Thoracic Surgery for the Acute Care Surgeon

Series Foreword
Preface
Contents
Low-Resource Environments
	Epidemiology and Global Disparities
	Diagnosis
		History
		Physical Exam
		Labs
		Imaging
			Chest Radiography
			Ultrasound
				Pulmonary Exam
					Pneumothorax
					Pulmonary Edema/Consolidation
					Pleural Effusion
				Cardiac Function
				Extended Focused Assessment with Sonography in Trauma (eFAST)
			Computed Tomography
		Diagnostic Modality Pitfalls
	Management
		Pain
		Anesthesia
		Blood Transfusion
		Tube Thoracostomy
			Indications
			Procedure
			Management
			Pitfalls and Challenges
		Thoracotomy
			Indications
			Procedure
			Management
			Pitfalls and Challenges
		Pericardial Drainage and Pericardiectomy
			Indications
			Procedure
			Management
			Pitfalls and Challenges
		Tracheostomy and Cricothyroidotomy
			Indications
			Procedure
			Management
			Pitfalls and Challenges
	Conclusion
	References
Part I: Acute Surgery Thoracic Emergencies
	Esophageal Rupture
		Introduction
		Etiology
		Presentation
		Diagnosis
			Physical Examination
			Imaging
				Plain Radiographs
				Contrasted Esophagography
				Computerized Tomography
			Endoscopy
			Thoracentesis
		Management
			Initial Management
			Nonoperative and Hybrid Approaches to Management
			Endoscopic Management
				Endoscopic Stenting
				Endoscopic Clipping and Suturing
				Endoscopic VAC
			Operative Management
				Surgical Approach
			Management of Intrathoracic Esophageal Rupture
				Video-Assisted Thoracoscopic Surgery (VATS)
				Thoracotomy
				Primary Repair
				Buttressed Repair with Autologous Tissue
				Exclusion
				Resection
			Postoperative Management
				Sepsis
				Nutrition
				Drains and Wound Care
				Stent Migration
			Complications and Outcomes
				Leak
				Stricture/Stenosis
				Mortality
		Conclusions
		References
	Incarcerated Hiatal Hernia
		Introduction
		Clinical Presentation
		Diagnosis and Preoperative Work-up
		Surgical Treatment
			Technique of Laparoscopic Repair
		Management of Acute Presentations
		Conclusions
		References
	Pulmonary Embolism
		Introduction
		Pathophysiology
		Classification
		Diagnosis
			Clinical Decision Rules
			PERC
			Wells Score
			Geneva Score
			D-Dimer
		Diagnostic Imaging
			Venous Duplex
			Chest Radiography
			Radionucleotide (V/Q) Scan
			Pulmonary Angiogram
			CT Scan
			MRI
			V/Q Single-Photon Emission Computed Tomography
		Cardiac/Hemodynamic Evaluation
			Troponin
			Natriuretic Peptides
			Electrocardiogram
			CT
			ECHO
		Prognostication
		Management
			Medical Therapy
				Anticoagulation
				Thrombolysis
				Inhaled Nitric Oxide
			Catheter-Directed Therapy
				Catheter-Directed Thrombolysis
				Catheter-Directed Embolectomy
			Surgery
			Extracorporeal Life Support (ECLS)
			Prevention
		Conclusion
		References
	Empyema and Effusions
		Pleural Empyema
			Introduction
			Epidemiology and Pathogenesis
			Diagnosis
			Classification
			Treatment
		Pleural Effusion
			Introduction
			Plural Space Physiology
			Evaluation of Plural Effusion
			Treatment
		References
	Pericarditis and Pericardial Effusions
		Acute Pericarditis
			Epidemiology
			Etiology
			Clinical Presentation and Diagnosis
			Management
				Post-Cardiac Injury Syndrome
				Idiopathic, Viral and Immune-Mediated Acute Pericarditis
				Recurrent Pericarditis
				Uremic Pericarditis
				Purulent Pericarditis
				Tuberculous Pericarditis
				Pericardial Neoplasms
			Prognosis
		Constrictive Pericarditis
			Etiology
			Clinical Presentation and Diagnosis
			Management
		Cardiac Tamponade
			Etiology
			Clinical Presentation and Diagnosis
			Management
		Pericardial Procedures
			Pericardiocentesis
			Pericardiotomy and Pericardial Biopsy
			Pericardioscopy
			Pericardiectomy
		References
	Necrotizing Lung Infections
		Introduction
		Bacteriology and Other Causative Organisms
		Diagnosis
		Treatment and Surgical Indications
		Conclusion
		References
	Incidental Pulmonary Nodule
		Part 1: Incidental Finding on Imaging
			Identification and Prediction Models
		Part 2: Intraoperative Pulmonary Lesion
			Bullous Disease
			Lung Masses
			Chronic Effusion/Trapped Lung
			Pleural Plaques
			Traumatic Pulmonary Pseudocyst
			Cavitary Lung Lesions
			Empyema
			Empyema Necessitans
			Massive Hemoptysis
			Congenital Pulmonary Sequestration
		References
	Chylothorax
		Introduction
		Anatomy
		Etiology
		Diagnosis
		Imaging
		Treatment
			Non-surgical Management
			Surgical Management
				Thoracic Duct Embolization
				Video-Assisted Thoracoscopic Ligation
				Thoracotomy
				Transabdominal Approaches
		Complications
		Conclusion
		References
Part II: Trauma
	Rib Fractures and Chest Wall Injury
		Demographics, Epidemiology and Clinical Significance
		Chest Wall Injury Biomechanics
		Sternal Fractures
		Chest Wall Trauma Scoring Systems
			Organ Injury Scale
			Rib Fracture Score
			Chest Trauma Score
			Rib Score
			Clinical Rib Score
		Surgical Management
			Patient Positioning and Incision
			Exposition and Fracture Reduction
			Sternal Fracture ORIF
			Rib and Sternal Fracture Nonunions
			Chest Wall Injury Reconstruction
		References
	Pneumothorax and Hemothorax
		Incidence and Etiology
		Chest Wall Injury
			Associated Injuries
			Physical Examination and Initial Management
			Radiographic, Sonographic, and Laboratory Evaluation
			Specific Injuries
				Open Chest Wound
		Pneumothorax
			Etiology and Presentation
			Diagnosis
			Management
		Hemothorax
			Etiology and Presentation
			Management
		Further Reading
	Pulmonary Contusions and ARDS
		Definition of ARDS
		Pathophysiology
		Respiratory Monitoring
			Compliance
			Elastance
			Transpulmonary Pressure
			Driving Pressure
		Mechanical Ventilation in ARDS Patients
			Controlled Ventilation
				VT Selection
				PEEP Selection
				Recruitment Maneuvers
				Pronation
			Assisted Ventilation
		Extracorporeal Membrane Oxygenation (ECMO)
		Pulmonary Contusion
		ARDS: Medical Management
			Fluid Balance and Administration
			Pain Management and Muscle Paralysis
			Steroids
			Vasodilating Agents
			Β2 Agonists
			Vitamins and Statins
			Aspirin
		Summary
		References
	Tracheal and Bronchial Injury
		Epidemiology
		Clinical Presentation
		Diagnostic Evaluation
			Imaging
			Bronchoscopy
			Exploration
		Management
			Airway Control
			Exposure
			Repair
			Tracheostomy
		Conclusions
		References
	Lung Injury
		Introduction
		Blunt Injury
			Evaluation
			Management
			Operative Intervention
		Penetrating Injury
			Evaluation
			Management
			Operative Intervention
		References
	Cardiac Injury
		History
		Demographics and Etiology
		Prehospital Issues
		Emergency Center Presentation and Management
			Echocardiography
			Electrocardiogram
			Subxiphoid Window
			Emergency Department Thoracotomy
		Operative Approach
		Pericardial Injury
		Postoperative Care
		Screening for Blunt Cardiac Injury
			Electrocardiogram
			Troponin
			Echocardiography
			Other Studies
			Patient Management in BCI
		Summary
		References
	Blunt Thoracic Aortic Injury in Thoracic Surgery for the Acute Care Surgeon
		Introduction
		Presentation and Workup
		Management: Medical
		Open Repair
			Management-Endovascular Repair
		When Is Open Repair Indicated in the Age of TEVAR?
		Is TEVAR the Answer for All Injuries?
		Conclusion
		References
	Thoracic Vascular Trauma
		Introduction
		Diagnosis
		Innominate Artery Injury
		Subclavian–Axillary Artery Injury
		Carotid Artery
		Internal Jugular Vein
		Pulmonary Artery
		Pulmonary Veins
		Venous Injury
		Final Comments
		References
	Diaphragm
		Introduction
		Anatomy
		Diagnosis and Grading of Diaphragm Injuries
		Surgical Repair
			Repair During Exploratory Laparotomy
			Laparoscopic Repair
			Thoracoscopic Repair
			Complex Diaphragm Injuries
		Complications
		Conclusion
		References
Part III: Special Considerations
	Acute Care Pediatric Thoracic Surgical Conditions
		Esophageal Rupture
			Presentation
			Diagnosis
			Treatment
				Nonsurgical Treatment
				Surgical Intervention
		Caustic Ingestion
			Presentation
			Diagnosis and Initial Management
			Nonsurgical Treatment, Including Alternative and Adjuvant Treatments
			Surgical Treatment
		Tracheal Foreign and Esophageal Bodies
			Airway Foreign Bodies
				Diagnosis and Initial Management
				Procedural Intervention
				Post-Procedural Care
			Esophageal Foreign Bodies
				Diagnosis and Initial Management
				Nonoperative Management, Including Alternative and Adjuvant Treatments
				Procedural Intervention
			Button Batteries
		Spontaneous Pneumothorax
			Epidemiology and Presentation
			Assessment
			Nonoperative Management
			Operative Intervention
				Postoperative Considerations
		Parapneumonic Effusion and Empyema
			Epidemiology and Presentation
			Medical Management
			Surgical and Procedural Intervention
			Tube Thoracostomy
			Surgical Cortical Debridement
			Complications
				Pediatric Thoracic Trauma and Acute Surgical Care
					Epidemiology
					Anatomy and Physiology of the Pediatric Thorax
					Pathophysiology of Thoracic Injuries
					Life-Threatening Chest Injuries in the Unstable Patient
						Tension Pneumothorax
						Open Pneumothorax (“Sucking Chest Wound”)
						Massive Hemothorax
						Flail Chest
						Cardiac Tamponade
					Potentially Lethal Chest Injuries in the Stable Patient
						Pulmonary Contusion With or Without Flail Chest
						Myocardial Contusion
						Traumatic Aortic Rupture
						Traumatic Diaphragmatic Rupture
						Tracheobronchial Tree Injuries
							Trachea
							Bronchus
						Esophageal Trauma
						Subcutaneous Emphysema
						Crushing Injury to the Chest (Traumatic Asphyxia)
			References
	Surgical Consideration of Bacteria, Fungi, and Parasites
		Introduction
		Lung Abscess
			Background
			Diagnosis
			Treatment
		Pulmonary Tuberculosis
			Background
			Diagnosis
			Treatment
		Invasive Pulmonary Aspergillosis
			Background
			Diagnosis
			Treatment
		Hydatidosis
			Background
			Diagnosis
			Treatment
		Conclusion
		References
	Travel and Transport
		Physiology and Limitations of Air and Ground Transport
			Confined Spaces
			Lighting
			Noise, Vibration, Turbulence, G-Loading
			Temperature
			Gas Laws
			Available Monitoring and Equipment
			Imaging
		Choice of Appropriate Transport Mode
			Ground EMS
			HEMS
			Fixed Wing
			Critical Care Air Transport Team
			Commercial Airliner
		Complications During Transport
			Pneumothorax
			Hemothorax
			Chest Tube Management
			Pneumomediastinum
			Tracheobronchial Bleeding
			Cardiac Tamponade
			Loss of Airway
		Management of Specific Injuries During Transport
			Flail Chest and Pulmonary Contusion
			Tracheobronchial Injuries
			Esophageal Injuries
			Damage Control, the Open Chest
		Special Considerations During Transport
			Pain Control
			Respiratory Therapy
			Fluid Management
			ECMO/ECLS
			Interfacility Transport
			Safety of Transport
		References