Acute Care Surgery

 

Description:

Publisher's Note: Products purchased from 3rd Party sellers are not guaranteed by the Publisher for quality, authenticity, or access to any online entitlements included with the product. Substantially updated with more illustrations and brand-new chapters that reflect the growth and advances in the field, this latest edition of Acute Care Surgery features an editorial board drawn from the ranks of trauma surgery, emergency surgery, and critical care surgery. A comprehensive, updated, and timely overview of this fledgling specialty!

 

Table of Contents:

 

Section 1: Fundamental Principles

Chapter 1 Acute Care Surgery: General Principles

Overview

Acute Care Surgery—Core Principles

Core Management Principles (the 4 Es)

Expeditious Initial Assessment

End Point–Guided Resuscitation

The Full Spectrum of Management—General Principles

Primary Survey

Secondary Survey

Topography and Clinical Anatomy

Mechanism of Injury—Penetrating Trauma

Physical Examination

Diagnostic Studies

Penetrating Abdominal Injuries and the Hemodynamically Stable and Unstable Patient

Trauma Laparotomy

General Principles in Management of Specific Injuries

Small Intestines

Colon

Stomach/Duodenum

Pancreas

Spleen

Gallbladder and Liver

Genitourinary System

Retroperitoneal Hematomas

Intra-abdominal Packing and “Damage Control” Strategy

Mechanism of Injury—Blunt Trauma

Current Diagnostic and Imaging Techniques

Focused Abdominal Sonography for Trauma

Computed Tomography

Specific Organ Injury

The Spleen

The Liver

Intestine

Lung and Chest Wall

Summary

References

Chapter 2 Acute Care Surgery: Advancement and Challenges

References

Chapter 3 Curriculum Development and Training in Acute Care Surgery

Training Paradigm Structure

Refining the Curriculum

Ongoing Evaluation of the Educational Process

Conclusion

References

Chapter 4 Host Response to Acute Illness and Injury

Cardiovascular

Pulmonary

Neurologic

Renal

Endocrine

Gastrointestinal

Hematologic

Mediators of Injury

References

Chapter 5 Shock and Current Resuscitation Strategies

Pathophysiology

Back to Basics: Normal Oxygen Kinetics

When Cells Cannot Breathe: The Cellular Response to Hypoxia

Classification of Shock States

Hypovolemic Shock

Diagnosis

Treatment

Sepsis and Septic Shock

Initial Resuscitation

Diagnosis

Treatment

Obstructive Shock

Cardiogenic Shock

Diagnosis

Treatment

Neurogenic Shock

Diagnosis

Treatment

Summary

References

Chapter 6 Preoperative Assessment of the Emergency General Surgery Patient

Introduction

Evaluation

Comprehensive History

Physical Examination

Laboratory Parameters

Imaging

Resuscitation

Fluid and Electrolytes

Blood Transfusion

Glucose Control

Hemodynamic Support

Antimicrobial Therapy

Monitoring: Endpoints of Resuscitation

Urine Output and Concentration

Pulse and Blood Pressure

Serum Lactate

Invasive Hemodynamic Parameters

Electrolytes

Conclusion

References

Chapter 7 Imaging in Acute Care Surgery

Trauma

Thorax

Abdominal Injury

Interventional Imaging

References

Chapter 8 Surgical Rescue

Surgical Complications

Complications and Errors

The Importance of Elective General Surgery in Surgical Rescue

Rescue and Failure to Rescue

Safety Culture

Special Considerations for Rescue in Trauma

A New Era of Surgical Rescue

References

Chapter 9 Complications of Wound Healing

Scope of the Problem

Preoperative Strategies

Operative Strategies

Closing the Abdomen

Postoperative Strategies

Seromas and Hematomas

Surgical Site Infection

Fascial Dehiscence

Ventral Hernia

Conclusion

References

Chapter 10 Damage Control Management/Open Abdomen

History and Evolution of Damage Control

Damage Control Indications

Damage Control Sequence

Ground Zero: Prehospital Care/Initial Resuscitation

Part 1: Control of Hemorrhage and Contamination (Initial Laparotomy)

Part 2: Resuscitation in Intensive Care Unit

Part 3: Definitive Injury Repair (Subsequent Laparotomy)

Part 4: Open Abdominal Wounds and Definitive Abdominal Closure

Complications and Damage Control

Nutritional Consideration for the Open Abdomen

Damage Control and Abdominal Sepsis

Acknowledgment

References

Chapter 11 Basic Operative Strategies and Techniques in Acute Care Surgery

Operative Approach to Neck Trauma

Zone I Innominate and Subclavian Vessel Injury

Zone II Carotid Artery Injury

Vertebral Artery Injury

Venous Injury

Cervical Esophagus

Operative Approaches to Chest Trauma

Emergency Department Thoracotomy

Injury to the Thoracic Esophagus

Control of Intrathoracic Bleeding

Damage-control Procedures in the Chest

Tracheobronchial Injury

Operative Approach to Abdominal Trauma

Solid Organ Injury

Pancreas

Enteric Injury

Abdominal Vascular Injury

Celiac Axis Injury

Portal Venous Injury, Hepatic Artery Injury, or Retrohepatic Vena Caval Injury

Retrohepatic Venous Injury

Minimally Invasive Surgery in Acute Care Surgery

Diagnostic and Therapeutic Laparoscopy in the Evaluation of Acute Abdomen

The Role of Thoracoscopy in Trauma

Damage Control (Abbreviated Laparotomy)

Basic Operative Approaches in Extremity Injuries

Summary and Conclusion

References

Chapter 12 Catheter Intervention and Hemorrhage Control

Introduction

Diagnostic Angiography

Angioembolization

Covered Stents

Endovascular Therapy in Unstable Patients

Endovascular Applications in Traumatic Hemorrhage

Large Vessel Injury

Pelvic Hemorrhage

Endovascular Hemostasis for Splenic Injury

Catheter Techniques for Hepatic Trauma

Other Trauma Applications of Embolization

Nontraumatic Hemorrhage

Gastrointestinal Bleeding

Postpartum Hemorrhage

Resuscitative Endovascular Balloon Occlusion of the Aorta

Indications and Procedure

Procedural Challenges

Duration of Occlusion

Complications

Technology

Training and Credentialing

Reboa in the ED and Prehospital Environments

Hybrid Trauma Operating Room

Summary

References

Chapter 13 Airway Management

History

The Identification of Airway Compromise

Mask Ventilation

Airway Adjuncts

Laryngeal Mask Airway

Esophageal–Tracheal Combination Tubes

Rapid Sequence Induction

Endotracheal Intubation

Direct Laryngoscopy

Video Laryngoscopy

Invasive Approaches to Airway Management

Cricothyroidotomy

Tracheostomy

The Known Difficult Airway

Special Considerations in Trauma

Pediatric Considerations

Summary

References

Chapter 14 Transfusion Management

Transfusion Therapy

Indications for Transfusion of Blood Components in the Intensive Care Unit

Fresh Frozen Plasma Transfusion

Platelet Transfusion

Cryoprecipitate Transfusion

Coagulopathy

Hypercoagulable and Hypocoagulable States

Blood Transfusion in Trauma

Massive Transfusion

Strategies to Reduce Complications Associated with Massive Transfusion

Massive Transfusion and Trauma-Induced Coagulopathy

Hypotensive or Delayed Resuscitation

Hemostatic/Damage Control Resuscitation (DCR)

Massive Transfusion Protocols

Viscoelastic Testing for Massive Transfusion

Transfusion After Hemorrhage Control

Efficacy of Red Blood Cell Transfusion in Trauma and Associated Risks

Hematologic Abnormalities

Red Blood Cell Disorders

Platelet Disorders

Conclusion

References

Chapter 15 Nutrition Support in Acute Care Surgery

Introduction

Nutrient Utilization During Normal States of Health

Nutrient Utilization During Acute Surgical Illness

The Physiologic Response to Starvation As a Starting Point in the Design of Nutrition Intervention Therapy

Starvation: A Physiologic Process in the Acutely Ill?

Nutritional Intervention Therapy

Nutrition Intervention Team: More Than Just the Doctor

How to Calculate Nutritional Goals

Nutrition Intervention Therapy

Side Effects of Nutrition Intervention Therapy

Overfeeding

Hyperglycemia and Glucose Control

Hypertriglyceridemia

Gastrointestinal Intolerance

Specialized Nutrition Intervention

Immunonutrition

The Future

References

Chapter 16 Sepsis: Biology, Pathophysiology, and Management

The Biology

Innate Immunity: Pathogen and Cell Damage Pattern Recognition

Nonimmune Cells: Cellular Bioenergetics in Sepsis

Autophagy

Pathophysiology

Hypometabolism and Organ Failure in Sepsis

Aging and the Response to Sepsis

Management

Diagnosis

Treatment

References

Chapter 17 Antibiotic Use and Misuse

Infection Control

Pharmacokinetics and Pharmacodynamics

Antibiotic Prophylaxis

Principles of Antibiotic Therapy

Evaluation of Possible Infection

Empiric Antibiotic Therapy

Duration of Therapy

Managing Microbial Ecology (including Outbreaks)

Spectra of Antibiotic Activity

Cell Wall–Active Agents: Beta-Lactam Antibiotics

Monobactams

Carbapenems

Cell Wall–Active Agents: Lipoglycopeptides

Cell Wall–Active Agents: Cyclic Lipopeptides

Cell Wall–Active Agents: Polymyxins

Protein Synthesis Inhibitors

Aminoglycosides

Tetracyclines

Oxazolidinones

The Macrolide–Lincosamide–Streptogramin (MLS) Family

Drugs That Disrupt Nucleic Acids

Cytotoxic Antibiotics

Antibiotic Toxicities

Beta-Lactam Allergy

“Red Man” Syndrome

Nephrotoxicity

Ototoxicity

Avoiding Toxicity: Adjustment of Antibiotic Dosage

Hepatic Insufficiency

Renal Insufficiency

Prophylaxis and Therapy of Fungal Infections

Central Venous Catheters

Prediction of Invasive Candida Infection

Prophylaxis of Fungal Infection

Antifungal Prophylaxis of Solid Organ Transplant Recipients

Principles of Antifungal Therapy

Antifungal Agents in the Practice of Acute Care Surgery

References

Chapter 18 Pathophysiology and Management of Pain

Epidemiology

Pathophysiology of Pain

Classification

Therapy

Education

Pain Assessment

Medications

Nonopioid Analgesics

Opioid Analgesics

Adjuvant Analgesics

Nonpharmacologic Approaches

Multimodal Therapy

References

Chapter 19 Acute Care Surgery in Special Populations

Acute Care Surgery in the Elderly

Physiologic Changes Associated with Aging

Clinical Presentation

Perioperative Management of the Elderly

Frailty and Perioperative Risk

Specific Considerations

Ethical and End-of-Life Issues

Acute Care Surgery and Pregnancy

Normal Physiologic Changes Associated with Pregnancy

Specific Considerations

Pediatric Surgery for the Acute Care Surgeon

Pediatric Anatomy and Physiology

Specific Considerations

References

Chapter 20 Regionalization and System Development

Regionalization

Program Design

Operational Objectives

Conclusions

References

Chapter 21 Disaster Preparedness and Mass Casualty Management

Definitions

Phases of the Disaster

Planning

Administrative Structure of the Response

Medical Care Concerns

Triage

Specifics of the Hospital Response

Specific Injury Patterns

Recovery

Surgical Volunteerism

Summary

Suggested Resources

References

Chapter 22 Injury Prevention

Introduction

Historical Perspective

Nomenclature, Definitions, and Framework

Specific Injury Prevention Areas and Efforts

Motor Vehicle Collisions

Helmets

Alcohol

Firearm-Related Injury

Burns

Suicide

Domestic Violence

Falls

The Role of the Acute Care Surgeon in Injury Prevention

References

Chapter 23 The Immunocompromised Patient and the Acute Abdomen

The Immune System

Profound Immunocompromised States

Organ Transplantation

Hematopoietic Cell Transplantation

Autoimmune Disorders

Neutropenia

Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome

Relative Immunocompromised States

Diabetes Mellitus

Burns and Critical Illness

Substance Abuse

Aging and Malnutrition

Surgical Disease Processes Related to the Immunocompromised State

Pseudomembranous Colitis

Neutropenic Enterocolitis

Mycobacterium Enteritis

Gastrointestinal Cytomegalovirus Infection

Acute Graft vs Host Disease

General Considerations

Diagnosis

Preoperative Management

Operative Considerations

Postoperative Management

Postoperative Complications Related to the Immunocompromised State

Postoperative Fungal Infections

Other Postoperative Infectious Concerns

Postoperative Transplant Rejection

Posttransplant Lymphoproliferative Disorder

Conclusion

References

Chapter 24 Endoscopic Interventions in the Acute Care Setting

Perforations of the GI Tract

Causes and Selection of Patients Amenable to Endoscopic Treatment

Incidence of Iatrogenic Perforation During Endoscopy

Clipping of Iatrogenic Perforations

Stenting of Esophageal Perforation

Endoscopic Drainage of the Pancreatic Pseudocyst

Choledocholithiasis in the Bariatric Surgical Patient

Percutaneous Endoscopic Gastrostomy Tube Placement

Colonic Obstruction

Malignant Colonic Obstruction

Patient Selection for Colonic Stenting

Technique of Colonic Stenting

Benign Colonic Obstruction

Stricture

Balloon Dilation Technique

Volvulus

Cecal Volvulus

Summary

Acknowledgments

References

Chapter 25 Palliative Care

Introduction

Origins, Evolution, and Evidence Base of Surgical Palliative Care

Relevance of Palliative Care to Acute Care Surgery

Principles of Surgical Palliative Care

Surgical Palliative Care in Practice

General Palliative Care Competencies for the Acute Care Surgeon

Pretherapeutic/Preoperative Considerations

Therapeutic/Intraoperative Considerations

Posttherapeutic/Postoperative Considerations

Care of the Dying Patient and Their Family

Common Ethical and Legal Issues

The Surgeon and Palliative Care

Acknowledgments

References

Chapter 26 Recovery and Rehabilitation

The Interdisciplinary Team

Amputations

Spinal Cord Injury

Pulmonary Complications

Cardiovascular

Autonomic Dysreflexia

Gastrointestinal

Genitourinary

Endocrine

Skin

Musculoskeletal

Burns

Pain Management in the Burn Patient

Traumatic Brain Injury

The Medically Complex Acute Care Surgery and Trauma Patient

Nervous System

Prolonged Ventilation

Summary

References

Chapter 27 Grading and Scoring Systems for Acute Care

Introduction

Scoring Systems for Injury

Anatomic Injury Scoring Systems

Physiologic Injury Scoring Systems

Scores That Combine Anatomic and Physiologic Parameters

Scoring Systems for Emergency General Surgery

Overview of Emergency General Surgery Scoring Systems

Traditional Disease-Specific Scoring Systems for EGS Severity

AAST Grading System for Anatomic Severity of Emergency General Surgery Diseases

Physiologic Scoring Systems

Single Organ Scoring Systems

Multi-Organ Scoring Systems

References

Chapter 28 The Role of Laparoscopy/Thoracoscopy in Acute Care Surgery

Physiology of Laparoscopy

Cardiovascular Changes

Respiratory Changes

Renal Changes

Hepatic Changes

Laparoscopy in Emergency General Surgery (EGS)

Historical Perspectives and Evolution of Laparoscopy in EGS

Advantages of Laparoscopy over Laparotomy in Emergency General Surgery

Contraindications to use of Laparoscopy in EGS

Specific use of Laparoscopy in EGS

Laparoscopy in Trauma

Historical Perspectives and Evolution of Laparoscopy in Trauma

Advantages of Laparoscopy over Laparotomy in Trauma

Contraindications to use of Laparoscopy in Trauma

Specific use of Laparoscopy in Trauma

Thoracoscopy in Acute Care Surgery

History

Indications for Video-assisted Thoracoscopic Surgery

Advantages of VATS

Disadvantages and Complications of VATS

Contraindications to VATS

Technique of VATS

VATS in Trauma

Laparoscopy and Thoracoscopy in Pediatric Acute Care Surgery

History

Advantages of Minimally Invasive Techniques in Pediatric Surgery

Neonatal Minimally Invasive Surgery

Minimally Invasive Surgery in Pediatric Trauma

Laparoscopic Appendectomy

Laparoscopic Pyloromyotomy

Laparoscopic Ladd’s Procedure

Incarcerated Inguinal Hernias

Congenital Diaphragmatic Hernia Repair

Tracheoesophageal Fistula/Esophageal Atresia

Challenges to the Adoption of MIS in Pediatric Acute Care Surgery

Summary

References

Section 2: Trauma

Chapter 29 Maxillofacial Injuries

Initial Assessment

Airway

Breathing

Circulation

Deficit and Environment

Secondary Survey

Examination of Specific Regions

Diagnostic Imaging

Soft Tissue Injuries

Dentoalveolar Injuries

Orbital Fractures

Maxillary Fractures

Mandible Fractures

Nasal Fractures

Zygoma Fractures

Ocular Injuries

Parotid

Nerve

Antibiotics for Facial Fractures

Conclusions

References

Chapter 30 Blunt and Penetrating Neck Injury

Penetrating Injuries

Epidemiology

Anatomical Zones

Airway Management

Initial Control of Hemorrhage

Initial Evaluation

Evaluation for Nervous System Injuries

The Value of a Protocolized Approach to Penetrating Neck Injury Management

Investigations

Blunt Injuries

Epidemiology

Investigations

Specific Neck Injuries

Cerebrovascular Injuries

Operative Management: Carotid Arteries

Operative Management: Vertebral Arteries

Laryngotracheal Injuries

Pharyngoesophageal Injuries

References

Chapter 31 Traumatic Brain Injury

Initial Decisions—Emergency Department Management

Airway and Breathing

Circulation

Neurologic Assessment

Penetrating Injuries

Imaging Studies

Cervical Spine Management

Computed Tomography of the Head

Magnetic Resonance Imaging

Surgical Management

Evacuation of Mass Lesions

Decompressive Craniectomy

Depressed Skull Fractures

Penetrating Injuries

Cerebrovascular Injury

Intensive Care Unit Management

Intracranial Pressure

Cerebral Perfusion Pressure

Advanced Cerebral Monitoring

Penetrating Injury

Systemic Management

Outcome

Brain Death and Organ Donation

References

Chapter 32 Spinal Column and Spinal Cord Injury

Bony and Ligamentous Anatomy of the Vertebral Column

Anatomy and Physiology of the Spinal Cord

Acute Vertebral Column Injuries

Spinal Stability

Atlanto-Occipital Dislocation

Occipital Condyle Fractures

Bony and Ligamentous Injuries to the Cervical Spine

C1 Fractures

Atlantoaxial Instability

C2 Fractures

Injuries of the Subaxial Cervical Spine (C3-C7)

Injuries to the Thoracic Spine

Injuries to the Thoracolumbar Spine

Acute Spinal Cord Injury

Mechanism of Injury

Pathophysiology of Injury

Clinical Presentation

Grading of Spinal Cord Injuries

Spinal Cord Syndromes

Clearing the Cervical Spine

Clearing the Thoracolumbar Spine

Pharmacotherapy in Spinal Cord Injury

Hypothermic Management of Acute Spinal Cord Injury

Nonoperative Management of Spine Injuries

Surgical Management of Spinal Injuries

Penetrating Spine Trauma

Complications Following Spinal Cord Injury

Novel Therapies for Spinal Cord Injury

References

Chapter 33 Chest Injury

Initial Assessment

Secondary Survey and Radiologic Adjuncts

Indications for Operation

Emergency Department Resuscitative Thoracotomy

Urgent Thoracotomy

Incision Choice

Thoracic Damage Control

Indications for Delayed Thoracotomy

Management of Specific Injuries

Chest Wall Injuries

Penetrating Chest Wall Injury

Pleura and Lungs

Tracheobronchial Injuries

Esophageal Injury

Thoracic Duct Injuries

Cardiac Injury

Blunt Aortic Injuries

Great Vessel Injuries

Summary

References

Chapter 34 Thoracic Wall Stabilization

History

Surgical Intervention

Literature and Studies

Summary

References

Chapter 35 Pleural Effusion, Hemothorax, and Empyema

Pleural Effusion

Diagnosis

Treatment

Retained Hemothorax

Diagnosis

Treatment

Empyema

Diagnosis

Treatment

Summary

References

Chapter 36 Abdominal Trauma

Abdominal Trauma

Stable vs Unstable

Trauma Laparotomy

Preparation

Initial Conduct

Laparotomy in the Unstable Patient: Damage Control

Laparotomy in the Stable Patient: Definitive Therapy of Specific Traumatic Injuries

Diaphragmatic Injury

Splenic Injury

Duodenal Injury

Pancreatic Injury

Stomach and Bowel Injury

Management of Gastric Injury

Surgical Management of Injury of the Small Bowel

Colon and Rectal Injury

Anatomy

Diagnosis

Management

Abdominal Vascular Injury

Anatomic Location of Injury

Operative Intervention

Exposure and Incisions

Surgical Technique

Mechanism of Injury and Clinical Presentation

Diagnosis

Management of Traumatic Retroperitoneal Hematoma

Morbidity and Mortality

References

Chapter 37 Pelvic Fractures

Demographics

Anatomy

Fracture Classification

Initial Management

Treatment of Pelvic Hemorrhage

Angiography

Preperitoneal Pelvic Packing

Other Techniques

Associated Injuries

Lower Urinary Tract and Urethra

Bladder

Open Pelvic Fractures

Summary

Acknowledgments

References

Chapter 38 Genitourinary Trauma

Renal Trauma

Epidemiology

Initial Evaluation

Nonoperative Management

Operative Management

Complications

Ureteral Trauma

Epidemiology

Initial Evaluation

Operative Management

Complications and Follow-up

Bladder Trauma

Epidemiology

Initial Evaluation

Nonoperative Management

Operative Management

Complications and Follow-up

Urethral Trauma

Epidemiology

Initial Evaluation

Posterior Urethral Injury Management

Anterior Urethral Injury Management

Complications and Follow-up

Genital Trauma

Epidemiology

Initial Evaluation

Operative Management

Injuries to the Female Genitalia

References

Chapter 39 Extremity Vascular Injuries

Introduction

Types of Injuries/Pathophysiology

Diagnosis

Physical Examination

Arterial Pressure Index

Duplex Ultrasonography

Angiography

Nonoperative Management

Endovascular Treatment

Operative Management (Table 39.2)

Exposure

Upper Extremity

Lower Extremity

Venous Injury and Repair

Damage Control and Definitive Repair

Temporary Intraluminal Vascular Shunts

Reconstruction Options

Fasciotomy and Compartment Syndrome

The Mangled Extremity

Postoperative Management

Complications

Early Occlusion

Soft Tissue Infection

Prognosis

References

Chapter 40 Burns

Epidemiology

Pathophysiology

Local Changes

Systemic Changes

Initial Evaluation and Classification

Primary Assessment

Secondary Assessment

Burn Depth

First Degree Burns/Superficial Burns

Second Degree Burns/Partial Thickness Burns

Third Degree Burns/Full Thickness Burns

Fourth Degree Burns

Determination of Burn Size

Fluid Resuscitation

Pathophysiological Changes in the Capillary Structure

Type of Fluid and Amount of Replacement

Resuscitation with Crystalloid

Use of Colloids

Monitoring Fluid Resuscitation

Fluid Creep

Pain Management

Inhalation Injury

Compartment Syndrome

Electrical Injuries

Chemical Burns

Topical Antimicrobials Agents

Creams

Ointments

Antimicrobial Solutions

Surgical Excision of the Burn Wound

Tangential Excision

Full Thickness Excision

Fascial Excision

Blood Loss

Techniques to Minimize Blood Loss

Burn Wound Coverage

Hypermetabolism and Nutrition

Nutrition

Surgical Complications of Burn Patients

Transport

Burn Survival and Outcomes Measures

Predictors of Mortality

Outcomes

References

Section 3: Emergency General Surgery

Chapter 41 Evaluation of the Acute Abdomen

Introduction

Patient History

Character and Progression

Duration

Location

Alleviating or Exacerbated Factors

Associated Symptoms

Past Medical History

Physical Exam

Vital Signs

Inspection

Auscultation

Palpation

Percussion

Laboratory Evaluation

Imaging

Plain x-ray

Ultrasound

Computed Tomography

Magnetic Resonance Imaging

Angiography

Hepatobiliary Imaging (HIDA)

Diagnostic Procedures

Upper Endoscopy

Lower Endoscopy

Diagnostic Peritoneal Lavage

Laparoscopy

Common Etiologies

Bowel Obstruction

Special Populations

Gastric Bypass Patients

Cirrhotic Patients

Geriatric Populations

Summary

References

Chapter 42 Complications of Gastrointestinal Surgery

General Complications of Gastrointestinal Surgery

Anastomotic Leak

Fistulae

Adhesions and Early Small Bowel Obstruction

Organ-Specific Complications of GI Surgery

Stomach and Duodenum (Table 42.2)

Pancreas (Table 42.3)

Small Intestine (Table 42.6)

Appendix

Colorectal Surgery (Table 42.7)

References

Chapter 43 Complications after Endoscopic and Enteral Access Procedures

Upper Endoscopy

Signs of Symptoms of Perforation

Diagnosis

Management

Percutaneous Endoscopic Gastrostomy Tube

Wound Infection

Bleeding

Injury to Adjacent Viscera

Buried Bumper Syndrome

Gastric Obstruction

Tube Dislodgement

Peristomal Leakage

Nonclosure of the Fistula Tract

Jejunostomy

Catheter Site Infection

Catheter Obstruction/Blockage

Bowel Obstruction

Late Complications

Colonoscopy

Bleeding

Perforation

Postpolypectomy Syndrome

Endoscopic Retrograde Cholangio Pancreatography

Pancreatitis

Bleeding

Perforation

References

Chapter 44 Acute and Long-Term Complications of Bariatric Surgery

Complications of Laparoscopic Adjustable Gastric Banding

Band Slippage

Band Erosion

Complications of Laparoscopic Sleeve Gastrectomy

Bleeding

Leak

Stenosis

Complications of Laparoscopic Roux-en-y Gastric Bypass

Anastomotic Leak

Small Bowel Obstruction

Gastrojejunal Ulceration

Biliary Disease

Summary

References

Chapter 45 Inflammatory Conditions of the Small and Large Intestines

Inflammatory Diseases of the Stomach and Small Intestine

Gastroduodenal Perforation

Marginal Ulcer

Iatrogenic Perforation

Crohn’s Disease of the Small Bowel

Enterocutaneous Fistula

Infectious Enteritis

Small Bowel Diverticular Disease

Meckel’s Diverticulum

Inflammatory and Infectious Diseases of the Colon

Anatomy/Physiology

Inflammatory and Infectious Emergencies of the Colon

Diverticulitis

Infectious Colitides

Bacterial Enterocolitides

Ischemic Colitis

Acute Presentation of Inflammatory Bowel Disease

Miscellaneous Causes of Colonic Inflammation

Summary

References

Chapter 46 Acute Gastrointestinal Hemorrhage

General Considerations and Epidemiology

Clinical Features

Risk Scores and Prognostic Factors

Initial Resuscitation and Overall Diagnostic Approach

Nonsurgical Diagnostic Modalities and Interventions

Esophagogastroduodenoscopy

Colonoscopy

Ct Angiography, Visceral Angiography, and Transcatheter Treatment

Radionuclide Scans

Approaches to Obscure Gastrointestinal Hemorrhage

Balloon Enteroscopy

Wireless Capsule Endoscopy

Intraoperative Endoscopy

Surgical Considerations and Procedures in Patients with Gastrointestinal Hemorrhage

Peptic Ulcer Disease

Stress-Related Mucosal Disease (Gastritis and Ulceration)

Gastroesophageal Varices

Gastric Varices Secondary to Sinistral Portal Hypertension

Aortoenteric Fistula

Other Causes of Gastric and Duodenal Bleeding

Colonic Diverticular Disease

Colonic Angiodysplasia

Ischemic Colitis

Meckel’s Diverticulum

Conclusion

References

Chapter 47 Intestinal Obstruction and Dysmotility

Acute Intestinal Obstruction

Pathophysiology of Intestinal Obstruction

Diagnosis and Evaluation

Physical Examination and Initial Management

Diagnostic Studies

Plain Radiographs

Laboratory Studies

Adjunctive Tests

Computed Tomography

Other Radiographic Modalities

Sigmoidoscopy

Determination of the Need for Operation

Mechanical Obstruction

Adhesive Small Bowel Obstruction

Surgical Management

Intestinal Obstruction in the Early Postoperative Period

Bowel Obstruction in Patients Without Prior Abdominal Surgery

Strangulation and Closed Loop Obstruction

Intestinal Obstruction Due to Hernia

Volvulus

Inflammatory Conditions

Partial Colonic Obstruction

Malignant Bowel Obstruction

Nonmechanical Obstruction

Ileus

Pseudo-obstruction

Conclusions

References

Chapter 48 Surgical Emergencies of the Foregut

Foreign Body Ingestion

Caustic Injury

Esophageal, Gastric, and Duodenal Perforation

Esophageal Perforation

Surgical Management—Esophagus

Gastric Perforation

Duodenal Perforation

Esophageal, Gastric, and Duodenal Hemorrhage

Portal Hypertension and Esophageal Bleeds

Gastroduodenal Bleeds

Surgical Management—Gastric Hemorrhage

Other Causes of Upper GI Bleeding

Gastric Volvulus and Paraesophageal Hernia

Complications of Endoscopy

Complications of Weight Loss Surgery

Summary

References

Chapter 49 Appendicitis

Embryology

Anatomy

History

Epidemiology

Pathophysiology

Diagnosis

Physical Examination

Laboratory Data

Radiology

Management

Operative Procedure

Nonoperative Management of Uncomplicated Appendicitis

Antibiotic Prophylaxis and Therapy

Special Situations

Complications

Negative Appendectomy

Managing Appendiceal Phlegmon/Mass

Interval Appendectomy

Immune Compromise

Appendicitis in Pregnancy

Inflammatory Bowel Disease

Stump Appendicitis

Summary

References

Chapter 50 Acute Pancreatitis

Incidence

Etiology and Pathogenesis

Clinical Presentation and Diagnosis

History and Physical Examination

Laboratory Examinations

Imaging

Classification and Severity Determination

Differential Diagnosis

Treatment Principles

Mild Acute Pancreatitis

Severe Acute Pancreatitis

Fluid Resuscitation

Enteral Nutrition

Antibiotics

Interventions in Biliary Pancreatitis

Treatment of Complications

Infected Pancreatic Necrosis

Abdominal Compartment Syndrome

Disconnected Distal Duct Syndrome

Management of Extrapancreatic Complications

Prognosis

References

Chapter 51 Cholecystitis, Cholangitis, and Jaundice

Anatomy

Biliary Anatomy

Arterial Anatomy

Venous Anatomy

Physiology

Cardiac Physiology

Coagulation

Renal

Wound Healing

Immune System

Imaging of the Biliary Tree

Ultrasound

Computed Tomography

Scintigraphy

Cholangiography

Disorders of the Gallbladder

Asymptomatic Cholelithiasis

Biliary Colic

Acute Cholecystitis

Variations of Cholecystitis

Mirizzi’s Syndrome

Acalculous Cholecystitis

Gangrenous Cholecystitis

Emphysematous Cholecystitis

Hydrops of the Gallbladder

Cholecystitis During Pregnancy

Gallstone Ileus

Disorders of the Common Bile Duct

Choledocholithiasis

Cholangitis

Recurrent Pyogenic Cholangitis

Laparoscopic Cholecystectomy

Identification of Anatomy

The Difficult Cholecystectomy

Intraoperative Cholangiography

Common Bile Duct Exploration

Complications of Biliary Surgery

Hemorrhage

Bile Leak

Injury to the Common Bile Duct

Late Stricture of the Common Bile Duct

Advanced Endoscopic Modalities for Biliary Disease

Conclusion

References

Chapter 52 Anorectal Abscess and Inflammatory Processes

Anorectal Abscess

Fournier’s Gangrene

Anal Fissure

Hemorrhoids

Pilonidal Cysts and Abscesses

References

Chapter 53 Abdominal Wall Hernias: Emergencies

Timing of Intervention

Preoperative Preparation

Type of Hernia Repair

Laparoscopy for Emergent Repair of Ventral Hernias

Emergent Inguinal Hernia Repair

Emergent Femoral Hernia Repair

Emergent Parastomal Hernia Repair

Emergent Surgery for Abdominal Wall Hernias in Cirrhotic Patients with Ascites

Emergent Surgery for Abdominal Wall Hernias in Pregnancy

Conclusions

References

Chapter 54 Emergency Groin Hernia Surgery

History

Surgical Anatomy

Definitions

Epidemiology

Clinical Presentation

History

Physical Examination

Imaging Studies

Anesthetic Considerations

Operative Management

Principles

Emergency Herniorrhaphy in the Unstable Patient

Repair of an Incarcerated Inguinal Hernia Without Contamination

Repair of an Incarcerated Femoral Hernia Without Contamination

What If I Can’t Reduce the Hernia?

Management of the Spermatic Cord

Management of the Hernia SAC in a Communicating Hydrocele

Assessment of Bowel Viability

Management of Strangulated or Infected Groin Hernias with or Without Associated Infection

Management of a Sliding Hernia

The Special Problem of Giant Inguinoscrotal Hernia

Indications for Elective Repair of an Asymptomatic Hernia

Summary

References

Chapter 55 Surgical Infections of Skin and Soft Tissue

Risk Factors

Pathogenesis

Microbiology

Abscesses, Furuncles, and Carbuncles

Treatment

Diabetic Foot Infection

Diagnosis

Bacteriology

Treatment

Surgical Site Infections

Risk Factors

Prevention

Diagnosis

Treatment

Necrotizing Soft Tissue Infections

Pathogenesis and Microbiology

Diagnosis

Treatment

Adjuncts

Pyomyositis

References

Chapter 56 Nontraumatic Vascular Emergencies

Arterial Emergencies and Arterial Rupture

Abdominal Aortic Rupture

Thoracic Aortic Rupture

Iliac Artery Rupture

Peripheral Artery Rupture

Visceral Artery Rupture

Arterial Ischemia

Lower Limb Ischemia

Popliteal Artery Aneurysm

Upper Extremity Ischemia

Cerebrovascular Ischemia

Visceral Ischemia

Acute Aortic Dissection

Venous Emergencies

Lower Extremity

Upper Extremity

Visceral Venous Thrombosis

Central Venous Obstruction

References

Chapter 57 Acute Abdomen in Pregnant Women

Acute Surgical Care Considerations in the Pregnant Patient

Maternal Physiology

Acid/Base

Cardiovascular

Respiratory

Renal

Metabolism

Preoperative Evaluation

Imaging in Pregnancy

Preoperative Considerations

Anesthesia

Fetal Considerations

Outcomes After Nonobstetric Surgery During Pregnancy

Surgical Emergencies in Pregnancy

Trauma

Nontraumatic Obstetric Hemorrhage

Abdominal Pain

Appendicitis

Biliary Disease

Surgery Outside the Abdomen

Postoperative Management

Medications

Gynecologic Emergencies

Pregnancy-Related Emergencies

Ectopic Pregnancy

References

Section 4: Surgical Critical Care

Chapter 58 Surgical Complications in the ICU

Intracranial Pressure Monitors

ICP Monitor-Related Intracranial Hemorrhage

ICP Monitor-Related Infection

Tube Thoracostomy Complications

Insertional Complications

Positional Complications

Infection Complications

Pericardial Tamponade

Failure of Source Control

Central Venous Line Complications

Deep Venous Thrombosis

Central Venous Stenosis

Inadvertent Arterial Cannulation

Pneumothorax

Concomitant venous or arterial injury

Air embolism

Pulmonary Artery Catheters

Pulmonary Artery Rupture

Cardiac Arrhythmia

Arterial Catheters

Complications

Risk Prevention and Technique

Complication Management

Arterial Cannulas/Sheaths

Nasoenteric Tube Complications

Nonocclusive Mesenteric Ischemia (Shock Bowel)

Intra-abdominal Hypertension/Abdominal Compartment Syndrome

Acute Colonic Pseudo-obstruction (Ogilvie’s Syndrome)

Paracentesis

Fecal (Bowel) Management Systems

References

Chapter 59 Complications of Tracheostomy and Intubation

Introduction

Endotracheal Intubation

Indications

Procedure

Complications

Cricothyroidotomy

Indications

Procedure

Complications

Tracheostomy

Indications

Procedure

Open Tracheostomy

Percutaneous Tracheostomy

Complications

Conclusion

References

Chapter 60 Acute Respiratory Dysfunction

Physiology of Respiration

Hypoxemia

Ventilatory Failure

Perioperative and Neurologic Impairment

Shock

Populations With Unique Pathophysiology

Children

Elderly

Obesity

Pregnancy

Common Etiologies of Acute Respiratory Failure in Acute Care Surgery

Laryngotracheal Trauma

Pneumothorax

Hemothorax

Chest Wall Trauma

Pulmonary Embolism

Fat Embolism

Inhalation Injuries

Acute Respiratory Distress Syndrome

Summary

References

Chapter 61 Multiple Organ Dysfunction Syndrome

Historic Perspective

Epidemiology

Pathophysiology

Inflammation and Tissue Injury

Anti-inflammatory Response

Organ System Manifestations

Diagnosis

Management

Antimediator Therapy

Outcomes of Multiple Organ Dysfunction Syndrome

Survival and Long-term Outcomes

The Future

References

Chapter 62 Mechanical Ventilator Support

Noninvasive Ventilation

Mechanical Ventilation

Ventilation

Terms Utilized for Mechanical Ventilation

Modes of Mechanical Ventilation

Acute Lung Injury

Pharmacologic Approach to Mechanical Ventilation

Delirium

Sedation and Anxiety

Neuromuscular Blockade

Additional Therapy to Improve Oxygenation

Prone Ventilation

Heliox

Nitric Oxide

Extracorporeal Membrane Oxygenation

Surfactant Therapy and Liquid Ventilation

Inhalational Therapy

Ventilator-associated Pneumonia

Initiating Mechanical Ventilation

Weaning From Mechanical Ventilation

References

Chapter 63 Cardiovascular Failure and Circulatory Support-Monitoring and Essential Adjuncts

Introduction

Cardiovascular Physiology

Evaluation of Cardiovascular Performance

Support for Cardiovascular Dysfunction

Fluid Resuscitation

Pharmacologic Support

Classification of Cardiovascular Failure

Intrinsic Causes of Cardiovascular Failure

Extrinsic Causes of Cardiovascular Failure

Conclusion

References

Chapter 64 Acute Liver Failure and Portal Hypertension

Acute Liver Failure

Etiologies

Presentation, Clinical Course, and Transfer to a Transplant Center

Liver Transplantation for Acute Liver Failure

Patient Selection and Listing for Liver Transplantation

Prognostic Models

Intensive Care of the Acute Liver Failure Patient

General

Etiology-Directed Treatment

Infection

Hepatic Encephalopathy and Cerebral Edema

Renal Failure

Coagulopathy

Liver Support Devices

Waitlist and Outcomes

Portal Hypertension

Initial Approach to Portal Hypertensive Hemorrhage

Approach to Refractory Portal Hypertensive Bleeding

Balloon Tamponade

TIPS and BRTO

Endoscopic Stent

Shunt Surgery

Summary

References

Chapter 65 Acute Kidney Injury

Overview of Renal Physiology

The Glomerulus

The Proximal Tubule

The Loop of Henle

The Distal Convoluted Tubule

Overview of Acute Kidney Injury

Clinical Syndromes of AKI

Prerenal Azotemia

Intrinsic Acute Kidney Injury

Postrenal Acute Kidney Injury

Detection of Acute Kidney Injury

Prevention of Acute Kidney Injury

Nephrotoxins

Rhabdomyolysis

Contrast Nephropathy

Basic Principles of Treatment of Acute Kidney Injury

Evaluation of Oliguria

Treatment of AKI of Prerenal Etiology

Management of AKI From Intrinsic and Postrenal Causes

Complications of Acute Kidney Injury

Renal Replacement Therapy

Medication Dosing in Acute Kidney Injury

Prognosis of Acute Kidney Injury

References

Chapter 66 Nosocomial Infections

Hospital-acquired Pneumonia and Ventilator-associated Pneumonia

Pathogenesis and Risk Factors

Diagnosis

Treatment

Prevention

Central Line–Associated Bloodstream Infection

Pathogenesis/Risk Factors

Diagnosis

Treatment

Prevention

Catheter-associated Urinary Tract Infections

Pathogenesis and Risk Factors

Treatment

Prevention

Nosocomial Diarrhea

Pathogenesis

Diagnosis

Treatment

Prevention

References

Chapter 67 Thromboembolic Disease

Risk Factors, Incidence, and Cost

Vte Prophylaxis

Diagnosis and Surveillance

The Diagnosis of Pulmonary Embolism

Treatment

Duration of Treatment for Patients with Dvt or Pe

Linking Process Improvement and Outcome Measures

References

Section 5: Special Topics

Chapter 68 Comparative Effectiveness Research in Acute Care Surgery

Randomized Controlled Trials

Pragmatic Trials

Cluster Randomized Trials

Adaptive Trials

Observational Study Designs

Cross-sectional Cohort Study Design

Cohort Study Design

Case–Control Study Design

Accounting for Bias Within Observational Studies

Assessing the Quality of Observational Studies

Systematic Reviews and Meta-analyses

Putting it all Together

Rating the Quality of Evidence and Strength of Recommendations

Helpful Tips for Completing Your Own Surgical Research Study

Landmark Cer Within Acute Care Surgery

Randomized Controlled Trials

Observational Studies

References

Chapter 69 Continual Quality Improvement (CQI) in Acute Care Surgery

Continuous Quality Improvement in Surgery

CQI in Acute Care Surgery

Quality Improvement in Trauma

Trauma Center Verification

Trauma Center Designation

Core Components of QI Programs in Trauma

Quality Improvement Initiatives in Trauma

Quality Improvement in Emergency General Surgery

Hospital Accreditation and Verification

Core Components of QI Programs in Emergency General Surgery

Quality Improvement Initiatives in Emergency General Surgery

Quality Improvement in Surgical Critical Care

Hospital Accreditation and Verification

Core Components of QI Programs in Emergency General Surgery

Quality Improvement Initiatives in Surgical Critical Care

Conclusions

References

Chapter 70 Informed Surgical Consent

Introduction

Background

Informational Disclosure

Obtaining Consent

Competence

Cultural Issues

Conclusion

References

Chapter 71 The Affordable Care Act and its Impact on Acute Care Surgery

Medicare Program

Medicare History

Administrative Control and Legislative Oversight

Medicare Benefits and Parts A-D

Hospital Reimbursement

Physician Reimbursement

Financing and Fiscal Impact

Impact and Interaction of the ACA on Medicare

Medicaid Program

Medicaid History

Financing and Fiscal Impact

Impact and Interaction of the ACA on Medicaid

Aca, Associated Legislation, and Macra

Affordable Care Act History

Aca: Major Provisions

Impact of Aca on Health Care Delivery

Medicare Access and Macra Impact on Aca

Impact of Health Care Reform and Aca on Acs

Acknowledgments

References

Chapter 72 Advance Medical Directives

Introduction

Terminology

Doctor–Patient Relationship

Informed Consent or Informed Decision-making

The Evolution of Advance Care Planning

History

Advance Medical Directives

Special Circumstances

Decision-making During a Medical Crisis

Surgical Interventions

End-of-Life Care in the Intensive Care Unit

Summary

References

Chapter 73 Ethical and Medical Legal Considerations for the Acute Care Surgeon

Introduction

Ethical Considerations

Lack of Access to Emergency Surgical Care: A Perfect Storm

Providing Access to Quality Emergency Surgical Care

Providing Emergency Patient-centered Care

Futile Care

Organ Donation

The Impaired Surgeon

Medicolegal Issues

Medical Malpractice

Communicating Complications to Patients

Exceptions to Informed Consent

Consenting the Patient with Limited English Proficiency

Consenting the Cognitively Impaired Patient

Emergency Surgery in the Minor

The Pregnant Patient Who Refuses Surgery

The Suicidal Patient

Determination of Brain Death

Conclusion

References

Chapter 74 Simulation Training in Surgical Education

Early Uses of Simulation in Surgical Training

Changing Health Care and Educational Landscape

Benefits of Simulation: Exposure to Low-frequency, High-stake Events

Surgical Simulation Education

Other Educational Gaps Open to the use of Simulation

The Postsimulation Debrief

Simulation Modalities

Simulated Patients

Task Trainers

Computerized High-fidelity Simulators

Team Training

Virtual Reality

Simulation Curricula

Simulation Training and Clinical Competency

Essentials for Establishing Successful Simulation Training

Barriers to Establishing Successful Simulation Training

Validation of Simulation Models

Summary

References

Index

 

An aparitie	1 Oct. 2018
Autor	L.D. Britt, Andrew B. Peitzman, Philip S. Barie, Gregory J. Jurkovich
Dimensiuni	22.1 x 4.32 x 28.96 cm
Editura	LWW
Format	Hardcover
ISBN	9781496370044
Limba	Engleza
Nr pag	960