ACS surgery : principles & practice

SURGERY: PRINCIPLES & PRACTICE (2004) Front Matter Title & Copyright Page Editorial Board & Contributors What's New In Medicine Elements of Contemporary Practice 1. Basic Surgical and Perioperative Considerations 2. Breast, Skin, Soft Tissue, and Neck 3. Alimentary Tract and Abdomen 4. Vascular System 5. Trauma and Thermal Injury 6. Critical Care 7. Care in Special Situations 8. Normal Laboratory Values What's New In Medicine April 2004 The Best Surgical Thinking Recommended Reading This Month's Updates This Month's Algorithm March 2004 The Best Surgical Thinking References This Month's Updates Figures February 2004 The Best Surgical Thinking This Year in ACS Surgery ACS Surgery 2004: New or Revised Chapters Sidebars January 2004 The Best Surgical Thinking This Month's Updates This Month's Algorithm December 2003 The Best Surgical Thinking This Month's Updates This Month's Algorithm November 2003 The Best Surgical Thinking This Month's Updates Elements of Contemporary Practice 1 Patient Safety in Surgical Care: A Systems Approach Author(s) Introduction The Magnitude of the Problem Shortcomings of Existing Quality-Improvement Methods Patient Care as a System Basic Principles of Human Performance and Human Error Performance and Error in Clinical Context Examples of Systems Approaches to Improving Quality Identifying Systems and System Failures General Techniques for Safety Improvement Obstacles to Safety Improvement Future Implementation of Quality-Improvement Efforts Conclusion References Sidebars Tables 2 Risk Stratification, Preoperative Testing, and Operative Planning Author(s) Introduction Assessment of Surgical Risk Assessment of Physical and Mental Happiness Reduction of Perioperative Cardiac Risk Epidemiology of Surgical Risk Changing Paradigms of Cost-effectiveness References Figures Tables 3 Outpatient Surgery Author(s) Introduction Selection of Patients for Inpatient and Outpatient Procedures Selection of Appropriate Site for Procedure Performance of the Operation Postoperative Care Discussion References Tables 4 Fast Track Surgery Author(s) Introduction Basic Concept Constituent Elements Reported Results Future Developments References Tables 5 Infection Control in Surgical Practice Author(s) Introduction The Surgical Wound and Infection Control Activities of an Infection Control Program Benefits of an Infection Control Program Organization of an Infection Control Program References Tables 6 Minimizing the Risk of Malpractice Claims Author(s) Introduction The Malpractice Climate Personal Issues for the Defendant Physician Who Brings Medical Malpractice Claims? Who Are the Defendants in Medical Malpractice Cases? Reducing Malpractice Claims What Can Surgeons Do to Assist in Their Defense if They Are Sued? References 7 Elements of Cost-Effective Nonemergency Surgical Care Author(s) Introduction Demise of "Appropriateness" as Indicator of Quality Application of New Concept of Quality Understanding Systems of Care Analysis of Cost-Effectiveness Implications of Outcome Variations Relation of Volume to Outcome Practical Issues in Improving Cost-Effectiveness Ethical and Legal Concerns The Future References Figures Tables 1. Basic Surgical and Perioperative Considerations 1 Preparation of the Operating Room Author(s) Introduction General Principles of OR Design and Construction Environmental Issues in the OR Basic Safety Concerns in the OR Equipment The Endovascular OR The Laparoscopic OR Infection Control in the OR Housekeeping Procedures Data Management in the OR Acknowledgment References Figures Tables 2 Prevention of Postoperative Infection Author(s) Epidemiology of Surgical Site Infection Definition of Surgical Site Infection Bacteria Environment: Local Factors Host Defense Mechanisms Discussion Antibiotic Prophylaxis of Surgical Site Infection Skin Preparation Infection Prevention in Bowel Surgery Integration of Determinants of Infection Acknowledgment References Algorithm - Epidemiology of Surgical Site Infection Figures Sidebars Tables 3 Perioperative Considerations for Anesthesia Author(s) Introduction Perioperative Patient Management Inpatient versus Outpatient Surgery Elective versus Emergency Surgery Choice of Anesthesia Patient Monitoring General Anesthesia Techniques Regional Anesthesia Techniques Recovery Special Scenarios References Tables 4 Bleeding and Transfusion Author(s) Approach to the Patient with Ongoing Bleeding Exclusion of Technical Causes of Bleeding Initial Assessment of Potential Coagulopathy Measurement of Coagulation Parameters Management of Anemia and Indications for Transfusion Discussion Mechanics of Hemostasis Bleeding Disorders Laboratory Assessment of Bleeding Experimental Therapy for Bleeding Acknowledgments References Algorithm - Approach to the Patient with Ongoing Bleeding Figures Tables 5 Postoperative Pain Author(s) Approach to the Patient with Postoperative Pain Inadequate Treatment of Pain Guidelines for Postoperative Pain Treatment Treatment Modalities Discussion Physiologic Mechanisms of Acute Pain Effects of Pain Relief References Algorithm - Approach to the Patient with Postoperative Pain Figures Tables 6 Postoperative Management Author(s) Introduction Postoperative Orders Postoperative Monitoring Postoperative Pain Relief Management of Fluid Imbalance, Electrolyte Abnormalities, and Acid-Base Disorders Management of Tubes and Drains Antinausea Prophylaxis Ambulation and Nutrition Postoperative Complications Discharge from Hospital and Follow-up Care Acknowledgments References Figures Sidebars Tables 7 Acute Wound Care Author(s) Approach to Acute Wound Management Tetanus Prophylaxis Antibiotic Prophylaxis Timing of Wound Closure Method of Wound Closure Dressings Physiology of Wound Healing Role of Cytokines in Wound Healing Physiology of Skin Graft Healing Disturbances of Wound Healing Acknowledgments References Algorithm - Approach to Acute Wound Management Figures Tables 2. Breast, Skin, Soft Tissue, and Neck 1 Breast Complaints Author(s) Assessment and Management of Breast Complaints Common Presenting Symptoms of Breast Disease Risk Factors for Breast Cancer Workup of the Patient with a Breast Complaint Management of Specific Breast Problems Management of the Patient with Breast Cancer Acknowledgments References Algorithm - Assessment and Management of Breast Complaints Figures Sidebars Tables 2 Soft Tissue Infection Author(s) Approach to the Patient with Soft Tissue Infection Focal Inflammation Diffuse Inflammation Miscellaneous Infections Discussion Recognizing the Disorder Value of Classification Systems Role of Operation Roles of Antibiotics and Pathogen Identification Pathogenesis of Necrotizing Infections Gas in the Wound Bite Wounds Pathogenesis of Purpura Fulminans Acknowledgments References Algorithm - Approach to the Patient with Soft Tissue Infection Figures Tables 3 Open Wound Requiring Reconstruction Author(s) Approach to Surgical Reconstruction Acute Reconstruction Secondary Reconstruction Discussion Wound Healing Postoperative Management Issues Acknowledgment References Algorithm - Approach to Surgical Reconstruction Figures Tables 4 Skin Lesions Author(s) Assessment and Management of Skin Lesions Nonsuspicious Lesions Suspicious Lesions Discussion Basal Cell Carcinoma Squamous Cell Carcinoma Malignant Melanoma Surgical Technique Acknowledgments References Recommended Reading Algorithm - Assessment and Management of Skin Lesions Figures 5 Breast Procedures Author(s) Introduction Breast Ultrasonography Breast Duct Visualization and Epithelial Cell Sampling Breast Biopsy Terminal Duct Excision Surgical Options for Breast Cancer Lumpectomy Minimally Invasive Ablative Techniques Lymphatic Mapping and SLN Biopsy Axillary Dissection Mastectomy Breast Reconstruction after Mastectomy Acknowledgments References Figures 6 Lymphatic Mapping and Sentinel Lymph Node Biopsy Author(s) Introduction Lymphatic Mapping and SLN Biopsy for Melanoma Lymphatic Mapping and SLN Biopsy for Breast Cancer Discussion Acknowledgment References Figures Sidebars 7 Surface Reconstruction Procedures Author(s) General Technical Issues in Plastic Surgical Wound Repair Skin Grafts Local Flaps Acknowledgments References Algorithm - Approach to Surgical Reconstruction Figures Tables 8 Thyroid and Parathyroid Procedures Author(s) Thyroidectomy Parathyroidectomy Acknowledgment References Recommended Reading Figures 9 Neck Mass Author(s) Assessment of a Neck Mass Clinical Evaluation Initial Diagnostic Impressions Investigative Studies Management of Specific Disorders Acknowledgment References Recommended Reading Algorithm - Assessment of a Neck Mass Figures Tables 3. Alimentary Tract and Abdomen 1 Acute Abdominal Pain Author(s) Assessment of Acute Abdominal Pain Clinical Evaluation Basic Investigative Studies Working Diagnosis Acute Abdominal Crisis Suspected Surgical Abdomen Uncertain Diagnosis Suspected Nonsurgical Abdomen Acknowledgment References Algorithm - Assessment of Acute Abdominal Pain Figures Tables 2 Abdominal Mass Author(s) Evaluation of Abdominal Masses Clinical History Tentative Differential Diagnosis Physical Examination Working Diagnosis Investigative Studies Exploratory Laparotomy References Algorithm - Evaluation of Abdominal Masses Figures 3 Morbid Obesity Author(s) Approach to the Morbidly Obese Patient Cardiac Dysfunction Respiratory Insufficiency Embolism Anesthesia in Patients with Respiratory Insufficiency Postoperative Management Complications of Gastric Surgery for Obesity Diabetes Mellitus Wound Care Other Obesity-Related Diseases Discussion Morbidity Associated with Central Fat Deposition Respiratory Insufficiency of Obesity Cardiac Dysfunction in the Morbidly Obese Patient Thrombophlebitis, Venous Stasis Ulcers, and Pulmonary Embolism in the Morbidly Obese Patient Pseudotumor Cerebri in the Morbidly Obese Patient Conclusion Acknowledgments References Algorithm - Approach to the Morbidly Obese Patient Figures 4 Jaundice Author(s) Approach to the Jaundiced Patient Clinical Assessment Imaging Workup and Management of Posthepatic Jaundice Postoperative Jaundice Acknowledgment References Algorithm - Approach to the Jaundiced Patient Figures Sidebars Tables 5 Intestinal Obstruction Author(s) Assessment of Intestinal Obstruction Clinical Evaluation Investigative Studies Determination of Need for Operation and Classification of Obstruction Mechanical Obstruction Nonmechanical Obstruction Cost Considerations References Algorithm - Partial obstruction Figures Tables 6 Upper Gastrointestinal Bleeding Author(s) Assessment and Management of Upper Gastrointestinal Bleeding Presentation and Initial Management Clinical Evaluation Investigative Tests Management of Specific Sources of Upper GI Bleeding Recommended Reading Algorithm - Assessment and Management of Upper Gastrointestinal Bleeding Figures 7 Lower Gastrointestinal Bleeding Author(s) Approach to Lower GI Bleeding Initial Evaluation and Resuscitation Diagnostic Testing Therapeutic Intervention Discussion Etiology of Lower GI Bleeding References Algorithm - Assessment and Management of Lower Gastrointestinal Bleeding Figures Tables 8 Gastrointestinal Endoscopy Author(s) Gastrointestinal Endoscopy Diagnostic Esophagogastroduodenoscopy Therapeutic Esophagogastroduodenoscopy Diagnostic Endoscopic Retrograde Cholangiopancreatography Therapeutic Endoscopic Retrograde Cholangiopancreatography Diagnostic Colonoscopy Therapeutic Colonoscopy Chromoendoscopy Endoscopic Mucosal Resection Endoscopic Ultrasonography Endoscopic Suturing Acknowledgment References Figures Tables Videos 9 Open Esophageal Procedures Author(s) Introduction General Preoperative Considerations Cricopharyngeal Myotomy and Excision of Zenker's Diverticulum Transthoracic Hiatal Hernia Repair Resection of Esophagus and Proximal Stomach References Figures 10 Minimally Invasive Esophageal Procedures Author(s) Introduction Laparoscopic Nissen Fundoplication Laparoscopic Partial (Guarner) Fundoplication Laparoscopic Heller Myotomy with Partial Fundoplication Left Thoracoscopic Myotomy Right Thoracoscopic Myotomy Reoperation for GERD Reoperation for Esophageal Achalasia Acknowledgment References Figures Tables Videos 11 Video-Assisted Thoracic Surgery Author(s) Introduction Operative Planning Basic Operative Technique VATS Procedures for Pleural Disease VATS Pulmonary Wedge Resection VATS Procedures for Spontaneous Pneumothorax and Bullous Disease VATS Lung Volume Reduction Surgery VATS Lobectomy and Pneumonectomy VATS Mediastinal Lymph Node Dissection VATS Esophagectomy VATS Pericardial Window VATS Procedures for Mediastinal Masses VATS Management of Thoracic Trauma VATS Sympathectomy and Splanchnicectomy Miscellaneous VATS Procedures Clinical Considerations Cost Considerations Training and Certification in VATS References Figures Sidebars Tables 12 Ultrasonography: Surgical Applications Author(s) Introduction Physics and Instrumentation Clinical Applications of Ultrasonography in Surgical Practice General Considerations for Diagnostic Ultrasound Examinations Technique for Selected Surgical Applications of Ultrasonography Acknowledgments References Figures Tables 13 Gastroduodenal Procedures Author(s) Gastroduodenal Procedures for Benign Disorders Gastric Procedures for Cancer Duodenal Procedures for Cancer Acknowledgment References Figures 14 Gastric Procedures for Morbid Obesity Author(s) Introduction Choice between Gastric Bypass and Gastric Restriction Preparation for Operation Vertical Banded Gastroplasty Laparoscopic Adjustable Gastric Banding Proximal Gastric Bypass Laparoscopic Gastric Bypass Postoperative Management References Figures 15 Laparoscopic Cholecystectomy Author(s) Introduction Preoperative Evaluation Operative Planning Operative Tecnique Complications Special Problems Acknowledgments General References Patient Selection Establishment of Pneumoperitoneum Cholangiography and the Management of Common Bile Duct Stones Conversion to Open Cholecystectomy Complications of Laparoscopic Cholecystectomy Acute Cholecystitis Figures Tables Videos 16 Biliary Tract Procedures Author(s) Introduction Preoperative Evaluation Operative Planning Open Cholecystectomy Common Bile Duct Exploration (Open) Choledochoduodenostomy Cholecystojejunostomy Choledochojejunostomy Transduodenal Sphincteroplasty Choledochal Cyst Resection Resection of Middle-Third and Proximal Bile Duct Tumors Intrahepatic Cholangiojejunostomy Postoperative Care Acknowledgments Recommended Reading Figures Videos 17 Hepatic Resection Author(s) Introduction Hepatic Anatomy Preoperative Evaluation Operative Planning Operative Technique Postoperative Care Special Considerations Repeat Hepatic Resection Hand-Assisted Laparoscopic Hepatic Resection Acknowledgment References Figures 18 Pancreatic Procedures Author(s) Pylorus-Preserving Pancreaticoduodenectomy (Whipple Procedure) Distal Pancreatectomy for Chronic Pancreatitis Longitudinal Pancreaticojejunostomy (Puestow Procedure) Drainage of Pancreatic Pseudocyst into a Roux-en-Y Jejunal Loop Drainage of Pancreatic Pseudocyst into the Stomach Palliative Bypass for Unresectable Pancreatic Cancer Acknowledgments References Selected Readings Figures 19 Laparoscopic Splenectomy Author(s) Introduction Preoperative Evaluation Operative Planning Operative Technique Postoperative Care Complications Special Considerations Outcome Evaluation References Figures Tables 20 Laparoscopic Adrenalectomy Author(s) Introduction Indications Anatomic Considerations Preoperative Evaluation Operative Planning Operative Technique Postoperative Care Complications Outcome Evaluation References Figures Tables 21 Open Hernia Repair Author(s) Introduction Epidemiology of Hernia Classification of Hernia Types Abdominal Wall Anatomy Inguinal Herniorrhaphy: Choice of Procedure Inguinal Herniorrhaphy: Conventional Anterior Nonprosthetic Repairs Inguinal Herniorrhaphy: Conventional Anterior Prosthetic Repairs Inguinal Herniorrhaphy: Preperitoneal Nonprosthetic Repairs Inguinal Herniorrhaphy: Preperitoneal Prosthetic Repairs Inguinal Herniorrhaphy: Complications Incisional Herniorrhaphy Repair of Other Abdominal Wall Hernias Acknowledgments References Figures Tables Videos 22 Laparoscopic Hernia Repair Author(s) Introduction Laparoscopic Inguinal Hernia Repair Laparoscopic Incisional Hernia Repair References Figures Tables 23 Intestinal Anastomosis Author(s) Introduction Intestinal Anastomotic Healing Technical Options for Fashioning Anastomoses Factors Contributing to Failure of Anastomoses Controversial Issues in Intestinal Anastomosis Operative Techniques for Selected Anastomoses Conclusion Acknowledgment References Figures Tables 24 Appendectomy Author(s) Introduction Open Appendectomy Laparoscopic Appendectomy Choice between Open and Laparoscopic Appendectomy Special Considerations Acknowledgments References Figures Tables 25 Stomal Care Author(s) Approach to Perioperative Stomal Care Preoperative Counseling Preoperative Selection and Marking of the Stoma Site Postoperative Care Reviews Acknowledgments References Algorithm - Approach to Perioperative Stomal Care Figures Sidebars Tables 26 Anal Procedures Author(s) Operative Management of Hemorrhoids Operative Management of Abscess and Fistula Operative Management of Ulcer/Fissure Disease Acknowledgment References Recommended Reading Figures Sidebars Tables 27 Colorectal Procedures Author(s) Total Colectomy with Ileorectal Anastomosis Total Proctocolectomy with Conventional Ileostomy Restorative Proctocolectomy with Ileal Pouch-Anal Anastomosis Low Anterior Resection with Coloproctostomy Abdominoperineal Resection Acknowledgment References Figures 28 Laparoscopic Colectomy Author(s) Introduction Indications Operative Planning Operative Technique Postoperative Care Troubleshooting Complications Outcome Evaluation Acknowledgment References Recommended Reading Figures 4. Vascular System 1 Stroke and Transient Ischemic Attack Author(s) Assessment and Management of Stroke and TIA Incidence and Risk Factors Clinical Evaluation Diagnostic Studies Differentiation of Hemorrhagic from Ischemic Stroke Indications for and Timing of Therapy Stroke in Evolution References Algorithm - Assessment and Management of Stroke and TIA Figures Tables 2 Asymptomatic Carotid Bruit Author(s) Introduction Clinical Assessment Diagnosis of Asymptomatic Carotid Stenosis Carotid Endarterectomy Patient Education Follow-up of Patients with Lower-Grade Stenosis Epidemiology Economic Considerations Screening Issues Subgroup Analyses for Potential High-Risk Factors Special Situations Effect of Center-Specific Variations on Risk-to-Benefit Ratio Issues for the Future References Algorithm - Approach to the Patient with an Asymptomatic Carotid Bruit Figures Tables 3 Pulsatile Abdominal Mass Author(s) Assessment of a Pulsatile Abdominal Mass Clinical Evaluation Patient Is Unstable Patient Is Stable Preoperative Evaluation of Nonemergency AAA Repair Candidates Complications of AAAs Rare Causes of Pulsatile Abdominal Mass References Algorithm - Perform clinical evaluation. Figures Tables 4 Pulseless Extremity and Atheroembolism Author(s) Approach to the Acutely Ischemic Limb Pulseless Extremity Atheroembolism Discussion Pathophysiology of ALI Etiology of ALI References Algorithm - Category IIa ALI Figures Tables 5 Diabetic Foot Author(s) Evaluation and Management of the Diabetic Foot Clinical Evaluation Assessment of Clinical Findings Therapy Acknowledgment References Algorithm - Obtain history: inciting event, duration, healing, previous Figures 6 Venous Thromboembolism Author(s) Introduction Prophylaxis against Thromboembolism Superficial Thrombophlebitis Deep Venous Thrombosis Pulmonary Embolism General Principles of Anticoagulation and Lytic Therapy Hypercoagulability States References Figures Tables 7 Fundamentals of Endovascular Surgery Author(s) Introduction Choice of Vascular Access Site Puncture of Artery Placement of Guide Wires Placement of Sheaths Insertion of Catheters Use of Balloon Catheters Placement of Vascular Stents Postprocedural Management of Arterial Access Site Summary: Basic Steps in Endovascular Procedures Acknowledgment References Figures 8 Carotid Arterial Procedures Author(s) Introduction Preoperative Evaluation Operative Planning Operative Technique Postoperative Management Follow-up Alternatives to Direct Carotid Reconstruction References Recommended Reading Figures 9 Repair of Infrarenal Abdominal Aortic Aneurysms Author(s) Introduction Preoperative Evaluation Operative Planning Operative Technique Special Considerations Outcome Evaluation Endovascular Repair Acknowledgment References Figures 10 Aortoiliac Reconstruction Author(s) Introduction Preoperative Evaluation Operative Technique Complications Outcome Evaluation Acknowledgments References Figures 11 Infrainguinal Arterial Procedures Author(s) Introduction Preoperative Evaluation Femoropopliteal Bypass Infrapopliteal Bypass Plantar Bypass Alternative Bypasses Using More Distal Inflow Vessels Acknowledgment References Figures 12 Sclerotherapy Author(s) Introduction Preoperative Evaluation Operative Planning Technique Complications Cost Considerations References Figures Tables 13 Varicose Vein Surgery Author(s) Introduction Indications for Varicose Vein Surgery Preoperative Evaluation Operative Planning Operative Technique Complications Outcome Evaluation Alternatives to Saphenous Vein Stripping Acknowledgment References Figures Tables 14 Lower-Extremity Amputation for Ischemia Author(s) Introduction General Preoperative Planning Toe Amputation Transmetatarsal Amputation Guillotine Ankle Amputation Below-the-Knee Amputation Above-the-Knee Amputation Acknowledgment References Figures 15 Vascular and Peritoneal Access Author(s) Vascular Access via Arteriovenous Fistulas Vascular Access via Percutaneous Catheters Peritoneal Access Acknowledgments References Figures Tables 5. Trauma and Thermal Injury 1 Trauma Resuscitation Author(s) Initial Approach to the Critically Injured Patient Prehospital Care Emergency Department Management Discussion Prehospital Care Emergency Department Management Acknowledgments References Algorithm - Initial Approach to the Critically Injured Patient Figures 2 Injuries to the Central Nervous System Author(s) Introduction Head Injury Spinal Cord Injury Discussion Pathophysiology Acknowledgments References Figures Tables 3 Injuries to the Face and Jaw Author(s) Assessment and Management of Maxillofacial Injuries Initial Survey Definitive Evaluation Treatment of Soft Tissue Injuries Treatment of Maxillofacial Fractures Discussion Acknowledgment References Algorithm - Assessment and Management of Maxillofacial Injuries Figures 4 Injuries to the Neck Author(s) Assessment and Management of Neck Injuries Airway Compromise Isolated Laryngotracheal Injuries Injuries to the Carotid Arteries, Jugular Veins, Pharynx, and Esophagus Wounds at the Base of the Neck Known Vertebral Artery Injuries Superficial Wounds Discussion Repair versus Ligation of Carotid Arteries Nonoperative Management and Stenting of Carotid Artery Injuries Angiographic Embolization of Distal Vertebral Artery Injuries Conversion of Cricothyrotomy to Tracheotomy Reviews Acknowledgments References Algorithm - Assessment and Management of Neck Injuries Figures 5 Injuries to the Chest Author(s) Introduction Resuscitative Thoracotomy Choice of Incision Cardiac Trauma Aortic Injuries Thoracic Outlet Injuries Major Airway Disruption Pulmonary Lacerations Esophageal Injuries Chest Wall Injuries Special Operative Considerations Damage Control Tactics Postoperative Management Acknowledgments Recommended Reading Resuscitative Thoracotomy Choice of Incision Cardiac Injuries Aortic Injuries The Extrapericardial Vessels Major Airway Disruption Pulmonary Lacerations Esophageal Injuries Chest Wall Injuries Damage Control Tactics Postoperative Management Figures 6 Injuries to the Liver, Biliary Tract, Spleen, and Diaphragm Author(s) Assessment and Management of Injuries in the Liver, Biliary Tract, Spleen, and Diaphragm Injuries to the Liver Injuries to the Bile Ducts and Gallbladder Injuries to the Spleen Injuries to the Diaphragm Discussion Nonoperative Treatment of Blunt Hepatic and Splenic Injury Acknowledgments References Figures Tables 7 Injuries to the Stomach, Duodenum, Pancreas, Small Bowel, Colon, and Rectum Author(s) Introduction Determination of Need for Operation Injuries to the Stomach Injuries to the Duodenum Injuries to the Pancreas Injuries to the Small Bowel Injuries to the Colon Injuries to the Rectosigmoid and Rectum Acknowledgments References Figures Tables 8 Operative Exposure of Abdominal Injuries and Closure of the Abdomen Author(s) Introduction Patient Preparation Incision and Initial Exploration Operative Exposure Priorities in Management Closure Acknowledgments Recommended Reading Figures 9 Injuries to the Great Vessels of the Abdomen Author(s) Introduction Injuries in Zone 1 Injuries in Zone 2 Injuries in Zone 3 Injuries in the Porta Hepatis or Retrohepatic Area Damage Control Laparotomy Complications Acknowledgments References Recommended Reading Figures Tables 10 Injuries to the Urogenital Tract Author(s) Introduction Injuries to the Kidneys Injuries to the Ureters Injuries to the Bladder Injuries to the Urethra Injuries to the Vagina, Uterus, and Ovaries Injuries to the Gravid Uterus Injuries to the Scrotum Acknowledgments References Figures Tables 11 Injuries to the Extremities Author(s) Assessment and Management of Extremity Injuries Initial Assessment, Temporizing of Fracture-Dislocations, and Secondary Evaluation Injuries to Blood Vessels Injuries to Nerves Open Fractures and Dislocations Closed Fractures Compartment Syndrome Injuries to Soft Tissue The Mangled Extremity Acknowledgments References Algorithm - Assessment and Management of Extremity Injuries Figures Tables 12 Burn Care in the Immediate Resuscitation Period Author(s) Approach to the Burn Patient in the First 24 Hours Neutralization of the Source of the Burn Establishment of Airway and Adequate Ventilation Restoration and Maintenance of Hemodynamic Stability Initiation of Wound Management Transfer to Specialized Burn Facility Acknowledgment Selected Readings Algorithm - Approach to the Burn Patient in the First 24 Hours Figures Tables 13 Burn Care in the Early Postresuscitation Period Author(s) Approach to the Burn Patient during the Second to Fifth Days after the Burn Maintenance of Pulmonary Function Maintenance of Hemodynamic Stability Control of Burn Infection Wound Closure Stress Control Physical Therapy and Splinting Acknowledgment Selected Readings Algorithm - Approach to the Burn Patient during the Second to Fifth Days after the Burn Figures Sidebars Tables 14 Burn Care after the First Postburn Week Author(s) Management of the Burn Patient from 7 Days after the Burn until Complete Wound Closure Maintenance of Adequate Lung Function Maintenance of Hemodynamic Stability Nutrition Burn Wound Care Wound Remodeling and Scar Formation Acknowledgments Selected Readings Algorithm - Management of the Burn Patient from 7 Days after the Burn Figures Tables 15 Miscellaneous Burns and Cold Injuries Author(s) Electrical Injury Nonsurgical Problems Related to Electrical Injury Lightning Injury Chemical Burns War and Chemicals of Mass Destruction Cold Injury Toxic Epidermal Necrolysis Ionizing Radiation Burns References Figures 16 Rehabilitation of the Burn Patient Author(s) Introduction Quality of Life after Burn Injury Components of Rehabilitation Special Problems Burn Wound Reconstruction References Figures Tables 6. Critical Care 1 Cardiac Resuscitation Author(s) Introduction The Chain of Survival The Primary and Secondary Surveys of Cardiac Resuscitation Cardiac Resuscitation Based on Rhythm Findings Immediate Postresuscitation Care Ending a Resuscitation Attempt Acknowledgment References Algorithm - Approach to Cardiac Resuscitation Figures Tables 2 Acute Cardiac Dysrhythmia Author(s) Management of Acute Dysrhythmias Patient Is Hemodynamically Unstable Patient Is Hemodynamically Stable Cardiac Dysrhythmias during Pregnancy Proarrhythmia with Antidysrhythmic Drugs Discussion Antidysrhythmic Agents Cellular Electrophysiology Pathophysiology of Cardiac Dysrhythmias References Algorithm - Patient has a cardiac dysrhythmia Figures Sidebars 3 Shock Author(s) Approach to the Treatment of Shock Classification of Shock Recognition of Shock Identification and Treatment of Immediately Life-Threatening Conditions Treatment of Shock on the Basis of the Underlying Physiologic Abnormality Treatment of Shock That Persists Despite Initial Management References Algorithm - Approach to the Treatment of Shock Sidebars Tables 4 Cardiopulmonary Monitoring Author(s) Introduction Systemic Arterial Pressures Central Venous Pressure Pulmonary Arterial Pressures Cardiac Output Right Ventricular End-Diastolic Volume Hemoglobin Concentration Levels of Oxygen and Carbon Dioxide Minute Ventilation and Tidal Volume Cardiopulmonary Descriptors Derived from Primary Measurements Noninvasive Summary Measurements Influence of Age, Body Size, and Other Variables on Cardiopulmonary Descriptors Acknowledgments References Algorithm - Indications for and Uses of ICU Monitoring Equipment Figures Sidebars Tables 5 Pulmonary Insufficiency Author(s) Approach to Pulmonary Insufficiency Preoperative Pulmonary Function Testing Preoperative Measures to Prevent Pulmonary Insufficiency Intraoperative Measures to Prevent Pulmonary Complications Postoperative Measures to Prevent Pulmonary Insufficiency Clinical Presentation of Postoperative Pulmonary Insufficiency Treatment of Postoperative Pulmonary Insufficiency Caused by Atelectasis or Edema Progression to Pneumonia, Intubation, or ARDS Normal Pulmonary Physiology Pathogenesis of Postoperative Pulmonary Insufficiency Algorithm - Approach to Pulmonary Insufficiency Figures Tables 6 Use of the Mechanical Ventilator Author(s) Approach to Mechanical Ventilator Basic Mechanical Ventilation Worsening Respiratory Status Improving Respiratory Status Weaning from Mechanical Ventilation Difficult Weaning Postventilation Prophylaxis Discussion Pulmonary Physiology and Mechanical Ventilation Types and Features of Mechanical Ventilators Modes of Ventilation Monitors and Alarms Learning to Use a Mechanical Ventilator Writing Ventilator Orders Related Topics Special Techniques for Patients with Severe Respiratory Failure Summary Acknowledgments References Algorithm - Approach to Mechanical Ventilation Figures Tables 7 Renal Failure Author(s) Approach to the Patient with Renal Failure Recognition of Acute Renal Dysfunction Initial Clinical Assessment Initial Treatment Measures Evaluation to Determine Cause of Renal Failure Management Return to Normal Renal Function Progressive Renal Dysfunction Chronic Renal Failure Perioperative Management of Patients with Renal Failure Discussion Perspective on Acute Renal Failure Normal Renal Physiology Pathophysiology of Acute Renal Failure: Cellular and Molecular Changes Treatment of Developing Acute Renal Failure Differential Diagnosis of Acute Renal Failure Acknowledgment References Algorithm - Approach to the Patient with Renal Failure Figures Tables 8 Disorders of Water and Sodium Balance Author(s) Overview of Body Fluid Homeostasis Disorder of Water Excess: Hyponatremia Disorder of Water Deficiency: Hypernatremia Disorder of Water Conserva