Primary Management in General, Vascular and Thoracic Surgery: A Practical Approach

✍ Scribed by Daniele Bissacco, Alberto M. Settembrini, Andrea Mazzari

• Publisher: Springer
• Year: 2022
• Tongue: English
• Leaves: 240
• Category: Library

✦ Synopsis

“Thinking as a specialist, acting as an ER doctor”

The emergency setting remains one of the most important parts of daily clinical practice for surgeons. Moreover, the triage surgeon may be faced with complicated patients, who are often suffering from a wide range of diseases and emerging conditions. To this end, the emergency surgeon must know how to interpret the symptoms/signs of each condition and initiate appropriate management before directing the patient to the most correct path and specialist.  Although several books have been published concerning a specific surgical field (e.g. emergencies in vascular, thoracic or general surgery), this book provides a concise and quick point of view describing the clinical and instrumental surgical pictures in all vascular, thoracic, and general surgical emergencies. This approach can be useful in gaining a practical understanding of different clinical scenarios in order to adopt a correct management and treatment. It offers a simple guide to discriminating between urgent and non-urgent conditions, avoiding unnecessary diagnostic and interventional workup. This book would like to be a practical help also for general practitioners and emergency physicians to learn more about primary management of life threatening pathologies.

✦ Table of Contents

Preface
Contents
1: Historical Overview
1.1 New Science
1.2 Young People in Science
Part I: Surgical Instruments and Materials
2: Surgical Instruments and Materials in General Surgery
2.1 Cut and Dissect Instruments
2.1.1 Monopolar Electrosurgery
2.1.2 Bipolar Electrosurgery
2.1.3 Ultrasonic Energy
2.1.4 Radiofrequency Energy
2.2 Grasp and Hold Instruments
2.3 Clamp Instruments
2.4 Suture Instruments
2.5 Suction Instruments
2.6 Surgical Staplers and Clips
2.7 Retractors
2.8 Laparoscopic Surgery
References
3: Surgical Instruments and Materials in Thoracic Surgery
3.1 Thoracentesis
3.2 Tube Thoracostomy
3.3 Thoracotomy
3.4 Video-assisted Thoracic Surgery (VATS)
Further Reading
4: Surgical Instruments and Materials in Vascular Surgery
4.1 Introduction
4.1.1 Open Surgery
4.1.2 Endovascular Surgery
4.1.3 Hybrid Surgery
References
Part II: Neck
5: Supra-aortic Trunks Emergency Conditions
5.1 Introduction
5.2 Anatomy of Supra-aortic Trunks
5.3 Stroke
5.4 Internal Carotid Artery Stenosis
5.4.1 Etiology
5.4.2 Asymptomatic and Symptomatic Patients
5.4.3 Clinical Presentation
5.4.4 Diagnosis
5.4.5 Treatment
5.4.5.1 Complication Following Carotid Intervention
5.5 Carotid Artery Dissection
5.5.1 Etiology
5.5.2 Clinical Presentation
5.5.3 Diagnosis
5.5.4 Treatment
5.6 Vertebral Artery Disease
5.6.1 Etiology
5.6.2 Clinical Presentation
5.6.3 Diagnosis
5.6.4 Treatment
5.7 Vascular Injuries to the Cervical Vessels
5.7.1 Etiology
5.7.2 Clinical Presentation
5.7.3 Diagnosis
5.7.4 Treatment
References
6: Upper Airways Tract in Emergency Settings
6.1 Hemoptysis
6.1.1 Etiology
6.1.2 Clinical Presentation
6.1.3 Diagnosis
6.1.4 Treatment
6.2 Airway Obstruction
6.2.1 Etiology
6.2.2 Clinical Presentation
6.2.3 Diagnosis
6.2.4 Treatment
6.2.5 Main Causes of Airway Obstruction
6.2.5.1 Foreign Bodies’ Inhalation
6.2.5.2 Tracheal Stenosis
6.2.5.3 Malignant Airway Obstruction
6.3 Tracheobronchial Injuries
6.3.1 Etiology
6.3.2 Clinical Presentation
6.3.3 Diagnosis
6.3.4 Management
6.4 Pneumomediastinum
6.4.1 Etiology
6.4.2 Clinical Presentation
6.4.3 Diagnosis
6.4.4 Management
References
7: Multidisciplinary Surgical Consensus on Neck Emergencies
7.1 General Approach to Neck Emergencies
7.1.1 Airway Patency Assessment
7.1.2 Evaluation of Bleeding
7.1.3 Evaluation of a Possible Involvement of the Surrounding Tissues
7.2 Etiologies of Neck Emergencies
7.2.1 Traumatic Neck Emergencies
7.2.2 Remember
7.2.2.1 Extrinsic Forces
7.2.2.2 Intrinsic Forces
Foreign Bodies
7.2.2.3 Caustics
7.2.2.4 Non-traumatic Neck Emergencies
7.2.3 Infections
7.2.4 Malignant
7.2.5 Emergencies Occurring in Patients with Tracheostomy Tube
7.2.5.1 Obstruction
7.2.5.2 Bleeding
7.2.5.3 Infection
7.2.5.4 Dislodgment
7.2.5.5 Tracheal stenosis
References
Part III: Chest
8: Chest: Surgical Anatomy and General Consideration in Emergency Settings
8.1 Chest Wall Surface Landmarks
8.2 Muscles of the Chest Wall
8.3 Anatomy of the Intercostal Space
8.4 Anatomy of the Pleura
8.5 Anatomy of the Lungs
8.6 Anatomy of the Mediastinum
Further Reading
9: Acute Aortic Syndromes and Thoracic Aortic Aneurysms: From Diagnosis to Treatment
9.1 Introduction
9.2 Anatomical Classification
9.3 Temporal Classification
9.4 Clinical Presentation
9.5 Diagnosis
9.6 Primary Management
9.6.1 Initial Management in Case of Stable and Uncomplicated Patients
9.6.2 Initial Management in Case of Unstable and Complicated Patients
9.7 Principles of Surgical Treatment
9.7.1 Type A Aortic Dissection
9.7.2 Type B Aortic Dissection
9.7.3 Penetrating Aortic Ulcer and Intramural Hematoma
9.7.4 Thoracic Aortic Aneurysm
9.8 Conclusions
References
10: Pulmonary and Thoracic Emergencies
10.1 Pneumothorax
10.1.1 Etiology
10.1.1.1 Primary Spontaneous Pneumothorax (PSP)
10.1.1.2 Secondary Spontaneous Pneumothorax (SSP)
10.1.1.3 Non-spontaneous Pneumothorax
10.1.2 Signs and Symptoms
10.1.3 Diagnosis
10.1.4 Management and Treatment [9, 10]
10.2 Pleural Effusion
10.2.1 Etiology
10.2.2 Signs and Symptoms
10.2.3 Diagnosis
10.2.4 Management and Treatment
10.2.5 Hemothorax
10.2.6 Empyema
10.2.7 Chylothorax
10.3 Trauma: Rib Fractures, Sternal Fractures, Diaphragm Injury
10.3.1 Rib Fractures
10.3.2 Sternal Fractures
10.3.3 Diaphragm Injuries
References
11: Upper Gastrointestinal Tract Acute Conditions
11.1 General Approach to Upper Gastrointestinal Bleeding
11.1.1 Assessment of Hemodynamic Stability
11.1.2 Diagnostic Studies
11.2 Etiologies of Upper Gastrointestinal Bleeding and Therapeutic Approach
11.2.1 Esophagus
11.2.2 Stomach
11.2.3 Duodenum
11.3 General Approach to Upper Gastrointestinal Perforation
11.3.1 Assessment of Hemodynamic Stability
11.3.2 Diagnostic Studies
11.4 Etiologies of Upper Gastrointestinal Perforation and Therapeutic Approach
11.4.1 Esophagus
11.4.2 Stomach
11.4.3 Duodenum
11.5 General Approach to Upper Gastrointestinal Ingestion of Foreign Bodies and Food Impactions
11.5.1 Assessment of Hemodynamic Stability
11.5.2 Diagnostic Studies
11.5.2.1 Esophagus
11.5.2.2 Stomach
11.6 Etiologies and Therapeutic Approach
11.6.1 Esophagus
11.6.2 Stomach and Proximal Duodenum
11.7 Ingestion of Caustics
References
12: Multidisciplinary Surgical Consensus on Chest Emergencies
12.1 Spontaneous Esophageal Injuries
12.1.1 Signs and Symptoms
12.1.2 Diagnosis
12.1.3 Thoracic Treatments
12.2 Conclusion
References
Part IV: Abdomen
13: Abdomen: Surgical Anatomy and General Consideration in Emergency Settings
13.1 Basic Surgical Abdominal Anatomy
13.1.1 Surface Anatomy of the Abdomen and Abdominal Wall
13.1.1.1 Boundaries
13.1.1.2 Lines and Planes
13.1.1.3 Regions of the Abdomen
13.1.1.4 Abdominal Wall
13.1.1.5 Inguinal Canals
13.2 Initial Assessment of the Patient with Abdominal Pain
13.2.1 Assessment of the Patient’s Pain [2]
13.2.2 Physical Examination
13.2.3 Approach to the Unstable Patient [3]
13.2.4 Diagnostic Studies
13.3 Some Useful Considerations in Emergency Setting
13.3.1 Timing of Surgery
13.3.2 Role of Laparoscopy in Emergency Setting
13.3.3 Final Consideration
References
14: Acute Abdominal Aorta and Visceral Vessel Disease
14.1 Introduction
14.2 Acute Abdominal Aorta
14.2.1 Abdominal Aortic Aneurysm
14.2.2 Penetrating Atherosclerotic Ulcer
14.2.3 Intramural Hematoma
14.2.4 Aortic Dissection
14.3 Abdominal Visceral Vessel Disease
14.3.1 Mesenteric Ischemia
14.3.2 Visceral Artery Aneurysms
References
15: Acute Abdomen and Acute Abdominal Conditions
15.1 Acute Calculus Cholecystitis
15.1.1 Introduction
15.1.2 Diagnostic Criteria for ACC
15.1.3 Which Initial Imaging Technique Should Be Used in Case of a Suspected Diagnosis of ACC?
15.1.4 Stratification of the Risk and Severity of ACC
15.1.5 When ACC Was Associated Common Bile Duct Stones: Which Tools to Use for Suspicion and Diagnosis at Presentation?
15.1.6 Surgical Treatment of ACC
15.1.7 Alternative Treatment for Patients with ACC: Observation and Techniques for Gallbladder Drainage
15.1.8 Antibiotic Therapy
15.2 Acute Colonic Diverticulitis
15.2.1 Introduction
15.2.2 Which Classification Should Be Used in Patients with ALCD?
15.2.3 The Diagnosis of ALCD
15.2.4 The Nonoperative Treatment
15.2.4.1 Stage 0: Uncomplicated Acute Diverticulitis
15.2.4.2 Stage 1 and 2: Locally Complicated Acute Diverticulitis
15.2.4.3 Stage 2b: The Role of Nonoperative Treatment
15.2.5 Operative Treatment
15.2.5.1 Stage 3 and 4
15.2.6 The Planning Elective Resection in Cases of Acute Diverticulitis Treated Nonoperatively
15.2.7 Antibiotic Therapy
15.3 Sigmoid Volvulus
15.3.1 Introduction
15.3.2 Diagnosis
15.3.3 Management
15.3.3.1 Nonoperative Treatment
15.3.4 Operative Treatment
15.3.4.1 Urgent Setting
15.3.4.2 Elective Setting
15.4 Acute Appendicitis
15.4.1 Introduction
15.4.2 Classification
15.4.3 Diagnosis and Indication
15.4.4 Diagnostic Scores (Tables 15.7 and 15.8)
15.4.5 Therapy
15.4.6 Tips and Tricks for Laparoscopic Appendectomy
15.4.6.1 Patients Position
15.4.6.2 Trocars Position
15.4.6.3 Diagnostic Laparoscopy
15.4.6.4 Mesoappendix Dissection
15.4.6.5 Stapler vs Endoloop for Stump Closure
15.4.6.6 Vesical Catheter
15.4.6.7 Drainage
15.4.6.8 SILA (Single Incision Laparoscopic Appendectomy)
15.5 Acute Presentation of Abdominal Wall Disease
15.5.1 Epidemiology and Clinical Presentation
15.5.2 Diagnosis
15.5.2.1 Blood Exam
15.5.2.2 Radiological Exams
15.5.3 Surgery for Hernias
15.5.4 Surgery for Urgent Groin Hernia
15.5.5 Incisional and Other Midline Hernias
15.6 Anorectal Emergencies
15.6.1 Introduction
15.6.2 Acute Thrombosed External Hemorrhoids
15.6.3 Thrombosed Internal Hemorrhoids
15.6.4 Rectal Bleeding
15.6.5 Anal Fissure
15.6.6 Anorectal Abscess
15.6.7 Rectal Prolapse
15.6.8 Bowel Obstruction
15.6.8.1 Introduction
15.6.9 Diagnosis
15.6.10 Therapy
15.6.10.1 Conservative Treatment
15.6.10.2 Surgery
References
16: Abdominal Emergencies Requiring a Multidisciplinary Approach
16.1 Aortoenteric Fistula Clinical Case
16.1.1 Introduction
16.1.2 Pathogenesis
16.1.3 Clinical Presentation
16.1.3.1 Diagnosis
16.1.4 Decision-Making
16.1.5 Vascular Management
16.1.6 Bowel Reconstruction
16.1.7 Postoperative Time and Long-Term Follow-up
16.1.8 Take-home Messages (Fig. 16.4)
16.2 Acute and Chronic Mesenteric Ischemia Clinical Case
16.2.1 Introduction
16.2.2 Mesenteric Collateral Patterns
16.2.3 Pathogenesis
16.2.4 Clinical Presentation
16.2.5 Diagnosis
16.2.6 Treatment
16.2.7 Damage Control Surgery
16.2.8 Postoperative Management
References
Part V: Upper and Lower Limbs
17: Upper and Lower Limbs: Surgical Anatomy and General Consideration in Emergency Settings
17.1 Introduction
17.2 Emergency Settings
17.2.1 Signs of Vascular Lesions in Trauma Patients
17.2.2 Signs of Vascular Lesions in Non-trauma Patients
17.3 Diagnosis
17.3.1 Ischaemic Limb
17.3.2 Haemorrhagic Limb
17.4 Decision-making and Initial Management
17.4.1 Ischaemic Limb
17.4.2 Haemorrhagic Limb
References
18: Acute and Chronic Limb Ischemia
18.1 Introduction
18.2 Multimodal Approach to ALI and CLI
18.3 Diagnostic Imaging
18.4 Surgical Approach to ALI and CLI
18.5 Operating Theater Requirements
18.6 Glossary of Most Common Procedure Using in Acute and Chronic Limb Treatment
18.6.1 Thrombus Management
18.6.2 Atherosclerotic Lesions Management
Further Reading
19: Popliteal Artery Aneurysm and Non-atherosclerotic Limb Disease
19.1 Thoracic Outlet Syndrome (TOS)
19.1.1 Clinical Evaluation and Decision-Making
19.1.2 Treatment
19.2 Adventitial Cystic Lesion of Popliteal Artery
19.2.1 Clinical Evaluation and Decision-Making
19.2.2 Treatment
19.3 Popliteal Entrapment
19.3.1 Clinical Evaluation and Decision-Making
19.4 Popliteal Artery Aneurysm
19.4.1 Clinical Evaluation and Decision-Making
19.4.2 Treatment
19.4.3 BOX Indication for PA Treatment
19.4.4 BOX indications for type of PA treatment
19.4.4.1 Endovascular IF
19.4.4.2 Open Surgery
References
Part VI: Specific Clinical Pictures: Surgeon Perspectives
20: The Infected and Septic Patient
20.1 Infection and Sepsis
20.1.1 Definitions
20.2 Epidemiology
20.2.1 Incidence
20.2.2 Pathogens
20.3 Pathophysiology
20.4 Disease Severity
20.5 Risk Factors
20.6 Clinical Presentation and Diagnosis
20.6.1 Symptoms and Signs
20.6.2 Laboratory Signs
20.6.3 Imaging
20.6.4 Microbiology
20.6.5 Diagnosis
20.6.6 Initial Evaluation of Common Sources of Sepsis: Symptoms/Signs
20.6.7 Initial Microbiologic Evaluation
20.7 Prognosis
20.8 Management of Sepsis and Septic Shock
20.8.1 Initial Resuscitation
20.8.2 Specimen Analysis
20.8.3 Antimicrobial Therapy
20.8.4 Vasoactive Medications and Corticosteroids
20.8.5 Venous Thromboembolism Prophylaxis and Stress Ulcer Prophylaxis
References
21: Hemorrhagic Patient
21.1 Diagnosis and Management
21.2 Imaging
21.3 Lab Tests
21.4 Treatment
21.5 Conclusions
References
22: The Polytrauma Patient
22.1 Introduction
22.2 Signs and Symptoms
22.3 Diagnosis
22.3.1 Briefly
22.4 Therapy
22.5 Diagnostic Algorithm (Fig. 22.2)
References