RT Book, Section
A1 Burlew, Clay Cothren.
A1 Moore, Ernest E.
A2 Brunicardi, F. Charles
A2 Andersen, Dana K.
A2 Billiar, Timothy R.
A2 Dunn, David L.
A2 Hunter, John G.
A2 Matthews, Jeffrey B.
A2 Pollock, Raphael E.
SR Print(0)
ID 1117741443
T1 Trauma
T2 Schwartz's Principles of Surgery, 10e
YR 2015
FD 2015
PB McGraw-Hill Education
PP New York, NY
SN 9780071796743
LK accessmedicine.mhmedical.com/content.aspx?aid=1117741443
RD 2024/04/19
AB Trauma  remains  the  most  common  cause  of  death  for  all  individuals  between  the  ages  of  1  and  44  years  and  is  the  third  most  common  cause  of  death  regardless  of  age.The  initial  management  of  seriously  injured  patients  consists  of  performing  the  primary  survey  (the  “ABCs”—Airway  with  cervical  spine  protection,  Breathing,  and  Circulation);  the  goals  of  the  primary  survey  are  to  identify  and  treat  conditions  that  constitute  an  immediate  threat  to  life.All  patients  with  blunt  injury  should  be  assumed  to  have  unstable  cervical  spine  injuries  until  proven  otherwise;  one  must  maintain  cervical  spine  precautions  and  in-line  stabilization.Patients  with  ongoing  hemodynamic  instability,  whether  “nonresponders”  or  “transient  responders,”  require  prompt  intervention;  one  must  consider  the  four  categories  of  shock  that  may  represent  the  underlying  pathophysiology:  hemorrhagic,  cardiogenic,  neurogenic,  and  septic.Indications  for  immediate  operative  intervention  for  penetrating  cervical  injury  include  hemodynamic  instability  and  significant  external  arterial  hemorrhage;  the  management  algorithm  for  hemodynamically  stable  patients  is  based  on  the  presenting  symptoms  and  anatomic  location  of  injury,  with  the  neck  being  divided  into  three  distinct  zones.The  gold  standard  for  determining  if  there  is  a  blunt  descending  torn  aorta  injury  is  CT  scanning;  indications  are  primarily  based  on  injury  mechanisms.The  abdomen  is  a  diagnostic  black  box.  However,  physical  examination  and  ultrasound  can  rapidly  identify  patients  requiring  emergent  laparotomy.  Computed  tomographic  (CT)  scanning  is  the  mainstay  of  evaluation  in  the  remaining  patients  to  more  precisely  identify  the  site  and  magnitude  of  injury.Manifestation  of  the  “bloody  vicious  cycle”  (the  lethal  combination  of  coagulopathy,  hypothermia,  and  metabolic  acidosis)  is  the  most  common  indication  for  damage  control  surgery.  The  primary  objectives  of  damage  control  laparotomy  are  to  control  bleeding  and  limit  GI  spillage.Blunt  injuries  to  the  carotid  and  vertebral  arteries  are  usually  managed  with  systemic  antithrombotic  therapy.The  abdominal  compartment  syndrome  may  be  primary  (i.e.,  due  to  the  injury  of  abdominal  organs,  bleeding,  and  packing)  or  secondary  (i.e.,  due  to  reperfusion  visceral  edema,  retroperitoneal  edema,  and  ascites).