A Case and Evidence-Based Textbook About the book Trauma, Critical Care and Surgical Emergencies is essential reading for all surgeons, fellows, residents and students, especially those working in trauma, emergency and critical care environments About the editors Reuven Rabinovici MD, Chief, Trauma Division, Tufts Medical Center, Boston, Massachusetts, USA; Professor of Surgery, Tufts University School of Medicine, Boston, Massachusetts, USA Heidi L Frankel MD, Chief, Division of Trauma and Critical Care and Acute Care Surgery; Director, Shock Trauma Center, Penn State Milton S Hershey Medical Center, Pennsylvania, USA; Charlene J Smith Endowed Professor of Surgery, The Pennsylvania State University College of Medicine, Pennsylvania, USA Orlando Kirton MD, Professor of Surgery, Vice Chairman, Department of Surgery, University of Connecticut School of Medicine, Farmington, Connecticut, USA; the Ludwig J Pyrtek, M.D Chair in Surgery and Director of Surgery, Hartford Hospital, Connecticut, USA With an introduction on Evidence Based Medicine by Timothy C Fabian MD, Wilson Alumni Professor of Surgery and Chairman of the Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA Telephone House, 69-77 Paul Street, London EC2A 4LQ, UK 52 Vanderbilt Avenue, New York, NY 10017, USA www.informahealthcare.com Trauma, Critical Care and Surgical Emergencies This book provides a comprehensive and contemporary discussion about the three key areas of acute care surgery; trauma, surgical critical care, and surgical emergencies The 65 chapters, written by prominent surgeons in the field, are arranged by organ, anatomical site and injury type, and each includes a case study with evidence-based analysis of diagnosis, management, and outcomes Unless stated otherwise, the authors used the GRADE evidence classification system established by the American College of Chest Physicians Rabinovici Frankel • Kirton Trauma, Critical Care and Surgical Emergencies Trauma, Critical Care and Surgical Emergencies A Case and Evidence-Based Textbook Edited by Reuven Rabinovici Heidi L Frankel Orlando Kirton Trauma, Critical Care and Surgical Emergencies: A Case and Evidence-Based Textbook Edited by Reuven Rabinovici, MD, FACS Chief, Division of Trauma and Acute Care Surgery Tufts Medical Center Professor of Surgery Tufts University Medical School Boston, Massachusetts, USA Heidi L Frankel, MD, FACS Charlene J Smith Endowed Professor of Surgery Penn State University Chief, Division of Trauma, Acute Care and Critical Care Surgery Penn State Hershey Medical Center Medical Director, Penn State Shock Trauma Center Hershey, Pennsylvania, USA Orlando C Kirton, MD, FACS Ludwig J Pyrtek, MD Chair in Surgery Director of Surgery Chief Division of General Surgery Hartford Hospital, Hartford, Connecticut Professor of Surgery Program Director, Integrated General Surgery Residency Program Vice Chair, Department of Surgery University of Connecticut School of Medicine Farmington, Connecticut, USA © 2010 Informa UK First published in 2010 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 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 A CIP record for this book is available from the British Library Library of Congress Cataloging-in-Publication Data Data available on application ISBN-13: 9780849398957 Orders Informa Healthcare Sheepen Place Colchester Essex CO3 3LP UK Telephone: +44 (0)20 7017 5540 Email: CSDhealthcarebooks@informa.com Typeset by C&M Digitals (P) Ltd, Chennai, India Printed and bound in Great Britain by MPG Books Ltd, Bodmin, Cornwall, UK Contents List of Contributors Preface Evidence-Based Medicine Timothy C Fabian vii xv xvii I Trauma   Fluid resuscitation for the trauma patient Michael M Krausz   Complex airway Thomas C Mort and Joseph V Portereiko   Major blunt head injury Brian Hood, Leo Harris, and M Ross Bullock 31   Minor blunt head injury in the intoxicated patient Eleanor S Winston and Lisa Patterson 47   Stab wound to the carotid artery Jonathan B Lundy and Stephen M Cohn 52   Cervical spine fracture with quadriplegia Eric B Harris, James Lawrence, Jeffrey Rihn, Li Gang, and Alexander R Vaccaro 60   Blunt thoracic aortic injury David Wisner 76   Transmediastinal penetrating trauma Kevin Schuster and Erik Barquist 86   Diaphragmatic injury following penetrating trauma Anthony Shiflett, Joe DuBose, and Demetrios Demetriades 91 10 Blunt liver injury Leslie Kobayashi, Donald Green, and Peter Rhee 97 11 Blunt splenic injury Amy D Wyrzykowski and David V Feliciano 107 12 Penetrating renal injuries Rao R Ivatury 114 13 Blunt pancreaticoduodenal injury Nasim Ahmed and Jerome J Vernick 119 14 Penetrating colon injury Aaron Winnick and Patricia O’Neill 128 15 Rectal injury with pelvic fracture Kimberly K Nagy 142 16 Abdominal aortic injury Gainosuke Sugiyama and Asher Hirshberg 145  contents 17 Blunt pelvic fracture with hemoperitoneum John H Adamski II and Thomas M Scalea 151 18 The mangled extremity Samuel C Schecter, Scott L Hansen, and William P Schecter 164 19 Damage control laparotomy Brett H Waibel and Michael F Rotondo 174 20 The pulseless trauma patient Reuven Rabinovici and Horacio Hojman 186 21 Related blast injury Gidon Almogy, Howard Belzberg, and Avraham I Rivkind 196 22 Pediatric blunt trauma Sarah J McPartland, Carl-Christian A Jackson, and Brian F Gilchrist 203 23 Blunt trauma in pregnancy Amy D Wyrzykowski and Grace S Rozycki 227 II Surgical Critical Care 24 Acute respiratory failure Randall Friese 234 25 Ventilator-associated pneumonia Fredric M Pieracci, Jennifer Dore, and Philip S Barie 241 26 Acute respiratory distress syndrome Nabil Issa and Michael Shapiro 252 27 Weaning and liberation from mechanical ventilation Walter Cholewczynski and Michael Ivy 261 28 Deep vein thrombosis and pulmonary embolism Wesley D McMillian and Frederick B Rogers 264 29 Shock Jill Cherry-Bukowiec and Lena M Napolitano 275 30 Perioperative management of a patient undergoing noncardiac surgery Roxie M Albrecht and Jason S Lees 287 31 Postoperative cardiac arrythmias Scott C Brakenridge and Joseph P Minei 293 32 Oliguria Heather L Evans and Eileen M Bulger 298 33 Hyponatremia in the surgical intensive care unit Christine C Wyrick 305 34 Glycemic control in the critically ill surgical patient Stanley A Nasraway and Jeffrey Lee 309 35 Postoperative anemia: Risks, benefits, and triggers for blood transfusion Matthew D Neal, Samuel A Tisherman, and Jason L Sperry 315 36 Nutritional considerations in the surgical intensive care unit Chaitanya Dahagam and Steven E Wolf 322 37 Pain, agitation, and delirum Aviram Giladi and Bryan A Cotton 330 38 Care of the potential organ donor Carrie A Sims and Patrick Reilly 339  contents 39 End of life care in the icu: Ethical considerations a family-centered, multidisciplinary approach Felix Y Lui, Mark D Siegel, and Stanley Rosenbaum 347 40 Acute trauma-related coagulopathy Bryan A Cotton and John B Holcomb 352 41 Adrenal insufficiency in critical illness Carrie A Sims and Vicente Gracias 358 42 Sepsis Philip A Efron and Craig M Coopersmith 362 43 Catheter-related infections Spiros G Frangos and Heidi L Frankel 369 44 Special populations in trauma Kimberly M Lumpkins and Grant V Bochicchio 375 45 Ultrasound in the intensive care unit Kazuhide Matsushima and Heidi L Frankel 383 III Surgical Emergencies 46 Appendicitis John W Mah 390 47 Bariatric surgery complications Terrence M Fullum and Patricia L Turner 396 48 Diverticulitis Carrie Allison, Daniel Herzig, and Robert Martindale 406 49 Perforated peptic ulcers Meredith S Tinti and Stanley Z Trooskin 412 50 Acute mesenteric ischemia Daniel T Dempsey 418 51 Acute cholecystitis Adam D Fox and John P Pryor CS† 427 52 Acute pancreatitis Pamela A Lipsett 435 53 Incarcerated femoral and inguinal hernias Robert T Brautigam 449 54 Esophageal perforation Alykhan S Nagji, Christine L Lau, and Benjamin D Kozower 455 55 Acute upper gastrointestinal bleeding Kimberly Joseph 463 56 Acute lower GI hemorrhage Amanda Ayers and Jeffrey L Cohen 471 57 Perirectal and Perineal sepsis Frederick D Cason and Yazan Duwayri 479 58 Necrotizing soft tissue infections Lisa Ferrigno and Andre Campbell 490 59 Acute intestinal obstruction Pierre E de Delva and David L Berger 498 60 Anastomotic leak and postoperative abscess Peter A Pappas and Ernest FJ Block 509  contents 61 Anesthesia for bedside surgical procedures Richard P Dutton 515 62 Acute care surgery in immunocompromised patients Richard J Rohrer 522 63 Hyperbaric oxygen therapy: A primer for the acute care surgeon Louis DiFazio and George A Perdrizet 527 64 Trauma and surgical critical care system issues Alan Cook and Heidi L Frankel 536 Index 545  List of contributors John H Adamski II R Adams Cowley Shock Trauma Centre University of Maryland School of Medicine Baltimore, Maryland, USA Ernest FJ Block Department of Surgery University of Central Florida Orlando, Florida, USA Nasim Ahmed Surgical ICU (SICU) Jersey Shore University Medical Center Neptune, New Jersey, USA Grant V Bochicchio BVAMC RAC Shock Trauma Center Baltimore, Maryland, USA Roxie M Albrecht Department of Surgery University of Oklahoma Oklahoma City, Oklahoma, USA Carrie Allison Department of Surgery Oregon Health & Science University Portland, Oregon, USA Scott C Brakenridge Department of Surgery UT Southwestern Medical Center Dallas, Texas, USA Robert T Brautigam Department of Surgery Hartford Hospital Hartford, Connecticut, USA Gidon Almogy Department of General Surgery and Shock Trauma Unit Hadassah University Hospital Jerusalem, Israel Jill Cherry-Bukowiec Division of Acute Care Surgery Department of Surgery University of Michigan Ann Arbor, Michigan, USA Amanda Ayers Integrated General Surgery Program University of Connecticut Farmington, Connecticut, USA Eileen M Bulger Department of Surgery University of Washington Seattle, Washington, USA Philip S Barie Surgery and Public Health Weill Cornell Medical College New York, New York, USA M Ross Bullock Department of Neurosurgery University of Miami Miller School of Medicine Lois Pope LIFE Center Miami, Florida, USA Erik Barquist Jackson South Community Hospital Miami, Florida, USA Howard Belzberg Department of Surgery Los Angeles County and University of Southern California Medical Center Los Angeles, California, USA David L Berger Department of Surgery Massachusetts General Hospital Harvard Medical School Boston, Massachusetts, USA Andre Campbell Department of Surgery UCSF School of Medicine San Francisco General Hospital San Francisco, California, USA Frederick D Cason Department of Surgery Louis Stokes Veterans’ Administration Medical Center Case Western Reserve University School of Medicine Cleveland, Ohio, USA  list of contributors Walter Cholewczynski Surgical Critical Care Department of Surgery Bridgeport Hospital Bridgeport, Connecticut, USA Jeffrey L Cohen Connecticut Surgical Group Division of Colon and Rectal Surgery Hartford Hospital Hartford University of Connecticut Storrs, Connecticut, USA Stephen M Cohn University of Texas Health Science Center San Antonio, Texas, USA Alan Cook Department of Surgery East Texas Medical Center Tyler, Texas, USA Craig M Coopersmith Emory University School of Medicine, Atlanta, Georgia, USA Bryan A Cotton The University of Texas Health Science Center Department of Surgery The Center for Translational Injury Research Houston, Texas, USA Chaitanya Dahagam Department of Surgery University of Texas Health Science Center San Antonio, Texas, USA Pierre E de Delva Division of Thoracic Surgery Massachusetts General Hospital Harvard Medical School Boston, Massachusetts, USA Demetrios Demetriades Emergency Surgery and Surgical Critical Care University of Southern California Los Angeles, California, USA Daniel Dempsey Department of Surgery Temple University School of Medicine Philadelphia, Pennsylvania, USA Louis DiFazio Department of Surgery Morristown Memorial Hospital Morristown, New Jersey, USA  Jennifer Dore General Surgery NewYork-Presbyterian Hospital/Weill Cornell Medical Center New York, New York, USA Joe DuBose Division of Trauma and Surgical Critical Care University of Southern California Los Angeles, California, USA Richard P Dutton Department of Anesthesiology University of Maryland School of Medicine Baltimore, Maryland, USA Yazan Duwayri Department of Surgery Washington University in St Louis St Louis, Missouri, USA Philip A Efron Laboratory of Inflammation Biology and Surgical Science Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care University of Florida, Health Science Center Gainesville, Florida, USA Heather L Evans Department of Surgery University of Washington Harborview Medical Center Seattle, Washington, USA Timothy C Fabian Harwell Wilson Professor and Chairman Department of Surgery University of Tennessee Health Sciences Center Memphis, Tennessee, USA David V Feliciano Emory University School Of Medicine Surgeon-in-Chief Grady Memorial Hospital Atlanta, Georgia, USA Lisa Ferrigno General Surgery Medical University of South Carolina Charleston, South Carolina, USA Adam D Fox Division of Traumatology and Surgical Critical Care University of Pennsylvania Philadelphia, Pennsylvania, USA list of contributors Spiros G Frangos Department of Surgery Section of Surgical Critical Care New York University School of Medicine New York, New York, USA Heidi L Frankel Division of Trauma Acute Care and Critical Care Surgery Shock Trauma Center Penn State Milton S Hershey Medical Center The Pennsylvania State University College of Medicine Hershey, Pennsylvania, USA Randall Friese Department of Surgery University of Arizona Health Sciences Center Tucson, Arizona, USA Terrence M Fullum Division of Minimally Invasive and Bariatric Surgery Howard University Department of Surgery Washington, DC, USA Li Gang Harvard Medical School Boston, Massachusetts, USA Aviram Giladi Department of Plastic Surgery University of Michigan Hospitals Ann Arbor, Michigan, USA Brian F Gilchrist Pediatric Surgery Children’s Initiatives The Elliot Hospital System Manchester, New Hampshire, USA Vicente Gracias Trauma/Surgical Critical Care UMDNJ-Robert Wood Johnson Medical School Robert Wood Johnson University Hospital (RWJUH) New Brunswick, New Jersey, USA DJ Green Division of Trauma & Surgical Critical Care LAC+USC Medical Center Naval Trauma Training Center Los Angeles, California, USA Scott L Hansen Divisions of Plastic and Reconstructive Surgery Department of Surgery University of California San Francisco, California, USA Eric B Harris Department of Orthopaedic Surgery Naval Medical Center San Diego San Diego, California, USA Leo Harris Department of Neurosurgery University of Miami Miller School of Medicine Lois Pope LIFE Center, Miami, Florida, USA Daniel Herzig Division of General Surgery Oregon Health & Science University Portland, Oregon, USA Asher Hirshberg Department of Surgery SUNY Downstate College of Medicine Emergency Vascular Surgery Kings County Hospital Center Brooklyn, New York, USA Horacio Hojman Surgical Intrensive Care Unit Tufts Medical Center and Tufts University School of Medicine Boston, Massachusetts, USA John B Holcomb Center for Translational Injury Research (CeTIR) Department of Surgery The University of Texas Medical School Houston, Texas, USA Brian Hood Department of Neurosurgery University of Miami Miller School of Medicine Lois Pope LIFE Center, Miami, Florida, USA Nabil Issa Northwestern University Feinberg School of Medicine Department of Surgery Division of Trauma and Surgical Critical Care Chicago, Illinois, USA Rao R Ivatury Division of Trauma, Critical Care & Emergency Surgery Virginia Commonwealth University Medical Center Richmond, Virginia, USA Michael Ivy Bridgeport Hospital Bridgeport, Connecticut, USA  ... Anesthesiology and Critical Care Medicine, and Nursing General Surgery and Surgical Critical Care Surgical Intensive Care Units Johns Hopkins University Schools of Medicine and Nursing Baltimore, Maryland,... subspecialty, we hope to improve the care of trauma, surgical critical care, and surgical emergency patients We also hope that this book will assist trauma, critical care, and general surgeons in addressing... trauma care with both surgical critical care and surgical emergencies, and as most surgical societies aggressively promote this concept, we believe that this book has a clear niche in the surgical