d te ni -U r9 tahir99 - UnitedVRG vip.persianss.ir Trim: 5.25in × 8.375in Gutter: 0.498in LWW-Peitzman-educational September 19, 2012 THE TRAUMA MANUAL: TRAUMA AND ACUTE CARE SURGERY r9 -U ni te dV R G Fourth Edition hi LWBK1111-fm Top: 0.249in ta P1: tahir99 - UnitedVRG vip.persianss.ir i 19:44 Trim: 5.25in × 8.375in Gutter: 0.498in LWW-Peitzman-educational September 19, 2012 19:44 ni te dV R G LWBK1111-fm Top: 0.249in hi r9 -U This page intentionally left blank ta P1: tahir99 - UnitedVRG vip.persianss.ir ii Trim: 5.25in × 8.375in Gutter: 0.498in LWW-Peitzman-educational September 19, 2012 THE TRAUMA MANUAL: TRAUMA AND ACUTE CARE SURGERY Fourth Edition R G Editors ni te Mark M Ravitch Professor Chief, Trauma and General Surgery Department of Surgery University of Pittsburgh School of Medicine Pittsburgh, PA dV Andrew B Peitzman, MD Donald M Yealy, MD -U Professor and Chair of Emergency Medicine University of Pittsburgh/University of Pittsburgh Physicians Pittsburgh, PA Timothy C Fabian, MD r9 Harwell Wilson Alumni Professor and Chairman Department of Surgery University of Tennessee Health Science Center Memphis, TN hi LWBK1111-fm Top: 0.249in Michael Rhodes, MD ta P1: Professor of Surgery Thomas Jefferson University Chair, Department of Surgery Christiana Care Health Systems Wilmington, DE C William Schwab, MD Professor of Surgery Department of Surgery Perelman School of Medicine University of Pennsylvania Division of Traumatology, Surgical Critical Care & Emergency Surgery Hospital of the University of Pennsylvania Philadelphia, PA tahir99 - UnitedVRG vip.persianss.ir iii 19:44 Trim: 5.25in × 8.375in LWBK1111-fm Top: 0.249in Gutter: 0.498in LWW-Peitzman-educational September 19, 2012 Acquisitions Editor: Brian Brown Product Manager: Brendan Huffman Production Manager: Bridgett Dougherty Senior Manufacturing Manager: Benjamin Rivera Marketing Manager: Lisa Lawrence Design Coordinator: Teresa Mallon Production Service: Aptara, Inc ©2013 by LIPPINCOTT WILLIAMS & WILKINS, a WOLTERS KLUWER business Two Commerce Square 2001 Market Street Philadelphia, PA 19103 USA LWW.com R G All rights reserved This book is protected by copyright No part of this book may be reproduced in any form by any means, including photocopying, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews Materials appearing in this book prepared by individuals as part of their official duties as U.S government employees are not covered by the above-mentioned copyright dV P1: ni te Printed in China -U Library of Congress Cataloging-in-Publication Data available upon request ISBN-13: 978-1-4511-1679-3 ISBN-10: 1-4511-1679-3 ta hi r9 Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication Application of the information in a particular situation remains the professional responsibility of the practitioner The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with current recommendations and practice at the time of publication However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions This is particularly important when the recommended agent is a new or infrequently employed drug Some drugs and medical devices presented in the publication have Food and Drug Administration (FDA) clearance for limited use in restricted research settings It is the responsibility of the health care provider to ascertain the FDA status of each drug or device planned for use in their clinical practice To purchase additional copies of this book, call our customer service department at (800) 638-3030 or fax orders to (301) 223-2320 International customers should call (301) 2232300 Visit Lippincott Williams & Wilkins on the Internet: at LWW.com Lippincott Williams & Wilkins customer service representatives are available from 8:30 am to pm, EST 10 tahir99 - UnitedVRG vip.persianss.ir iv 19:44 Trim: 5.25in × 8.375in Gutter: 0.498in LWW-Peitzman-educational September 19, 2012 r9 -U ni te dV R G This book is dedicated to those who have given their lives, and those who daily risk their lives, in the care of the injured hi LWBK1111-fm Top: 0.249in ta P1: tahir99 - UnitedVRG vip.persianss.ir v 19:44 P1: Trim: 5.25in × 8.375in LWBK1111-fm Top: 0.249in Gutter: 0.498in LWW-Peitzman-educational September 19, 2012 19:44 This page intentionally left blank tahir99 - UnitedVRG vip.persianss.ir vi P1: Trim: 5.25in × 8.375in LWBK1111-fm Top: 0.249in Gutter: 0.498in LWW-Peitzman-educational September 19, 2012 Contributors Michel B Aboutanos, MD, MPH, FACS Professor of Surgery Director, International Trauma System Development Program Division of Trauma, Critical Care & Emergency Surgery Department of Surgery Virginia Commonwealth University Medical Center Richmond, VA Syed M Faisal Alam, MD Vascular Surgery Fellow Division of Vascular and Endovascular Surgery Department of Surgery The University of Tennessee Health Science Center Memphis, TN Louis H Alarcon, MD Medical Director, Trauma Surgery Associate Professor of Surgery and Critical Care Medicine University of Pittsburgh School of Medicine Pittsburgh, PA Darwin Ang, MD, PhD, MPH Associate Professor of Surgery Trauma Medical Director, Ocala Regional Director of Research USF/HCA Trauma Network University of South Florida Tampa, FL Derek C Angus, MD, MPH, FRCP Chair, Department of Critical Care Medicine The Mitchell P Fink Endowed Chair in Critical Care Medicine Professor of Critical Care Medicine University of Pittsburgh School of Medicine Pittsburgh, PA Juan A Asensio, MD, FACS, FCCM, FRCS Professor of Surgery Department of Surgery University of Miami Miller School of Medicine Director, Trauma Clinical Research, Training and Community Affairs Department of Surgery University of Miami Miller School of Medicine Miami, FL Vishal Bansal, MD, FACS Assistant Professor of Surgery Division of Trauma, Burns and Surgical Critical Care University of California San Diego Health Sciences San Diego, CA Philip S Barie, MD, MBA, FIDSA, FCCM, FACS Professor Departments of Surgery and Public Health Weill Cornell Medical College Chief Preston A (Pep) Wade Acute Care Surgery Service New York-Presbyterian Hospital/Weill Cornell Medical Center New York, NY Tiffany K Bee, MD Associate Professor of Surgery The University of Tennessee Health Science Center Memphis, TN Matthew V Benns, MD Assistant Professor of Surgery School of Medicine University of Louisville Louisville, KY Timothy R Billiar, MD, FACS George Vance Foster Professor and Chairman Department of Surgery University of Pittsburgh School of Medicine Pittsburgh, PA Thane A Blinman, MD Associate Director of Trauma Division of General, Thoracic and Fetal Surgery The Children’s Hospital of Philadelphia Philadelphia, PA Deanna M Blisard, MD Department of Critical Care Medicine and Surgery University of Pittsburgh Medical Center Pittsburgh, PA Amir Blumenfeld, MD, MHA Former Chief, Trauma Branch Israeli Defense Forces Israel vii tahir99 - UnitedVRG vip.persianss.ir 19:44 P1: Trim: 5.25in × 8.375in LWBK1111-fm viii Top: 0.249in Gutter: 0.498in LWW-Peitzman-educational September 19, 2012 Contributors Charles C Branas, PhD Professor of Epidemiology Perelman School of Medicine University of Pennsylvania Philadelphia, PA Benjamin Braslow, MD, FACS Associate Professor of Surgery Division of Trauma, Emergency General Surgery & Surgical Critical Care Section Chief of Emergency General Surgery Department of Surgery Perelman School of Medicine University of Pennsylvania Philadelphia, PA Susan Miller Briggs, MD, MPH Associate Professor of Surgery Harvard Medical School Director, International Trauma and Disaster Institute Massachusetts General Hospital Boston, MA L.D Britt, MD, MPH, FACS, FCCM, FRCSEng (Hon), FRCSEd (Hon), FWACS (Hon), FRCSI (Hon), FCS(SA) (Hon) Brickhouse Professor and Chairman Eastern Virginia Medical School Department of Surgery Norfolk, VA Joshua B Brown, MD General Surgery Resident Department of Surgery University of Pittsburgh Medical Center Pittsburgh, PA Jodie A Bryk, MD Chief Internal Medicine Resident University of Pittsburgh School of Medicine Pittsburgh, PA Christopher H Byrne, MD Assistant Professor of Surgery Department of Surgery The University of Tennessee Health Science Center Memphis, TN Asim F Choudhri, MD Assistant Professor of Radiology and Neurosurgery The University of Tennessee Health Science Center Memphis, TN Director of Neuroradiology Le Bonheur Neuroscience Institute Le Bonheur Children’s Hospital Memphis, TN William L Chung, DDS, MD Associate Professor Department of Oral & Maxillofacial Surgery University of Pittsburgh Medical Center Pittsburgh, PA Mark Cipolle, MD, PhD Medical Director, Trauma Program Christiana Care Health System Wilmington, DE Mitchell J Cohen, MD Associate Professor of Surgery Division of General Surgery Director of Acute Care Research San Francisco Injury Center University of California San Francisco, CA Raul Coimbra, MD, PhD, FACS The Monroe E Trout Professor of Surgery Executive Vice-Chairman, Department of Surgery Chief Division of Trauma, Surgical Critical Care, and Burns UC San Diego Health System San Diego, CA David C Cone, MD Professor and EMS Section Chief Department of Emergency Medicine Yale University School of Medicine New Haven, CT Michael W Cripps, MD Assistant Professor of Surgery UT Southwestern Medical Center Dallas, TX Martin A Croce, MD Professor of Surgery Chief, Trauma and Surgical Critical Care The University of Tennessee Health Science Center Memphis, TN tahir99 - UnitedVRG vip.persianss.ir 19:44 P1: Trim: 5.25in × 8.375in LWBK1111-fm Top: 0.249in Gutter: 0.498in LWW-Peitzman-educational September 19, 2012 Contributors Frederick J Denstman, MD Section, Colon and Rectal Surgery Christiana Care Health System Wilmington, DE Jennifer M DiCocco, MD General Surgery Chief Resident Department of Surgery The University of Tennessee Health Science Center Memphis, TN Soumitra R Eachempati, MD, FACS, FCCM Professor of Surgery and Public Health Weill Cornell Medical College Chief, Trauma Services and Surgical Intensive Care Unit New York-Presbyterian Hospital New York Weill Cornell Center New York, NY Philip A Efron, MD Assistant Professor of Surgery and Anesthesiology Co-director, Laboratory of Inflammation Biology and Surgical Science Associate Director, Trauma ICU Program Director, Surgical Critical Care Residency Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care College of Medicine University of Florida Gainesville, FL Timothy C Fabian, MD Harwell Wilson Alumni Professor and Chairman Department of Surgery University of Tennessee Health Science Center Memphis, TN David V Feliciano, MD Professor Department of Surgery Emory University School of Medicine Surgeon-in-Chief Department of Surgery Grady Memorial Hospital Atlanta, GA John Fildes, MD, FACS, FCCM Professor and Vice Chair Department of Surgery Chief, Division of Acute Care Surgery University of Nevada School of Medicine Las Vegas, NV ix Abe Fingerhut, MD Hippokration Hospital and Medical School Athens, Greece Gerard Fulda, MD, FACS, FCCM Director, Surgical Critical Care and Surgical Research Christiana Care Health Systems Associate Professor of Surgery Jefferson Medical College Newark, DE Gary N Galang, MD Vice Chairman for Operations UPMC Rehabilitation Institute UPMC Mercy Hospital Pittsburgh, PA Frederick Giberson, MD, MS Assistant Professor of Surgery Jefferson Medical College Program Director, General Surgery Christiana Care Health Services Newark, DE Steven P Goldberg, MD Assistant Professor of Surgery Division of Pediatric Cardiothoracic Surgery The University of Tennessee Health Science Center Le Bonheur Children’s Hospital Memphis, TN Daniel J Grabo, MD Division of Traumatology, Surgical Critical Care and Emergency Surgery Perelman School of Medicine University of Pennsylvania Philadelphia, PA Vicente H Gracias, MD Professor of Surgery Department of Surgery Chief Trauma, Emergency Surgery, Surgical Critical Care UMDNJ-Robert Wood Johnson Medical School New Brunswick, NJ Francis X Guyette, MD, MPH Assistant Professor, Department of Emergency Medicine Medical Director, STAT MedEvac Pittsburgh, PA tahir99 - UnitedVRG vip.persianss.ir 19:44 P1: Trim: 5.25in × 8.375in LWBK1111-Index 784 Top: 0.249in Gutter: 0.498in LWW-Peitzman-educational September 7, 2012 Index Hernias (Contd.) planned ventral hernia and open abdomen, 691–693 presentation of, 684, 686 spigelian, 688–689, 688f umbilical, 687 Heterotopic ossification (HO), 205 High mobility group box-1 (HMGB1), 19 Hinchey classification for diverticulitis, 737–738, 737t Hip dislocation, reduction of, 721–722 Hydrofluoric acid (HF) burn, 452 Hydromorphone, 166, 481t Hyperbaric oxygen (HBO) therapy, 670 Hyperkalemia, 473 Hypertonic saline, for ICP control, 257–258 Hyphema, 310–311, 311t Hypocalcemia, 473–474 and coagulopathy, 63 Hypokalemia, 473 Hypomagnesemia, 474 Hypothermia, 460–462, 554–560 accidental, 555 classification of, 554 clinical effects of, 554–555 coagulation, 555 hemodynamic, 555 metabolic, 554 neurologic, 555 renal, 555 respiratory, 554–555 and coagulopathy, 62–63 drowning and, 559–560 exposure, 559 frostbite and, 560 physiology of, 554–555 rewarming, 558–559, 559t therapeutic, 560 treatment of, 556–558, 556t, 557f Hypovolemic shock, 45, 46, 48, 458 I Iatrogenic perforation, 643–644 ICD-based Injury Severity Score (ICISS), IL-6, 18 IL-8, 18–19 IL-10, 19 IL-1␤, 18 Iliopsoas sign, 565t Imaging, 110–120 in abdominal trauma, 114–116 in chest trauma, 113–114 considerations in, 118 electronic and mobile review of images, 119 MRI safety, 119 obese patient, 119–120 radiation safety, 118–119 in facial trauma, 112 goal of, 110 in intensive care unit, 118 modalities, 110–111 angiography, 110–111 computed tomography, 110 conventional radiography, 110 magnetic resonance imaging, 110 ultrasonography, 110 in pediatric trauma patients, 222 in pelvic trauma, 116–117 in skull and brain trauma, 111–112 in spine injuries, 112–113 in unstable blunt trauma patient, 39 Immune response, after trauma, 14–17 adaptive and the innate immune reaction, 14–15 early, 15–17 local versus systemic, 14 Immunonutrition, 78 Impalement wounds, 250–251 Incident command system (ICS), 184–185 hierarchy, 184 key concepts of, 184 use of, 184–185 Infection, 128, 138 See also Sepsis conditions increasing risk of, 141t duration of antibiotic prophylaxis and, 144–145 epidemiology, 138 comparison with nontrauma patients, 138 incidence, 138 patterns of injury, 138 immune dysfunction after trauma and, 139t microbiology and, 146–148 bacteria, 146–148 fungi and yeast, 148 principles of resistance, 146 nosocomial, 148–153 central line–associated blood stream infection, 149–150 Clostridium difficile infection, 151 decubitus ulcer, 152 peritonitis/intra-abdominal infection, 150–151 pneumonia, 148–149 sinusitis, 151–152 urinary tract infection, 152–153 prevention of, 142–144 antibiotic prophylaxis, 144 catheter care, 143–144 contact isolation, 143 hand hygiene, 142–143 infection control, 142–143 principles related to, 142 risk factors for, 138–142, 139t–142t hyperglycemia, 141–142 immune dysfunction, 139–140 inflammation and stress response, 140 injury severity, 139 medical comorbidity, 140 transfusion, 140–141 tahir99 - UnitedVRG vip.persianss.ir 15:53 P1: Trim: 5.25in × 8.375in LWBK1111-Index Top: 0.249in Gutter: 0.498in LWW-Peitzman-educational September 7, 2012 Index specific injuries and, 145–146 abdominal injury, 145 chest injuries, 145 fractures, 146 skin and soft-tissue injuries, 146 Inferior vena cava filter (IVCF), 177 insertion, 729–730 Inflammatory diseases of intestines, 643–655 gastroduodenal perforation, 643–652 colonic diverticulitis, 650–652 Crohn’s disease of small bowel, 644–647 duodenal diverticula, 648–649 enterocutaneous fistula, 647–648 iatrogenic perforation, 643–644 jejunoileal diverticula, 649 marginal ulcer, 643 Meckel’s diverticulum, 650 small bowel diverticular disease, 648 infectious colitides, 652–655 bacterial enterocolitis, 654 Clostridium difficile–associated disease (CDAD), 653–654, 653t Cytomegalovirus colitis, 654 ischemic colitis, 654–655 Information management, in trauma systems, Informed consent, 572 Inhalation injury, 450–451 Injury prevention, 3, 195–201 physicians role in, 198–201 primary, 196 science of, 196–198 secondary, 196 tertiary, 196 Injury scoring, 3–4 related principles, 3–4 scoring systems, validation of scoring system, Injury severity score (ISS), 4, 733, 734t Intensive care unit (ICU), 456–487 admission criteria, 456, 457t bedside procedure, 728–731 fiberoptic bronchoscopy, 728–729 inferior vena cava filter insertion, 729–730 nasoenteric post-pyloric feeding tube insertion, 730 percutaneous endoscopic gastrostomy, 730–731 percutaneous tracheostomy, 731 end-of-life care, 485–486 goals of care, 456 invasive monitoring, 463–465 arterial catheterization, 463 central venous pressure monitoring, 463–464 intracranial pressure monitoring, 465 pulmonary artery catheterization, 464–465 missed injuries in, discovery of, 465 785 monitoring and data interpretation, 459–463 blood gas monitoring, 460 blood sampling, 459 capnography, 462, 462t electrocardiography, 460 esophageal Doppler monitor, 463 near-infrared spectroscopy, 463 pulse oximetry, 460 temperature measurement, 460–462 thoracic bioimpedance, 463 organ donor identification and care, 486 organ system support, 468–480 acid–base and electrolyte disturbances, 471–474 cardiovascular, 468–471 microvascular bleeding, 479 neurologic support, 479–480 pulmonary support, 474–477 renal support, 477–479 support of coagulation, 479 patient safety and system management, 486–487 phases of care, 456–458 early phase, 456–457 intermediate phase, 457 late phase, 457 recovery phase, 458 prophylaxis, 465–468 cardiovascular, 465 metabolic prevention, 466–467 stress-related gastric mucosal hemorrhage, 465–466 venous thromboembolism, 466, 466t ventilator bundle, 467–468 rehabilitation in, 484–485 resuscitation and initial management, 458–459 classification of shock, 458–459 endpoints of resuscitation, 458, 459t hemostasis in resuscitation, 458 sedation and analgesia in, 480, 481t–483t special considerations ICU as operating room, 484 neurologic support, 480, 484 Interhospital transport, 97–99 before, 97–98 during, 98–99 after, 99 legal considerations, 99 physician medical directors and, 97 referring physician and, 97 International classification of diseases injury severity score (ICISS), 735 International Medical Surgical Response Teams (IMSURT), 185 International sensitivity index (ISI), 63 Interventional radiology, 121–127 anatomically specific concepts, 124–126 aorta and great arteries, 124 chest and abdominal wall, 126 tahir99 - UnitedVRG vip.persianss.ir 15:53 P1: Trim: 5.25in × 8.375in LWBK1111-Index 786 Top: 0.249in Gutter: 0.498in LWW-Peitzman-educational September 7, 2012 Index Interventional radiology (Contd.) craniocervicocerebral arteries, 125 intracranial interventions, 126 kidneys, 126 liver, 125–126 pelvis, 126 spleen, 125 vessels of extremities, 126 special procedures environment, 121 subacute interventions, 127 drainage of fluid collections, 127 inferior vena cava (IVC) filters, 127 vascular/interventional techniques, 121–124 access, 121 diagnostic angiography, 121–123 embolization, 123–124 stents, 124 Intestinal injury, in children, 224 Intraabdominal abscess (IAA), 58 Intra-abdominal adhesions, 704 Intraabdominal hypertension (IAH), 529 See also Abdominal compartment syndrome (ACS) Intracranial hypertension (ICH), 536–538 Intracranial pressure (ICP), 253, 479 See also Traumatic brain injuries (TBIs) monitoring, in ICU, 465 Intraocular foreign bodies (IOFBs), 311–312 Intravenous pyelography (IVP), 115 in genitourinary injuries, 396–397 Ireton–Jones equation for burn patients, 80t in sepsis, 78t Ischemia monitoring, 499–500 ST segment depression, 500 ST segment elevation, 499–500 Ischemic colitis, 654–655 clinical manifestations, 655 diagnosis, 655 management, 655 pathophysiology, 654–655 IV immune globulin treatment (IVIG), 670 J Jaw-thrust maneuver, 23 Jejunoileal diverticula, 649 Jet ventilation See Percutaneous translaryngeal catheter insufflation Joint contractures, 203–204 Jugular venous bulb oximetry (SjO2 ), 259 K Ketamine, 481t for endotracheal intubation, 29t Ketorolac, 163, 483t Kidney injury scale, 750t Kinetic energy (KE), of missile, Kussmaul’s sign, 333 L Labetalol, in aortic injury, 337 Labor and delivery, 698–699 Laboratory studies in trauma, 43 See also specific topics Laboratory technician, 108t Lactate and base deficit, 47, 49–50 Lactated Ringer’s (LR), 444 Laparoscopic appendectomy (LA), 627 Lap belts, Large bowel obstruction (LBO), 587–590 etiology, 587–588 colonic pseudo-obstruction, 588 diverticulitis, 588 fecal impaction, 588 foreign body, 588 inflammatory bowel disease, 588 neoplasm, 587 volvulus, 587 presentation and initial assessment, 588 radiographic evaluation, 588, 589f treatment, 588–590, 590f Laryngeal mask airway (LMA), 30, 90f, 331 Lead bullets, Leadership, in trauma systems, Le Fort fractures, 273, 274f Left anterolateral thoracotomy, 352–353 advantage, 352 disadvantage, 352 technique, 352–353 Left/right posterolateral thoracotomy, 353–354 advantages, 353 disadvantages, 353 technique, 353–354, 354f Lens anaphylaxis, 313 Leukocyte, 15, 17 Leukocytosis, 577 Leukotrienes, 20 Levator pain, 665 Lidocaine ointment, 657 Ligamentous injury and muscle strain, in children, 223 Lighted-stylet (transillumination) ETI, 30 Linear skull fractures, 261 Lipoglycopeptides, 157 Lips, injury to, 281, 282f Liver failure, 535–544 acute, 535–540 (See also Acute liver failure (ALF)) portal hypertension, 540–543 Liver injury, 377–382 in children, 223 diagnosis of, 378, 378f hepatic anatomy, 377–378, 377f incidence of, 377 outcomes for, 382 treatment, 378–382, 379f, 381f Liver injury scale, 746t Logistic organ dysfunction (LOD) systems score, 490 tahir99 - UnitedVRG vip.persianss.ir 15:53 P1: Trim: 5.25in × 8.375in LWBK1111-Index Top: 0.249in Gutter: 0.498in LWW-Peitzman-educational September 7, 2012 Index Lorazepam, 29, 481t Lower genital tract trauma, 706 vulvar and vaginal hematoma, 706 vulvar and vaginal lacerations, 706 Lower velocity missile wounds, 261 Low molecular weight heparin (LMWH), 174, 176 M Macintosh blade, 25, 26 Macrophages, 17 Magnetic resonance cholangiopancreatogram (MRCP), 607 Magnetic resonance imaging (MRI), 110 in spinal injuries, 113 Mandibular fractures, 267–270 evaluation of, 267–269 management of, 269–270 cervical immobilization, 269 control of airway, 269 prophylactic antibiotics, 270 specific treatment, 269–270 temporary immobilization, 269 mandibular anatomy and location of, 267, 268f Mangled extremity severity score, 420t Mannitol, for ICP control, 257–258 Marginal ulcer, 643 Marshal MOF score, 490 Mass casualty incident (MCI) See Disasters/mass casualty incident Mass casualty triage, 85–87 principles of, 85 simple triage and rapid treatment, 85 triage tags, 85, 87 Massive hemothorax, 334 Massive transfusion protocols (MTP), 67–69 Mastitis, 705 diagnosis, 705 epidemiology and pathophysiology, 705 management, 705 Maxillofacial injury, 264–286 anatomic considerations in repairing soft tissue, 277–281 and anesthesia, 281 animal and human bites, 286 cleaning of wound, 281–282 debridement and care, 281 dentoalveolar trauma, 264–267 evaluation of patient with, 264 frontal sinus fractures, 276–277 mandibular fractures, 267–270 midface fractures, 270–276 nonsuture technique of wound closure, 284 removal of sutures, 286 suture technique, 284–286 wound type, 282–284 MCI response, 183 See also Disasters/mass casualty incident MDCT, in C-spine imaging, 113 787 Mean arterial pressure (MAP), 500 Mechanical ventilation (MV), 476, 478t, 517–527 adjuncts to, in ARDS and severe hypoxemia, 523–524 extracorporeal membrane oxygenation, 524 fluid management, 524 inhaled nitric oxide, 524 neuromuscular blockade, 524 prone position, 524 recruitment maneuvers, 524 advanced modes of, 520–521 adaptive support ventilation, 520 neurally adjusted ventilatory assist, 520–521 proportional assist ventilation, 520 SmartCare, 521 ARDS mechanical ventilation algorithm, 526f goals of, 517 liberation from, 477 modes of, 518–520 airway pressure-release ventilation, 520 assist-control ventilation mode, 518–519 bi-level/ biphasic ventilation, 520 controlled mechanical ventilation mode, 518 pressure-control ventilation, 520 pressure modes, 519–520, 519f pressure-regulated volume control, 520 pressure support ventilation, 520 synchronous intermittent mandatory ventilation mode, 519 volume control plus, 520 volume modes, 518 pocket card summary of, 522t strategies for patients with ALI and ARDS, 521–523 airway pressure-release ventilation, 523 high-frequency oscillatory ventilation, 521–523 low tidal volume ventilation, 521 open lung strategy, 521 permissive hypercapnia, 521 variables adjusted for, 517–518 weaning and liberation from, 526–527 Mechanism of injury, 241–251 blunt trauma, 241–245 penetrating trauma, 245–251 Meckel’s diverticulum, 650 Median sternotomy, 352, 353f Medical triage, 185–186 Meninges, 253 Menorrhagia, 701–702 Mesenteric ischemia, 678–680 diagnosis, 679 etiology, 679 outcomes, 680 treatment, 679–680 tahir99 - UnitedVRG vip.persianss.ir 15:53 P1: Trim: 5.25in × 8.375in LWBK1111-Index 788 Top: 0.249in Gutter: 0.498in LWW-Peitzman-educational September 7, 2012 Index Mesh absorbable, 532 biologic, 532 Metastable patient, 35 Methohexital, for endotracheal intubation, 29t Metronidazole, 159–160 Midazolam, 481t Midface fractures, 270–276 evaluation of, 271–272 Le Fort fractures, 273, 274f management of, 272–273 midfacial anatomy and location of injury, 270–271, 271f nasal fracture, 276 NOE complex fracture, 276 orbital blowout fractures, 275–276, 275f zygomatic arch fractures, 274–275, 275f zygomaticomaxillary complex fractures, 273–274, 274f Miller blade, 25, 26 Mirizzi’s syndrome, 613 Miscarriage, 696–697 complete abortion, 697 diagnosis, 697 epidemiology, 697 incomplete abortion, 697 inevitable abortion, 697 management, 697 missed abortion, 697 pathophysiology, 697 spontaneous abortion, 696 threatened abortion, 696–697 Mivacurium, 482t Model Trauma Care System Plan, by HRSA, Monobactams, 156 Monro–Kellie doctrine, 253 Monteggia fracture–dislocations, 423 Morphine, 163t, 166, 481t Motorcycle crashes, 243 Motor vehicle collisions, determinants of injury in, injury patterns in, 4–5 role of restraints in, 5–6 Motor vehicle crashes (MVCs), 1, 241–243, 242f, 242t determinants of injury in, 241–243 ejection, 243 elderly and, 237 frontal impacts, 243 injury in, 241 lateral crashes, 243 rear-end impact collisions, 243 restraint devices, 241–243, 243t rollover collisions, 243 Multiple organ dysfunction (MOD) score, 490 Multiple organ dysfunction syndrome (MODS), 489–497, 606 after trauma, 489 classification of, 489 definition, 489 mechanisms, 489 pathophysiology, 491–493 cardiac, 491–492 endocrine, 493 gastrointestinal/nutrition, 493 hepatic, 493 neurologic, 491 pulmonary, 491 renal, 492–493 prediction/prognosis, 490–491, 490t treatment, 493–497 abdominal compartment syndrome, 497 cardiac, 496 FFP transfusion criteria, 494t gastrointestinal/nutrition, 496–497 hepatic, 496 neurologic, 494 nosocomial infections prevention, 494 PRBC transfusion criteria, 494t pulmonary, 494–495, 495t renal, 496 source control, 493 Murphy’s sign, 565t Musculoskeletal system, in elderly, 234 MV See Mechanical ventilation (MV) N Naloxone, 165, 483t Nasal fracture, 276 Nasal–orbital–ethmoid (NOE) complex, 270, 271f, 276 Nasoenteric post-pyloric feeding tube insertion, 730 Nasopharyngeal airway, 23 Nasotracheal intubation, 30 National Association of EMS Physicians (NAEMSP), 85 National Disaster System (NDMS), 185 National Highway Traffic Safety Administration (NHTSA), National Veterinary Response Teams (NVRT), 185 Near-infrared spectroscopy (NIRS), 50, 463 Neck trauma, 315–326 anatomy of neck, 315–317 triangles of neck, 315, 316f zones of neck, 315–317, 316f blunt, 320–326 carotid artery injury algorithm, 324f imaging modalities in, 321–322 initial evaluation in, 320–321 physical examination in, 320–321 radiographic evaluation in, 321 specific injuries, 322–323 treatment, 323–326, 324f, 325f vertebral artery injury algorithm, 325f penetrating, 317–320 diagnostic testing in, 317 incisions for exposure of, 319f initial evaluation in, 317 tahir99 - UnitedVRG vip.persianss.ir 15:53 P1: Trim: 5.25in × 8.375in LWBK1111-Index Top: 0.249in Gutter: 0.498in LWW-Peitzman-educational September 7, 2012 Index neck injury algorithm, 318f surgical management of, 318–320, 319f Necrotizing soft tissue infection clinical score, 740–741, 740t Necrotizing soft tissue infections (NSTIs), 667–670 complications, 670 diagnosis, 668–669 imaging, 669 laboratory, 669 presentation, 668–669 HBO therapy, 670 laboratory risk indicator for, 668t outcomes, 670 pathophysiology, 667–668 treatment, 669–670 antibiotic therapy, 670 IVIG, 670 surgical debridement, 669 wound care, 669 type II infections, 667 type I infections, 667 Needle cric See Percutaneous translaryngeal catheter insufflation Needle thoracostomy, 92–84, 93f Neostigmine with glycopyrrolate, 483t Nervous system, in elderly, 234 Neurogenic bladder, 208–209 Neurogenic bowel, 209–210 Neurogenic shock, 45, 46, 49, 458–459 Neuromuscular blocking agents (NMBAs), 22, 28–30, 29t, 482t Neutrophils, 17 New Injury Severity Score (NISS), Noninvasive and continuous hemoglobin (SpHb) monitoring, 507 Non-invasive positive-pressure ventilation (NIPPV), 476 Noninvasive ventilation (NIV), 514–515 Non-rebreather mask, 22 Nose, injury to, 281 Nosocomial infection, 148–153 NSAID, 163 Nutation, Nutrition intervention (NI), 73–81 burn patients and, 79, 80t categories, 76 controlled starvation, 76 enteral nutrition, 76–77 immunonutrition, 78 oral intake at will, 76 oral nutrition supplements, 77–78 total parenteral nutrition, 77 clinical guidelines for, 80–81 elderly patients and, 80 metabolic demands of trauma and burn patients and, 73–75 hyperglycemia and resistance to insulin, 75 immune-mediated amino acid destruction, 75 789 increased protein breakdown, 74 lipid mobilization, 75 resting energy expenditure, 75 vitamin deficiencies, 75 nutrient requirements and, 78–79 carbohydrate requirements, 78 lipid requirements, 79 meeting caloric goals, 78 micronutrients, 79 protein requirements, 78–79 obese patients and, 79–80 O Obstructive shock, 45, 46, 49, 458 Obturator sign, 565t, 626 Odontoid fractures types I, 300, 302f types II, 300, 302f, 303f types III, 300, 302f Ogilvie’s syndrome, 588 Omega-3 fatty acids, 79 Open abdomen, 531–533 complications from, 532–533 enterocutaneous fistula, 532 hernia development, 532 intra-abdominal abscess formation, 532 enteroatmospheric fistula management, 532–533 permanent closure, 532 delayed abdominal wall reconstruction, 532 primary closure, 532 skin mobilization and closure, 532 split-thickness skin graft, 532 temporary closure, 531–532 prosthetic coverage, 531–532 vacuum-assisted closure devices, 531 Open cric See Cricothyroidotomy Open globe, 310 Open pneumothorax, 333 Operating room practice, 179–212 conducting trauma operation and, 179–180 ED to OR transfer, 180 hand-off communication, 180–181 operating room priorities, 181 OR patient preparation, 180f surgical simulation training and performance improvement, 181–182 Operation, preoperative evaluation and preparation, 569–572 advanced directives, 572 fluid resuscitation, 569–571 informed consent, 572 operative checklists, 572 preoperative antibiotics, 571 reversal of anticoagulation, 571–572 antiplatelet therapy, 571–572 coumadin, 571 tahir99 - UnitedVRG vip.persianss.ir 15:53 P1: Trim: 5.25in × 8.375in LWBK1111-Index 790 Top: 0.249in Gutter: 0.498in LWW-Peitzman-educational September 7, 2012 Index Ophthalmic injuries, 308–314 cataract, 313 chemical injury, 310 commotio retinae, 314 corneal abrasions and foreign bodies, 312 eyelid lacerations, 312–313 hemorrhage and orbital bone fractures, 313 history examination, 308 intraocular foreign bodies, 311 open globe, 310 physical examination, 308–310 retinal detachment, 314 traumatic hyphema, 310–311, 311t traumatic optic neuropathy, 313 Opioids, 162–163, 163t See also Pain management Oral factor Xa inhibitors, 174–175 Oral nutritional supplements (ONS), 77–78 Orbital blowout fractures, 275–276, 275f Orbital fractures, 313 Organ donor, support of, 545–542 brain death, determination of, 546–548, 547t care of potential organ donor, 548–552 acidosis, 552 alternative colloids, 552 antibiotic prophylaxis, 552 cardiovascular support, 548, 550 coronary angiography, 551 dysrhythmias, 551 echocardiogram, 551 endocrine support, 552 fluid and electrolyte therapy, 551–552 hematologic support, 552 hyperglycemia, 552 hypernatremia, 552 pulmonary support, 551 temperature regulation, 552 vasopressors, 551 donation after cardiac death, 548, 549t failure to procure organs, reasons for, 545, 546t physiologic goals in organ donor, 550t potential organ donors, 545–546 Uniform Anatomical Gift Act of 1968, 545 Uniform Determination of Death Act of 1981, 545 Organ injury scale (OIS), Organ Procurement and Transplantation Network (OPTN), 548 Organ procurement organization (OPO), 545 Oropharyngeal airway, 23 Orotracheal intubation See Endotracheal intubation (ETI) Orthopaedic traumatic injuries, 404–426 acetabular fractures, 412–413, 414f–415f amputations, 424 ankle fractures, 420 calcaneus fractures, 421 care of open fractures, 408–410 definitive treatment of fractures/dislocations, 408 dislocation, 404, 405f emergent treatment of fractures/dislocations, 407–408 femoral neck fractures, 413, 415, 416f femoral shaft fractures, 416 fracture, 404 classification, 404, 406f closed, 404, 406f open, 404, 406f gunshot injuries and, 410, 411f hip dislocation, 413 knee dislocation, 416 metatarsal fractures, 421 neurovascular injuries associated with, 405t patellar fractures, 416–417 pediatric fractures, 404 pelvic injuries, 410–412, 411t, 412f pertrochanteric femur fractures, 415–416 physical examination, 405, 407 radiographic evaluation, 407 splinting and, 424–426 principles of splinting, 424 purpose for splinting, 424 specific areas, 425–426 splints type, 425 subluxation, 404 supracondylar femur fractures, 416, 417f talar neck fractures, 421 tarsometatarsal (Lisfranc) fractures, 421 tibial plafond fractures, 420 tibial plateau fractures, 417, 418f tibial shaft fractures, 417–419, 418f, 419f upper extremity fractures, 421–424 acromioclavicular joint sprains, 421 Barton’s fracture, 423 clavicle shaft fractures, 421 Colles fracture, 423 combined radius and ulna fractures, 423 coronoid fractures, 423 distal humerus fractures, 422 distal radius fractures, 423 elbow dislocations, 423 Galeazzi fracture, 423 glenohumeral dislocation, 422 humeral shaft fractures, 422 olecranon fractures, 422–423 perilunate dislocations, 424 proximal humerus fractures, 422 radial head fractures, 423 radius fractures, 423 reversed Barton’s fracture, 423 scaphoid fractures, 424 scapula fractures, 422 Smith’s fracture, 423 sternoclavicular dislocation, 421 ulnar shaft fractures, 423 Orthotopic liver transplantation (OLT), 540 Ovarian cysts, 702–703 Ovarian torsion, 703 tahir99 - UnitedVRG vip.persianss.ir 15:53 P1: Trim: 5.25in × 8.375in LWBK1111-Index Top: 0.249in Gutter: 0.498in LWW-Peitzman-educational September 7, 2012 Index Ovary injury scale, 753t Oxazolidinones, 159 Oxygen debt, 47 P Packed red blood cells (pRBCs), 65 Pain management, 162–169 analgesia during resuscitation, 165–166 basic principles of analgesia and, 162–165 long-term opioid therapy and, 169 nerve injury and, 168 non-opioid analgesics/NSAID for, 164t opioid analgesics for, 163t overview, 165 procedural sedation and analgesia, 166–167 rib fractures/chest wall pain and, 167–168 Pancreas injury scale, 747t Pancreatic injury, 370, 372–374, 372f in children, 223–224 diagnosis of, 370, 372–373 incidence of, 370 outcomes for, 374 related anatomy, 370, 372f treatment, 373–374 Pancuronium, 482t Paracentesis, 484 Parenchymal hematomas, 112 Parotid duct lacerations, 278–279, 280f Pathogen associated molecular patterns (PAMPs), 15, 16f Patient-controlled analgesia (PCA), 162–163 Patient in extremis, 35, 41–43 blunt injury, 42–43, 43f penetrating injury, 41–42, 42f Pedestrian–automobile collisions, elderly and, 237 Pedestrian–automobile impacts, 244, 244f Pediatric appendicitis score (PAS), 738 Pediatric burn rule of nines, 225t Pediatric trauma score (PTS), 226, 226t, 737 Pelvic angiography, 117 Pelvic fractures, in children, 224 Pelvic inflammatory disease (PID), acute, 699–701 CDC treatment schedule for, 701t consequences of, 700 criteria for hospitalization of patients with, 700t diagnosis of, 700 epidemiology of, 700 management of, 700 pathophysiology of, 700 risk factors for, 700 Pelvic trauma, imaging in, 116–117 Penetrating Abdominal Trauma Index (PATI), Penetrating trauma, 6–8, 245–251 gunshot injury assessment, 249–250 gunshot wounds, 6–8, 245–249 shotgun wounds, 791 stab wounds, 8, 250–251 types of, 6–8 Penicillins, 154–156 Penile injuries, 402–403 Penis injury scale, 754t Peptic ulcer disease (PUD), 635–638 clinical manifestations, 636 complications, 638 diagnostic modalities, 636 incidence, 635 operative indications, 636 outcomes, 637–638 pathogenesis/etiology, 635–636 risk factors, 635 surgical management, 636–637 Percutaneous dilator-based cricothyroidotomy kits, 31 Percutaneous endoscopic gastrostomy (PEG), 730–731 Percutaneous tracheostomy, 731 Percutaneous translaryngeal catheter insufflation, 31 Perforation, 616 Perianal infections, 661–662 diagnosis, 662 etiology, 661–662 treatment, 662 Pericardial tamponade, 332–333 diagnosis, 332–333, 332f treatment, 333 Pericardial window, 347–349, 348f Pericardiocentesis, 346–347, 348f complications, 347 indications, 346 technique, 346–347 Peripheral vascular injuries, 427–440 arterial injuries, 428–433 axillary artery, 437–438, 438f brachial artery, 438, 439f femoral arteries, 438–439, 440f forearm vascular injury, 438 management of, 437–440 peroneal artery, 440 popliteal artery, 439–440 blunt trauma, 427 compartment syndrome, 433–436 etiology of, 427 hard signs of arterial injury, 428t immediate amputation, indications for, 437 limb loss in vascular trauma, factors for, 428t management algorithm for, 429f penetrating injuries, 427 restoration of distal perfusion, 437 with specific orthopedic injuries, 429t venous injuries, 436–437 Peripheral vascular organ injury scale, 754t Peripheral venous catheters, placement of, 32 Peritonitis, 150–151 secondary, 150–151 tertiary, 151 tahir99 - UnitedVRG vip.persianss.ir 15:53 P1: Trim: 5.25in × 8.375in LWBK1111-Index 792 Top: 0.249in Gutter: 0.498in LWW-Peitzman-educational September 7, 2012 Index Pharmacodynamics (PD), 153 Pharmacokinetics (PK), 153 bioavailability, 153 clearance, 153 half-life, 153 Physicians, role of, in injury prevention, 198–201 Physiologic response, to injury, 10–20 continued volume shifts, 13, 14f cytokines and, 17–20 flight response, 10 hemostasis and, 11–13 immune response, 14–17 initial responses, 10, 11t macrophages and, 17 neutrophils and, 17 organ system response, 11t Physiologic scores, Pilonidal disease, 663 Placental abruption, 232, 697–698 Placenta previa, 698 Plain-film skull radiography, 111 Plasma, 65–66 Plasminogen activator inhibitor-1 (PAI-1), 13 Platelets, 66 Pneumatic compression devices (PCDs), 173–174 Pneumonia, 148–149 early-onset, 149 late-onset, 149 Polymyxins, 157–158 Portal hypertension (PH), 540–543 classification of, 540 clinical manifestation of, 540 ascites, 542 encephalopathy, 543 gastrointestinal bleeding, 540–542 hepatorenal syndrome, 543 definition of, 540 Positive end-expiratory pressure (PEEP), 503 Postconcussion syndrome, 260 Post-hospital care, Precession, Pregnancy acute cholecystitis in, 617–618 appendicitis in, 628–629 Pregnancy, trauma in, 228–233 anatomic and physiologic changes in pregnancy and, 228, 229t management of, 229–232 diagnostic modalities, 231 emergency cesarean delivery, 232 exploratory laparotomy, 231–232 fetal assessment, 230–231 general considerations, 229 medications, 231 primary survey modifications, 229–230 secondary survey modifications, 230 mechanisms of injury for, 228–229 blunt trauma, 228 penetrating trauma, 228–229 problems related to, 232–233 disseminated intravascular coagulation, 232 fetomaternal hemorrhage, 232 placental abruption, 232 preterm labor, 232 uterine rupture, 232–233 Prehospital and air medical care, 83–99 Prehospital care, Prehospital trauma management (nonarrest), 91–96 airway management, 91–92 axial spine immobilization, 95–96 intravenous access and fluid therapy, 92 needle thoracostomy, 92–84, 93f splinting, 94–95 tourniquets, 94 Preterm labor, 232 Primary resuscitator, 108t Primary survey, in pediatric trauma patients, 213–220 Procoagulant agents, 66–67 Proctalgia fugax, 665 Professional resources, in trauma systems, Prolapsing hemorrhoids (PPH), 664–665 Propofol, 29, 167, 481t for endotracheal intubation, 29t Prostaglandins, 19 Prostatic pain, 665 Proteases, 17 Protective garments, 102–103 Protein C pathway, systemic activation of, 11, 13f Protein synthesis inhibitors, 158–159 Prothrombin complex concentrate (PCC), 66 Psoas sign, 625 Public health model, 197–198, 198f PUD See Peptic ulcer disease (PUD) Pulmonary angiography, for PE diagnosis, 177 Pulmonary artery catheterization, in ICU, 464–465 Pulmonary artery catheter monitoring (PAC), 504–505 cardiac output, 505 continuous monitoring, 505 continuous cardiac output, 505 continuous mixed venous oximetry, 505 potential drawbacks, 505 RVEDV, 505 indications for, 504, 504t, 505t insertion, 504 values derived from, 504t wedge pressure, 504–505 Pulmonary artery wedge pressure (PAWP), 504–505 Pulmonary contusion, 344 Pulmonary embolism (PE), 176–177 definition of, 176 diagnosis of, 176–177 incidence of, 176 prophylaxis, 177 tahir99 - UnitedVRG vip.persianss.ir 15:53 P1: Trim: 5.25in × 8.375in LWBK1111-Index Top: 0.249in Gutter: 0.498in LWW-Peitzman-educational September 7, 2012 Index treatment of anticoagulation, 177 suction embolectomy, 177 surgical embolectomy, 177 thrombolysis, 177 Pulse contour analysis, 506–507 FloTrac system, 506 LiDCO plus system, 507 PiCCO system, 506 Pulse oximetry, in ICU, 460 Pulsus paradoxus, 332–333 R Radioactive material, use of, 191–193 Radiography, 110 in abdominal injury, 359 in chest trauma, 113 for evaluation of abdomen, 577 in pelvic fractures, 116 in spinal injuries, 113 Radiology technologist, 108t Ranson’s criteria, for acute pancreatitis, 738–740, 739t Rapid Needs Assessment (RNA), 186 Rapid-sequence intubation (RSI), 23, 28, 30 Reactive oxygen species (ROS), 17, 19 Recombinant factor VIIa (rFVIIa), 66 Recorder, 108t Rectal injuries, 369–370 Rectum injury scale, 749t Regional anesthesia, 33–34 Rehabilitation, 202–211 general effects of neurotrauma and immobilization after injury, 202–206 post-injury problems and, 207–210 agitation, 207–208 autonomic dysreflexia, 208 neurogenic bladder, 208–209 neurogenic bowel, 209–210 scope of, 210–211 Relative afferent pupillary defect (RAPD), 308–309 Renal failure, 508 Renal injuries, 397–399, 397f–399f and complications, 398–399 mechanism and diagnosis of, 397 treatment of, 398 Renal replacement therapy, indications for initiation of, 478t Renal system, in elderly, 234 Research, in trauma systems, Respiratory system, in elderly, 234 Respiratory technician, 108t Restraints, role of, Resuscitation, 32–33, 569–571, 594–595 adjunctive procedures to naso/orogastric tube intubation, 719–720 optical tonometry/lateral canthotomy, 720 reduction of common dislocations, 720–722 793 ring removal from compromised digit, 722–723 skeletal traction pin insertion, 723 Retinal detachment, 314 Retrograde urethrography (RUG), 117 in genitourinary injuries, 395 Revised trauma score (RTS), 4, 736–737, 736t Richter’s hernia, 691 RIFLE criteria, 492t for acute kidney injury, 508, 509f Rifling, Right thoracotomy, 356 Right ventricular end-diastolic volume index (RVEDVI), 50, 505 Ring of fire, 695 Rocuronium, 482t for endotracheal intubation, 29t Rovsing’s sign, 565t, 626 Ruptured aortic aneurysm, 672–674 diagnosis, 672–673, 673t history and physical examination, 672 imaging modalities, 672–673 outcomes, 674 risk factors for, 673t treatment, 673–674 endovascular repair, 674 open repair, 673–674 S Scoring systems, 733 in emergency general surgery appendicitis, 738 cholecystitis, 738 diverticulitis, 737–738 necrotizing soft tissue infections, 740–742 pancreatitis, 738–740, 739t, 740t in injury and trauma anatomic scoring, 733–735 combined scores, 737 physiologic scoring, 735–737 types of, 733 Scrotal injury, 402 Scrotum injury scale, 754t Seatbelt/Chance fracture, 303 Seat belt syndrome, Selective factor Xa inhibitors, 174 Sepsis, 14, 49, 128–136 bacteria implicated in, 131f definition of, 128 diagnosis of, 128–132, 130t, 131f, 132t management of, 133–136 adjuvant therapies, 136 anemia and coagulopathy, 135–136 antibiotics, 134–135 circulatory support, 133–134 corticosteroids, 135 deep vein thrombosis prophylaxis, 136 glucose management, 135 hemodynamic goals and devices, –134 nutrition, 135 tahir99 - UnitedVRG vip.persianss.ir 15:53 P1: Trim: 5.25in × 8.375in LWBK1111-Index 794 Top: 0.249in Gutter: 0.498in LWW-Peitzman-educational September 7, 2012 Index Sepsis (Contd.) renal support, 136 respiratory support, 133 sedation, analgesia, and neuromuscular blockade, 135 stress ulcer prophylaxis, 136 vasopressor/inotrope use, 134 risk factors for, 128, 129t severe, 128 Septic abdomen, damage control sequence for, 59 Septic shock, 45, 49, 128 Sequential organ failure assessment (SOFA), 490 Serial casting of extremity, 203 A Severity Characterization of Trauma (ASCOT), 4, 737 Sexual assault, 705–706 incidence and epidemiology, 705 management, 705–706 Shaken impact syndrome, 225 Shock, 45–50 and acute respiratory failure, 474 classification of, 45 definition of, 45 and goals of resuscitation, 49–50 management of, 48–49 manifestations of, 46–47 clinical findings, 46–47 coagulopathy of trauma, 47 quantification of hypoperfusion, 47 physiologic response in, 45–46 afferent signaling, 45 cardiovascular, 45–46 cellular effects, 46 inflammatory and immune, 46 neuroendocrine, 46 Shotgun, 8, 248–249 Shoulder dislocation, reduction of, 720–721 Shoulder dystocia, 699 Simple triage and rapid treatment (START), 85, 87t Sinusitis, 151–152 Skin and soft-tissue injuries, and infection, 146 Skull, 253 Skull fractures, 261–262 basilar, 262 depressed, 261–262 linear, 261 Skull trauma, imaging in, 111–112 Slash wounds, 250 Small bowel diverticular disease, 648 Small bowel injury scale, 748t Small bowel obstruction (SBO), 584–587 etiology, 584 adhesions, 584 Crohn’s disease, 584 foreign bodies, 584 gallstone ileus, 584 hernias, 584 intussusception, 584 neoplasms, 584 laboratory evaluation, 585 complete blood count, 585 electrolyte panel, 585 presentation and initial assessment, 584–585 radiographic evaluation, 585–586 abdominal x-ray, 585–586, 585f CT, 586 treatment, 586–587, 586t adhesions, 586–587 non-adhesive causes, 587 Small intestine injuries, 369, 369t, 371t Social worker, 108t Sodium nitroprusside, in aortic injury, 337 Soft tissue infection, 666–670 anatomy related to, 666 dermis, 666 epidermis, 666 investing fascia, 666 muscle, 666 subcutaneous tissue, 666 necrotizing, 667–670 (See also Necrotizing soft tissue infections (NSTIs)) risk factors, 666–667 Spasticity, 203 Spinal cord/spinal column injury, 287–307 anatomy of spinal cord and, 287–288, 288f Canadian C-spine rule, 295f cervical spine fractures, 299–300, 299f, 301f–304f mechanics of spinal column injury and, 288–289 medical management of SCI, 297–299 neurologic evaluation and physical examination in, 290–294 anterior cord injury, 294 Brown-Sequard syndrome, 294 central cord injury, 294 conus medullaris and cauda equina syndromes, 294 motor evaluation, 290 posterior cord injury, 294 reflex testing, 290 sensory testing, 290, 291f–292f penetrating spinal column injury, 306–307 prehospital measures, 289–290 radiographic examination, 294–297, 296f surgical management of, 303–306, 306t thoracolumbar spine fractures, 302–303 Spine boards, 95–96 Spine inuries, imaging in, 112–113 Spine radiographs, 110 Spleen injury scale, 746t Splenic injury, 383–387 anatomy and function of spleen, 383 in children, 223 diagnosis of, 383 incidence of, 383 outcomes and complications, 386–387 tahir99 - UnitedVRG vip.persianss.ir 15:53 P1: Trim: 5.25in × 8.375in LWBK1111-Index Top: 0.249in Gutter: 0.498in LWW-Peitzman-educational September 7, 2012 Index treatment, 383–386 nonoperative management, 383–385, 384f operative management, 385–386, 386f, 387f Splint application, 723–726 available internet images/video, 725 complications, 725 contraindications, 723 indications, 723 pelvic sling/binder application, 725–726 splinting technique, 723–724 post-procedure, 724 pre-procedure, 723 splinting procedure, 723–724 traction splint application, 726 types of splint lower extremity, 725 upper extremity, 724 Splinting, 94–95, 424–426 See also Orthopaedic traumatic injuries complications of, 94–95 indications for, 94 type of splint, 94 Sports-related head injury, 260 grading of, 260t Stab wounds, 8, 250 Stomach injuries, 367–369, 371t Stomach injury scale, 748t Storage lesion, 69 Straddle injury, in children, 224 Subarachnoid hemorrhage, 111 Subaxial Cervical Injury Classification and Severity Score (SLICS), 306t Subcutaneous heparin (SCH), 174 Subdural hematomas, 111 Succinylcholine, for endotracheal intubation, 29t Supraglottic airways, 30, 90f Suprapubic catheter insertion, 727–728 available internet video, 728 complications, 728 contraindications, 727 indications, 727 technique, 727–728 Surgical airways, 30–31 Survival Risk Ratios (SRR), Surviving Sepsis Campaign Guidelines, 133 See also Sepsis Susceptibility weighted imaging (SWI), 112 Systemic inflammatory response syndrome score (SIRS score), 4, 741–742, 741t Systemic inflammatory response syndrome (SIRS), 14, 128, 140t, 490t See also Infection; Sepsis T Tactile (digital) ETI, 30 TBIs See Traumatic brain injuries (TBIs) Team activation and organization, 101–108 795 transfer of patient to trauma team and, 107–108 trauma response and, 101 trauma resuscitation area and, 102–105 trauma team and, 105–107 Teardrop fractures, 300 Technology, in trauma systems, Telavancin, 157 Temporary abdominal closure (TAC), 54–55 Tension pneumothorax, 331–332 causes, 331 diagnosis, 332 treatment, 332 Terrorism, 189 See also Disasters/mass casualty incident Testis injury scale, 753t Tetracyclines, 158–159 Thiopental, for endotracheal intubation, 29t Third trimester bleeding, 697–698 management of, 698 placental abruption, 697–698 placenta previa, 698 Thoracentesis, 484 Thoracic bioimpedance, 463 Thoracic injuries, 327–356, 331t chest wall injury, 345 and emergency thoracic procedures, 345–356 bilateral thoracotomy, 354, 355f emergency department thoracotomy, 349–352, 350f, 351f left anterolateral thoracotomy, 352–353 left/right posterolateral thoracotomy, 353–354, 354f median sternotomy, 352 pericardial window, 347–349, 348f pericardiocentesis, 346–347, 348f right thoracotomy, 356 thoracoabdominal incision, 356 tube thoracostomy, 345, 346f–347f immediate evaluation of, 327–328 arterial blood gas, 328 chest x-ray, 327 indications for immediate operation, 328 oxygen administration, 327 physical examination, 327 resuscitation, 327 immediate life-threatening injuries, 330–335 airway obstruction, 330–331 commotio cordis, 335 flail chest, 334–335 massive hemothorax, 334 open pneumothorax, 333 pericardial tamponade, 332–333 tension pneumothorax, 331–332 mortality from, 327 penetrating thoracic wounds, immediate management of, 328 potentially life-threatening injuries, 335 cardiac injuries, 339–341 tahir99 - UnitedVRG vip.persianss.ir 15:53 P1: Trim: 5.25in × 8.375in LWBK1111-Index 796 Top: 0.249in Gutter: 0.498in LWW-Peitzman-educational September 7, 2012 Index Thoracic injuries (Contd.) diaphragmatic injury, 342–343 esophageal injury, 343–344 pulmonary contusion, 344 tracheobronchial injuries, 338–339 traumatic rupture of aorta, 335–338, 337f vascular injuries, 341–342 transmediastinal penetrating wounds, immediate evaluation of, 328–330, 329f, 330f traumatic asphyxia, 344–345 Thoracic vascular injuries, 341–342 azygos and hemiazygos veins injuries, 342 carotid artery injury, 341–342 clinical signs, 341 diagnosis, 341 injury complexes, 341 massive hemothorax, 341 middle mediastinal hematoma, 341 superior mediastinal hematoma, 341 intercostal arteries injuries, 342 internal mammary artery injury, 342 pulmonary hilum, 342 subclavian artery injury, 342 Thoracic vascular injury scale, 745t Thoracoabdominal incision, 356 Thoracolumbar burst fractures, 302–303 Thoracolumbar Injury Classification and Severity Score (TLICS), 306t Thoracotomy, 341 Three-point seat belt restraints, Thromboelastogram (TEG), 64–65 Thrombosed and prolapsed hemorrhoids, 600–661 Thromboxanes, 20 Tigecycline, 159 Tissue plasminogen activator (tPA), 13 Tizanidine, 204 TNF-␣, 18 Tokyo guidelines, for acute cholecystitis, 738, 739t Total body surface area (TBSA), 443, 447 See also Burns/inhalation injuries Total parenteral nutrition (TPN), 73, 77 Tourniquets, 94 Tracheobronchial injuries, 338–339 bronchial injuries, 338 cervical tracheal injuries, 338 management, 339 radiographic signs, 338 Tracheostomy, 31, 484, 527–528 Tranexamic acid (TXA), 66 Transcranial Doppler, 259 Transesophageal echocardiography (TEE), 506 for aortic injury, 337 Transfusion associated circulatory overload (TACO), 70–71 Transfusion related acute lung injury (TRALI), 70 Transjugular intrahepatic portosystemic shunt (TIPS), 542 Transthoracic echocardiography (TTE), 506 Trauma in children, 213–227 definition of, epidemiology of, injury patterns and mechanism in, 1–2 mechanisms of injury in, 4–9 blunt injury, 4–6 combined injury, 8–9 penetrating injury, 6–8 mortality after, 1, 2f in older adults, 234–239 (See also Elderly, trauma in) physiologic response in, 10–20 in pregnant women, 228–233 (See also Pregnancy, trauma in) Trauma and injury severity score (TRISS), 4, 737 Trauma Center environment, 35 Trauma centers level I, 101 level II, 101 level III, 101 level IV, 101 non-designated, 101 Trauma databases, Trauma-induced coagulopathy (TIC), 11 Trauma nurse, 108t Trauma patient anesthesia for, 32–34 definition of, initial assessment and resuscitation of, 35–44 approach of trauma team and, 35, 36f laboratory studies and, 43 multiple victims and, 43–44 patient in extremis and, 41–43 patient stability and, 35–37 stable adult with blunt trauma and, 37–38 stable adult with penetrating trauma and, 40 unstable adult with blunt trauma and, 38–39 unstable adult with penetrating trauma and, 40–41 response to, 101 institutional capability and, 101 levels of, 101 team approach to, 35 Trauma patient classification system, 106t Trauma resuscitation area (TRA), 102–105 communication in, 105 equipment in, 103–105 layout of, 104f medications in, 105 physical plant, 102 and protective garments, 102–103 Trauma score (TS), 4, 736 tahir99 - UnitedVRG vip.persianss.ir 15:53 P1: Trim: 5.25in × 8.375in LWBK1111-Index Top: 0.249in Gutter: 0.498in LWW-Peitzman-educational September 7, 2012 Index Trauma systems, 2–3 definition of, fundamental components of, infrastructure elements, overview of, Trauma team, 105–107, 107f, 108t Trauma team leader, 108t Traumatic arrest, 87–91 etiology, 87–88 management of, 89–91 resuscitation criteria, 88 special conditions, 88–89 survival determination, 88 Traumatic asphyxia, 344–345 definition, 344 diagnosis, 345 treatment, 345 Traumatic brain injuries (TBIs), 253–262, 479 in children, 222 initial evaluation and treatment of, 254–255 mild/moderate TBI, 254 mild head injury, 259 postconcussion syndrome, 260 return to play after sports-related head injuries, 260–261 penetrating brain injuries, 261 related anatomy and physiology, 253–254 severe TBI, 254 adjunctive monitoring, 259 ICP monitoring, 257 initial treatment, 256–257 physiologic monitoring, 255–256 prognosis after severe TBI, 259 treatment of elevated ICP, 257–259, 258f skull fractures, 261–262 Traumatic myositis ossificans, 205 Traumatic optic neuropathy, 313 Traumatic rupture of the aorta, 335–338 chest x-ray, 335–336 clinical signs, 335 definition, 335 diagnosis, 335–337 diagnostic algorithm for, 336f management, 337–338 mechanism of injury, 335 Traumatic shock, 45, 48 Trauma triage, 83–87 field triage, 83–85 (See also Field triage) limitations to, 87 over-triage, 87 under-triage, 87 mass casualty triage, 85–87 Triad of Death, 61 Trigeminal nerve, 278, 279f Trimethoprim-Sulfamethoxazole (TMP-SMX), 160 Tube thoracostomy, 345, 346f–347f, 484 U Ultrasound (US), 110 for evaluation of abdomen, 578 797 in genitourinary injuries, 397 in ICU, 118 Unilateral facet fractures, 300 United Network for Organ Sharing (UNOS), 548 University of Wisconsin donation after cardiac death evaluation tool, 549t Unstable patient, 35, 37t See also Trauma patient Upper GI (UGI) bleeding, 540–542 Ureteral injuries, 399–400 and complications, 400 mechanism and diagnosis, 399 treatment of, 399–400 Ureter injury scale, 751t Urethra injury scale, 751t Urethral injuries, 401–402 complications of, 402 diagnosis of, 401 mechanism of, 401 treatment of, 401–402 anterior urethral injury, 402 posterior urethral injury, 401–402 Urinary catheter insertion, 726–727 available internet video, 727 complications, 727 contraindications, 726 indications, 726 technique in female patient, 727 in male patient, 726–727 in pediatric patient, 727 Urinary tract infection (UTI), 152–153 Uterine bleeding, abnormal, 701–702 evaluation, 702 management, 702 pathophysiology, 702 Uterine pain, 665 Uterine rupture, 232–233 Uterus (nonpregnant) injury scale, 752t Uterus (pregnant) injury scale, 752t V Vagina injury scale, 753t Vaginal injuries, 403 Vancomycin, 157 VAP See Ventilator-associated pneumonia (VAP) Vascular emergencies, 672–682 acute lower extremity ischemia, 680–682 aortic dissection, 675–677 aortoenteric fistula, 678 mesenteric ischemia, 678–680 ruptured aortic aneurysm, 672–674 visceral aneurysms, 674–675 Vasoactive drugs, 33 Vasogenic shock, 45, 46, 49 Vasopressors, 570–571 Vecuronium, 482t for endotracheal intubation, 29t tahir99 - UnitedVRG vip.persianss.ir 15:53 P1: Trim: 5.25in × 8.375in LWBK1111-Index 798 Top: 0.249in Gutter: 0.498in LWW-Peitzman-educational September 7, 2012 Index Venous injuries, 436–437 diagnosis, 436 treatment, 437 Venous thromboembolism, 170–178 deep venous thrombosis, 170–176 pulmonary embolism, 176–178 Venous thromboembolism (VTE), 466 Ventilation–perfusion scintigraphy (V/Q scan), for PE diagnosis, 177 Ventilator-associated pneumonia (VAP), 144, 149 prevention of, 516–517 Ventilator-induced lung injury (VILI), 517 Ventilator settings, 477 See also Mechanical ventilation (MV) Ventriculostomy catheters, 257 Violence, elderly and, 237 Visceral arterial aneurysms, 674–675 diagnosis, 674 presentation, 674 vessels affected, 674–675 celiac artery, 675 hepatic artery, 675 SMA, 675 splenic artery, 674–675 Visual acuity, 308, 309f Vitamin K antagonists (VKAs), 174, 176 Volume shifts, after trauma, 13, 14f fluid mobilization and diuresis, 13 obligatory extravascular fluid sequestration, 13 shock and active hemorrhage, 13 Vulva injury scale, 753t W Waddle’s triad of injury, 244 Warfarin, 176 Waveform capnographers, 27 Weapons of mass destruction (WMD), 183, 189–193 See also Disasters/mass casualty incident Wedge compression fractures, 302, 305f World Society of Abdominal Compartment Syndrome (WSACS), 529 Wound, maxillofacial injury, 282–284 X X-rays, 110 See also Chest x-ray; Radiography Y Yaw, Z Zenker’s diverticulum, 630 Zygomatic arch fractures, 274–275, 275f Zygomaticomaxillary complex fractures, 273–274, 274f tahir99 - UnitedVRG vip.persianss.ir 15:53 ... processes and based on the chronology of patient care The emergency department and the trauma/ acute care surgery services at many hospitals are essentially the “safety nets” for the inpatients and the. .. injury or non -trauma critical disease The 4th edition of The Trauma Manual has expanded its coverage of all components of the field: trauma, critical care, and emergency surgery The chapters are... September 19, 2012 THE TRAUMA MANUAL: TRAUMA AND ACUTE CARE SURGERY Fourth Edition R G Editors ni te Mark M Ravitch Professor Chief, Trauma and General Surgery Department of Surgery University