In this chapter, we review the important clinical aspects of abdominal transplantation relevant to the general surgeon. Whereas only a fraction of readers will go on to specialize in transplantation, most will care for these patients during training. Operative techniques, post-transplantation management, outcomes, and transplantation complications are covered in this chapter. All providers will encounter patients with end-stage organ disease in the course of their careers, and therefore, they must understand the indications for transplantation and considerations for caring for these patients. Likewise, transplant recipients require general surgery procedures, and thus, an appreciation for the unique aspects of caring for this population is essential. This review contains 11 figures, 1 table, and 57 references. Key Words: dialysis, end-organ disease, graft survival, immunosuppression, intestine transplantation, kidney transplantation, liver transplantation, pancreas transplantation, patient survival, United Network of Organ Sharing /Organ Procurement and Transplantation Network
{"title":"Transplantation for the General Surgeon: Care of the Transplant Patient","authors":"S. Nazarian, Meera Gupta","doi":"10.2310/surg.2321","DOIUrl":"https://doi.org/10.2310/surg.2321","url":null,"abstract":"In this chapter, we review the important clinical aspects of abdominal transplantation relevant to the general surgeon. Whereas only a fraction of readers will go on to specialize in transplantation, most will care for these patients during training. Operative techniques, post-transplantation management, outcomes, and transplantation complications are covered in this chapter. All providers will encounter patients with end-stage organ disease in the course of their careers, and therefore, they must understand the indications for transplantation and considerations for caring for these patients. Likewise, transplant recipients require general surgery procedures, and thus, an appreciation for the unique aspects of caring for this population is essential.\u0000\u0000This review contains 11 figures, 1 table, and 57 references. \u0000Key Words: dialysis, end-organ disease, graft survival, immunosuppression, intestine transplantation, kidney transplantation, liver transplantation, pancreas transplantation, patient survival, United Network of Organ Sharing /Organ Procurement and Transplantation Network","PeriodicalId":11151,"journal":{"name":"DeckerMed Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87893959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In the absence of contraindications, enteral feeding is recommended for patients who are expected to be intolerant of oral feedings beyond 7 days. Enteral access can be accomplished by a variety of means, including surgical, endoscopic, or radiographic methods. This review focuses on endoscopy-guided options for enteral access. These methods include gastric feeding, which can be accomplished by orogastric, nasogastric, or percutaneous endoscopic gastrostomy tube placement, and postpyloric feeding, accessed through oral or nasal jejunal tubes, percutaneous gastrostomy with a jejunal extension, or direct percutaneous jejunostomy. The indications, techniques, complications, and comparative data of these placement options are outlined, and special clinical considerations (including establishing access in patients with dementia or cirrhosis and those on anticoagulation) are discussed. This review contains 5 figures, 1 table, and 33 references. Key words: direct percutaneous jejunostomy, endoscopy, enteral access in cirrhosis, enteral access in dementia, enteral feeding, enteric access, nasogastric feeding tubes, percutaneous endoscopic gastrojejunostomy tubes, percutaneous endoscopic gastrostomy tubes
{"title":"Endoscopic Techniques for Obtaining Enteral Access","authors":"M. Ryou, S. Salgado","doi":"10.2310/surg.9055","DOIUrl":"https://doi.org/10.2310/surg.9055","url":null,"abstract":"In the absence of contraindications, enteral feeding is recommended for patients who are expected to be intolerant of oral feedings beyond 7 days. Enteral access can be accomplished by a variety of means, including surgical, endoscopic, or radiographic methods. This review focuses on endoscopy-guided options for enteral access. These methods include gastric feeding, which can be accomplished by orogastric, nasogastric, or percutaneous endoscopic gastrostomy tube placement, and postpyloric feeding, accessed through oral or nasal jejunal tubes, percutaneous gastrostomy with a jejunal extension, or direct percutaneous jejunostomy. The indications, techniques, complications, and comparative data of these placement options are outlined, and special clinical considerations (including establishing access in patients with dementia or cirrhosis and those on anticoagulation) are discussed.\u0000\u0000This review contains 5 figures, 1 table, and 33 references.\u0000Key words: direct percutaneous jejunostomy, endoscopy, enteral access in cirrhosis, enteral access in dementia, enteral feeding, enteric access, nasogastric feeding tubes, percutaneous endoscopic gastrojejunostomy tubes, percutaneous endoscopic gastrostomy tubes","PeriodicalId":11151,"journal":{"name":"DeckerMed Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91005084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This chapter provides a glimpse of the complex regulatory, financial, ethical, and procedural aspects of transplantation. The general surgeon should appreciate the evolution of the field as seen through a brief review of its history as well as its evolving self-governance as manifested through national policies. Knowledge of the process of organ donation is important for any practitioner as is an understanding of the burden of end-organ disease. This review contains 2 figures, 1 table and references. Key Words: brain death, donation after cardiac death, epidemiology and costs of end-organ disease, history of immunosuppression, history of transplantation, living donation, organ allocation, organ donation, transplantation ethics, transplantation regulation
{"title":"Transplantation for the General Surgeon: History of Transplantation, End-organ Disease, Organ Donation and Allocation, and Transplantation Regulation and Ethics","authors":"S. Nazarian, J-K Hwang, Meera Gupta, M. Goldshore","doi":"10.2310/surg.2320","DOIUrl":"https://doi.org/10.2310/surg.2320","url":null,"abstract":"This chapter provides a glimpse of the complex regulatory, financial, ethical, and procedural aspects of transplantation. The general surgeon should appreciate the evolution of the field as seen through a brief review of its history as well as its evolving self-governance as manifested through national policies. Knowledge of the process of organ donation is important for any practitioner as is an understanding of the burden of end-organ disease.\u0000\u0000This review contains 2 figures, 1 table and references.\u0000Key Words: brain death, donation after cardiac death, epidemiology and costs of end-organ disease, history of immunosuppression, history of transplantation, living donation, organ allocation, organ donation, transplantation ethics, transplantation regulation","PeriodicalId":11151,"journal":{"name":"DeckerMed Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75875292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
With the critical advances in material science and bioengineering, the clinical availability of biomaterials is rapidly expanding. Biomaterials are used to restore or correct function of tissues that have been modified by injury, malformation, pathology, or aging. Materials used in contact with living tissues should meet the criteria of biocompatibility, which are (1) biosafety, (2) biofunctionality, and (3) biointegration. Depending on the function they are asked to perform and the target tissue, the choice is among nonresorbable or resorbable biomaterials, metallic or polymeric, and natural or synthetic. Although some materials such as titanium are able to osteointegrate inducing minimal scarring at the interface with living tissues, it seems that a common limitation across all biomaterials is to induce some extent of foreign body reaction and scar encapsulation, which affects negatively the function of the device. Novel surface technologies at the micro- or nano-scale and advanced biomaterials will improve the biointegration of medical devices and allow for permanent implantation of functional biomaterials. This review contains 9 figures, 9 tables and 63 references Key Words: biocompatibility, biofilm, biofunctionality, biointegration, biomaterials, encapsulation, foreign body reaction, wound healing
{"title":"Biomaterials","authors":"P. G, S. Scherer","doi":"10.2310/ps.10009","DOIUrl":"https://doi.org/10.2310/ps.10009","url":null,"abstract":"With the critical advances in material science and bioengineering, the clinical availability of biomaterials is rapidly expanding. Biomaterials are used to restore or correct function of tissues that have been modified by injury, malformation, pathology, or aging. Materials used in contact with living tissues should meet the criteria of biocompatibility, which are (1) biosafety, (2) biofunctionality, and (3) biointegration. Depending on the function they are asked to perform and the target tissue, the choice is among nonresorbable or resorbable biomaterials, metallic or polymeric, and natural or synthetic. Although some materials such as titanium are able to osteointegrate inducing minimal scarring at the interface with living tissues, it seems that a common limitation across all biomaterials is to induce some extent of foreign body reaction and scar encapsulation, which affects negatively the function of the device. Novel surface technologies at the micro- or nano-scale and advanced biomaterials will improve the biointegration of medical devices and allow for permanent implantation of functional biomaterials.\u0000 \u0000This review contains 9 figures, 9 tables and 63 references\u0000Key Words: biocompatibility, biofilm, biofunctionality, biointegration, biomaterials, encapsulation, foreign body reaction, wound healing","PeriodicalId":11151,"journal":{"name":"DeckerMed Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84304859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
When a patient presents with a mass at the angle of the mandible, a neoplasm within the parotid gland is a strong consideration. The parotid is the largest of the salivary glands. Terminal branches of the facial nerve are found within the gland. Their functional preservation is an important goal of parotid surgery. Risks of facial nerve injury rise in reoperative procedures and resection of cancers. Surgical principles apply in parotidectomy. In addition to facial nerve injury, a numb earlobe, contour deficit, salivary fistula, and gustatory sweating should be discussed with the patient before an operation. Most lesions can be removed after identification of the main trunk of the facial nerve, but a retrograde approach after finding a peripheral branch may be required. No randomized trials support a benefit from nerve monitoring. An intact facial nerve will usually begin to function, but months of recovery time may be needed. Permanent paralysis is rare. Salivary fistulae are usually self-limited. Many methods to ameliorate the cosmetic changes after parotidectomy have been described. None has gained ascendency. This review contains 6 figures and 61 references. Key words: facial nerve, facial paralysis, Frey syndrome, gustatory sweating, nerve monitoring, parotid gland, parotid neoplasm, parotidectomy, salivary fistula
{"title":"Parotidectomy","authors":"J. A. Ridge, Francis Si Wai Zih","doi":"10.2310/surg.2030","DOIUrl":"https://doi.org/10.2310/surg.2030","url":null,"abstract":"When a patient presents with a mass at the angle of the mandible, a neoplasm within the parotid gland is a strong consideration. The parotid is the largest of the salivary glands. Terminal branches of the facial nerve are found within the gland. Their functional preservation is an important goal of parotid surgery. Risks of facial nerve injury rise in reoperative procedures and resection of cancers. Surgical principles apply in parotidectomy. In addition to facial nerve injury, a numb earlobe, contour deficit, salivary fistula, and gustatory sweating should be discussed with the patient before an operation. Most lesions can be removed after identification of the main trunk of the facial nerve, but a retrograde approach after finding a peripheral branch may be required. No randomized trials support a benefit from nerve monitoring. An intact facial nerve will usually begin to function, but months of recovery time may be needed. Permanent paralysis is rare. Salivary fistulae are usually self-limited. Many methods to ameliorate the cosmetic changes after parotidectomy have been described. None has gained ascendency.\u0000\u0000This review contains 6 figures and 61 references.\u0000Key words: facial nerve, facial paralysis, Frey syndrome, gustatory sweating, nerve monitoring, parotid gland, parotid neoplasm, parotidectomy, salivary fistula ","PeriodicalId":11151,"journal":{"name":"DeckerMed Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84133785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The thyroid is key to numerous metabolic and homeostatic processes, including thermomodulation, protein synthesis, carbohydrate and lipid metabolism, and adrenergic regulation. A normal thyroid gland weighs 15 to 25 g and is firm, mobile, and smooth to palpation. There are two distinct physiologically active cell types: follicular cells, which synthesize thyroid hormone, and parafollicular or C cells, which produce calcitonin. Surgery is indicated for three broad categories of thyroid disease: (1) a hyperfunctioning gland, (2) an enlarged gland (goiter) causing compressive symptoms, and (3) diagnosing or treating malignancy. These indications may overlap in a patient presenting for surgical consultation. Regardless of the indication, a thorough discussion with the patient about the thyroid disease and other diagnostic or therapeutic options (if any) should be conducted. This reviews contains 3 figures, 13 tables, and 56 references. Key Words: anaplastic thyroid cancer, antithyroid medications, Bethesda classification, follicular thyroid cancer, Graves disease, medullary thyroid cancer, nontoxic multinodular goiter, papillary thyroid cancer, radioactive iodine, toxic nodular goiter
{"title":"Benign and Malignant Thyroid Diseases","authors":"L. Kuo, Matthew A. Nehs","doi":"10.2310/surg.2409","DOIUrl":"https://doi.org/10.2310/surg.2409","url":null,"abstract":"The thyroid is key to numerous metabolic and homeostatic processes, including thermomodulation, protein synthesis, carbohydrate and lipid metabolism, and adrenergic regulation. A normal thyroid gland weighs 15 to 25 g and is firm, mobile, and smooth to palpation. There are two distinct physiologically active cell types: follicular cells, which synthesize thyroid hormone, and parafollicular or C cells, which produce calcitonin. Surgery is indicated for three broad categories of thyroid disease: (1) a hyperfunctioning gland, (2) an enlarged gland (goiter) causing compressive symptoms, and (3) diagnosing or treating malignancy. These indications may overlap in a patient presenting for surgical consultation. Regardless of the indication, a thorough discussion with the patient about the thyroid disease and other diagnostic or therapeutic options (if any) should be conducted.\u0000\u0000This reviews contains 3 figures, 13 tables, and 56 references.\u0000Key Words: anaplastic thyroid cancer, antithyroid medications, Bethesda classification, follicular thyroid cancer, Graves disease, medullary thyroid cancer, nontoxic multinodular goiter, papillary thyroid cancer, radioactive iodine, toxic nodular goiter","PeriodicalId":11151,"journal":{"name":"DeckerMed Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74018019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Historically, thyroidectomy was associated with a high mortality rate, now understood to likely be secondary to postoperative hypocalcemia. In the modern age, perioperative morbidity and mortality rates are extremely low, although some complications, such as recurrent laryngeal nerve injury, can have significant consequences. Understanding the safe approach to total thyroidectomy and thyroid lobectomy is key to minimizing operative morbidity. In particular, the capsular dissection technique facilitates identification and preservation of the recurrent laryngeal nerve and parathyroid glands. The postoperative care of the patient, including diagnosis and management of the more common complications such as hematoma or hypocalcemia, is crucial to optimize patient outcomes. Although novel thyroidectomy techniques have been developed to avoid or minimize the traditional neck incision, these approaches have not become widely used. This review contains 9 figures, 1 table, and 29 references. Key Words: capsular dissection, external branch of the superior laryngeal nerve, intraoperative nerve monitoring, minimally invasive thyroidectomy, postoperative hematoma, postoperative hoarseness, postoperative hypocalcemia, recurrent laryngeal nerve, remote access thyroidectomy
{"title":"Thyroidectomy: Technique, Tips, and Troubleshooting","authors":"L. Kuo, Matthew A. Nehs","doi":"10.2310/surg.2408","DOIUrl":"https://doi.org/10.2310/surg.2408","url":null,"abstract":"Historically, thyroidectomy was associated with a high mortality rate, now understood to likely be secondary to postoperative hypocalcemia. In the modern age, perioperative morbidity and mortality rates are extremely low, although some complications, such as recurrent laryngeal nerve injury, can have significant consequences. Understanding the safe approach to total thyroidectomy and thyroid lobectomy is key to minimizing operative morbidity. In particular, the capsular dissection technique facilitates identification and preservation of the recurrent laryngeal nerve and parathyroid glands. The postoperative care of the patient, including diagnosis and management of the more common complications such as hematoma or hypocalcemia, is crucial to optimize patient outcomes. Although novel thyroidectomy techniques have been developed to avoid or minimize the traditional neck incision, these approaches have not become widely used.\u0000\u0000This review contains 9 figures, 1 table, and 29 references.\u0000 Key Words: capsular dissection, external branch of the superior laryngeal nerve, intraoperative nerve monitoring, minimally invasive thyroidectomy, postoperative hematoma, postoperative hoarseness, postoperative hypocalcemia, recurrent laryngeal nerve, remote access thyroidectomy","PeriodicalId":11151,"journal":{"name":"DeckerMed Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90783737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The production of health as an output of various inputs is a key concept of health care economics and a key influence on health care policy. Similarly, the notion of risk—that an outcome might not turn out as expected or hoped—underpins the entire theory of insurance. Insurance, and the benefits it can provide, cannot be understood without understanding risk, or without understanding how the features of an insurance contract transform risk for the individual, the payer, or society. The health economist, policy maker, leader, expert operator, financier, insurer, clinician of any stripe, patient or family or advocate, or other interested stakeholder must always consider the structural, clinical, and economic anatomy of health care in the context of the underlying physiology of these economic concepts. This review contains 2 figures, 1 table, and 14 references. Key Words: health economics, health policy, health production, marginal return (diminishing), utility, inputs, QALY, risk (aversion or tolerance), insurance (contract features)
{"title":"Health Economics: Select Concepts of the Health Production Function, Risk, and Insurance","authors":"B. Hall","doi":"10.2310/surg.2405","DOIUrl":"https://doi.org/10.2310/surg.2405","url":null,"abstract":"The production of health as an output of various inputs is a key concept of health care economics and a key influence on health care policy. Similarly, the notion of risk—that an outcome might not turn out as expected or hoped—underpins the entire theory of insurance. Insurance, and the benefits it can provide, cannot be understood without understanding risk, or without understanding how the features of an insurance contract transform risk for the individual, the payer, or society. The health economist, policy maker, leader, expert operator, financier, insurer, clinician of any stripe, patient or family or advocate, or other interested stakeholder must always consider the structural, clinical, and economic anatomy of health care in the context of the underlying physiology of these economic concepts.\u0000\u0000This review contains 2 figures, 1 table, and 14 references.\u0000Key Words: health economics, health policy, health production, marginal return (diminishing), utility, inputs, QALY, risk (aversion or tolerance), insurance (contract features)","PeriodicalId":11151,"journal":{"name":"DeckerMed Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74951794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A picture of the overall structure of the US health care industry can be garnered by examining national health expenditures. In 2015, US national health expenditures grew to $3.2 trillion (US), outpacing growth in gross domestic product. Valuable insights are found by examining categories of spending, sources of funds, and target areas of spending, raising questions about the logic and performance of the US system. These perspectives can inform deeper consideration of healthcare policy and reform. This review contains 3 tables and 20 references. Key Words: health economics, health policy, Medicaid, Medicare, national health expenditures, opportunity cost, projections
{"title":"Health Economics: National Health Care Expenditures","authors":"B. Hall","doi":"10.2310/ps.2404","DOIUrl":"https://doi.org/10.2310/ps.2404","url":null,"abstract":"A picture of the overall structure of the US health care industry can be garnered by examining national health expenditures. In 2015, US national health expenditures grew to $3.2 trillion (US), outpacing growth in gross domestic product. Valuable insights are found by examining categories of spending, sources of funds, and target areas of spending, raising questions about the logic and performance of the US system. These perspectives can inform deeper consideration of healthcare policy and reform.\u0000\u0000This review contains 3 tables and 20 references.\u0000Key Words: health economics, health policy, Medicaid, Medicare, national health expenditures, opportunity cost, projections","PeriodicalId":11151,"journal":{"name":"DeckerMed Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85586541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Management of the critically injured patient is optimized by a coordinated team effort in an organized trauma system that allows for rapid assessment and initiation of life-preserving therapies. This initial assessment must proceed systematically and be prioritized according to physiologic necessity for survival. Beginning in the prehospital setting, coordination, preparation, and appropriate triage of the injured are crucial to facilitating rapid resuscitation of the trauma patient. Next, active efforts to support airway, breathing, circulation, and disability are performed with simultaneous intervention to treat life-threatening injuries and restore hemodynamic stability in the primary survey. With ongoing evaluation and continued resuscitation, a secondary survey provides a head-to-toe assessment of the patient allowing for further diagnosis of injuries and triage to more definitive care. This review contains 12 figures, 8 tables and 63 references Key Words: advanced trauma life support, definitive airway, FAST/eFAST, field triage, Glasgow coma scale, primary survey, 1:1:1 resuscitation, secondary survey
{"title":"Initial Management of Life-Threatening Trauma","authors":"Emily F. Cantrell, J. Doucet","doi":"10.2310/surg.2129","DOIUrl":"https://doi.org/10.2310/surg.2129","url":null,"abstract":"Management of the critically injured patient is optimized by a coordinated team effort in an organized trauma system that allows for rapid assessment and initiation of life-preserving therapies. This initial assessment must proceed systematically and be prioritized according to physiologic necessity for survival. Beginning in the prehospital setting, coordination, preparation, and appropriate triage of the injured are crucial to facilitating rapid resuscitation of the trauma patient. Next, active efforts to support airway, breathing, circulation, and disability are performed with simultaneous intervention to treat life-threatening injuries and restore hemodynamic stability in the primary survey. With ongoing evaluation and continued resuscitation, a secondary survey provides a head-to-toe assessment of the patient allowing for further diagnosis of injuries and triage to more definitive care.\u0000\u0000This review contains 12 figures, 8 tables and 63 references\u0000Key Words: advanced trauma life support, definitive airway, FAST/eFAST, field triage, Glasgow coma scale, primary survey, 1:1:1 resuscitation, secondary survey","PeriodicalId":11151,"journal":{"name":"DeckerMed Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81457439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：