General Trauma Care and Related Aspects: Trauma Surgery II

Foreword......Page 6
Preface......Page 8
Contents......Page 10
1.1.1	 History [ 1 ]......Page 12
1.1.3	 Definitions......Page 13
1.2.1	 USA......Page 15
1.2.3	 Australia [ 23 ]......Page 16
1.2.6	 The Netherlands [ 28 ]......Page 17
1.3.1	 Prevention......Page 18
1.3.2.2 Canada......Page 19
1.3.2.5 The Netherlands......Page 20
1.3.2.7 France [ 12, 21 ]......Page 21
1.3.3	 In-Hospital Care and the Role of the Team Leader......Page 22
1.3.5.1 The USA [ 46 ]......Page 24
1.3.6	 Education......Page 25
1.4	 The Future......Page 26
References......Page 27
2.2	 Prehospital Care......Page 29
2.3.1	 Primary Survey......Page 30
2.3.2	 Secondary Survey......Page 32
References......Page 34
3.2	 What Are Trauma Scores Used for?......Page 35
3.3.3	 ISS......Page 36
3.3.6	 TASH......Page 37
3.5	 Limitations......Page 38
References......Page 39
4.1	 Definitions......Page 40
4.2	 Risks of MIs in Modern Societies......Page 41
4.4.1	 Demands on Prehospital Response in MIs......Page 42
4.4.4.1 The First Report......Page 43
4.4.4.2 Taking Command......Page 45
4.4.4.4 Safety......Page 46
4.4.5.1 The Need for Simplicity......Page 47
4.4.5.2 The First Step: Starting Triage and Transport......Page 48
 The Injury Zone......Page 49
 Non-injured People......Page 50
4.4.6.1 General Principles......Page 51
4.4.6.2 Categories of Priority......Page 52
4.4.6.4 Triage in Incidents of Physical Trauma......Page 53
4.4.7	 Indications for Treatment at the Scene......Page 55
4.4.8	 Transport of Casualties......Page 56
4.4.9.2 Identification and Destination......Page 57
4.5.1	 Functions of Critical Importance for the Capacity of the Hospital......Page 59
4.5.2.3 The Content of the Disaster Plan......Page 60
4.5.3.3 Further Processing of the Alarm......Page 61
4.5.4.3 Red Alert (“Full Mobilization”)......Page 62
4.5.5.3 The Hospital Command Group (HCG)......Page 63
4.5.5.5 Medical Staff in Charge in Different Functions......Page 64
4.5.7	 Preparing the Hospital......Page 65
4.5.8.2 Severely Injured......Page 66
4.5.8.4 Non-injured......Page 68
4.5.10	 Psychosocial Support......Page 69
4.5.12	 Contact with Media......Page 70
4.5.14.4 Communication......Page 71
4.6	 Treatment Principles in MIs......Page 72
4.7.3	 Methodology of Training......Page 73
Overview Literature......Page 75
Literature Covering Specific Areas......Page 76
Websites......Page 77
5.3	 Pathophysiological Background......Page 78
5.4	 Timing and Priorities of Surgery (Fig.  5.2)......Page 79
5.6	 Pros and Cons of Different Fixation Methods......Page 81
5.7.3	 Early Fixation of Femoral Shaft Fractures in Severe Polytrauma Patients or Polytrauma Patients with Chest Injury......Page 82
References......Page 84
6.1.2	 Endocrine Stress Reaction and Stress Concepts......Page 86
6.1.4	 Anesthetics and Anesthetic Procedures......Page 88
6.2.1.1 General......Page 89
6.2.1.4 Fentanyl......Page 90
6.2.1.7 Midazolam......Page 91
6.2.2.2 Preclinical Anesthesia......Page 92
6.2.2.3 Special Aspects with of Polytrauma Patients......Page 94
6.3.1	 Receiving the Patient......Page 95
6.3.3	 Continuation of Anesthesia......Page 96
6.4.1	 Fundamentals......Page 97
6.4.2.2 Medications......Page 98
6.4.3.1 Fundamentals......Page 99
6.4.3.3 Procedures and Indications......Page 100
References......Page 101
7.2	 Pathophysiology of Trauma......Page 103
7.3	 Intensive Care......Page 105
7.4.1	 Hemorrhage......Page 106
7.4.3	 Disturbed Coagulation......Page 107
7.4.4	 Hypercoagulability......Page 108
7.4.6	 Hypothermia......Page 109
7.4.8.2 Respiration......Page 110
7.4.8.3 Bowel System......Page 112
 Abdominal Compartment Syndrome......Page 113
References......Page 114
8.2	 Epidemiology......Page 118
8.3	 Predisposing Risk Factors......Page 119
8.4.1	 Host Response Initiation......Page 120
8.4.2	 Hyperinflammation: SIRS......Page 121
8.4.3	 Hypoinflammation: Compensatory Anti-inflammatory Response Syndrome......Page 122
8.4.5	 Coagulation Cascade......Page 123
8.4.7	 Leukocytes Recruitment and Oxidative Stress......Page 124
8.4.8	 Leukocytes Apoptosis......Page 125
8.4.10	 Autonomic Nervous System and Neuroendocrine Reaction......Page 126
8.4.11	 Metabolic Alterations......Page 127
8.5	 Diagnosis......Page 128
8.6.1	 Preventive Interventions......Page 129
8.6.2	 Therapeutic Interventions......Page 130
8.7	 Prognosis......Page 132
Suggested Reading......Page 133
9.2	 Predisposing Factors......Page 134
9.4.1.1	 Cellulitis......Page 135
9.4.1.6	 Necrotizing Fasciitis......Page 136
9.4.3	 Toxic Shock Syndrome......Page 137
9.4.4.3 Laboratory Tests......Page 139
9.4.5	 Therapy......Page 140
9.4.7	 Antibiotics......Page 141
Bibliography......Page 142
10.4	 Closed Fractures (Tscherne and Oestern) [ 2, 3 ]......Page 145
10.5.1	 Classification (Gustilo and Anderson) [ 2 ]......Page 147
10.5.2.1 Primary Treatment at the Scene......Page 148
 Definitive Assessment......Page 149
 Fracture Stabilization......Page 150
 Wound Closure......Page 153
References......Page 154
11.3	 Pathophysiology......Page 155
11.5.2	 Forearm......Page 156
11.5.6	 Lower Leg......Page 157
11.6	 Prognosis......Page 158
References......Page 160
12.2	 Ladder of Reconstruction: Reconstructive Clockwork......Page 161
12.3.1	 Defect Description......Page 162
12.3.2	 Timing......Page 163
12.3.4	 Wound Coverage Techniques and Possibilities of Defect Closure......Page 164
References......Page 173
13.4	 Burn Pathophysiology......Page 174
13.5.1	 Burn Depth......Page 175
13.5.3	 Transfer Criteria to a Burn Center......Page 176
13.6.3	 Aspects of Burn Care......Page 178
13.6.4	 Follow-Up Care......Page 179
References......Page 180
14.2	 Risk Factors......Page 182
14.4.1	 Post-Thrombotic Syndrome......Page 184
14.5	 Physiology of Plug Formation......Page 185
14.5.1	 Coagulation......Page 186
14.7	 Mechanical Methods of Thromboprophylaxis......Page 187
14.8.1	 Vitamin-K Dependent Clotting Factors, Coumarins......Page 188
14.8.2	 Heparin......Page 189
14.8.3	 Low-Molecular-Weight Heparin......Page 190
14.8.5	 Direct Xa Inhibitors......Page 191
14.8.7.1 Aspirin......Page 192
14.8.8.1 New Antiplatelet Drugs......Page 193
14.9.1	 Grading......Page 194
14.9.2.1 Mechanical Methods of Thromboprophylaxis......Page 195
14.11.1	 Trauma......Page 196
14.11.4	 Critical Care......Page 197
14.12.1	 Commencement of Thromboprophylaxis......Page 198
14.13.1	 Initial Anticoagulation of Acute DVT of the Leg......Page 199
14.13.7	 Percutaneous Venous Thrombectomy......Page 200
14.13.12	 Intensity of Anticoagulant Effect......Page 201
14.14	 IV or SC UFH, SC LMWH, SC Fondaparinux, and VKA for the Initial Treatment of PE......Page 202
14.14.3	 Pulmonary Embolectomy for the Initial Treatment of PE......Page 203
14.14.7	 Treatment of Superficial Vein Thrombosis......Page 204
References......Page 205
15.1.2	 Physiology and Pathophysiology......Page 207
15.1.5	 Diagnosis by Imaging Procedures......Page 208
 Recommended Therapeutic Measures in Accordance with the European Standard......Page 209
15.2.5.2 Procedure 2......Page 210
 Recommended Standardized Therapeutic Measures in Accordance with the European Standard......Page 211
15.4	 Special Muscle Injuries and Damage to the Pelvis and Lower Extremities......Page 212
 Recommended Standardized Therapeutic Measures According to the European Standard......Page 213
References......Page 214
16.1.3	 Specific Causes of Tendon Injuries......Page 215
16.1.6.1 Magnetic Resonance Imaging and Computed Tomography......Page 216
16.2.1.2 Further Useful Diagnostic Procedures......Page 217
 Recommended Therapeutic Measures in Accordance with the European Standard......Page 218
 Additional Useful Surgical Measures......Page 220
16.2.4	 Prognosis......Page 221
16.3	 Tendon Injuries to the Pelvis and Lower Extremity......Page 222
16.3.1.1 Recommended Diagnostic Measures in Accordance with the European Standard......Page 223
 Recommended Therapeutic Measures in Accordance with the European Standard......Page 224
16.3.5.1 Procedure 1......Page 225
16.3.6	 Special Remarks......Page 229
References......Page 231
17.2	 Classification......Page 232
17.4.4	 Pathological Mechanics......Page 233
17.8.1	 Improvement of Impaired Biology......Page 234
17.9.4	 Stabilization of Fragments......Page 235
17.10.1.1 Functions of Bone Graft......Page 236
17.10.2 Mechanical Stimulation......Page 237
17.11	 Infected Nonunion......Page 238
 Open Reduction......Page 239
 Nonunion of the Femoral Neck......Page 240
 Femoral Shaft Nonunion......Page 241
 Surgical Treatment......Page 242
17.12.3.1 Case 1......Page 243
17.12.3.2 Case 2......Page 244
References......Page 245
18.1.3	 Pathophysiology......Page 247
18.1.7	 Imaging Methods......Page 248
18.2.3	 Epidemiology/Etiology......Page 249
18.2.8.2 Useful Additional Surgical Treatment......Page 250
 Technique......Page 251
18.3.4	 Symptoms......Page 252
18.3.6.2 Useful Additional Examinations......Page 253
18.3.10.1 Removal of Implants......Page 256
18.4.1.5 Diagnosis......Page 258
18.4.2.6 Therapy......Page 259
18.4.3.7 Complications......Page 260
18.4.5.7 Complications......Page 261
References......Page 262
19.5	 Etiology of Pathological Fractures......Page 264
19.6.1.6 Osteogenesis Imperfecta......Page 265
 Multiple Myeloma......Page 266
19.7.1	 History......Page 267
19.9.1	 Plain Radiographs......Page 268
19.10.1 Bone Biopsy......Page 272
19.11.2 Surgical Treatment......Page 273
19.12.1 Osteoporosis......Page 274
19.12.7 Chronic Osteomyelitis......Page 275
19.12.9 Multiple Myeloma......Page 276
19.12.10 Bony Metastases......Page 277
19.12.11.1 Radiation Therapy and Chemotherapy......Page 280
References......Page 281
Index......Page 282