Cover
Half Title
Title Page
Copyright Page
Dedication
Contents
Foreword by Basil A. Pruitt
Author Biography
List of Contributors
Introduction
1. Patient Safety in the Care of Trauma Patients
1.1. Introduction
1.2. Incidence
1.3. Mechanisms of Errors
1.4. Errors in the Operative Phase of Trauma Care
1.5. Errors in the Intensive Care Unit and Postoperative Phases of Trauma Care
1.6. Result of Errors in Trauma Care
1.7. Methods to Reduce Errors in Trauma Care
1.8. Conclusions and Algorithm
Editor’s Note
References
2. Injury Prevention Strategies
2.1. Introduction
2.2. Foundational Components of Injury Prevention Strategies
2.3. Prevention Strategies
2.4. Summary
Editor’s Note
References
3. Trauma Systems: A Dynamic Public Health Strategy for Injury Control
3.1. The Global Phenomenon of Trauma Systems
3.2. A Defining Challenge in Public Health
3.3. Trauma Systems: The Evolution of a Public Health Response
3.4. Injury Prevention: Can Trauma Systems Prevent Injury?
3.5. Clinical Trauma Care
3.6. Future Directions
3.7. Summary
Editor’s Note
References
4. Military Injury Outcomes
4.1. Introduction
4.2. What Is the Role of a Trauma System in Combat Injury Outcomes?
4.3. What Are the Impacts of Damage Control Measures on the Morbidity and Mortality of Combat Injury?
4.4. What Are the Contemporary Techniques and Outcomes of Colon Surgery Performed on the Battlefield?
4.5. What Are the Contemporary Techniques and Outcomes of Vascular Surgery Performed on the Battlefield?
4.6. What Are the Contemporary Techniques and Outcomes of Burn Surgery Performed on the Battlefield?
4.7. What Are the Contemporary Techniques and Outcomes of Severe Brain Injury Sustained on the Battlefield?
Commentary on Military Injury Outcomes
References
5. Traumatized Airway
5.1. Introduction
5.2. What Is the Optimal Prehospital Airway?
5.3. What Is the Role of Prehospital Intubation?
5.4. What Is the Optimal Size Endotracheal Tube?
5.5. What Medications Should Be Used for Rapid Sequence Intubation?
5.6. What Airway Adjuncts Should Be Considered If Unable to Intubate?
5.7. What Is the Role of Video Laryngoscopy?
5.8. What Is the Role of Cricothyroidotomy?
5.9. What Is the Best Strategy for Establishing an Emergency Airway in Children?
5.10. How Should One Evaluate for Airway Injury?
5.11. How Does One Secure the Airway in the Setting of Airway Trauma?
5.12. Summary
Editor’s Note
References
6. Monitoring of the Trauma Patient
6.1. Are Heart Rate and Blood Pressure Adequate Indicators of Shock?
6.2. Do Local Tissue Perfusion Measures Improve Our Ability to Diagnose Shock? Does Their Use Improve Outcomes?
6.3. Does Hemodynamic Monitoring with a Pulmonary Artery Catheter Improve Outcomes?
6.4. Is There a Biochemical Parameter that Best Identifies Shock and Guides Resuscitation?
6.5. Should the Geriatric Trauma Patient Have More Invasive Monitoring?
6.6. What Is the Best Noninvasive Cardiac Monitor Available Today?
Editor’s Note
References
7. Resuscitation of the Trauma Patient
7.1. Introduction
7.2. Methods
7.3. Question Results
7.4. Closing Comments
Editor’s Note
References
8. Diagnosis of Injury in the Trauma Patient
8.1. Introduction
8.2. Focused Abdominal Sonography for Trauma
8.3. What Is the Role of FAST in the Initial Assessment of the Hemodynamically Stable Blunt Trauma Patient?
8.4. What Is the Role of FAST in the Initial Assessment of the Hemodynamically Unstable Blunt Trauma Patient?
8.5. What Is the Role of Ultrasound in the Initial Assessment of Penetrating Trauma Patients? Cardiac View and Abdominal View
8.6. What Is the Current Evidence to Support the Use of Ultrasound for the Diagnosis of Pneumothorax in the Resuscitation Area?
8.7. What Is the Role of CT Scan in the Assessment of Hollow Viscus Injury after Blunt Abdominal Trauma?
8.8. Can CT Scan Be Utilized to Diagnose or Rule Out Penetrating Diaphragmatic Injury?
Editor’s Note
References
9. Damage Control Laparotomy and Abdominal Compartment Syndrome
9.1. Introduction
9.2. Does a “Damage Control” Approach Improve Mortality?
9.3. How Do We Preoperatively Identify the Damage Control Patient?
9.4. How Do We Intraoperatively Identify the Damage Control Patient?
9.5. When Should We Terminate the Initial Damage Control Operation?
9.6. What Is the Best Method to Temporarily Close the Abdomen to Prevent Long-Term Morbidity?
9.7. What Is the Morbidity Rate from a Damage Control Approach?
9.8. What Is Abdominal Compartment Syndrome and How Should Patients Be Screened and/or Monitored for the Development of Intraabdominal Hypertension?
9.9. Is There an IAP Threshold Level that Mandates Intervention in IAH/ACS?
9.10. Are There Any Effective Nonsurgical Strategies for Treating IAH/ACS?
Disclaimer
Editor’s Note
References
10. Coagulopathy in the Trauma Patient
10.1. Introduction
10.2. Measuring Trauma-Induced Coagulopathy
10.3. Prehospital Resuscitation and Optimum Blood Product Type and Ratio
10.4. Adjuvant Therapies
10.5. Permissive Hypotension: What Do We Know about It?
Disclaimer
Editor’s Note
References
11. Traumatic Brain Injury
11.1. Should Routine Repeat Head CT Scans Be Performed in Stable Patients without Neurologic Change?
11.2. Does the Use of Continuous Hypertonic Saline vs. Standard Care Improve Outcomes?
11.3. Do Procoagulants Decrease Intracranial Hemorrhage in Coagulopathic TBI Patients?
11.4. When Should DVT Prophylaxis Be Initiated in TBI?
11.5. Is Standard Use of Antiepileptic Drugs for Seizure Prophylaxis Beneficial in Patients with TBI?
11.6. Do ICP Monitoring and Therapy Directed at Lowering ICP Improve Outcome?
11.7. Does the Use of a Hypothermia Protocol for TBI Treatment Improve Morbidity and Mortality?
11.8. Does a Decompressive Craniectomy for Severe TBI Improve Outcomes?
11.9. Does Amantadine after TBI Improve Cognition and Level of Consciousness?
Editor’s Note
References
12. Traumatic Spinal Cord Injuries
12.1. Introduction
12.2. What Is the Impact of Airway Maneuvers on Cervical Spine Movement?
12.3. What Is the Preferred Way to Achieve Tracheal Intubation in Patients with Suspected CSI?
12.4. What Criteria Should Be Used to Exclude Cervical Spine Injury in Trauma Patients?
12.5. What Imaging Study Is Needed to Clear the Cervical Spine in the Obtunded Patient?
12.6. What Is the Imaging Modality of Choice to Evaluate the Spine?
12.7. Should High-Dose Corticosteroids Be Used in Trauma Patients with SCI?
12.8. Surgical Intervention: Timing
Editor’s Note
References
13. Facial Injuries
13.1. Introduction
13.2. What Is the Proper Timing and Method of Closure? What Is the Optimal Subsequent Care for Facial Lacerations and Wounds after Closure?
13.3. What Is the Proper Timing of Repair of Facial Fractures, Especially in the Setting of Neurologic Trauma/Other Injuries?
13.4. Are Antibiotics Indicated in the Management of Facial Lacerations or Facial Fractures and, If So, When?
13.5. Which Treatment Is Better for Mandible Fractures: Closed or Open Reductions?
Editor’s Note
References
14. Ocular Trauma
14.1. Introduction
14.2. Major Ocular Traumas
14.3. Minor Ocular Traumas
References
15. Neck Trauma
15.1. Introduction
15.2. Assessment of Neck Trauma
15.3. Treatment of Neck Trauma
Editor’s Note
References
16. Resuscitative Thoracotomy
16.1. Introduction
16.2. Is There a Length of Prehospital CPR Time Beyond Which the Performance of Resuscitative Thoracotomy for Penetrating Trauma Should Be Considered Futile?
16.3. Should Resuscitative Thoracotomy Be Performed on Blunt Trauma Patients Who Lose Vitals in the Prehospital Setting?
16.4. Is Resuscitative Thoracotomy Effective at Reducing Mortality in Patients with Extrathoracic Injuries?
16.5. Can Resuscitative Endovascular Balloon Occlusion of the Aorta Serve as a Potential Replacement for Conventional Resuscitative Thoracotomy?
16.6. Should Bilateral Anterolateral (“Clamshell”) Thoracotomy Be Routinely Performed during Resuscitative Thoracotomy?
16.7. Should Organ Procurement Be Considered a Conditionally Positive Outcome of Resuscitative Thoracotomy?
16.8. Does Resuscitative Thoracotomy Expose Healthcare Providers to Increased Risk of Bloodborne Pathogen Exposure?
Editor’s Note
References
17. Chest Wall Trauma
17.1. Should Open Reduction and Internal Fixation Be Performed Routinely on Trauma Patients with Multiple Rib Fractures?
17.2. In Trauma Patients with Traumatic Hemothorax Who Require Blood Transfusion, Should Blood Collected from the Hemothorax Routinely Be Autotransfused?
17.3. Should Small-Bore Chest Drainage Catheters Be Used Rather than Large-Bore Tubes for Traumatic Hemothorax?
17.4. When Should VATS Be Performed in Trauma Patients Who Have a Retained Hemothorax after Initial Tube Thoracostomy?
Editor’s Note
References
18. Injury to the Thoracic Great Vessels
18.1. Introduction
18.2. What Is the Ultimate Imaging Modality for Diagnosing Blunt Thoracic Aortic Injury?
18.3. What Medications Should We Use in the Medical Management of Minimal Aortic Injuries?
18.4. What Is the Target Blood Pressure to Maintain When Nonoperative Management or Delayed Surgical Therapy Is Considered?
18.5. Which Operative Technique Should Be Used for Open Repair of Descending Thoracic Aortic Injuries?
18.6. Are Endovascular Stent Procedures Superior to Open Vascular Procedures?
18.7. Penetrating Injuries of the Aorta
Editor’s Note
References
19. Cardiac Trauma
19.1. Introduction
19.2. How Do You Rule Out Blunt Cardiac Injury?
19.3. What Is the Role of Chest CT Scan in Both Penetrating and Blunt Cardiac Trauma?
19.4. When Does the Stable BCI Patient Need Continuous ECG Monitoring and for How Long?
19.5. How Do You Initially Manage a Pericardial Effusion Secondary to Trauma?
19.6. How Do You Manage a Foreign Body in the Heart?
19.7. What Are Damage Control Techniques for Unstable Patients?
19.8. Is There an Advantage of Using Pledgets When Suturing the Heart?
Editor’s Note
References
20. Injury to the Esophagus, Trachea, and Bronchus
20.1. Trachea and Bronchus
20.2. Esophagus
Editor’s Note
References
21. Spleen Injury
21.1. Introduction
21.2. Which Patients Are at Risk of Failing Nonoperative Management?
21.3. What Is the Role of Nonoperative Management in Penetrating Spleen Injury?
21.4. Which Patients Should Undergo Splenic Angiography?
21.5. What Imaging Studies Should Be Obtained in Patients with Splenic Injuries?
21.6. What Steps Can Be Taken to Prevent Overwhelming Postsplenectomy Sepsis?
21.7. What Techniques of Splenic Artery Embolization Should Be Used?
21.8. When Is It Safe to Resume Activities after Splenic Injuries?
21.9. Special Circumstances in Splenic Injury
Editor’s Note
References
22. Injury to the Liver
22.1. What Are the Criteria for Selecting Blunt Trauma Patients for Nonoperative Management?
22.2. When Should NOM Patients Be Allowed Out of Bed after Sustaining a Liver Injury?
22.3. Does Drainage Prevent Complications in Surgically Treated Hepatic Injuries, and Should Routine Endoscopic Retrograde Cholangiopancreatography and Stenting Be Used for Bile Leaks?
22.4. Can Gunshot Wounds to the Liver of Stable Patients Be Managed Nonoperatively on Clinical Exam?
22.5. Is Arterial Embolization Effective in the Management of Penetrating and Blunt Hepatic Injuries?
Editor’s Note
References
23. Small Bowel and Colon Injuries
23.1. Is an Ostomy Ever Necessary Following Colon Trauma?
23.2. Is It Safe to Do a Colon Anastomosis Following Damage Control Laparotomy?
23.3. When Is Hand-Sewn Anastomosis Preferable to Stapled Anastomosis—If Ever?
23.4. Should the Skin Be Closed after Laparotomy for Colon Injury?
23.5. What Is the Appropriate Duration of Antibiotics after Colon Injury?
23.6. Should Presacral Drains Be Used in the Management of Rectal Injuries?
Editor’s Note
References
24. Diaphragmatic Injuries
24.1. What Is the Optimal Diagnostic Modality for the Diagnosis of Diaphragmatic Injury in Blunt Trauma?
24.2. What Is the Optimal Diagnostic Modality for the Diagnosis of Diaphragmatic Injury in Penetrating Trauma?
24.3. What Is the Clinically Useful Classification System that Guides Operative Management?
24.4. What Is the Optimal Approach to the Operative Management of Diaphragmatic Injuries?
24.5. What Is the Ideal Suture Material/Prosthesis for Repair of Diaphragmatic Injuries?
24.6. What Are the Differences in the Approach to Left- versus Right-Sided Injuries?
24.7. What Are the Consequences of Missed Injuries?
Editor’s Note
References
25. Pancreatic and Duodenal Injuries
25.1. History and Epidemiology
25.2. Injury Classification
25.3. Diagnosis and Management
Editor’s Note
References
26. Abdominal Vascular Trauma
26.1. Introduction
26.2. Initial Evaluation and Diagnosis
26.3. Imaging Techniques
26.4. Abdominal Vascular Trauma: Management
26.5. Conclusion
Editor’s Note
References
27. Pregnant Trauma Patients
27.1. Introduction
27.2. Anatomic and Physiologic Changes Unique to Pregnancy
27.3. Assessment of Pregnant Trauma Patients
27.4. Diagnostic Considerations
27.5. Emergent Cesarean Section for Trauma
27.6. Summary
References
28. Pelvic Fractures
28.1. Introduction
28.2. What Is the Role of Pelvic Fracture Stabilization with External Compression Devices, Binders, or Sheets?
28.3. What Is the Role of Resuscitative Endovascular Balloon Occlusion of the Aorta in Patients with Hemorrhagic Shock Due to Pelvic Fracture?
28.4. What Is the Role of Tranexamic Acid in Patients with Hemorrhage Due to Pelvic Fractures?
28.5. What Is the Role of Preperitoneal Pelvic Packing in Hemodynamically Unstable Patients with Pelvic Fractures?
28.6. Which Patients with Pelvic Fracture Warrant Early Angiography and Angioembolization?
28.7. What Is the Role of Fecal Diversion in Patients with Open Pelvic Fractures?
28.8. What Is the Optimal Timing for Definitive Operative Stabilization of Pelvic Ring Fractures?
28.9. What Are the Respective Roles of Early Chemical Venous Thromboembolism Prophylaxis and Prophylactic Inferior Vena Cava Filtration in Patients with Pelvic Fractures?
Editor’s Note
References
29. Extremity Vascular Injury
29.1. Introduction
29.2. Can a Diagnosis of Extremity Vascular Injury Be Adequately Made by Physical Exam Supplemented with Arterial Pressure Index?
29.3. What Role Do Tourniquets Play in the Management of Peripheral Vascular Injuries?
29.4. When Is a Computed Tomography Angiography Indicated for Extremity Vascular Trauma?
29.5. Which Extremity Vascular Injuries Are Appropriate for Endovascular Management?
29.6. Should Intravascular Shunting Be Used in the Management of Civilian Extremity Vascular Injuries?
29.7. What Are the Considerations in Choosing the Most Appropriate Conduit for Revascularization of an Acute Extremity Vascular Injury?
29.8. Following Repair of an Acute Vascular Injury, Should Fasciotomies Be Performed Prophylactically?
29.9. What Is the Role of Anticoagulation during Revascularization of an Acute Traumatic Extremity Vascular Injury?
29.10. Conclusions
Editor’s Note
References
30. Management of Extremity Trauma and Mangled Extremities
30.1. Introduction
30.2. How Are Common Soft Tissue Infections Such as Human or Animal Bites, Flexor Tenosynovitis, and Hand Abscess Treated, and Are the Current Empiric Antibiotics Used Based on Clinical Evidence?
30.3. When Is It Appropriate to Operate on Scaphoid Fractures, and What Are the Diagnostic Techniques Employed?
30.4. What Are the Indications for Replantation of Digits and Extremities?
30.5. What Are the Indications for the Release of Forearm Compartment Syndrome, Hand Compartment Syndrome, and Acute Carpal Tunnel Syndrome?
30.6. Which Management Strategies Reduce the Impact of Ischemia and Reperfusion Injury on Limb Salvage Following Trauma?
30.7. Is There a Difference in Limb Salvage Strategies in the Setting of Upper versus Lower Extremity Injury?
30.8. What Prehospital Adjuncts Are Available That Impact Limb Salvage Following Traumatic Extremity Injury?
30.9. What Strategies in Skeletal Reconstruction Impact Limb Salvage Following Traumatic Injury?
30.10. How Do Advances in Soft Tissue Wound Management Strategies Impact Limb Salvage?
30.11. How Do Patient and Injury Characteristics Impact Decision-Making Regarding Extremity Salvage?
30.12. What is the Role of Mangled Extremity Scores and Indices on Decision-Making in Limb Salvage?
30.13. What Is the Financial Cost of Extremity Reconstruction versus Early Amputation and the Impact on Quality of Life?
Editor’s Note
References
31. Support of the Burned Patient
31.1. Introduction
31.2. What Are the Optimal Resuscitation Methods and Goals of Resuscitation Following Severe Burn?
31.3. How Do We Determine Burn Depth?
31.4. What Is the Optimal Approach to Burn Wound Management According to the Depth of Injury?
31.5. What Is the Optimal Transfusion Strategy in Major Burns, and How Is Blood Loss Best Minimized During Burn Excision Procedures?
31.6. How Are Burn Wound and Multidrug-Resistant Infections Effectively Minimized?
31.7. Approach to the Patient with Inhalation Injury: Introduction
31.8. What Diagnostic Procedures Should Be Performed in Patients with Suspected Inhalation Injury?
31.9. What Are the Indications for Endotracheal Intubation and for Tracheostomy in Patients with Inhalation Injury?
31.10. What Mode of Mechanical Ventilation Is Most Effective for Patients with Inhalation Injury?
31.11. What Medications and Fluid Management Strategies Improve Outcomes?
31.12. What Immediate Treatments Are Safe and Effective for Metabolic Asphyxiation by Carbon Monoxide or Hydrogen Cyanide Toxicity?
31.13. Should Patients with Inhalation Injury Be Transferred to a Regional Burn Center?
31.14. Conclusions
References
32. Electrical, Cold, and Chemical Injuries
32.1. Introduction
32.2. Electrical Injuries
32.3. Cold Injuries
32.4. Chemical Injuries
Editor’s Note
References
33. Wound Care Management
33.1. Introduction
33.2. What Is the Optimal Way to Avoid Pressure Ulcers?
33.3. Does Negative Pressure Wound Therapy Improve Wound Healing?
33.4. Do Skin Grafting and Acellular Dermal Replacement Improve Wound Outcomes after Burn and Reconstructive Surgery?
33.5. Does Hyperbaric Oxygen Therapy Accelerate Wound Healing?
33.6. How Should We Treat Hypertrophic Scars and Keloids?
Editor’s Note
References
34. Pediatric Trauma
34.1. Introduction
34.2. When Is a CT Scan of the Head Indicated in Pediatric Head Trauma?
34.3. Is There a Role for Hypertonic Saline in Pediatric Head Injuries?
34.4. When Is Clinical Clearance of the Cervical Spine Appropriate in Children?
34.5. How Should Blunt Pancreatic Transections Be Managed in Children?
34.6. Damage Control Resuscitation: When Should Blood Be Used in Hypotensive Pediatric Trauma Patients and What Transfusion Ratio to Plasma?
Editor’s Note
References
35. The Advanced-Age Trauma Patient
35.1. Introduction
35.2. Are Advanced-Age Patients at Higher Risk for Poor Outcomes in Trauma?
35.3. How Should the Decision Be Made to Continue or Remove Life-Sustaining Supportive Care after Trauma? What Clinical Factors Inform the Likelihood of Survival and Recovery after Trauma?
35.4. What Is the Optimal Triage Strategy for the Advanced-Age Trauma Patient?
35.5. What Is the Impact on Treatment and Outcome for Patients with Medication-Induced Coagulopathy?
35.6. What Is the Impact on Treatment and Outcome for Patients on Beta-Blockers, and When Should They Be Used?
35.7. Can a Physical Exam Be Used to Select Advanced-Age Trauma Patients Who Do Not Require CT Imaging?
35.8. What Are the Optimal Strategies for Resuscitation and Monitoring of the Geriatric Trauma Patient?
35.9. What Are the Risk Factors for Elder Abuse and the Common Patterns of Injury to Be Recognized by the Trauma Provider?
35.10. Are There Any Injury-Prevention Programs that Have Been Shown to Work for Advanced-Age Patients?
Editor’s Note
References
36. Genitourinary Trauma
36.1. Evidence-Based Management of Genitourinary Trauma
36.2. Renal Trauma
36.3. Ureteral Injury
36.4. Bladder Trauma
36.5. Urethral Trauma
36.6. Penile and Scrotal Trauma
Editor’s Note
References
37. Ileus and Small Bowel Obstruction
37.1. Postoperative Ileus
37.2. Intraabdominal Adhesions
37.3. Adhesional SBO
Editor’s Note
References
38. Upper Gastrointestinal Bleeding
38.1. Introduction
38.2. What Is the Role of Medical Therapy in the Prevention of UGI Bleeds and How Successful Is It?
38.3. What Is the Role of Medical Therapy in Treating UGI Bleeds and How Effective Is It?
38.4. What Is the Role of Endoscopy in Treating or For Prophylaxis in UGI Bleeds and How Successful Is It?
38.5. What Is the Role of Interventional Radiology in Treating UGI Bleeds?
38.6. Under What Circumstances Is an Operation Indicated for a Bleeding Peptic Ulcer? What Techniques Are Associated with the Lowest Rate of Rebleeding?
38.7. What Approach Is Preferred for the Management of Perforated Peptic Ulcer Disease?
Disclaimer
Editor’s Note
References
39. Enterocutaneous Fistulas
39.1. What Is the Definition of ECF?
39.2. What Are the Risk Factors for Developing an ECF?
39.3. How Are ECFs Classified?
39.4. How Do ECFs Present Clinically?
39.5. What Is the Best Method to Define ECF Anatomy?
39.6. Medical Management
39.7. Surgical Management
Editor’s Note
References
40. Paraesophageal Hernia Repair
40.1. Introduction
40.2. Should All Paraesophageal Hernias Be Repaired?
40.3. What Is the Best Approach to Repair PEH When Indicated?
40.4. What Operative Strategies Have Been Shown to Minimize Recurrence Rates Following PEH Repair?
40.5. Is There a Role for Esophageal-Lengthening Procedures during Paraesophageal Hernia Repair?
40.6. Is There Evidence Supporting Routine Fundoplication in Patients Undergoing Laparoscopic PEH Repair?
40.7. What Are the Options for High-Risk Patients with Symptomatic PEH?
Conclusions
References
41. Lower Gastrointestinal Bleeding
41.1. Introduction
41.2. Has Computed Tomography Angiography (CTA) Replaced Technetium-99m (Tc-99m) Sulfur Colloid Injection or Tc-99m Tagged Red Cells as the Better Initial Test?
41.3. How Should We Compare the Diagnostic Accuracy of Colonoscopy, Radionuclide Scanning, Computed Tomography Angiography (CTA), and Angiography in the Setting of LGIB?
41.4. Is There an Ideal Single Test in the Setting of LGIB?
41.5. What Is the Rationale for Timing of Colonoscopy for LGIB and the Clinical Outcomes?
41.6. What Is the Appropriate Setting for Selective Transcatheter Embolization?
41.7. What Are the Criteria for Surgical Intervention in LGIB and What Operation Should Be Done?
41.8. Anticoagulant Use and Reversal in the Management of LGIB
Editor’s Note
References
42. Appendicitis
42.1. Introduction
42.2. What Clinical Signs and Symptoms Are Most Reliable to Rule In or Out Appendicitis?
42.3. What Is the Best Laboratory Test to Help Make the Diagnosis of Appendicitis?
42.4. Does Giving Pain Medicine to a Patient with Suspected Appendicitis Decrease the Ability of the Clinician to Make the Diagnosis of Acute Appendicitis?
42.5. What Is the Best Imaging Modality to Diagnose Acute Appendicitis?
42.6. Does Administration of Antibiotics to Patients with Appendicitis Who Undergo Appendectomy Decrease Postoperative Infectious Complications?
42.7. What Operation Is Better for Treating Acute Appendicitis: Laparoscopic or Open Appendectomy?
42.8. Is Interval Appendectomy Necessary?
42.9. Should Antibiotic Treatment Replace Appendectomy for Uncomplicated Acute Appendicitis?
Editor’s Note
References
43. Diverticular Disease of the Colon
43.1. Introduction
43.2. What Is the Appropriate Indication for Elective Sigmoid Resection after Uncomplicated Diverticulitis?
43.3. Should Younger Patients (<50 Years) Undergo Elective Sigmoid Colon Resection after a Single Attack of Diverticulitis?
43.4. Do Lifestyle Changes Such as Increased Fiber Intake, Increased Physical Activity, Weight Loss, Tobacco Cessation, and Reduced Red Meat Intake Reduce the Risk of Diverticulitis? Is the Practice of Prohibiting the Intake of Nuts, Seeds, Popcorn, etc., after an Acute Episode Valid?
43.5. What Is the Optimal Operation for Patients Requiring Surgery for Acute Complicated Diverticulitis? Is Performing a Primary Anastomosis an Option?
43.6. Is There a Role for Laparoscopic Lavage in Acute Complicated Diverticulitis?
43.7. Are Minimally Invasive Approaches for Colectomy for Diverticular Disease Preferred to Open Operations? What Place Do Robotic Approaches Have in Elective Colon Operations for Diverticular Disease?
Editor’s Note
References
44. Large Bowel Obstruction
44.1. How Does Colonic Obstruction Present?
44.2. What Are the Causes of Large Bowel Obstruction?
44.3. What Is the Proper Diagnostic Evaluation?
44.4. Management
44.5. What Is the Preferred Operative Approach?
44.6. What Is the Role of Laparoscopy in the Treatment of Large Bowel Obstruction?
44.7. Are There Any Nonoperative Options?
44.8. What Is the Preferred Management for Colonic Pseudo-Obstruction: Observation versus Medical or Endoscopic Decompression?
44.9. What Are the Outcomes?
Editor’s Note
References
45. Acute and Chronic Mesenteric Ischemia
45.1. Introduction
45.2. What Is the Ideal Mode of Imaging in the Diagnosis of Acute or Chronic Mesenteric Ischemia?
45.3. Can Endovascular Therapy Be Recommended for Acute Thromboembolic Mesenteric Ischemia?
45.4. Does Evidence Favor Open Bypass or Catheter-Based Endovascular Intervention for Chronic Mesenteric Ischemia?
45.5. Should Open Revascularization for CMI Include Single or Multiple-Vessel Reconstruction?
45.6. What Is the Ideal Treatment for Acute Mesenteric Venous Thrombosis?
45.7. What Is the Ideal Treatment for Nonocclusive Mesenteric Ischemia?
Editor’s Note
References
46. Hemorrhoids
46.1. Introduction
46.2. Management of Internal Hemorrhoids
46.3. Management of Thrombosed External Hemorrhoids
Editor’s Note
References
47. Anal Fissure, Fistula, and Abscess
47.1. Introduction
47.2. How Do Nonoperative Medical Therapies (Nitroglycerin, Calcium Channel Blockers, and Botulinum Toxin) Compare with Placebo and Lateral Internal Sphincterotomy in the Treatment of Anal Fissures?
47.3. What Is the Impact of Technique on the Outcomes of Patients Undergoing Surgery for Anal Fissure?
47.4. What Is the Healing and Incontinence Rate for Fistulotomy for Simple Fistula-in-Ano?
47.5. What Is the Healing and Incontinence Rate for More Complex Fistulas Treated with Fibrin Glue, Fistula Plug, or a Seton?
47.6. What Is the Healing and Incontinence Rate for More Complex Fistulas Treated with an Endorectal Advancement Flap?
47.7. What Is the Role of Ligation of the Intersphincteric Fistula Tract in the Treatment of Fistula-in-Ano?
47.8. Is There Any Role for Minimally Invasive Approaches (i.e., Video-Assisted or Laser Closure) in the Management of Fistula-in-Ano?
47.9. Are Antibiotics Unnecessary for Most Patients Undergoing Routine Incision and Drainage of Perirectal Abscesses?
Editor’s Note
References
48. Acute Cholecystitis and Cholangitis
48.1. History and Epidemiology
48.2. Anatomy, Physiology, and Pathophysiology
48.3. Initial Evaluation and Diagnosis
48.4. Management
48.5. Discussion
Editor’s Note
References
49. Acute Pancreatitis
49.1. What Is the Role (If Any) of Magnetic Resonance Cholangiopancreatography in Suspected Choledocholithiasis in Those with Acute Biliary Pancreatitis?
49.2. What Is the Role of Early Endoscopic Retrograde Cholangiopancreatography in Acute Biliary Pancreatitis?
49.3. Should Patients Have Early or Delayed Cholecystectomy Following Acute Biliary Pancreatitis?
49.4. What Is the Role of Prophylactic Antibiotics in Severe Acute Pancreatitis?
49.5. Is Enteral Nutrition Safe and Superior to Total Parenteral Nutrition in Severe Acute Pancreatitis?
49.6. Is Gastric Feeding Safe and Equivalent to Jejunal Feeding in Acute Pancreatitis?
49.7. Is the Step-Up Approach toward the Management of Pancreatic Necrosis Superior to Up-Front Open Pancreatic Necrosectomy?
Editor’s Note
References
50. Pancreatic Pseudocysts
50.1. Does the Size of a Pancreatic Pseudocyst Predict the Likelihood of Resolution Following Acute Pancreatitis?
50.2. How Can Complicated Pancreatic Pseudocysts Best Be Managed?
50.3. Is Surgical or Endoscopic Drainage of Pancreatic Pseudocysts Superior?
50.4. What Are the Implications of Failed Up-Front Nonsurgical Drainage of Pancreatic Pseudocysts?
Editor’s Note
References
51. Diagnosis and Treatment of Variceal Hemorrhage Due to Cirrhosis
51.1. Introduction
51.2. Pathophysiology
51.3. Reliable Predictors of Visceral Hemorrhage Development in Patients with Cirrhosis
51.4. Diagnosis and Workup of a Patient with a Visceral Bleed
51.5. Management
51.6. Intervention for Acute Variceal Hemorrhage
51.7. Prevention of Recurrence: Secondary Prophylaxis
51.8. Special Consideration for Gastric Varices
51.9. Conclusion
References
52. Acute Arterial Embolus
52.1. Is It Possible to Diagnose an Embolic versus Thrombotic Etiology for Acute Limb Ischemia Based on History and Physical Examination?
52.2. Is Perioperative Anticoagulation Necessary in the Treatment of Acute Limb Ischemia?
52.3. Is Percutaneous Endovascular Treatment the Preferred Initial Treatment over Surgical Revascularization?
Editor’s Note
References
53. Ruptured Aortic Aneurysm
53.1. What Are the Optimal Resuscitation Goals and Methods to Be Used in Patients with Ruptured Aneurysms?
53.2. Can Mortality from rAAA Be Predicted?
53.3. Do Delays in Reaching an Operating Room Affect Outcomes?
53.4. Is Endovascular Repair Preferred in Patients with rAAA?
53.5. Should Anticoagulation Be Used Intraoperatively?
53.6. Can Paraplegia Be Avoided?
53.7. Should Sigmoidoscopy Be Performed Routinely in the Postoperative Period?
53.8. Should Patients Be Monitored for Abdominal Compartment Syndrome?
Editor’s Note
References
54. Venous Thromboembolism: Deep Venous Thrombosis and Pulmonary Embolism
54.1. Deep Venous Thrombosis
54.2. What Are the Optimal Preventative Strategies for DVT?
54.3. How Is DVT Diagnosed?
54.4. What Is the Best Initial Treatment for Venous Thromboembolism?
54.5. Is Home Therapy for Venous Thromboembolism Safe and Effective Compared to Inpatient Care?
54.6. What Is the Optimal Oral Starting Dose of Vitamin K Antagonist Therapy?
54.7. What Is the Optimal Length of Oral VKA Treatment for DVT?
54.8. Does Catheter-Directed Thrombolysis Decrease DVT Recurrences and Incidence of Postthrombotic Syndrome?
54.9. Do Compression Stockings Reduce the Long-Term Complication of Postthrombotic Syndrome?
54.10. Pulmonary Embolism
54.11. Risk Factors
54.12. Diagnosis
54.13. Prevention
54.14. Treatment
Editor’s Note
References
55. Necrotizing Soft Tissue Infections
55.1. Introduction and Definitions
55.2. Necrotizing Fasciitis
55.3. Mainstay Therapy
55.4. Supplemental Therapy
55.5. Necrotizing Myositis
55.6. Diagnosis: Is Open Fascial Exploration and Biopsy Still the Standard for Diagnosis of NSTI, or Has It Been Supplanted by Radiographic Studies?
55.7. Mainstay Therapy: Which Is a Better Approach to Initial Resection in NSTI: Staged or “Complete”?
55.8. Supplemental Therapy: Is There Convincing Evidence for the Use of Hyperbaric Oxygen Therapy in the Treatment of Necrotizing Soft Tissue Infections?
55.9. Supplemental Therapy: Is Immunoglobulin Therapy Part of Standard Care for Necrotizing Soft Tissue Infections?
55.10. Conclusions
Editor’s Note
References
56. Incarcerated Hernias
56.1. Introduction
Editor’s Note
References
57. Surgical Endocrine Emergencies
57.1. Endocrine Surgical Emergencies
57.2. Central Diabetes Insipidus
57.3. Carcinoid Crisis
57.4. Thyroid Storm
57.5. Hypercalcemic Crisis
57.6. Adrenal Crisis
57.7. Hypertensive Crisis Due to Pheochromocytoma
Acknowledgments
Editor’s Note
References
Index