Download Manual of Definitive Surgical Trauma Care, Fifth Edition Free PDF


Developed for the International Association for Trauma Surgery and Intensive Care (IATSIC), the Manual of Definitive Surgical Trauma Care 5e is ideal for training all surgeons who encounter major surgical trauma on an infrequent basis.
This fifth edition had been revised and updated on the basis of new evidence-based information. The increasing role of non-operative management (NOM) has been recognised. With the increased need for humanitarian intervention, as well as military peacekeeping, the Military Module has been substantially updated and broadened to reflect recent conflict experience, and a new expanded section highlighting trauma management under austere conditions has been added.Written by faculty who teach the DSTC Course, this book focuses on life-saving surgical techniques to use in challenging and unfamiliar incidents of trauma.

Table of contents :
Cover......Page 1
Half Title......Page 2
Title Page......Page 4
Copyright Page......Page 5
Dedication......Page 6
Contents......Page 8
Video Contents......Page 26
Preface......Page 28
Training in the Initial Management of Severe Trauma......Page 32
The DATC™ Course......Page 34
Summary......Page 35
Board of Contributors......Page 36
Acknowledgements......Page 42
About the Author......Page 44
Part 1: Trauma System and Communication Principles......Page 46
1.2.1 Individual Factors......Page 48
1.2.3 Performance Improvement Activities......Page 50
1.2.5 National Activities......Page 51
1.2.6 Global Activities......Page 52
1.4 Conclusion......Page 53
2.1.1 The ‘Swiss Cheese’ Theory......Page 56
2.2.2 Resuscitation and Ongoing Management......Page 57
2.3 Leadership in Trauma Care......Page 58
2.5 Summary......Page 60
3.2.1 Resuscitation......Page 62
3.2.2 Management of Penetrating Trauma......Page 67
3.3.2 Chest Trauma......Page 68
3.3.5 Long Bone Fractures......Page 69
3.4 Summary......Page 70
Part 2: Physiology and the body's Response to Trauma......Page 72
4.1.2 Initiating Factors......Page 74
4.1.3 Immune Response......Page 75
4.1.4 Hormonal Mediators......Page 78
4.1.5 Effects of the Various Mediators......Page 79
4.2.2 Classification of Shock......Page 81
4.2.3 Measurements in Shock......Page 85
4.2.4 Endpoints in Shock Resuscitation......Page 86
4.2.5 Post-Shock and Multiple Organ Failure Syndromes......Page 87
4.2.6 Management of the Shocked Patient......Page 88
4.2.8 Recommended Protocol for Shock......Page 91
5.2.2 Blood......Page 94
5.2.3 Component Therapy (Platelets, Fresh Frozen Plasma, Cryoprecipitate)......Page 95
5.3.4 Coagulation Abnormalities......Page 96
5.3.5 Other Risks of Transfusion......Page 97
5.4.3 Transfusion Thresholds......Page 98
5.4.6 Monitoring the Coagulation Status: Traditional and VHA......Page 99
5.6 Red Blood Cell Substitutes......Page 104
5.6.3 Future Evolution......Page 105
5.8.1 Overview......Page 106
5.8.2 Tissue Adhesives......Page 108
5.8.3 Other Haemostatic Adjuncts......Page 109
6.1 Introduction......Page 112
6.3 Damage Control Surgery......Page 113
6.3.1 Stage 1: Patient Selection......Page 114
6.3.2 Stage 2: Operative Haemorrhage and Contamination Control......Page 115
6.3.3 Stage 3: Physiological Restoration in the ICU......Page 118
6.3.5 Stage 5: Abdominal Wall Closure......Page 120
6.4 Damage Control Orthopaedics......Page 122
Part 3: Anatomical and Organ System Injury......Page 124
7.2.1 Initial Assessment and Definitive Airway......Page 126
7.2.3 Injury Location......Page 127
7.3.1 Mandatory versus Selective Neck Exploration......Page 128
7.4.2 Incision......Page 129
7.4.3 Surgical Access......Page 130
7.4.4 Priorities......Page 131
7.4.5 Midline Visceral Structures......Page 132
7.4.8 Vertebral Arteries......Page 133
8.2.2 Potentially Life-Threatening Injuries......Page 136
8.3.1 Paediatric Considerations......Page 137
8.4.3 The Chest Contents......Page 138
8.5 Diagnosis......Page 140
8.6.3 Tension Pneumothorax (Haemo/­Pneumothorax)......Page 141
8.6.6 Oesophageal Injuries......Page 142
8.6.12 Air Embolism......Page 143
8.6.13 Cardiac Injuries......Page 145
8.7.1 Drain Insertion......Page 146
8.8 Surgical Approaches to the Thorax......Page 149
8.8.1 Anterolateral Thoracotomy......Page 150
8.8.2 Median Sternotomy......Page 151
8.9.1 History......Page 152
8.9.3 Indications and Contraindications......Page 153
8.9.6 Technique......Page 154
8.10.2 Cardiac Injury......Page 155
8.10.5 Lobectomy or Pneumonectomy......Page 156
8.12.1 Penetrating Thoracic Injury......Page 157
8.12.2 Blunt Thoracic Injury......Page 158
8.13 Anaesthetic Considerations......Page 159
9.1.1.1 Difficult Abdominal Injury Complexes......Page 162
9.1.1.3 Non-Operative Management of Penetrating Abdominal Injury......Page 163
9.1.2.1 Pre-Operative Adjuncts......Page 164
9.1.2.2 Draping......Page 165
9.1.2.4 Initial Procedure......Page 166
9.1.2.5 Perform a Trauma Laparotomy......Page 167
9.1.2.6 Perform Definitive Packing......Page 169
9.1.2.7 Specific Routes of Access......Page 170
9.1.2.8 Specific Organ Techniques......Page 172
9.1.3.3 Primary Closure......Page 173
9.1.4.3 Table Tilt......Page 174
9.1.4.8 Drains......Page 175
9.1.4.12 Early Tracheostomy......Page 176
9.1.6 Summary......Page 177
9.2.1 Overview......Page 178
9.2.2.3 Pelvic Haematoma......Page 179
9.2.3.2 Medial Visceral Rotation......Page 180
9.2.3.4 Superior Mesenteric Artery......Page 181
9.2.3.8 Inferior Vena Cava......Page 182
9.2.4 Shunting......Page 184
9.3.2 Diaphragm......Page 186
9.3.5 Small Bowel......Page 188
9.3.6 Large Bowel......Page 189
9.3.8 Mesentery......Page 190
9.3.9.1 Antibiotics......Page 191
9.4.1 Overview......Page 192
9.4.4 Liver Injury Scale......Page 194
9.4.5.1 Subcapsular Haematoma......Page 196
9.4.5.2 Non-Operative Management (NOM)..5.,.6......Page 197
9.4.6.1 Incision......Page 198
9.4.6.3 Techniques for Temporary Control of Haemorrhage......Page 199
9.4.6.4 Mobilization of the Liver......Page 202
9.4.7 Perihepatic Drainage......Page 203
9.4.8 Complications......Page 204
9.4.11 Injury to the Bile Ducts and Gallbladder......Page 205
9.4.12 Anaesthetic Considerations......Page 206
9.5.3.1 Clinical......Page 207
9.5.6 Surgical Approach......Page 208
9.5.6.7 Splenectomy......Page 211
9.5.8 Opportunistic Post-Splenectomy Infection......Page 212
9.6.1 Overview......Page 213
9.6.4.2 Serum Amylase and Serum Lipase......Page 214
9.6.4.8 Intra-operative Pancreatography......Page 215
9.6.6.1 Non-Operative Management......Page 216
9.6.7.2 Pancreatic Injury: Surgical Decision-Making......Page 217
9.6.10.1 Early Complications......Page 220
9.6.11 Summary of Evidence Based Guidelines......Page 221
9.7.3.1 Clinical Presentation......Page 224
9.7.5 Management......Page 225
9.7.6.1 Intramural Haematoma......Page 226
9.7.6.4 Complete Transection of the Duodenum......Page 227
9.7.6.8 Pyloric Exclusion......Page 228
9.8.2 Renal Injuries......Page 229
9.8.2.3 Management......Page 230
9.8.2.4 Surgical Approach......Page 232
9.8.2.5 Adjuncts......Page 234
9.8.3.2 Surgical Approach......Page 235
9.8.4.3 Surgical Approach......Page 236
9.8.5.3 Ruptured Urethra......Page 237
9.8.7.1 Management......Page 238
9.8.8 Injury of the Pregnant Uterus......Page 239
10.1 Anatomy......Page 240
10.2.1 Tile’s Classification......Page 241
10.2.2 Young and Burgess Classification......Page 243
10.3 Clinical Examination and Diagnosis......Page 245
10.4.2 Haemodynamically Stable Patients (Transient Responders)......Page 246
10.5.1 Iliac-Crest Route......Page 247
10.7 Extraperitoneal Pelvic Packing......Page 248
10.7.1 Technique of Extraperitoneal Packing......Page 249
10.8.5 Anorectal Injuries......Page 250
10.10 Summary......Page 251
11.2 Management of Severe Injury to the Extremity......Page 254
11.3 Management of Vascular Injury of the Extremity......Page 255
11.4 Crush Syndrome......Page 256
11.5.2 Sepsis and Antibiotics......Page 258
11.5.4 Timing of Skeletal Fixation in Polytrauma Patients......Page 259
11.6.1 Scoring Systems......Page 260
11.7 Compartment Syndrome......Page 262
11.8.1 Lower Leg Fasciotomy......Page 263
11.8.3 Upper and Lower Arm......Page 264
11.9 Complications of Major Limb Injury......Page 265
11.10 Summary......Page 266
12.2.2 Pathological Classification of TBI......Page 268
12.3.2 Intracranial Pressure......Page 269
12.6 Cerebral Perfusion Pressure Threshold......Page 270
12.7.2 ICP Management – Do’s and Don'ts......Page 271
12.9.1 Burr Holes and Emergency Craniotomy......Page 272
12.10.2 Seizure Prophylaxis......Page 274
12.13 Summary......Page 275
12.14 Anaesthetic Considerations......Page 276
13.3 Anatomy......Page 278
13.4.1 Chemical Burns......Page 279
13.4.2 Electrical Injury......Page 280
13.5.2 Superficial Partial Thickness......Page 281
13.6 Total Body Surface Area Burned......Page 282
13.7.2 First Aid......Page 283
13.7.3 Initial Management......Page 284
13.7.4 Escharotomy and Fasciotomy......Page 286
13.7.5 Definitive Management......Page 287
13.8.1 Face......Page 289
13.9.1 Nutrition in the Burned Patient......Page 290
13.9.5 Antibiotics......Page 291
13.10 Summary......Page 292
14.1.4 Resuscitation Room......Page 294
14.1.5 Specific Organ Injury......Page 295
14.1.6 Analgesia......Page 296
14.2.3 Physiology......Page 297
14.2.6 Decision to Operate......Page 298
14.4 Non-Beneficial (Futile) Care......Page 299
Part 4: Modern Therapeutic and Diagnostic Technology......Page 302
15.1.5 Technique......Page 304
15.1.7 Applications......Page 305
15.2.1 Technique......Page 306
15.3.1 Anatomy......Page 307
15.3.2 Physiology......Page 308
15.3.4 Monitoring......Page 309
15.3.7 Indications......Page 310
15.3.10 Summary......Page 311
15.4 Anaesthetic Considerations......Page 312
16.2 Radiation Doses and Protection from Radiation......Page 314
16.3 Principles of Trauma Imaging......Page 315
16.4 Pitfalls and Pearls......Page 316
16.5.2 Indications and Results......Page 317
16.5.4 Training......Page 318
16.5.5 Summary......Page 319
Part 5: Specialised Aspects of Total Trauma Care......Page 320
17.2.1 Resuscitative Phase (First 24 Hours Post-Injury)..1......Page 322
17.2.3 Prolonged Life Support (>72 Hours Post-Injury)......Page 323
17.2.4 Recovery Phase (Separation from the ICU)......Page 324
17.3.2 Modes of ECMO......Page 325
17.4 Coagulopathy of Major Trauma......Page 326
17.5 Hypothermia......Page 327
17.7 Systemic Inflammatory Response Syndrome (see also Chapter 4)......Page 328
17.9 Antibiotics......Page 329
17.10.1 Introduction......Page 336
17.10.4 Effect of Raised IAP on Individual Organ Function......Page 337
17.10.5 Measurement of IAP......Page 339
17.10.7 Surgery for Raised IAP......Page 340
17.13 Nutritional Support......Page 341
17.14.2 Deep Venous Thrombosis and Pulmonary Embolus......Page 344
17.15 Pain Control......Page 345
17.16.3 ICU Summary......Page 346
17.17 Family Contact and Support (see also Chapter 19)......Page 347
18.3 Damage Control Resuscitation......Page 350
18.3.1 Limited Fluid Administration......Page 351
18.3.3 Prevent and Treat Hypothermia......Page 352
18.4.1 Anaesthetic Procedures......Page 353
18.4.2 Monitoring......Page 354
18.5.2 Drugs for Anaesthesia Induction......Page 355
18.6.2 Battlefield Analgesia......Page 358
19.4 Trauma and ICU......Page 360
19.5.1 The Role of the Clinical Psychologist......Page 361
19.5.2 When to Call the Clinical Psychologist......Page 362
20.3 Rehabilitation Starts in ICU......Page 364
20.4.3 Rancho Los Amigos Scale......Page 365
20.5 Summary......Page 366
21.3 Infrastructure......Page 368
21.3.3 Health Protection of the Deployed Surgical Team......Page 369
21.4.4 Amputations......Page 370
21.6 Summary......Page 371
22.2 Injury Patterns......Page 374
22.3.1 The Echelons of Medical Care......Page 376
22.3.2 Incident Management and Multiple Casualties......Page 377
22.4.1 Source and Aim of Triage......Page 378
22.4.3 Forward Surgical Team Decision-Making......Page 379
22.5 Mass Casualties......Page 380
22.7.1 Overview......Page 381
22.7.2 Damage Control Resuscitation8......Page 382
22.7.3 Damage Control Surgery in the Military Setting10–12......Page 383
22.8.1 Diagnosis and Management of Blast Injuries......Page 384
22.10 Battlefield Anaesthesia......Page 385
22.10.1 Induction of Anaesthesia......Page 386
22.12.3 Common Training......Page 387
22.13 Summary......Page 388
A.3 Components of an Inclusive Trauma System......Page 392
A.3.3 Public Education......Page 393
A.5.4 Designation of Trauma Centres......Page 394
A.7 Summary......Page 395
B.2.2 Paediatric Trauma Score......Page 398
B.2.4 Acute Physiologic and Chronic Health Evaluation II......Page 399
B.3.1 Abbreviated Injury Scale......Page 400
B.3.4 Anatomic Profile Score......Page 401
B.3.7 Penetrating Abdominal Trauma Index......Page 402
B.4 Comorbidity Scoring Systems......Page 403
B.5.3 Major Trauma Outcome Study......Page 405
B.7 Scaling System for Organ Specific Injuries......Page 407
B.8 Summary......Page 426
C.1 Background......Page 430
C.3.4.2 National Organizations......Page 431
C.3.10 Course Syllabus......Page 432
C.5 Course Information......Page 433
D.3 The Abdominal Cavity......Page 434
D.8 The Genitourinary System......Page 435
D.11 Insertion of Resuscitative Balloon Occlusion of the Aorta (REBOA) Catheter......Page 436
E.2.2 Blood Loss......Page 438
E.2.5 Draping......Page 439
E.3.1 Instruments......Page 440
E.4 Abdominal Closure......Page 441
E.6 Medico-legal Aspects and Communication Skills......Page 442
E.8 Conclusion......Page 443
Index......Page 444