injury Severity Score (TRISS), 265 trauma care, reducing patient errors error-producing conditions, 269–71, 275 errors in patient care, 268–9, 274 HRO safety principles, 271–4, 275 phases, 268 trauma centers, trauma centres structure, 11–12 trauma outcomes, 11–12 assessment of EBM outcome, 20 EBM improves outcome, 19–20 evidence-based outcome evaluations, 18 groups using EBOES ACS, 20 IOM, 20 Leapfrog, 20 VA, 20 principles of EBM, 19 trauma process, 11–12 Trauma Score, 260 trauma system development, 265 trauma systems clinical trauma care, 10 golden hour concept, 10 prehospital care, 10–11 trauma centers, 11 functions, future directions, 13–14 injury prevention, 9–10 life savers, 11 long-term outcomes, 12 mode of transport, 11 population-based methods, 12 public health approach, structure, traumatic amputations, 195 traumatic brain injury beneficial effects of progesterone, 73 DVT prophylaxis, 73–4 guidelines, 72–3 repeat head CT, 73 seizure prophylaxis, beneficial effects of, 74–5 transfusion triggers, 75–6 traumatic injury, 1, 226 traumatized airway airway evaluation, 30 blind nasal intubation, avoiding, 30–1 Lefort fractures, 30 neck injuries coexisting injuries, 31 evaluation and diagnosis, 31 management, 31–2 triage, 259 tuberculous liver abscess, 399 Index ulcer disease causes, 285 ultrasonography, 148 unfractionated heparin versus LMWH, 433 unfractionated heparin (UFH), 439–40 upper airway injuries, 218 upper extremity electrical injuries, 227–8 upper extremity surgery bacteriology of animals bite, 186 compartment syndromes, 189 fingertip amputation, 191 hand extensor tendon injuries, 190–1 hand flexor tendon injuries, 189 hand fractures, 190–1 replantation of digits and extremities, 188–9 scaphoid fractures, 187 upper gastrointestinal bleeding, 285 angiography, 288 cause, 285 endoscopic banding ligation/banding ligation, 287 medical therapy in prevention, 285–6 beta-blockers, 286 PPI/H2RA prophylaxis, 285–6 medical therapy in treating PPIs/octreotide, 286–7 upper limb replantation success, 188 upper vs lower extremity injury, 201 VAC therapy, 202 vacuum-based temporary abdominal closures, 300 vancomycin, 469 vanillyl mandelic acid (VMA), 454 variceal hemorrhage hepatic vein pressure gradient, 407 resuscitative fluids, 409 role of prophylactic antibiotics, 409 surveillance upper endoscopy, 407–8 treatment to control endoscopic intervention, 410 liver transplantation, 411 pharmacological intervention, 409–10 rescue therapy, 410–11 treatment to prevent large varices EBL vs nonselective β-blockers, 408–9 EBL+nonselective β-blocker vs EBL, 409 endoscopic band ligation, 408 treatment to prevent recurrence β-blockers, 411 β-blockers vs EBL, 411 combination of EBL and β-blockers, 411–12 EBL vs EBL + sclerotherapy, 411 EBL vs sclerotherapy, 411 TIPSS vs EBL, 412 TIPSS vs surgical shunt, 412 treatment to prevent small varices, 408 upper endoscopy, 407 venous ligation, 200 ventilation-perfusion (V-P) scan, 439 ventilator-associated pneumonia, 515 antibiotics for treatment, 469 epidemiology, 470 invasive or noninvasive diagnosis of, 467 modifiable risk factors endotracheal tube attributes, 468 heat and moisture-inducing devices, 468 semi-recumbent position, 468–9 risk factors, 468 semi-recumbent position, 468 timing of tracheotomy, 469–70 treatment, 470 ventricular arrhythmias, 483–4 vessel ligation, 200 Veterans Administration, 20 video-assisted thoracoscopic surgery (VATS), 108 vitamin K antagonists, extended therapy, 434–5 Volumetric Diffusive Respiration (VDR-4) ventilator, 220–1 walking donor transfusion, 67 war wounds, 245 warfarin, 259 warfarin therapy, dosage, 434 wartime injuries, 201 World Society of the Abdominal Compartment Syndrome (WSACS), 509 wound healing acellular replacement dermis effect, 235–6 factors affecting, 233–4 HBO effect on ischemic/irradiated flaps, 236 mechanism of action of NPWT, 234 NPWT effect on healing time/cost, 234–5 risk of preoperative smoking, 234 treatments for keloid/hypertrophic scar, 236–7 583 ... Division of Acute Care Surgery, Trauma and Surgical Critical Care, Wilford Hall Medical Center Lackland AFB, Texas Clinical Instructor, Trauma and Surgical Critical Care Division of Trauma and Surgical.. .Acute Care Surgery and Trauma: Evidence Based Practice Edited by Stephen M Cohn MD FACS Witten B Russ Professor of Surgery University of Texas Health Science... Division of Trauma Surgery Department of Surgery Allegheny General Hospital Pittsburgh, Pennsylvania, USA Mark Gunst MD MPH Division of Acute Care Surgery Trauma and Surgical Critical Care Wilford