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(BQ) Part 2 book The trauma manual - trauma and acute care surgery has contents: Abdominal trauma, genitourinary injuries, orthopedic trauma, fractures, and dislocations, peripheral vascular injuries, cardiovascular disease and monitoring,.... and other contents.
P1: Trim: 5.25in × 8.375in LWBK1111-29 Top: 0.249in Gutter: 0.498in LWW-Peitzman-educational 29 September 18, 2012 Abdominal Trauma Matthew D Neal, L.D Britt, Greg Watson, Alan Murdock and Andrew B Peitzman I Abdominal injuries are divided into two broad categories: Blunt and penetrating abdom- inal trauma, based on the mechanism of injury Expedient diagnosis and treatment of intraabdominal injuries are essential to avoid preventable morbidity and death Since management guidelines are different for blunt and penetrating abdominal trauma, they will be discussed separately II Blunt abdominal trauma Common mechanisms include falls, motor vehicle crashes, motorcycle or bicycle crashes, sporting mishaps, and assaults A Intraabdominal injuries result from: Compression causing a crush injury Abrupt shearing force causing tears of organs or vascular pedicles Sudden rise in intraabdominal pressure causing rupture of an intraabdominal viscus B Evaluation Clinical Information regarding the mechanism of injury is essential to determine the likelihood of an intraabdominal injury (see Chapter 22) Abdominal examination after blunt trauma is often unreliable Altered level of consciousness, spinal cord or other distracting injury, and medication or substance effects can further confound the physical examination Although adjunctive tests are important in the evaluation of blunt abdominal trauma, careful, repeated physical examination of the patient remains essential in the early diagnosis of abdominal injury The choice of adjunctive diagnostic tests depends, in part, on the hemodynamic stability of the patient, the associated injuries and the patient volume at the treating institution (i.e., extremely busy centers may not have the personnel to perform serial physical examinations reliably) (Fig 29-1) In the hemodynamically unstable patient or the patient with ongoing fluid requirements, rapid evaluation of the abdomen while the patient is in the trauma resuscitation area is mandatory Ultrasound (focused abdominal sonography for trauma [FAST]), diagnostic peritoneal aspiration (DPA), or diagnostic peritoneal lavage (DPL) are appropriate diagnostic tools to determine the presence of hemoperitoneum; in recent years, the safety and rapidity of surgeon-performed focused ultrasound have substantially diminished the role of DPL In the stable patient without immediate need for the operating room (OR), computed tomography (CT) is the investigation of choice a Physical examination Evaluation of the patient will often uncover signs of hypoperfusion (e.g., obtundation, cool skin temperature, mottling, diminished pulse volume, or delayed capillary refill), which should initiate a search for a source of blood loss Factors associated with abdominal injury requiring laparotomy include chest injury, base deficit, pelvic fracture, or hypotension in the field or trauma resuscitation area i Evaluation of the abdomen may detect distension or signs of peritoneal irritation (usually associated with injury to a hollow viscus) On the other hand, blood in the peritoneum often does not produce peritoneal signs, and massive hemoperitoneum may be present without abdominal distension ii Commonly injured abdominal organs are generally solid organs: Liver, spleen, bowel mesentery, or kidney If the patient is a restrained victim in a 357 21:37 358 Selective management Observe Negative Continued observation/evaluation Positive Celiotomy Focused ultrasound or DPL Celiotomy LWW-Peitzman-educational Figure 29-1 Algorithm for the management of blunt abdominal trauma Positive Celiotomy Negative CT or DPL or focused ultrasound Serial abdominal examinations Peritoneal signs Top: 0.249in Equivocal examination Distended abdomen Trim: 5.25in × 8.375in Normal examination, reliable patient Abdominal injury not obvious Hemodynamically unstable LWBK1111-29 History Physical examination Radiologic assessment Blood tests Hemodynamically stable P1: Gutter: 0.498in August 28, 2012 20:46 P1: Trim: 5.25in × 8.375in LWBK1111-29 Top: 0.249in LWW-Peitzman-educational Gutter: 0.498in August 28, 2012 Chapter 29 r Abdominal Trauma 359 motor vehicle crash, particularly with a visible contusion on the abdomen from a lap belt, or a lumbar vertebral body fracture (especially a Chance fracture), suspect hollow viscus injury, an injury commonly missed Diagnostic tests The goal of the initial evaluation of the abdomen is to identify quickly the patient who requires laparotomy Victims of blunt trauma with hypotension and abdominal distension or peritoneal signs should proceed immediately to laparotomy without further workup For patients without an obvious indication for laparotomy, various modalities are available to evaluate the abdomen further Ancillary evaluation beyond physical examination should be considered for patients with: a Abnormal or equivocal abdominal evaluation b Concurrent injury to the chest or pelvic ring c Gross hematuria d Diminished level of consciousness e Spinal cord injury f Other injuries requiring a long general anesthetic for management, rendering repeat abdominal examination impossible g Diminished capacity to tolerate a delay in diagnosis of abdominal injury (e.g., extremes of age) The diagnostic test used depends upon the mechanism of injury, associated injuries, and hemodynamic stability Remember that control of cavitary bleeding takes precedence over further diagnostic testing Delays to control bleeding increase mortality a Plain radiographs The chest radiograph may reveal a ruptured hemidiaphragm or pneumoperitoneum Plain abdominal films are rarely productive, but may show retroperitoneal gas or findings associated with abdominal injury (e.g., fractures of the lumbar spine or lower rib cage) b Laboratory evaluation Patients with blunt injury received promptly from the scene may not be anemic or acidotic on presentation Similarly, amylase levels can be normal with significant pancreatic or intestinal injury, or can be elevated from extra-abdominal injury such as head and neck trauma c Focused assessment by sonography in trauma (FAST) is a rapid, noninvasive means to identify hemoperitoneum in the trauma resuscitation area and, as such, has replaced DPL in many centers (Fig 29-2) i Indications include a hemodynamically unstable patient without obvious indication for laparotomy; any patient requiring prompt transfer to the OR for nonabdominal cause; or use as a screening test for all others requiring abdominal evaluation ii Contraindications include obvious need for laparotomy or lack of FAST expertise iii Accuracy Sensitivity and specificity (60% to 85%) are generally less than those of CT in detection of hemoperitoneum It is not accurate for the detection and anatomic characterization of solid organ injury FAST is most valuable when positive in the hemodynamically unstable patient; prompt transfer to the operating room is thus facilitated On the other hand, with a false-negative rate as high as 40%, a negative FAST should generally be followed by a more definitive diagnostic test (CT or DPL) in the patient incurring high-energy injury iv Advantages Ultrasound is rapid and noninvasive; no need to transfer the patient to the radiology suite; can be performed by a trained member of the trauma team; can be repeated; is less expensive than CT v Disadvantages Can miss solid organ injury in the absence of hemoperitoneum or small amounts of hemoperitoneum; cannot distinguish between ascites, succus entericus and blood; requires specialized training and competency; and is difficult to interpret in the obese or patients with extensive subcutaneous emphysema vi Technique of FAST A to 5.0 MHz transducer is placed in the subxiphoid region in the sagittal plane to set the machine gain Sagittal views of 20:46 P1: Trim: 5.25in × 8.375in LWBK1111-29 360 Top: 0.249in Gutter: 0.498in LWW-Peitzman-educational August 28, 2012 The Trauma Manual: Trauma and Acute Care Surgery 01 Figure 29-2 Ultrasound Morison’s pouch and the splenorenal recess are performed, followed by a pelvic transverse view Free fluid appears anechoic (black) compared with the surrounding structures d CT can evaluate solid organ injury; intraabdominal fluid, blood, air; and retroperitoneal organ injury in hemodynamically stable patient suspected of intraabdominal injury CT of the abdomen and pelvis (upper abdominal cuts will show caudad pulmonary parenchyma and may reveal occult pneumothorax; pelvic cuts may reveal dependent hemoperitoneum) should be obtained, using intravenous (IV) contrast, and currently less so, oral contrast i Indications Hemodynamically stable patients requiring abdominal evaluation ii Contraindications Hemodynamically unstable patients or those with an obvious need for laparotomy iii Accuracy Recent experience with modern high-resolution CT technology shows accuracy rates of 92% to 98% Hollow viscus and pancreatic injuries are those most likely to be missed by CT iv Advantages a) Noninvasive b) Reveals solid organ injury with anatomic characterization c) Estimates free fluid volume d) Provides assessment of retroperitoneal injuries 20:46 P1: Trim: 5.25in × 8.375in LWBK1111-29 Top: 0.249in Gutter: 0.498in LWW-Peitzman-educational August 28, 2012 Chapter 29 r Abdominal Trauma 361 v Disadvantages a) Need for specialized personnel b) Cost c) Time d) Radiation e) Not an ideal environment for ongoing evaluation and resuscitation f) Variable reliability in detection of hollow viscus injury and pancreatic injury g) Intravenous contrast e DPL, a rapid and accurate modality for the diagnosis of intraabdominal injury in blunt trauma victims, has been supplanted by ultrasound at most centers for the rapid evaluation of the hemodynamically unstable patient Briefly, a catheter is placed into the peritoneal cavity for aspiration of blood or fluid If this is negative, a liter of warmed normal saline solution is infused (or 10 mL/kg in children) into the abdomen and allowed to drain by gravity The effluent is sent for laboratory analysis i Criteria for positive DPL a) 10 mL gross blood on aspiration b) >100,000 red blood cells/mm3 c) >500 white blood cells/mm3 d) Bacteria e) Bile f) Food particles ii Indications in general are as for FAST, but the utility of FAST has limited the benefit of DPL to situations where the rapid determination of the nature of free intraabdominal fluid is necessary, such as the patient with FAST- or CT-documented intraperitoneal fluid in the absence of solid organ injury, particularly if physical examination is unreliable for the diagnosis of peritonitis iii Contraindications are obvious need for laparotomy, previous abdominal operations (relative), pregnancy, or pelvic ring fracture (relative, may be performed supraumbilically) iv Accuracy The sensitivity and specificity of DPL approach 95% The falsenegative rate is 4% v Advantages DPL is quick, accurate, sensitive, and low cost vi Disadvantages DPL is invasive and results in nontherapeutic laparotomy in 15% to 27% DPL can fail to detect diaphragmatic or retroperitoneal injury vii Technique DPL can be performed in an open or closed technique In the open technique, skin, subcutaneous tissue fascia, and peritoneum are incised under direct vision for catheter insertion Seldinger technique is used for the closed method Pre-DPL gastric and urinary bladder drainage are mandatory, regardless of the technique utilized f DPA has been used in lieu of DPL at many centers This is a rapid technique to simply determine the presence of gross hemoperitoneum Ironically, DPL evolved in 1965, because of the inaccuracy of DPA Certainly, a grossly positive aspiration is useful information The false-negative rate of DPA is not well defined in the literature III Penetrating abdominal trauma is usually by gunshot wound (GSW) or stab wound The likelihood of injury requiring operative repair is higher for abdominal GSW (80% to 95%) than for stab wounds (25% to 33%) and the management algorithms differ Abdominal organs commonly injured with penetrating wounds include small bowel, liver, stomach, colon, and vascular structures Any penetrating wound from the nipple line anteriorly or scapular tip posteriorly to the buttocks inferiorly can produce an intraperitoneal injury A Gunshot injury In most instances, patients sustaining transperitoneal GSWs to the abdomen require laparotomy as their diagnostic and therapeutic modality 20:46 P1: Trim: 5.25in × 8.375in LWBK1111-29 362 Top: 0.249in Gutter: 0.498in LWW-Peitzman-educational August 28, 2012 The Trauma Manual: Trauma and Acute Care Surgery Physical examination Carefully inspect the patient to avoid missing wounds Bullets that not strike bone or other solid objects generally travel in a straight line Trajectory determination is the key to injury identification Hemodynamically unstable patients with abdominal GSW should not have extensive evaluation before celiotomy Carefully examine the patient paying special attention to the body creases, perineum, and rectum Bullet wounds should be counted and assessed An odd number of wounds suggest a retained bullet; elongated wounds without penetration typify graze injuries Palpate the abdomen for signs of tenderness A neurologic examination should be performed to exclude spinal cord injury Plain radiographs assist in determining trajectory Mark cutaneous bullet wounds with radiopaque markers In addition, the presence of pneumoperitoneum, spinal fractures, pneumo-, or hemothorax can be appreciated CT has a limited role in the evaluation of patients with abdominal GSW However, in the hemodynamically stable patient in whom it is questioned, peritoneal penetration can be excluded by visualizing the path of the bullet on CT If any doubt exists, laparotomy or laparoscopy is mandatory In addition, selected patients with right upper-quadrant GSW isolated to the liver may be candidates for nonoperative management (NOM) FAST, similarly, has a limited role in evaluation of abdominal GSW It can be useful to assess the pericardium or assist in operative planning in hypotensive patients with multi-cavity wounds Laparoscopy can be useful in assessing hemodynamically stable patients with tangential GSW, especially in the thoracoabdominal region B Stab wounds Indications for immediate exploration include hypotension, peritoneal signs, and evisceration If these are not present, a selective management approach is justified Anterior stab wounds refer to those in front of the anterior axillary line One-third is extraperitoneal, one-third is intraperitoneal requiring repair, and onethird is intraperitoneal not requiring visceral repair Flank stab wounds lie between the anterior and posterior axillary lines from the scapular tip to the iliac crest Back stab wounds are posterior to the posterior axillary line (Fig 29-3) Abdominal organs are at risk with thoracic wounds inferior to the nipple line anteriorly (ICS 4) and scapular tip posteriorly (ICS 7) Serial examination (selective management) can be used to detect the development of peritoneal signs in a hemodynamically stable patient The same surgeon should repeat abdominal examinations also documenting temperature, pulse rate, and white blood count Local wound exploration can be performed in the trauma resuscitation area on patients without indication for operation after anterior abdominal stab The skin is prepared and anesthetized and the original wound is enlarged Exploration is considered positive if anterior fascial penetration is observed Patients with positive local wound explorations progress to laparoscopy or laparotomy CT with triple contrast (oral, IV, and rectal) can be used to evaluate back and flank SW with a sensitivity of 89%, specificity of 98%, and accuracy of 97% CT is not very helpful in the evaluation of anterior abdominal stab wounds, especially in thin patients with slight abdominal musculature FAST is minimally useful in the workup of stable patients with abdominal stab wounds If positive, visceral injury can be inferred DPL can be performed to evaluate abdominal stab wounds The criteria for red blood cell (RBC) counts are generally lower than that for patients with blunt injury (i.e., 1,000 vs 100,000/mm3 ) Lower threshold values will improve the sensitivity of the modality, but increase the negative or nontherapeutic laparotomy rate C Shotgun wounds Close-range shotgun wounds are high-velocity injuries As such, they can result in blast and penetrating abdominal wounds Shotgun wounds with peritoneal penetration mandate laparotomy Those delivered from a distance can be evaluated with CT to determine peritoneal penetration by pellets D Impalement injuries The impaled object is secured in place and removed in the OR under direct visualization with the abdomen open 20:46 P1: Trim: 5.25in × 8.375in LWBK1111-29 Top: 0.249in Gutter: 0.498in LWW-Peitzman-educational August 28, 2012 Chapter 29 r Abdominal Trauma Tip of scapula Posterior axillary line Iliac crest Sixth intercostal space Anterior axillary line Posterior axillary line Iliac crest Figure 29-3 Posterior and flank zones of the abdomen 363 20:46 P1: Trim: 5.25in × 8.375in LWBK1111-29 364 Top: 0.249in Gutter: 0.498in LWW-Peitzman-educational August 28, 2012 The Trauma Manual: Trauma and Acute Care Surgery IV Conduct of an exploratory laparotomy Refinements in diagnostic capabilities have allowed a more selective application of laparotomy, reducing the number of nontherapeutic laparotomies A Indications for exploratory laparotomy Performed on the basis of physical examination findings or on the results of diagnostic tests Clinical a Obvious peritoneal signs on physical examination b Hypotension with a distended abdomen on physical examination c Abdominal GSW with peritoneal penetration d Abdominal stab wound with evisceration, hypotension, or peritonitis Diagnostic tests a Positive FAST with hemodynamic instability or DPL b Findings with any other diagnostic intervention (e.g., chest x-ray [ruptured diaphragm, pneumoperitoneum], abdominal ultrasound, abdominal CT, or laparoscopy suggestive of an intraabdominal injury requiring repair) B General setup An OR appropriately stocked with appropriate anesthesia, nursing, and support staff should be immediately available 24 hours a day Once the decision is made to operate, the patient must be rapidly transported directly to the OR with appropriate airway support personnel, trauma team surgeons, and trauma team nursing staff in attendance This is direct transfer to the operating room—not the preoperative holding area If possible, informed consent is obtained from the patient or relative before laparotomy This is not always possible or practical; the operation should proceed without delays to obtain consent in life-threatening circumstances Intravenous lines, tubes, and spinal precautions a The patient should already have at least two large-bore IVs placed; other IV and arterial access can be placed as necessary in the OR Control of cavitary bleeding should not be delayed by attempts at fluid resuscitation b Administer broad-spectrum, Gram-negative, and anaerobic antibiotic coverage (e.g., an extended spectrum penicillin or a third-generation cephalosporin) c Place chest tubes to underwater seal, not clamped, during transport and to suction drainage on arrival in the OR Place the canisters where they are readily visible and blood loss from the chest tubes can be observed d Place nasogastric or orogastric tube and a bladder catheter before laparotomy No procedure should be performed in such a way as to delay control of bleeding and contamination e Move the patient onto the operating table with appropriate cervical spine and thoracolumbar spine precautions; in many cases, spinal injury will not be excluded before arrival in the OR If the patient is still immobilized on a backboard, logroll the patient and remove the board before beginning the operation Occult penetrating wounds must be sought before beginning laparotomy f Sequential compression devices can be used for hemodynamically stable patients, if readily available Rapid-infusion system Prime the infusion system to infuse blood products and “cell-saved blood” quickly via large-bore lines before the incision releases the tamponade Ascertain that packed RBC are in the OR and plasma and platelets are available for the patient with active hemorrhage In the exsanguinating patient, the massive transfusion protocol should be activated to facilitate availability of blood products Preparation of the patient The patient is shaved (if time allows), and the entire anterolateral neck (remove anterior portion of cervical collar and then sandbag to maintain cervical spine immobilization), chest to the table bilaterally, abdomen, groin, and thigh region (to the knees bilaterally) are prepared and draped in sterile fashion (see Fig 17.1) C Initial goals Stop bleeding and control gastrointestinal contamination The exploratory laparotomy for trauma is a sequential, consistently conducted, operative procedure 20:46 P1: Trim: 5.25in × 8.375in LWBK1111-29 Top: 0.249in LWW-Peitzman-educational Gutter: 0.498in August 28, 2012 Chapter 29 r Abdominal Trauma 365 Incision For urgent laparotomy, a generous midline incision is preferred Alter- native abdominal incisions can be useful for known injuries in stable patients Adequate exposure is critical Self-retaining retractor systems and headlights are invaluable Bleeding control Scoop-free blood and rapidly pack all four quadrants to control bleeding as a first step With blunt injuries, the likely sources of bleeding are the liver, spleen, and mesentery Pack the liver and spleen, and quickly clamp the mesenteric bleeders With penetrating injuries, the likely sources of significant bleeding are the liver, retroperitoneal vascular structures, and mesentery, based on trajectory of the weapon or bullets Pack the liver and retroperitoneum, and quickly clamp mesenteric bleeding vessels If packing does not control a bleeding site, this source of hemorrhage must be controlled as the first priority Contamination control Quickly control bowel content contamination using Babcock clamps, Allis clamps, a stapler, rapid temporary sutures, or ligatures Systematic exploration Systematically explore the entire abdomen, giving priority to areas of ongoing hemorrhage to definitively control bleeding: a Liver b Spleen c Stomach d Right colon, transverse colon, descending colon, sigmoid colon, rectum, and small bowel, from ligament of Treitz to terminal ileum, looking at the entire bowel wall and the mesentery e Pancreas, by opening lesser sac (visualize and palpate) f Kocher maneuver to visualize the duodenum, with evidence of possible injury g Left and right hemidiaphragms and retroperitoneum h Pelvic structures, including the bladder i With penetrating injuries, exploration should focus on following the track of the weapon or missile Injury repair (section V) Closure a Running non-absorbable or absorbable monofilament suture (e.g., No nylon or No looped absorbable suture) b Leave skin open with delayed secondary closure if there is contamination or shock c If gross edema of abdominal contents precludes closure, absorbable mesh, sterileIV bags, or intestinal bags can be used with moist gauze and an impermeable dressing (e.g., Op-Site, VAC dressing) to prevent possible abdominal compartment syndrome Recognize the combination of complex injuries (often liver, pelvis, or major vascular injury) and physiologic signs (“the lethal triad”: Hypothermia, acidosis, and coagulopathy) that dictate abbreviated laparotomy (damage control) V SPECIFIC ORGAN INJURIES Treatment of an organ injury is similar whether the injury mechanism is penetrating or blunt An exception to the rule is a retroperitoneal hematoma Explore all retroperitoneal hematomas caused by penetrating injury A Diaphragm The diaphragm, a dome-shaped muscular structure with an aponeurotic sheath (“central tendon”), effectively separates the thoracic and abdominal cavities It attaches to the first three lumbar vertebrae, the ribs, and the posterior aspect of the lower sternum Because of the decussation of its crura and hiatal architecture, the diaphragm provides an avenue for many vital structures, including the aorta, esophagus, thoracic duct, vagus nerves, azygos vein, and the inferior vena cava Physiologically, the wide excursion of the diaphragm during inspiration and expiration contributes to both respiratory function and venous return Blunt Injury Blunt trauma accounts for up to 30% of diaphragmatic ruptures in the United States Motor vehicle collisions and falls from heights are the most common mechanisms of injury Diaphragmatic rupture occurs as a result of an acute increase 20:46 P1: Trim: 5.25in × 8.375in LWBK1111-29 366 Top: 0.249in Gutter: 0.498in LWW-Peitzman-educational August 28, 2012 The Trauma Manual: Trauma and Acute Care Surgery Figure 29-4 Thoracoabdominal region in the intraabdominal pressure Right-sided diaphragmatic ruptures occur less frequently than those on the left Penetrating Injury In addition to excluding possible cardiac injury if the penetrating wound is more central, the paramount reason that the thoracoabdominal region (Fig 29-4) presents such a diagnostic challenge to the acute care surgeon is the possibility of an occult diaphragmatic injury Patients who are hemodynamically labile or have peritoneal signs require mandatory exploration Clinically stable patients should undergo a more selective approach No conventional diagnostic modality consistently makes the definitive diagnosis of diaphragmatic injury Making the diagnosis of a diaphragmatic injury is important for two reasons First, the presence of an acute injury to the diaphragm mandates abdominal exploration with high risk for an associated intraabdominal injury Second, there are risks, both acutely and long-term, of diaphragmatic herniation and possible incarceration/strangulation Because of this diagnostic challenge, the thoracoabdominal region was correctly underscored as “the ultimate blind spot” in penetrating trauma Patients who present with indications for exploration (Table 29-1) require no essential TABLE 29-1 Absolute Indication for Celiotomy/Thoracotomy Hemodynamic lability Peritoneal signs Free air Bleeding from an orifice Massive hemothorax (thoracotomy required) Chest tube >1,500 cc initial output Chest tube >200 cc/h for more than h Impaled object 20:46 P1: Trim: 5.25in × 8.375in LWBK1111-Index 784 Top: 0.249in Gutter: 0.498in LWW-Peitzman-educational September 7, 2012 Index Hernias (Contd.) planned ventral hernia and open abdomen, 691–693 presentation of, 684, 686 spigelian, 688–689, 688f umbilical, 687 Heterotopic ossification (HO), 205 High mobility group box-1 (HMGB1), 19 Hinchey classification for diverticulitis, 737–738, 737t Hip dislocation, reduction of, 721–722 Hydrofluoric acid (HF) burn, 452 Hydromorphone, 166, 481t Hyperbaric oxygen (HBO) therapy, 670 Hyperkalemia, 473 Hypertonic saline, for ICP control, 257–258 Hyphema, 310–311, 311t Hypocalcemia, 473–474 and coagulopathy, 63 Hypokalemia, 473 Hypomagnesemia, 474 Hypothermia, 460–462, 554–560 accidental, 555 classification of, 554 clinical effects of, 554–555 coagulation, 555 hemodynamic, 555 metabolic, 554 neurologic, 555 renal, 555 respiratory, 554–555 and coagulopathy, 62–63 drowning and, 559–560 exposure, 559 frostbite and, 560 physiology of, 554–555 rewarming, 558–559, 559t therapeutic, 560 treatment of, 556–558, 556t, 557f Hypovolemic shock, 45, 46, 48, 458 I Iatrogenic perforation, 643–644 ICD-based Injury Severity Score (ICISS), IL-6, 18 IL-8, 18–19 IL-10, 19 IL-1, 18 Iliopsoas sign, 565t Imaging, 110–120 in abdominal trauma, 114–116 in chest trauma, 113–114 considerations in, 118 electronic and mobile review of images, 119 MRI safety, 119 obese patient, 119–120 radiation safety, 118–119 in facial trauma, 112 goal of, 110 in intensive care unit, 118 modalities, 110–111 angiography, 110–111 computed tomography, 110 conventional radiography, 110 magnetic resonance imaging, 110 ultrasonography, 110 in pediatric trauma patients, 222 in pelvic trauma, 116–117 in skull and brain trauma, 111–112 in spine injuries, 112–113 in unstable blunt trauma patient, 39 Immune response, after trauma, 14–17 adaptive and the innate immune reaction, 14–15 early, 15–17 local versus systemic, 14 Immunonutrition, 78 Impalement wounds, 250–251 Incident command system (ICS), 184–185 hierarchy, 184 key concepts of, 184 use of, 184–185 Infection, 128, 138 See also Sepsis conditions increasing risk of, 141t duration of antibiotic prophylaxis and, 144–145 epidemiology, 138 comparison with nontrauma patients, 138 incidence, 138 patterns of injury, 138 immune dysfunction after trauma and, 139t microbiology and, 146–148 bacteria, 146–148 fungi and yeast, 148 principles of resistance, 146 nosocomial, 148–153 central line–associated blood stream infection, 149–150 Clostridium difficile infection, 151 decubitus ulcer, 152 peritonitis/intra-abdominal infection, 150–151 pneumonia, 148–149 sinusitis, 151–152 urinary tract infection, 152–153 prevention of, 142–144 antibiotic prophylaxis, 144 catheter care, 143–144 contact isolation, 143 hand hygiene, 142–143 infection control, 142–143 principles related to, 142 risk factors for, 138–142, 139t–142t hyperglycemia, 141–142 immune dysfunction, 139–140 inflammation and stress response, 140 injury severity, 139 medical comorbidity, 140 transfusion, 140–141 tahir99 - UnitedVRG vip.persianss.ir 15:53 P1: Trim: 5.25in × 8.375in LWBK1111-Index Top: 0.249in Gutter: 0.498in LWW-Peitzman-educational September 7, 2012 Index specific injuries and, 145–146 abdominal injury, 145 chest injuries, 145 fractures, 146 skin and soft-tissue injuries, 146 Inferior vena cava filter (IVCF), 177 insertion, 729–730 Inflammatory diseases of intestines, 643–655 gastroduodenal perforation, 643–652 colonic diverticulitis, 650–652 Crohn’s disease of small bowel, 644–647 duodenal diverticula, 648–649 enterocutaneous fistula, 647–648 iatrogenic perforation, 643–644 jejunoileal diverticula, 649 marginal ulcer, 643 Meckel’s diverticulum, 650 small bowel diverticular disease, 648 infectious colitides, 652–655 bacterial enterocolitis, 654 Clostridium difficile–associated disease (CDAD), 653–654, 653t Cytomegalovirus colitis, 654 ischemic colitis, 654–655 Information management, in trauma systems, Informed consent, 572 Inhalation injury, 450–451 Injury prevention, 3, 195–201 physicians role in, 198–201 primary, 196 science of, 196–198 secondary, 196 tertiary, 196 Injury scoring, 3–4 related principles, 3–4 scoring systems, validation of scoring system, Injury severity score (ISS), 4, 733, 734t Intensive care unit (ICU), 456–487 admission criteria, 456, 457t bedside procedure, 728–731 fiberoptic bronchoscopy, 728–729 inferior vena cava filter insertion, 729–730 nasoenteric post-pyloric feeding tube insertion, 730 percutaneous endoscopic gastrostomy, 730–731 percutaneous tracheostomy, 731 end-of-life care, 485–486 goals of care, 456 invasive monitoring, 463–465 arterial catheterization, 463 central venous pressure monitoring, 463–464 intracranial pressure monitoring, 465 pulmonary artery catheterization, 464–465 missed injuries in, discovery of, 465 785 monitoring and data interpretation, 459–463 blood gas monitoring, 460 blood sampling, 459 capnography, 462, 462t electrocardiography, 460 esophageal Doppler monitor, 463 near-infrared spectroscopy, 463 pulse oximetry, 460 temperature measurement, 460–462 thoracic bioimpedance, 463 organ donor identification and care, 486 organ system support, 468–480 acid–base and electrolyte disturbances, 471–474 cardiovascular, 468–471 microvascular bleeding, 479 neurologic support, 479–480 pulmonary support, 474–477 renal support, 477–479 support of coagulation, 479 patient safety and system management, 486–487 phases of care, 456–458 early phase, 456–457 intermediate phase, 457 late phase, 457 recovery phase, 458 prophylaxis, 465–468 cardiovascular, 465 metabolic prevention, 466–467 stress-related gastric mucosal hemorrhage, 465–466 venous thromboembolism, 466, 466t ventilator bundle, 467–468 rehabilitation in, 484–485 resuscitation and initial management, 458–459 classification of shock, 458–459 endpoints of resuscitation, 458, 459t hemostasis in resuscitation, 458 sedation and analgesia in, 480, 481t–483t special considerations ICU as operating room, 484 neurologic support, 480, 484 Interhospital transport, 97–99 before, 97–98 during, 98–99 after, 99 legal considerations, 99 physician medical directors and, 97 referring physician and, 97 International classification of diseases injury severity score (ICISS), 735 International Medical Surgical Response Teams (IMSURT), 185 International sensitivity index (ISI), 63 Interventional radiology, 121–127 anatomically specific concepts, 124–126 aorta and great arteries, 124 chest and abdominal wall, 126 tahir99 - UnitedVRG vip.persianss.ir 15:53 P1: Trim: 5.25in × 8.375in LWBK1111-Index 786 Top: 0.249in Gutter: 0.498in LWW-Peitzman-educational September 7, 2012 Index Interventional radiology (Contd.) craniocervicocerebral arteries, 125 intracranial interventions, 126 kidneys, 126 liver, 125–126 pelvis, 126 spleen, 125 vessels of extremities, 126 special procedures environment, 121 subacute interventions, 127 drainage of fluid collections, 127 inferior vena cava (IVC) filters, 127 vascular/interventional techniques, 121–124 access, 121 diagnostic angiography, 121–123 embolization, 123–124 stents, 124 Intestinal injury, in children, 224 Intraabdominal abscess (IAA), 58 Intra-abdominal adhesions, 704 Intraabdominal hypertension (IAH), 529 See also Abdominal compartment syndrome (ACS) Intracranial hypertension (ICH), 536–538 Intracranial pressure (ICP), 253, 479 See also Traumatic brain injuries (TBIs) monitoring, in ICU, 465 Intraocular foreign bodies (IOFBs), 311–312 Intravenous pyelography (IVP), 115 in genitourinary injuries, 396–397 Ireton–Jones equation for burn patients, 80t in sepsis, 78t Ischemia monitoring, 499–500 ST segment depression, 500 ST segment elevation, 499–500 Ischemic colitis, 654–655 clinical manifestations, 655 diagnosis, 655 management, 655 pathophysiology, 654–655 IV immune globulin treatment (IVIG), 670 J Jaw-thrust maneuver, 23 Jejunoileal diverticula, 649 Jet ventilation See Percutaneous translaryngeal catheter insufflation Joint contractures, 203–204 Jugular venous bulb oximetry (SjO2 ), 259 K Ketamine, 481t for endotracheal intubation, 29t Ketorolac, 163, 483t Kidney injury scale, 750t Kinetic energy (KE), of missile, Kussmaul’s sign, 333 L Labetalol, in aortic injury, 337 Labor and delivery, 698–699 Laboratory studies in trauma, 43 See also specific topics Laboratory technician, 108t Lactate and base deficit, 47, 49–50 Lactated Ringer’s (LR), 444 Laparoscopic appendectomy (LA), 627 Lap belts, Large bowel obstruction (LBO), 587–590 etiology, 587–588 colonic pseudo-obstruction, 588 diverticulitis, 588 fecal impaction, 588 foreign body, 588 inflammatory bowel disease, 588 neoplasm, 587 volvulus, 587 presentation and initial assessment, 588 radiographic evaluation, 588, 589f treatment, 588–590, 590f Laryngeal mask airway (LMA), 30, 90f, 331 Lead bullets, Leadership, in trauma systems, Le Fort fractures, 273, 274f Left anterolateral thoracotomy, 352–353 advantage, 352 disadvantage, 352 technique, 352–353 Left/right posterolateral thoracotomy, 353–354 advantages, 353 disadvantages, 353 technique, 353–354, 354f Lens anaphylaxis, 313 Leukocyte, 15, 17 Leukocytosis, 577 Leukotrienes, 20 Levator pain, 665 Lidocaine ointment, 657 Ligamentous injury and muscle strain, in children, 223 Lighted-stylet (transillumination) ETI, 30 Linear skull fractures, 261 Lipoglycopeptides, 157 Lips, injury to, 281, 282f Liver failure, 535–544 acute, 535–540 (See also Acute liver failure (ALF)) portal hypertension, 540–543 Liver injury, 377–382 in children, 223 diagnosis of, 378, 378f hepatic anatomy, 377–378, 377f incidence of, 377 outcomes for, 382 treatment, 378–382, 379f, 381f Liver injury scale, 746t Logistic organ dysfunction (LOD) systems score, 490 tahir99 - UnitedVRG vip.persianss.ir 15:53 P1: Trim: 5.25in × 8.375in LWBK1111-Index Top: 0.249in Gutter: 0.498in LWW-Peitzman-educational September 7, 2012 Index Lorazepam, 29, 481t Lower genital tract trauma, 706 vulvar and vaginal hematoma, 706 vulvar and vaginal lacerations, 706 Lower velocity missile wounds, 261 Low molecular weight heparin (LMWH), 174, 176 M Macintosh blade, 25, 26 Macrophages, 17 Magnetic resonance cholangiopancreatogram (MRCP), 607 Magnetic resonance imaging (MRI), 110 in spinal injuries, 113 Mandibular fractures, 267–270 evaluation of, 267–269 management of, 269–270 cervical immobilization, 269 control of airway, 269 prophylactic antibiotics, 270 specific treatment, 269–270 temporary immobilization, 269 mandibular anatomy and location of, 267, 268f Mangled extremity severity score, 420t Mannitol, for ICP control, 257–258 Marginal ulcer, 643 Marshal MOF score, 490 Mass casualty incident (MCI) See Disasters/mass casualty incident Mass casualty triage, 85–87 principles of, 85 simple triage and rapid treatment, 85 triage tags, 85, 87 Massive hemothorax, 334 Massive transfusion protocols (MTP), 67–69 Mastitis, 705 diagnosis, 705 epidemiology and pathophysiology, 705 management, 705 Maxillofacial injury, 264–286 anatomic considerations in repairing soft tissue, 277–281 and anesthesia, 281 animal and human bites, 286 cleaning of wound, 281–282 debridement and care, 281 dentoalveolar trauma, 264–267 evaluation of patient with, 264 frontal sinus fractures, 276–277 mandibular fractures, 267–270 midface fractures, 270–276 nonsuture technique of wound closure, 284 removal of sutures, 286 suture technique, 284–286 wound type, 282–284 MCI response, 183 See also Disasters/mass casualty incident MDCT, in C-spine imaging, 113 787 Mean arterial pressure (MAP), 500 Mechanical ventilation (MV), 476, 478t, 517–527 adjuncts to, in ARDS and severe hypoxemia, 523–524 extracorporeal membrane oxygenation, 524 fluid management, 524 inhaled nitric oxide, 524 neuromuscular blockade, 524 prone position, 524 recruitment maneuvers, 524 advanced modes of, 520–521 adaptive support ventilation, 520 neurally adjusted ventilatory assist, 520–521 proportional assist ventilation, 520 SmartCare, 521 ARDS mechanical ventilation algorithm, 526f goals of, 517 liberation from, 477 modes of, 518–520 airway pressure-release ventilation, 520 assist-control ventilation mode, 518–519 bi-level/ biphasic ventilation, 520 controlled mechanical ventilation mode, 518 pressure-control ventilation, 520 pressure modes, 519–520, 519f pressure-regulated volume control, 520 pressure support ventilation, 520 synchronous intermittent mandatory ventilation mode, 519 volume control plus, 520 volume modes, 518 pocket card summary of, 522t strategies for patients with ALI and ARDS, 521–523 airway pressure-release ventilation, 523 high-frequency oscillatory ventilation, 521–523 low tidal volume ventilation, 521 open lung strategy, 521 permissive hypercapnia, 521 variables adjusted for, 517–518 weaning and liberation from, 526–527 Mechanism of injury, 241–251 blunt trauma, 241–245 penetrating trauma, 245–251 Meckel’s diverticulum, 650 Median sternotomy, 352, 353f Medical triage, 185–186 Meninges, 253 Menorrhagia, 701–702 Mesenteric ischemia, 678–680 diagnosis, 679 etiology, 679 outcomes, 680 treatment, 679–680 tahir99 - UnitedVRG vip.persianss.ir 15:53 P1: Trim: 5.25in × 8.375in LWBK1111-Index 788 Top: 0.249in Gutter: 0.498in LWW-Peitzman-educational September 7, 2012 Index Mesh absorbable, 532 biologic, 532 Metastable patient, 35 Methohexital, for endotracheal intubation, 29t Metronidazole, 159–160 Midazolam, 481t Midface fractures, 270–276 evaluation of, 271–272 Le Fort fractures, 273, 274f management of, 272–273 midfacial anatomy and location of injury, 270–271, 271f nasal fracture, 276 NOE complex fracture, 276 orbital blowout fractures, 275–276, 275f zygomatic arch fractures, 274–275, 275f zygomaticomaxillary complex fractures, 273–274, 274f Miller blade, 25, 26 Mirizzi’s syndrome, 613 Miscarriage, 696–697 complete abortion, 697 diagnosis, 697 epidemiology, 697 incomplete abortion, 697 inevitable abortion, 697 management, 697 missed abortion, 697 pathophysiology, 697 spontaneous abortion, 696 threatened abortion, 696–697 Mivacurium, 482t Model Trauma Care System Plan, by HRSA, Monobactams, 156 Monro–Kellie doctrine, 253 Monteggia fracture–dislocations, 423 Morphine, 163t, 166, 481t Motorcycle crashes, 243 Motor vehicle collisions, determinants of injury in, injury patterns in, 4–5 role of restraints in, 5–6 Motor vehicle crashes (MVCs), 1, 241–243, 242f, 242t determinants of injury in, 241–243 ejection, 243 elderly and, 237 frontal impacts, 243 injury in, 241 lateral crashes, 243 rear-end impact collisions, 243 restraint devices, 241–243, 243t rollover collisions, 243 Multiple organ dysfunction (MOD) score, 490 Multiple organ dysfunction syndrome (MODS), 489–497, 606 after trauma, 489 classification of, 489 definition, 489 mechanisms, 489 pathophysiology, 491–493 cardiac, 491–492 endocrine, 493 gastrointestinal/nutrition, 493 hepatic, 493 neurologic, 491 pulmonary, 491 renal, 492–493 prediction/prognosis, 490–491, 490t treatment, 493–497 abdominal compartment syndrome, 497 cardiac, 496 FFP transfusion criteria, 494t gastrointestinal/nutrition, 496–497 hepatic, 496 neurologic, 494 nosocomial infections prevention, 494 PRBC transfusion criteria, 494t pulmonary, 494–495, 495t renal, 496 source control, 493 Murphy’s sign, 565t Musculoskeletal system, in elderly, 234 MV See Mechanical ventilation (MV) N Naloxone, 165, 483t Nasal fracture, 276 Nasal–orbital–ethmoid (NOE) complex, 270, 271f, 276 Nasoenteric post-pyloric feeding tube insertion, 730 Nasopharyngeal airway, 23 Nasotracheal intubation, 30 National Association of EMS Physicians (NAEMSP), 85 National Disaster System (NDMS), 185 National Highway Traffic Safety Administration (NHTSA), National Veterinary Response Teams (NVRT), 185 Near-infrared spectroscopy (NIRS), 50, 463 Neck trauma, 315–326 anatomy of neck, 315–317 triangles of neck, 315, 316f zones of neck, 315–317, 316f blunt, 320–326 carotid artery injury algorithm, 324f imaging modalities in, 321–322 initial evaluation in, 320–321 physical examination in, 320–321 radiographic evaluation in, 321 specific injuries, 322–323 treatment, 323–326, 324f, 325f vertebral artery injury algorithm, 325f penetrating, 317–320 diagnostic testing in, 317 incisions for exposure of, 319f initial evaluation in, 317 tahir99 - UnitedVRG vip.persianss.ir 15:53 P1: Trim: 5.25in × 8.375in LWBK1111-Index Top: 0.249in Gutter: 0.498in LWW-Peitzman-educational September 7, 2012 Index neck injury algorithm, 318f surgical management of, 318–320, 319f Necrotizing soft tissue infection clinical score, 740–741, 740t Necrotizing soft tissue infections (NSTIs), 667–670 complications, 670 diagnosis, 668–669 imaging, 669 laboratory, 669 presentation, 668–669 HBO therapy, 670 laboratory risk indicator for, 668t outcomes, 670 pathophysiology, 667–668 treatment, 669–670 antibiotic therapy, 670 IVIG, 670 surgical debridement, 669 wound care, 669 type II infections, 667 type I infections, 667 Needle cric See Percutaneous translaryngeal catheter insufflation Needle thoracostomy, 92–84, 93f Neostigmine with glycopyrrolate, 483t Nervous system, in elderly, 234 Neurogenic bladder, 208–209 Neurogenic bowel, 209–210 Neurogenic shock, 45, 46, 49, 458–459 Neuromuscular blocking agents (NMBAs), 22, 28–30, 29t, 482t Neutrophils, 17 New Injury Severity Score (NISS), Noninvasive and continuous hemoglobin (SpHb) monitoring, 507 Non-invasive positive-pressure ventilation (NIPPV), 476 Noninvasive ventilation (NIV), 514–515 Non-rebreather mask, 22 Nose, injury to, 281 Nosocomial infection, 148–153 NSAID, 163 Nutation, Nutrition intervention (NI), 73–81 burn patients and, 79, 80t categories, 76 controlled starvation, 76 enteral nutrition, 76–77 immunonutrition, 78 oral intake at will, 76 oral nutrition supplements, 77–78 total parenteral nutrition, 77 clinical guidelines for, 80–81 elderly patients and, 80 metabolic demands of trauma and burn patients and, 73–75 hyperglycemia and resistance to insulin, 75 immune-mediated amino acid destruction, 75 789 increased protein breakdown, 74 lipid mobilization, 75 resting energy expenditure, 75 vitamin deficiencies, 75 nutrient requirements and, 78–79 carbohydrate requirements, 78 lipid requirements, 79 meeting caloric goals, 78 micronutrients, 79 protein requirements, 78–79 obese patients and, 79–80 O Obstructive shock, 45, 46, 49, 458 Obturator sign, 565t, 626 Odontoid fractures types I, 300, 302f types II, 300, 302f, 303f types III, 300, 302f Ogilvie’s syndrome, 588 Omega-3 fatty acids, 79 Open abdomen, 531–533 complications from, 532–533 enterocutaneous fistula, 532 hernia development, 532 intra-abdominal abscess formation, 532 enteroatmospheric fistula management, 532–533 permanent closure, 532 delayed abdominal wall reconstruction, 532 primary closure, 532 skin mobilization and closure, 532 split-thickness skin graft, 532 temporary closure, 531–532 prosthetic coverage, 531–532 vacuum-assisted closure devices, 531 Open cric See Cricothyroidotomy Open globe, 310 Open pneumothorax, 333 Operating room practice, 179–212 conducting trauma operation and, 179–180 ED to OR transfer, 180 hand-off communication, 180–181 operating room priorities, 181 OR patient preparation, 180f surgical simulation training and performance improvement, 181–182 Operation, preoperative evaluation and preparation, 569–572 advanced directives, 572 fluid resuscitation, 569–571 informed consent, 572 operative checklists, 572 preoperative antibiotics, 571 reversal of anticoagulation, 571–572 antiplatelet therapy, 571–572 coumadin, 571 tahir99 - UnitedVRG vip.persianss.ir 15:53 P1: Trim: 5.25in × 8.375in LWBK1111-Index 790 Top: 0.249in Gutter: 0.498in LWW-Peitzman-educational September 7, 2012 Index Ophthalmic injuries, 308–314 cataract, 313 chemical injury, 310 commotio retinae, 314 corneal abrasions and foreign bodies, 312 eyelid lacerations, 312–313 hemorrhage and orbital bone fractures, 313 history examination, 308 intraocular foreign bodies, 311 open globe, 310 physical examination, 308–310 retinal detachment, 314 traumatic hyphema, 310–311, 311t traumatic optic neuropathy, 313 Opioids, 162–163, 163t See also Pain management Oral factor Xa inhibitors, 174–175 Oral nutritional supplements (ONS), 77–78 Orbital blowout fractures, 275–276, 275f Orbital fractures, 313 Organ donor, support of, 545–542 brain death, determination of, 546–548, 547t care of potential organ donor, 548–552 acidosis, 552 alternative colloids, 552 antibiotic prophylaxis, 552 cardiovascular support, 548, 550 coronary angiography, 551 dysrhythmias, 551 echocardiogram, 551 endocrine support, 552 fluid and electrolyte therapy, 551–552 hematologic support, 552 hyperglycemia, 552 hypernatremia, 552 pulmonary support, 551 temperature regulation, 552 vasopressors, 551 donation after cardiac death, 548, 549t failure to procure organs, reasons for, 545, 546t physiologic goals in organ donor, 550t potential organ donors, 545–546 Uniform Anatomical Gift Act of 1968, 545 Uniform Determination of Death Act of 1981, 545 Organ injury scale (OIS), Organ Procurement and Transplantation Network (OPTN), 548 Organ procurement organization (OPO), 545 Oropharyngeal airway, 23 Orotracheal intubation See Endotracheal intubation (ETI) Orthopaedic traumatic injuries, 404–426 acetabular fractures, 412–413, 414f–415f amputations, 424 ankle fractures, 420 calcaneus fractures, 421 care of open fractures, 408–410 definitive treatment of fractures/dislocations, 408 dislocation, 404, 405f emergent treatment of fractures/dislocations, 407–408 femoral neck fractures, 413, 415, 416f femoral shaft fractures, 416 fracture, 404 classification, 404, 406f closed, 404, 406f open, 404, 406f gunshot injuries and, 410, 411f hip dislocation, 413 knee dislocation, 416 metatarsal fractures, 421 neurovascular injuries associated with, 405t patellar fractures, 416–417 pediatric fractures, 404 pelvic injuries, 410–412, 411t, 412f pertrochanteric femur fractures, 415–416 physical examination, 405, 407 radiographic evaluation, 407 splinting and, 424–426 principles of splinting, 424 purpose for splinting, 424 specific areas, 425–426 splints type, 425 subluxation, 404 supracondylar femur fractures, 416, 417f talar neck fractures, 421 tarsometatarsal (Lisfranc) fractures, 421 tibial plafond fractures, 420 tibial plateau fractures, 417, 418f tibial shaft fractures, 417–419, 418f, 419f upper extremity fractures, 421–424 acromioclavicular joint sprains, 421 Barton’s fracture, 423 clavicle shaft fractures, 421 Colles fracture, 423 combined radius and ulna fractures, 423 coronoid fractures, 423 distal humerus fractures, 422 distal radius fractures, 423 elbow dislocations, 423 Galeazzi fracture, 423 glenohumeral dislocation, 422 humeral shaft fractures, 422 olecranon fractures, 422–423 perilunate dislocations, 424 proximal humerus fractures, 422 radial head fractures, 423 radius fractures, 423 reversed Barton’s fracture, 423 scaphoid fractures, 424 scapula fractures, 422 Smith’s fracture, 423 sternoclavicular dislocation, 421 ulnar shaft fractures, 423 Orthotopic liver transplantation (OLT), 540 Ovarian cysts, 702–703 Ovarian torsion, 703 tahir99 - UnitedVRG vip.persianss.ir 15:53 P1: Trim: 5.25in × 8.375in LWBK1111-Index Top: 0.249in Gutter: 0.498in LWW-Peitzman-educational September 7, 2012 Index Ovary injury scale, 753t Oxazolidinones, 159 Oxygen debt, 47 P Packed red blood cells (pRBCs), 65 Pain management, 162–169 analgesia during resuscitation, 165–166 basic principles of analgesia and, 162–165 long-term opioid therapy and, 169 nerve injury and, 168 non-opioid analgesics/NSAID for, 164t opioid analgesics for, 163t overview, 165 procedural sedation and analgesia, 166–167 rib fractures/chest wall pain and, 167–168 Pancreas injury scale, 747t Pancreatic injury, 370, 372–374, 372f in children, 223–224 diagnosis of, 370, 372–373 incidence of, 370 outcomes for, 374 related anatomy, 370, 372f treatment, 373–374 Pancuronium, 482t Paracentesis, 484 Parenchymal hematomas, 112 Parotid duct lacerations, 278–279, 280f Pathogen associated molecular patterns (PAMPs), 15, 16f Patient-controlled analgesia (PCA), 162–163 Patient in extremis, 35, 41–43 blunt injury, 42–43, 43f penetrating injury, 41–42, 42f Pedestrian–automobile collisions, elderly and, 237 Pedestrian–automobile impacts, 244, 244f Pediatric appendicitis score (PAS), 738 Pediatric burn rule of nines, 225t Pediatric trauma score (PTS), 226, 226t, 737 Pelvic angiography, 117 Pelvic fractures, in children, 224 Pelvic inflammatory disease (PID), acute, 699–701 CDC treatment schedule for, 701t consequences of, 700 criteria for hospitalization of patients with, 700t diagnosis of, 700 epidemiology of, 700 management of, 700 pathophysiology of, 700 risk factors for, 700 Pelvic trauma, imaging in, 116–117 Penetrating Abdominal Trauma Index (PATI), Penetrating trauma, 6–8, 245–251 gunshot injury assessment, 249–250 gunshot wounds, 6–8, 245–249 shotgun wounds, 791 stab wounds, 8, 250–251 types of, 6–8 Penicillins, 154–156 Penile injuries, 402–403 Penis injury scale, 754t Peptic ulcer disease (PUD), 635–638 clinical manifestations, 636 complications, 638 diagnostic modalities, 636 incidence, 635 operative indications, 636 outcomes, 637–638 pathogenesis/etiology, 635–636 risk factors, 635 surgical management, 636–637 Percutaneous dilator-based cricothyroidotomy kits, 31 Percutaneous endoscopic gastrostomy (PEG), 730–731 Percutaneous tracheostomy, 731 Percutaneous translaryngeal catheter insufflation, 31 Perforation, 616 Perianal infections, 661–662 diagnosis, 662 etiology, 661–662 treatment, 662 Pericardial tamponade, 332–333 diagnosis, 332–333, 332f treatment, 333 Pericardial window, 347–349, 348f Pericardiocentesis, 346–347, 348f complications, 347 indications, 346 technique, 346–347 Peripheral vascular injuries, 427–440 arterial injuries, 428–433 axillary artery, 437–438, 438f brachial artery, 438, 439f femoral arteries, 438–439, 440f forearm vascular injury, 438 management of, 437–440 peroneal artery, 440 popliteal artery, 439–440 blunt trauma, 427 compartment syndrome, 433–436 etiology of, 427 hard signs of arterial injury, 428t immediate amputation, indications for, 437 limb loss in vascular trauma, factors for, 428t management algorithm for, 429f penetrating injuries, 427 restoration of distal perfusion, 437 with specific orthopedic injuries, 429t venous injuries, 436–437 Peripheral vascular organ injury scale, 754t Peripheral venous catheters, placement of, 32 Peritonitis, 150–151 secondary, 150–151 tertiary, 151 tahir99 - UnitedVRG vip.persianss.ir 15:53 P1: Trim: 5.25in × 8.375in LWBK1111-Index 792 Top: 0.249in Gutter: 0.498in LWW-Peitzman-educational September 7, 2012 Index Pharmacodynamics (PD), 153 Pharmacokinetics (PK), 153 bioavailability, 153 clearance, 153 half-life, 153 Physicians, role of, in injury prevention, 198–201 Physiologic response, to injury, 10–20 continued volume shifts, 13, 14f cytokines and, 17–20 flight response, 10 hemostasis and, 11–13 immune response, 14–17 initial responses, 10, 11t macrophages and, 17 neutrophils and, 17 organ system response, 11t Physiologic scores, Pilonidal disease, 663 Placental abruption, 232, 697–698 Placenta previa, 698 Plain-film skull radiography, 111 Plasma, 65–66 Plasminogen activator inhibitor-1 (PAI-1), 13 Platelets, 66 Pneumatic compression devices (PCDs), 173–174 Pneumonia, 148–149 early-onset, 149 late-onset, 149 Polymyxins, 157–158 Portal hypertension (PH), 540–543 classification of, 540 clinical manifestation of, 540 ascites, 542 encephalopathy, 543 gastrointestinal bleeding, 540–542 hepatorenal syndrome, 543 definition of, 540 Positive end-expiratory pressure (PEEP), 503 Postconcussion syndrome, 260 Post-hospital care, Precession, Pregnancy acute cholecystitis in, 617–618 appendicitis in, 628–629 Pregnancy, trauma in, 228–233 anatomic and physiologic changes in pregnancy and, 228, 229t management of, 229–232 diagnostic modalities, 231 emergency cesarean delivery, 232 exploratory laparotomy, 231–232 fetal assessment, 230–231 general considerations, 229 medications, 231 primary survey modifications, 229–230 secondary survey modifications, 230 mechanisms of injury for, 228–229 blunt trauma, 228 penetrating trauma, 228–229 problems related to, 232–233 disseminated intravascular coagulation, 232 fetomaternal hemorrhage, 232 placental abruption, 232 preterm labor, 232 uterine rupture, 232–233 Prehospital and air medical care, 83–99 Prehospital care, Prehospital trauma management (nonarrest), 91–96 airway management, 91–92 axial spine immobilization, 95–96 intravenous access and fluid therapy, 92 needle thoracostomy, 92–84, 93f splinting, 94–95 tourniquets, 94 Preterm labor, 232 Primary resuscitator, 108t Primary survey, in pediatric trauma patients, 213–220 Procoagulant agents, 66–67 Proctalgia fugax, 665 Professional resources, in trauma systems, Prolapsing hemorrhoids (PPH), 664–665 Propofol, 29, 167, 481t for endotracheal intubation, 29t Prostaglandins, 19 Prostatic pain, 665 Proteases, 17 Protective garments, 102–103 Protein C pathway, systemic activation of, 11, 13f Protein synthesis inhibitors, 158–159 Prothrombin complex concentrate (PCC), 66 Psoas sign, 625 Public health model, 197–198, 198f PUD See Peptic ulcer disease (PUD) Pulmonary angiography, for PE diagnosis, 177 Pulmonary artery catheterization, in ICU, 464–465 Pulmonary artery catheter monitoring (PAC), 504–505 cardiac output, 505 continuous monitoring, 505 continuous cardiac output, 505 continuous mixed venous oximetry, 505 potential drawbacks, 505 RVEDV, 505 indications for, 504, 504t, 505t insertion, 504 values derived from, 504t wedge pressure, 504–505 Pulmonary artery wedge pressure (PAWP), 504–505 Pulmonary contusion, 344 Pulmonary embolism (PE), 176–177 definition of, 176 diagnosis of, 176–177 incidence of, 176 prophylaxis, 177 tahir99 - UnitedVRG vip.persianss.ir 15:53 P1: Trim: 5.25in × 8.375in LWBK1111-Index Top: 0.249in Gutter: 0.498in LWW-Peitzman-educational September 7, 2012 Index treatment of anticoagulation, 177 suction embolectomy, 177 surgical embolectomy, 177 thrombolysis, 177 Pulse contour analysis, 506–507 FloTrac system, 506 LiDCO plus system, 507 PiCCO system, 506 Pulse oximetry, in ICU, 460 Pulsus paradoxus, 332–333 R Radioactive material, use of, 191–193 Radiography, 110 in abdominal injury, 359 in chest trauma, 113 for evaluation of abdomen, 577 in pelvic fractures, 116 in spinal injuries, 113 Radiology technologist, 108t Ranson’s criteria, for acute pancreatitis, 738–740, 739t Rapid Needs Assessment (RNA), 186 Rapid-sequence intubation (RSI), 23, 28, 30 Reactive oxygen species (ROS), 17, 19 Recombinant factor VIIa (rFVIIa), 66 Recorder, 108t Rectal injuries, 369–370 Rectum injury scale, 749t Regional anesthesia, 33–34 Rehabilitation, 202–211 general effects of neurotrauma and immobilization after injury, 202–206 post-injury problems and, 207–210 agitation, 207–208 autonomic dysreflexia, 208 neurogenic bladder, 208–209 neurogenic bowel, 209–210 scope of, 210–211 Relative afferent pupillary defect (RAPD), 308–309 Renal failure, 508 Renal injuries, 397–399, 397f–399f and complications, 398–399 mechanism and diagnosis of, 397 treatment of, 398 Renal replacement therapy, indications for initiation of, 478t Renal system, in elderly, 234 Research, in trauma systems, Respiratory system, in elderly, 234 Respiratory technician, 108t Restraints, role of, Resuscitation, 32–33, 569–571, 594–595 adjunctive procedures to naso/orogastric tube intubation, 719–720 optical tonometry/lateral canthotomy, 720 reduction of common dislocations, 720–722 793 ring removal from compromised digit, 722–723 skeletal traction pin insertion, 723 Retinal detachment, 314 Retrograde urethrography (RUG), 117 in genitourinary injuries, 395 Revised trauma score (RTS), 4, 736–737, 736t Richter’s hernia, 691 RIFLE criteria, 492t for acute kidney injury, 508, 509f Rifling, Right thoracotomy, 356 Right ventricular end-diastolic volume index (RVEDVI), 50, 505 Ring of fire, 695 Rocuronium, 482t for endotracheal intubation, 29t Rovsing’s sign, 565t, 626 Ruptured aortic aneurysm, 672–674 diagnosis, 672–673, 673t history and physical examination, 672 imaging modalities, 672–673 outcomes, 674 risk factors for, 673t treatment, 673–674 endovascular repair, 674 open repair, 673–674 S Scoring systems, 733 in emergency general surgery appendicitis, 738 cholecystitis, 738 diverticulitis, 737–738 necrotizing soft tissue infections, 740–742 pancreatitis, 738–740, 739t, 740t in injury and trauma anatomic scoring, 733–735 combined scores, 737 physiologic scoring, 735–737 types of, 733 Scrotal injury, 402 Scrotum injury scale, 754t Seatbelt/Chance fracture, 303 Seat belt syndrome, Selective factor Xa inhibitors, 174 Sepsis, 14, 49, 128–136 bacteria implicated in, 131f definition of, 128 diagnosis of, 128–132, 130t, 131f, 132t management of, 133–136 adjuvant therapies, 136 anemia and coagulopathy, 135–136 antibiotics, 134–135 circulatory support, 133–134 corticosteroids, 135 deep vein thrombosis prophylaxis, 136 glucose management, 135 hemodynamic goals and devices, –134 nutrition, 135 tahir99 - UnitedVRG vip.persianss.ir 15:53 P1: Trim: 5.25in × 8.375in LWBK1111-Index 794 Top: 0.249in Gutter: 0.498in LWW-Peitzman-educational September 7, 2012 Index Sepsis (Contd.) renal support, 136 respiratory support, 133 sedation, analgesia, and neuromuscular blockade, 135 stress ulcer prophylaxis, 136 vasopressor/inotrope use, 134 risk factors for, 128, 129t severe, 128 Septic abdomen, damage control sequence for, 59 Septic shock, 45, 49, 128 Sequential organ failure assessment (SOFA), 490 Serial casting of extremity, 203 A Severity Characterization of Trauma (ASCOT), 4, 737 Sexual assault, 705–706 incidence and epidemiology, 705 management, 705–706 Shaken impact syndrome, 225 Shock, 45–50 and acute respiratory failure, 474 classification of, 45 definition of, 45 and goals of resuscitation, 49–50 management of, 48–49 manifestations of, 46–47 clinical findings, 46–47 coagulopathy of trauma, 47 quantification of hypoperfusion, 47 physiologic response in, 45–46 afferent signaling, 45 cardiovascular, 45–46 cellular effects, 46 inflammatory and immune, 46 neuroendocrine, 46 Shotgun, 8, 248–249 Shoulder dislocation, reduction of, 720–721 Shoulder dystocia, 699 Simple triage and rapid treatment (START), 85, 87t Sinusitis, 151–152 Skin and soft-tissue injuries, and infection, 146 Skull, 253 Skull fractures, 261–262 basilar, 262 depressed, 261–262 linear, 261 Skull trauma, imaging in, 111–112 Slash wounds, 250 Small bowel diverticular disease, 648 Small bowel injury scale, 748t Small bowel obstruction (SBO), 584–587 etiology, 584 adhesions, 584 Crohn’s disease, 584 foreign bodies, 584 gallstone ileus, 584 hernias, 584 intussusception, 584 neoplasms, 584 laboratory evaluation, 585 complete blood count, 585 electrolyte panel, 585 presentation and initial assessment, 584–585 radiographic evaluation, 585–586 abdominal x-ray, 585–586, 585f CT, 586 treatment, 586–587, 586t adhesions, 586–587 non-adhesive causes, 587 Small intestine injuries, 369, 369t, 371t Social worker, 108t Sodium nitroprusside, in aortic injury, 337 Soft tissue infection, 666–670 anatomy related to, 666 dermis, 666 epidermis, 666 investing fascia, 666 muscle, 666 subcutaneous tissue, 666 necrotizing, 667–670 (See also Necrotizing soft tissue infections (NSTIs)) risk factors, 666–667 Spasticity, 203 Spinal cord/spinal column injury, 287–307 anatomy of spinal cord and, 287–288, 288f Canadian C-spine rule, 295f cervical spine fractures, 299–300, 299f, 301f–304f mechanics of spinal column injury and, 288–289 medical management of SCI, 297–299 neurologic evaluation and physical examination in, 290–294 anterior cord injury, 294 Brown-Sequard syndrome, 294 central cord injury, 294 conus medullaris and cauda equina syndromes, 294 motor evaluation, 290 posterior cord injury, 294 reflex testing, 290 sensory testing, 290, 291f–292f penetrating spinal column injury, 306–307 prehospital measures, 289–290 radiographic examination, 294–297, 296f surgical management of, 303–306, 306t thoracolumbar spine fractures, 302–303 Spine boards, 95–96 Spine inuries, imaging in, 112–113 Spine radiographs, 110 Spleen injury scale, 746t Splenic injury, 383–387 anatomy and function of spleen, 383 in children, 223 diagnosis of, 383 incidence of, 383 outcomes and complications, 386–387 tahir99 - UnitedVRG vip.persianss.ir 15:53 P1: Trim: 5.25in × 8.375in LWBK1111-Index Top: 0.249in Gutter: 0.498in LWW-Peitzman-educational September 7, 2012 Index treatment, 383–386 nonoperative management, 383–385, 384f operative management, 385–386, 386f, 387f Splint application, 723–726 available internet images/video, 725 complications, 725 contraindications, 723 indications, 723 pelvic sling/binder application, 725–726 splinting technique, 723–724 post-procedure, 724 pre-procedure, 723 splinting procedure, 723–724 traction splint application, 726 types of splint lower extremity, 725 upper extremity, 724 Splinting, 94–95, 424–426 See also Orthopaedic traumatic injuries complications of, 94–95 indications for, 94 type of splint, 94 Sports-related head injury, 260 grading of, 260t Stab wounds, 8, 250 Stomach injuries, 367–369, 371t Stomach injury scale, 748t Storage lesion, 69 Straddle injury, in children, 224 Subarachnoid hemorrhage, 111 Subaxial Cervical Injury Classification and Severity Score (SLICS), 306t Subcutaneous heparin (SCH), 174 Subdural hematomas, 111 Succinylcholine, for endotracheal intubation, 29t Supraglottic airways, 30, 90f Suprapubic catheter insertion, 727–728 available internet video, 728 complications, 728 contraindications, 727 indications, 727 technique, 727–728 Surgical airways, 30–31 Survival Risk Ratios (SRR), Surviving Sepsis Campaign Guidelines, 133 See also Sepsis Susceptibility weighted imaging (SWI), 112 Systemic inflammatory response syndrome score (SIRS score), 4, 741–742, 741t Systemic inflammatory response syndrome (SIRS), 14, 128, 140t, 490t See also Infection; Sepsis T Tactile (digital) ETI, 30 TBIs See Traumatic brain injuries (TBIs) Team activation and organization, 101–108 795 transfer of patient to trauma team and, 107–108 trauma response and, 101 trauma resuscitation area and, 102–105 trauma team and, 105–107 Teardrop fractures, 300 Technology, in trauma systems, Telavancin, 157 Temporary abdominal closure (TAC), 54–55 Tension pneumothorax, 331–332 causes, 331 diagnosis, 332 treatment, 332 Terrorism, 189 See also Disasters/mass casualty incident Testis injury scale, 753t Tetracyclines, 158–159 Thiopental, for endotracheal intubation, 29t Third trimester bleeding, 697–698 management of, 698 placental abruption, 697–698 placenta previa, 698 Thoracentesis, 484 Thoracic bioimpedance, 463 Thoracic injuries, 327–356, 331t chest wall injury, 345 and emergency thoracic procedures, 345–356 bilateral thoracotomy, 354, 355f emergency department thoracotomy, 349–352, 350f, 351f left anterolateral thoracotomy, 352–353 left/right posterolateral thoracotomy, 353–354, 354f median sternotomy, 352 pericardial window, 347–349, 348f pericardiocentesis, 346–347, 348f right thoracotomy, 356 thoracoabdominal incision, 356 tube thoracostomy, 345, 346f–347f immediate evaluation of, 327–328 arterial blood gas, 328 chest x-ray, 327 indications for immediate operation, 328 oxygen administration, 327 physical examination, 327 resuscitation, 327 immediate life-threatening injuries, 330–335 airway obstruction, 330–331 commotio cordis, 335 flail chest, 334–335 massive hemothorax, 334 open pneumothorax, 333 pericardial tamponade, 332–333 tension pneumothorax, 331–332 mortality from, 327 penetrating thoracic wounds, immediate management of, 328 potentially life-threatening injuries, 335 cardiac injuries, 339–341 tahir99 - UnitedVRG vip.persianss.ir 15:53 P1: Trim: 5.25in × 8.375in LWBK1111-Index 796 Top: 0.249in Gutter: 0.498in LWW-Peitzman-educational September 7, 2012 Index Thoracic injuries (Contd.) diaphragmatic injury, 342–343 esophageal injury, 343–344 pulmonary contusion, 344 tracheobronchial injuries, 338–339 traumatic rupture of aorta, 335–338, 337f vascular injuries, 341–342 transmediastinal penetrating wounds, immediate evaluation of, 328–330, 329f, 330f traumatic asphyxia, 344–345 Thoracic vascular injuries, 341–342 azygos and hemiazygos veins injuries, 342 carotid artery injury, 341–342 clinical signs, 341 diagnosis, 341 injury complexes, 341 massive hemothorax, 341 middle mediastinal hematoma, 341 superior mediastinal hematoma, 341 intercostal arteries injuries, 342 internal mammary artery injury, 342 pulmonary hilum, 342 subclavian artery injury, 342 Thoracic vascular injury scale, 745t Thoracoabdominal incision, 356 Thoracolumbar burst fractures, 302–303 Thoracolumbar Injury Classification and Severity Score (TLICS), 306t Thoracotomy, 341 Three-point seat belt restraints, Thromboelastogram (TEG), 64–65 Thrombosed and prolapsed hemorrhoids, 600–661 Thromboxanes, 20 Tigecycline, 159 Tissue plasminogen activator (tPA), 13 Tizanidine, 204 TNF-␣, 18 Tokyo guidelines, for acute cholecystitis, 738, 739t Total body surface area (TBSA), 443, 447 See also Burns/inhalation injuries Total parenteral nutrition (TPN), 73, 77 Tourniquets, 94 Tracheobronchial injuries, 338–339 bronchial injuries, 338 cervical tracheal injuries, 338 management, 339 radiographic signs, 338 Tracheostomy, 31, 484, 527–528 Tranexamic acid (TXA), 66 Transcranial Doppler, 259 Transesophageal echocardiography (TEE), 506 for aortic injury, 337 Transfusion associated circulatory overload (TACO), 70–71 Transfusion related acute lung injury (TRALI), 70 Transjugular intrahepatic portosystemic shunt (TIPS), 542 Transthoracic echocardiography (TTE), 506 Trauma in children, 213–227 definition of, epidemiology of, injury patterns and mechanism in, 1–2 mechanisms of injury in, 4–9 blunt injury, 4–6 combined injury, 8–9 penetrating injury, 6–8 mortality after, 1, 2f in older adults, 234–239 (See also Elderly, trauma in) physiologic response in, 10–20 in pregnant women, 228–233 (See also Pregnancy, trauma in) Trauma and injury severity score (TRISS), 4, 737 Trauma Center environment, 35 Trauma centers level I, 101 level II, 101 level III, 101 level IV, 101 non-designated, 101 Trauma databases, Trauma-induced coagulopathy (TIC), 11 Trauma nurse, 108t Trauma patient anesthesia for, 32–34 definition of, initial assessment and resuscitation of, 35–44 approach of trauma team and, 35, 36f laboratory studies and, 43 multiple victims and, 43–44 patient in extremis and, 41–43 patient stability and, 35–37 stable adult with blunt trauma and, 37–38 stable adult with penetrating trauma and, 40 unstable adult with blunt trauma and, 38–39 unstable adult with penetrating trauma and, 40–41 response to, 101 institutional capability and, 101 levels of, 101 team approach to, 35 Trauma patient classification system, 106t Trauma resuscitation area (TRA), 102–105 communication in, 105 equipment in, 103–105 layout of, 104f medications in, 105 physical plant, 102 and protective garments, 102–103 Trauma score (TS), 4, 736 tahir99 - UnitedVRG vip.persianss.ir 15:53 P1: Trim: 5.25in × 8.375in LWBK1111-Index Top: 0.249in Gutter: 0.498in LWW-Peitzman-educational September 7, 2012 Index Trauma systems, 2–3 definition of, fundamental components of, infrastructure elements, overview of, Trauma team, 105–107, 107f, 108t Trauma team leader, 108t Traumatic arrest, 87–91 etiology, 87–88 management of, 89–91 resuscitation criteria, 88 special conditions, 88–89 survival determination, 88 Traumatic asphyxia, 344–345 definition, 344 diagnosis, 345 treatment, 345 Traumatic brain injuries (TBIs), 253–262, 479 in children, 222 initial evaluation and treatment of, 254–255 mild/moderate TBI, 254 mild head injury, 259 postconcussion syndrome, 260 return to play after sports-related head injuries, 260–261 penetrating brain injuries, 261 related anatomy and physiology, 253–254 severe TBI, 254 adjunctive monitoring, 259 ICP monitoring, 257 initial treatment, 256–257 physiologic monitoring, 255–256 prognosis after severe TBI, 259 treatment of elevated ICP, 257–259, 258f skull fractures, 261–262 Traumatic myositis ossificans, 205 Traumatic optic neuropathy, 313 Traumatic rupture of the aorta, 335–338 chest x-ray, 335–336 clinical signs, 335 definition, 335 diagnosis, 335–337 diagnostic algorithm for, 336f management, 337–338 mechanism of injury, 335 Traumatic shock, 45, 48 Trauma triage, 83–87 field triage, 83–85 (See also Field triage) limitations to, 87 over-triage, 87 under-triage, 87 mass casualty triage, 85–87 Triad of Death, 61 Trigeminal nerve, 278, 279f Trimethoprim-Sulfamethoxazole (TMP-SMX), 160 Tube thoracostomy, 345, 346f–347f, 484 U Ultrasound (US), 110 for evaluation of abdomen, 578 797 in genitourinary injuries, 397 in ICU, 118 Unilateral facet fractures, 300 United Network for Organ Sharing (UNOS), 548 University of Wisconsin donation after cardiac death evaluation tool, 549t Unstable patient, 35, 37t See also Trauma patient Upper GI (UGI) bleeding, 540–542 Ureteral injuries, 399–400 and complications, 400 mechanism and diagnosis, 399 treatment of, 399–400 Ureter injury scale, 751t Urethra injury scale, 751t Urethral injuries, 401–402 complications of, 402 diagnosis of, 401 mechanism of, 401 treatment of, 401–402 anterior urethral injury, 402 posterior urethral injury, 401–402 Urinary catheter insertion, 726–727 available internet video, 727 complications, 727 contraindications, 726 indications, 726 technique in female patient, 727 in male patient, 726–727 in pediatric patient, 727 Urinary tract infection (UTI), 152–153 Uterine bleeding, abnormal, 701–702 evaluation, 702 management, 702 pathophysiology, 702 Uterine pain, 665 Uterine rupture, 232–233 Uterus (nonpregnant) injury scale, 752t Uterus (pregnant) injury scale, 752t V Vagina injury scale, 753t Vaginal injuries, 403 Vancomycin, 157 VAP See Ventilator-associated pneumonia (VAP) Vascular emergencies, 672–682 acute lower extremity ischemia, 680–682 aortic dissection, 675–677 aortoenteric fistula, 678 mesenteric ischemia, 678–680 ruptured aortic aneurysm, 672–674 visceral aneurysms, 674–675 Vasoactive drugs, 33 Vasogenic shock, 45, 46, 49 Vasopressors, 570–571 Vecuronium, 482t for endotracheal intubation, 29t tahir99 - UnitedVRG vip.persianss.ir 15:53 P1: Trim: 5.25in × 8.375in LWBK1111-Index 798 Top: 0.249in Gutter: 0.498in LWW-Peitzman-educational September 7, 2012 Index Venous injuries, 436–437 diagnosis, 436 treatment, 437 Venous thromboembolism, 170–178 deep venous thrombosis, 170–176 pulmonary embolism, 176–178 Venous thromboembolism (VTE), 466 Ventilation–perfusion scintigraphy (V/Q scan), for PE diagnosis, 177 Ventilator-associated pneumonia (VAP), 144, 149 prevention of, 516–517 Ventilator-induced lung injury (VILI), 517 Ventilator settings, 477 See also Mechanical ventilation (MV) Ventriculostomy catheters, 257 Violence, elderly and, 237 Visceral arterial aneurysms, 674–675 diagnosis, 674 presentation, 674 vessels affected, 674–675 celiac artery, 675 hepatic artery, 675 SMA, 675 splenic artery, 674–675 Visual acuity, 308, 309f Vitamin K antagonists (VKAs), 174, 176 Volume shifts, after trauma, 13, 14f fluid mobilization and diuresis, 13 obligatory extravascular fluid sequestration, 13 shock and active hemorrhage, 13 Vulva injury scale, 753t W Waddle’s triad of injury, 244 Warfarin, 176 Waveform capnographers, 27 Weapons of mass destruction (WMD), 183, 189–193 See also Disasters/mass casualty incident Wedge compression fractures, 302, 305f World Society of Abdominal Compartment Syndrome (WSACS), 529 Wound, maxillofacial injury, 282–284 X X-rays, 110 See also Chest x-ray; Radiography Y Yaw, Z Zenker’s diverticulum, 630 Zygomatic arch fractures, 274–275, 275f Zygomaticomaxillary complex fractures, 273–274, 274f tahir99 - UnitedVRG vip.persianss.ir 15:53 ... views of 20 :46 P1: Trim: 5 .25 in × 8.375in LWBK111 1 -2 9 360 Top: 0 .24 9in Gutter: 0.498in LWW-Peitzman-educational August 28 , 20 12 The Trauma Manual: Trauma and Acute Care Surgery 01 Figure 2 9 -2 Ultrasound... injury, the segment of injured 20 :46 P1: Trim: 5 .25 in × 8.375in LWBK111 1 -2 9 370 Top: 0 .24 9in Gutter: 0.498in LWW-Peitzman-educational August 28 , 20 12 The Trauma Manual: Trauma and Acute Care Surgery. .. adults, the risk of NOM failure also 20 :46 P1: Trim: 5 .25 in × 8.375in LWBK111 1 -2 9 384 Top: 0 .24 9in Gutter: 0.498in LWW-Peitzman-educational August 28 , 20 12 The Trauma Manual: Trauma and Acute Care Surgery