Difficult Decisions in Trauma Surgery: An Evidence-Based Approach (Difficult Decisions in Surgery: An Evidence-Based Approach)

✍ Scribed by Kenneth Wilson (editor), Selwyn O. Rogers (editor)

• Publisher: Springer
• Year: 2021
• Tongue: English
• Leaves: 443
• Category: Library

✦ Synopsis

This book provides a practical guide to decision making within the realm of trauma surgery. Each chapter covers the ideal approach, rather than customary care, for the treatment of the chosen difficult decision or controversy. A broad range of topics are covered with particular attention given to resuscitation, wound management, thoracic and abdominal trauma, antimicrobial management, transplant considerations, vascular trauma, traumatic brain injury, pediatric trauma and ethics.
Difficult Decisions in Trauma Surgery aims to help improve the treatment of trauma patients and is relevant to surgical trainees and practicing surgeons, and as well as medical professionals working within trauma medicine.

✦ Table of Contents

Preface
Acknowledgement
Contents
Part I: Resuscitation
1: Difficult Decisions in Trauma: Is ABC the Right Mantra?
Introduction
Search Strategy
Results
Military Experience
Circulation First
Pre-hospital/ER/OR Intubation
Recommendations Based on Data
Summary of Recommendations
Personal View of the Data
References
2: Difficult Decisions in Trauma Surgery: What Is the Clinical Impact of Whole Blood as Compared to Component Therapy in Civilian Trauma?
Introduction
PICO Questions and Search Strategy
Results
Results for Mortality (PICO 1)
Qualitative Synthesis
Quantitative Synthesis
Grading the Evidence
Results for Any Complications (PICO 2)
Qualitative Synthesis
Quantitative Synthesis
Grading the Evidence
Results for Whole Blood Transfusion in Women of Childbearing Age (PICO 3)
Qualitative Synthesis
Recommendations Based on the Data
Summary of Recommendations
Personal View of the Data
References
3: Helicopter Emergency Medical Services in Trauma
Introduction
Search Strategy
Results
Transport Time
Triage
Scope of Practice
Cost and Safety
Recommendations Based on the Data
Personal View of the Data
References
4: Futility of Care in Hemorrhagic Shock: When Prolonging the Massive Transfusion Protocol Is of No Benefit
Introduction
Futility in the Context of Massive Transfusion Protocol
Search Strategy
Markers of Futility in the General Trauma Population
Markers of Futility in Unique Populations
Geriatric
Pediatric
Resource Constrained Environments
Recommendations Based on the Data
Summary of Recommendations
A Personal View of the Data
References
5: Is it Time for REBOA to be Considered as an Equivalent to Resuscitative Thoracotomy?
Introduction
Search Strategy
PICO
Procedural Complexity: Who Can Perform What?
The Ideal Setting: Where and When Should the Intervention Occur?
Hemorrhage Control in Austere Environments
In-Hospital Management: When to Inflate or Directly Operate?
Catch-22: Anatomic Indication Does Not Necessarily Imply Physiologic Indication!
In-Hospital Outcomes: What the Evidence Suggests?
Complications and Limitations
Recommendations Based on the Data
Summary of Recommendations
Personal View of the Data
References
Part II: Wound Management
6: In Patients with Traumatic Extremity Wounds Is Negative Pressure Wound Therapy Superior as Compared to Standard Dressing Changes?
Introduction
Search Strategy
Results
The Advent of Negative Pressure Wound Therapy
Impact on Wound Healing
Effect on Hospital Length of Stay
Influence on Infectious Complications
Role in Quality of Life
Recommendations Based on the Data
Summary of Recommendations
A Personal View of the Data
References
7: Enterocutaneous Fistula Management in Trauma
Introduction
Search Strategy
Results
Fistulas: Patience, Do Not Panic
Fistulas in the Open Abdomen
Long-Term Maintenance
Surgical Management
Recommendations Based upon the Data
Summary of Recommendations
A Personal View of the Data
References
Part III: Antimicrobial Management
8: Does Prophylactic Antibiotics for Emergent Tube Thoracostomy Decrease Rates of Infection?
Introduction
Search Strategy
Results
Duration of Antibiotics
Antibiotic Selection
Recommendations Based on the Data
Summary of Recommendations
Personal View of the Data
References
9: Antibiotics Prophylaxis after Penetrating Colon Injuries
Introduction
Search Strategy
Results
Recommendations Based Upon Data
Summary of Recommendations
Personal View of the Data
References
10: Antibiotic Regimen in Treating Complicated Intra-abdominal Infections
Introduction
Search Strategy
Results
Antibiotic Choice
Favorable Clinical and Microbiological Response
Mortality
Adverse Events
Duration of Antibiotic Therapy
Antibiotic-Free Days
Recurrent Infection and Extra-Abdominal Infection
Need for Additional Source Control
Mortality
Emergence of Resistant Organisms
Recommendations Based on Data
Antibiotic Choice
Duration of Therapy
Personal View of the Data
References
11: Is Vaccine Prophylaxis Necessary for Patients Undergoing Splenic Embolization?
Introduction
Search Strategy
Results
Recommendations
A Personal Approach to the Data
References
Part IV: Trauma Imaging
12: The Trauma Pan-Scan: Who Benefits from Immediate Whole-Body Imaging?
Introduction
Search Strategy
Results
Overall Survival
Decreased Time to Care
Impact of WBCT on Cost and Length of Stay
Injury Severity Score
Low-Velocity Blunt Trauma
Hemodynamic Stability
Recommendations Based on Data
Summary of Recommendations
Personal View of Data
References
13: Nonselective Arterial Embolization for Pelvic Fractures
Introduction
Results
Anatomic Considerations
Pelvic Ring
Pelvic Fracture Classification
Use of Angioembolization
Arterial Angioembolization Technique
Timing of Arterial Angioembolization
Selective Versus Nonselective Angioembolization Indications
Complications
Recommendations Based Upon the Data
Summary of the Data
Personal View of the Data
References
14: Clinical Clearance of the Cervical Spine in the Presence of a Distracting Injury
Introduction
Literature Review Process
Summary of Evidence
Guidelines
Recommendations
Personal Perspective
References
15: MRI Clearance for the Cervical Spine
Introduction
Search Strategy
Results
MRI Screening
Timing and Risk of MRI Clearance of C-Spine
Recommendations Based on the Data
Summary of Recommendations
Personal View of the Data
References
Part V: Traumatic Brain Injury
16: ECMO Safety in the Setting of Traumatic Brain Injury
Introduction
Search Strategy
Recommendations Based on the Data
Summary of Recommendations
A Personal View of the Data
References
17: Can Abdominal Decompression Improve Refractory Intracranial Hypertension?
Introduction
Search Strategy
Results
Management of Elevated Intracranial Pressure and Intracranial Hypertension
Pathophysiology of Elevated Intra-Abdominal Pressure
Our Novel Approach
Multicompartment Syndrome
Recommendations Based on the Data
Summary of Recommendation
A personal View of the Data
References
18: Is There an Optimal Screening Tool to Best Diagnose and Treat Blunt Cerebrovascular Injury (BCVI)?
Introduction
Search Strategy
Screening Tools
Computed Tomography Angiography (CTA)
Duplex Ultrasound
Four Vessel Arteriography
Diagnosis of BCVI
Treatment
Recommendation Based Upon the Data
Summary of Recommendations
Personal View of the Data
References
Part VI: Abdominal Trauma
19: Does Specific Sequencing of Operative Interventions in Thoracoabdominal Trauma Improve Outcomes?
Introduction
Search Strategy
Results
Presentation and Diagnosis
Recommendations Based on the Data
Summary of Recommendations
A Personal View of the Data
References
20: Selective Non-operative Management for Abdominal Gunshot Wounds
Introduction
Search Strategy
Results
Patient Selection
Importance of Imaging
Importance of the Observation Period
Evidence Validating Safety and Efficacy of SNOM
Recommendation Based on the Data
References
21: What Is the Optimal Management of Traumatic Duodenal Injury?
Introduction
Search Strategy
Results
Imaging
Duodenal Hematoma
Historical Procedures
Pyloric Exclusion
Primary Repair
Drain Placement
Pancreaticoduodenectomy
Enteric Feeding
Imaging Surveillance
Recommendations Based Upon the Data
A Personal View
References
22: Timing of Ostomy Reversal in Trauma and Acute Care Surgery
Introduction
Search Strategy
Results
Early Versus Delayed Stomal Closure for Trauma Patients Requiring Fecal Diversion with an Ileostomy
Early Versus Delayed Stomal Closure for Trauma Patients Requiring Fecal Diversion with a Colostomy
Early Closure Versus Delayed Closure for General Surgery (Emergency and Colorectal) Patients Requiring Fecal Diversion with Ileostomy
Early Closure Versus Delayed Closure for General Surgery (Emergency and Colorectal) Patients Requiring Fecal Diversion with Colostomy
Systematic Reviews for Early Closure Versus Delayed Closure
Examining the Need for Diverting or “Protective” Ostomies
Recommendations Based on Data
Personal View of Data
References
Part VII: Thoracic Trauma
23: Resuscitative Thoracotomy
Introduction
Search Strategy
Results
Summary of Available Evidence
Recommendations Based on the Data
Summary of Recommendations
Personal View of the Data
References
24: Extracorporeal Membrane Oxygenation for Patients with Traumatic Injury and Respiratory Failure
Introduction
Search Strategy
Results
Modes and Configurations
Evidence for ECMO in All-Cause ARDS
All-Cause ARDS Literature
Global Indications and Contraindications
Direct Pulmonary Trauma
Hemorrhage, Thrombosis, and Anticoagulation Management
ECMO for Traumatic Brain Injury and Respiratory Failure
Respiratory Failure After Burn Injury
Operative Procedures on ECMO
ECMO Transport
Recommendation Based on the Data
Summary of Recommendations
A Personal View of the Data
References
25: Is There a Gold Standard for Screening Blunt Cardiac Injury?
Introduction
Search Strategy
Results
Screening for Blunt Cardiac Injury
Use of FAST
Treatment of BCI
Recommendations Based on the Data
Summary of Recommendation Options
A Personal View of the Data
References
26: Optimal Chest Tube Size for Hemothorax Evacuation
Introduction
Search Strategy
Results
Hemothoraces
Management
Pigtail Catheters
Retained Hemothorax
Recommendation Based on the Data
Summary of Recommendations
References
27: Tissue Plasminogen Activator (tPA) for Post-traumatic Retained Hemothorax
Introduction
Search Strategy
Results
Preliminary Evidence for Intrapleural Fibrinolytic Therapy
Results
Recommendations Based on the Data
Personal View of the Data
References
28: Rib Plating in the Acute Trauma Setting
Introduction
Search Strategy
Results
Study Designs
Randomized Trials
Systematic Reviews
Outcomes
Mortality
Duration of Mechanical Ventilation
Length of Intensive Care
Length of Hospitalization
Incidence of Pneumonia/ARDS
Tracheostomy
Cost Effectiveness
Timing of Surgery
Indications for Rib Fracture Fixation in Patients Without Flail Chest
Recommendations Based on the Data
A Personal View of the Data
References
29: Does Thoracic Irrigation at the Time of Chest Tube Placement Decrease the Incidence of a Retained Hemothorax?
Introduction
Search Strategy
Results
Irrigation with Initial Tube Thoracostomy
Recommendations Based on the Data
A Personal View on the Data
References
30: The Timing of VATS for a Retained Hemothorax
Introduction
Search Strategy
Results
Recommendations Based on the Data
Review of Recommendations
Personal View of the Data
Bibliography
Part VIII: Ethics
31: Donation After Cardiac Death in the Emergency Department
Introduction
Search Strategy
Results
Recommendations Based on the Data
Summary of Recommendation
A Personal View of the Data
References
32: Resuscitative Thoracotomy for Organ Donation
Introduction
Search Strategy
Results
Early Feasibility Studies for Feasibility of Organ Donation in Trauma Patients
Effects of Race on Organ Donation
Organ Donation Following Traumatic Cardiac Arrest is Infrequent
Organ Donation Following RT is Infrequent
FAST Examination May Predict Successful Organ Donation Following RT
Recommendations Based on the Data
A Personal View to the Data
References
33: Resilience Training for the Trauma Surgeon
Introduction
“Resilience”
“Burnout”
“Moral Distress”
“Compassion Fatigue”
“Trauma”
“Trauma Informed Care”
Search Strategy
Results
Existing Guidelines and Recommendations
Recommendations Based on the Data
Summary of the Data
A Personal View on the Data
References
34: Youth Violence Prevention: Violence Recovery Programs
Introduction
Search Strategy
The Results
Recommendations Based on the Data
Summary of Recommendations
A Personal View of the Data
References
Part IX: Peripheral Vascular Trauma
35: Are Temporary Vascular Shunts (TVS) Effective Damage Control Adjuncts for Limb Salvage?
Introduction
Search Strategy
Results
Is It Safe to Deploy TVS in a Far-Forward Setting?
TVS and Military Amputation Rates
Blast Injuries Amputation Rates
TVS in the Civilian Setting
Civilian Amputation Rates
Penetrating Civilian Trauma
Mangled Extremity
Timing of TVS Placement
Maximum Duration of TVS Deployment
Recommendations Based on the Data
Review of Recommendations
A Personal View of the Data
Bibliography
36: Difficult Decisions in Surgery: An Evidence-Based Approach Limb Salvage for the Mangled Extremity
Introduction
Search Strategy
Results
What Is a Mangled Extremity?
Scoring/Tools for Classification of Mangled Extremities
Decision-Making and Outcome Predictors
Extent of the Local Injury
Vascular Injuries
Nerve Injuries
Concomitant Injury Pattern and Shock
Age and General Health Conditions
Patients’ Preferences
Reconstruction and Delayed Amputation
Outcome
Mangled Upper Limb Injuries
Recommendations Based on the Data
Summary of Recommendations
A Personal View of the Data
References
Part X: Pediatric Trauma
37: The Use of FAST in the Pediatric Trauma Setting
Introduction
Search Strategy
Results
Missed Injuries
CT Use
Cost
Need for Significant Intervention/Operation
Emergency Department Length of Stay
Overall Length of Stay
Recommendations Based on the Data
Summary of Recommendations
A Personal View of the Data
References
38: Selective Nonoperative Management of Children with Penetrating Abdominal Trauma
Introduction
Search Strategy
Results
Review of the Literature
Recommendations Based on the Data
Criteria for Selective NOM
NOM of the Stable Pediatric Patient
Safety and Efficacy of Selective NOM for Pediatric Penetrating Abdominal Trauma
Review of Recommendations
A Personal View of the Data
Appendix
References
39: Are Outcomes Equivalent for Injured Children Treated at Pediatric Versus Adult Trauma Centers, and What Are the Implications with Respect to the Design of Optimal Trauma Systems?
Introduction
Search Strategy
Results
Recommendations Based on the Data
Summary of Recommendations
Rank Preferences
A Personal View of the Data
References
Index