Trauma, Seventh Edition

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 DEDICATION

The editors of Trauma, Seventh Edition, gratefully dedicate this edition to our
five unique “families”: our spouses, children, grandchildren, and extended
families; our trainees, who now dot the globe—our lasting legacy; our
medical schools and academic anchors; our organizations and associations;
and our patients, who continue to teach us so very much.
 CONTENTS

Contributors
Preface

SECTION 1
TRAUMA OVERVIEW

1. Kinematics
John P. Hunt, Alan B. Marr, and Lance E. Stuke
2. Epidemiology
Thomas J. Esposito and Karen J. Brasel
3. Injury Prevention
Ronald V. Maier and Charles Mock
4. Trauma Systems, Triage, and Transport
Raul Coimbra, David B. Hoyt, and Vishal Bansal
5. Injury Severity Scoring and Outcomes Research
Robert D. Becher, J. Wayne Meredith, and Patrick D. Kilgo
6. Acute Care Surgery
Gregory J. Jurkovich

SECTION 2
GENERALIZED APPROACHES TO THE TRAUMATIZED PATIENT

7. Prehospital Care
Jeffrey P. Salomone and Joseph A. Salomone III
8. Disaster and Mass Casualty
Eric R. Frykberg and William P. Schecter
9. Rural Trauma
Charles F. Rinker II and Nels D. Sanddal
10. Initial Assessment and Management
Panna A. Codner and Karen J. Brasel
11. Airway Management
 Eric A. Toschlog, Scott G. Sagraves, and Michael F. Rotondo
12. Management of Shock
Louis H. Alarcon, Juan Carlos Puyana, and Andrew B. Peitzman
13. Postinjury Hemotherapy and Hemostasis
Fredric M. Pieracci, Jeffry L. Kashuk, and Ernest E. Moore
14. Emergency Department Thoracotomy
Clay Cothren Burlew and Ernest E. Moore
15. Diagnostic and Interventional Radiology
Salvatore J.A. Sclafani
16. Surgeon-Performed Ultrasound in Acute Care Surgery
Christopher J. Dente and Grace S. Rozycki
17. Principles of Anesthesia and Pain Management
Dirk Younker
18. Infections
Michael A. West and Daniel Dante Yeh

SECTION 3
MANAGEMENT OF SPECIFIC INJURIES

19. Injury to the Brain

Alexander F. Post, Thomas Boro, and James M. Ecklund
20. Eye
Petros E. Carvounis and Yvonne I. Chu
21. Face
Robert M. Kellman
22. Neck
David V. Feliciano and Gary A. Vercruysse
23. Vertebrae and Spinal Cord
Maneesh Bawa and Reginald Fayssoux
24. Trauma Thoracotomy: Principles and Techniques
Kenneth L. Mattox, Matthew J. Wall, Jr., and Peter Tsai
25. Lung, Trachea, and Esophagus
Joseph A. DuBose, James V. O’Connor, and Thomas M. Scalea
26. Heart and Thoracic Vascular Injuries
Matthew J. Wall, Jr., Peter Tsai, and Kenneth L. Mattox
27. Trauma Laparotomy: Principles and Techniques
Asher Hirshberg
28. Diaphragm
Kevin M. Schuster and Kimberly A. Davis
29. Liver and Biliary Tract
Timothy C. Fabian and Tiffany K. Bee
30. Injury to the Spleen
David H. Wisner
31. Stomach and Small Bowel
Lawrence N. Diebel
32. Duodenum and Pancreas
Walter L. Biffl
33. Colon and Rectal Trauma
Demetrios Demetriades and Kenji Inaba
34. Abdominal Vascular Injury
Christopher J. Dente and David V. Feliciano
35. Pelvis
George C. Velmahos
36. Genitourinary Trauma
Michael Coburn
37. Trauma in Pregnancy
M. Margaret Knudson and Daniel Dante Yeh
38. Trauma Damage Control
Amy D. Wyrzykowski and David V. Feliciano
39. Upper Extremity
Nata Parnes, Peleg Ben-Galim, and David Netscher
40. Lower Extremity
Philip F. Stahel, Wade R. Smith, and David J. Hak
41. Peripheral Vascular Injury
Michael J. Sise and Steven R. Shackford

SECTION 4
SPECIFIC CHALLENGES IN TRAUMA

42. Alcohol and Drugs

Larry M. Gentilello
43. The Pediatric Patient
David W. Tuggle and Nathaniel S. Kreykes
44. The Geriatric Patient
Jay A. Yelon
45. Ethics of Acute Care Surgery
Laurence B. McCullough
46. Social Violence
James W. Davis
47. Wounds, Bites, and Stings
Charles A. Adams, Jr., Daithi S. Heffernan, and William G. Cioffi
48. Burns and Radiation
Jong O. Lee and David N. Herndon
49. Temperature-Related Syndromes: Hyperthermia, Hypothermia, and
Frostbite
David H. Ahrenholz
50. Organ Procurement for Transplantation
Aditya K. Kaza and Max B. Mitchell
51. Rehabilitation
Paul F. Pasquina, Caitlin L. McAuliffe, and Kevin F. Fitzpatrick
52. Modern Combat Casualty Care
Jay Johannigman, Peter Rhee, Donald Jenkins, and John B. Holcomb
53. Genomics and Acute Care Surgery
 Grant E. O’Keefe and J. Perren Cobb
54. Trauma, Medicine, and the Law
Kenneth L. Mattox and Stacey A. Mitchell

SECTION 5
MANAGEMENT OF COMPLICATIONS AFTER TRAUMA

55. Principles of Critical Care

Raul Coimbra, Jay Doucet, and Vishal Bansal
56. Cardiovascular Failure
Mary Margaret Wolfe and Fred Luchette
57. Respiratory Insufficiency
Jeffrey L. Johnson and James B. Haenel
58. Gastrointestinal Failure
Rosemary A. Kozar and Frederick A. Moore
59. Renal Failure
Charles E. Lucas, Michael T. White, and Anna M. Ledgerwood
60. Nutritional Support and Electrolyte Management
Kenneth A. Kudsk and Caitlin Curtis
61. Multiple Organ Failure
Angela Sauaia, Frederick A. Moore, and Ernest E. Moore

SECTION 6
ATLAS OF TRAUMA

Introduction to the Atlas

Head and Neck
Thoracic Outlet and Chest
Abdomen
Vascular

Index
 CONTRIBUTORS

Charles A. Adams, Jr., MD, FACS

Assistant Professor of Surgery
Alpert Medical School of Brown University
Chief
Division of Trauma and Surgical Critical Care
Department of Surgery
Rhode Island Hospital
Providence, Rhode Island
Chapter 47: Wounds, Bites, and Stings

David H. Ahrenholz, MD, FACS

Associate Professor of Surgery
University of Minnesota Medical School
St. Paul, Minnesota
Chapter 49: Temperature-Related Syndromes: Hyperthermia,
Hypothermia, and Frostbite

Louis H. Alarcon, MD
Associate Professor of Surgery and Critical Care Medicine
Medical Director of Trauma Surgery
University of Pittsburgh
Pittsburgh, Pennsylvania
Chapter 12: Management of Shock

Vishal Bansal, MD, FACS

Assistant Professor of Surgery
Assistant Director
Trauma Services
University of California, San Diego
San Diego, California
Chapter 4: Trauma Systems, Triage, and Transport
Chapter 55: Principles of Critical Care
Maneesh Bawa, MD
San Diego Orthopaedic Associates/Mercy Hospital
San Diego, California
Assistant Professor
Chief of Trauma Spine Surgery
Emory University Department of Orthopaedic Surgery
Atlanta, Georgia
Chapter 23: Vertebrae and Spinal Cord

Robert D. Becher, MD
Howard H. Bradshaw Surgical Research Fellow
Department of General Surgery
Wake Forest University School of Medicine
Winston-Salem, North Carolina
Chapter 5: Injury Severity Scoring and Outcomes Research

Tiffany K. Bee, MD
Associate Professor of Surgery
University of Tennessee Health Science Center
Memphis, Tennessee
Chapter 29: Liver and Biliary Tract

Peleg Ben-Galim, MD
Assistant Professor
Department of Orthopedic Surgery
Baylor College of Medicine
Houston, Texas
Chapter 39: Upper Extremity

Walter L. Biffl, MD
Professor of Surgery
Denver Health Medical Center
University of Colorado School of Medicine
Denver, Colorado
Chapter 32: Duodenum and Pancreas
Thomas Boro, MD
Chief Trauma Resident
Department of Surgery
Inova Fairfax Hospital
Falls Church, Virginia
Chapter 19: Injury to the Brain

Karen J. Brasel, MD, MPH

Professor of Surgery, Bioethics and Humanities
Medical College of Wisconsin
Milwaukee, Wisconsin
Chapter 2: Epidemiology
Chapter 10: Initial Assessment and Management

Clay Cothren Burlew, MD

Director
Surgical Intensive Care Unit
Associate Professor of Surgery
Denver, Colorado
Chapter 14: Emergency Department Thoracotomy

Petros E. Carvounis, MD
Assistant Professor
Baylor College of Medicine
Houston, Texas
Chapter 20: Eye

Yvonne I. Chu, MD
Assistant Professor
Baylor College of Medicine
Houston, Texas
Chapter 20: Eye

William G. Cioffi, MD
J. Murray Beardsley Professor and Chairman
Department of Surgery
 Alpert Medical School of Brown University
Surgeon-in-Chief
Rhode Island Hospital
Providence, Rhode Island
Chapter 47: Wounds, Bites, and Stings

J. Perren Cobb, MD, PhD

Director
Critical Care Center
Massachusetts General Hospital
Associate Professor of Anaesthesia and Surgery
Harvard Medical School
Boston, Massachusetts
Chapter 53: Genomics and Acute Care Surgery

Michael Coburn, MD
Professor and Chair
Scott Department of Urology
Baylor College of Medicine
Chief of Urology
Ben Taub General Hospital
Houston, Texas
Chapter 36: Genitourinary Trauma

Panna A. Codner, MD, FACS

Assistant Professor
Department of Surgery
Medical College of Wisconsin
Milwaukee, Wisconsin
Chapter 10: Initial Assessment and Management

Raul Coimbra, MD, PhD, FACS

The Monroe E. Trout Professor of Surgery
Executive Vice-Chairman
Department of Surgery
 Chief
Division of Trauma, Surgical Critical Care, and Burns
Director
Surgical Critical Care Fellowship Program
University of California San Diego School of Medicine
San Diego, California
Chapter 4: Trauma Systems, Triage, and Transport
Chapter 55: Principles of Critical Care

Caitlin Curtis, MD
Nutrition Support Pharmacist
University of Wisconsin Hospital and Clinics
Madison, Wisconsin
Chapter 60: Nutritional Support and Electrolyte Management

James W. Davis, MD, FACS

Professor of Clinical Surgery
University of California, San Francisco, Fresno
Chief of Trauma
Community Regional Medical Center
Fresno, California
Chapter 46: Social Violence

Kimberly A. Davis, MD, FACS, FCCM

Associate Professor of Surgery
Vice Chair for Clinical Affairs
Chief of the Section of Trauma, Surgical Critical Care and Surgical
Emergencies
Department of Surgery
Yale University School of Medicine
New Haven, Connecticut
Chapter 28: Diaphragm

Demetrios Demetriades, MD, PhD, FACS

Professor and Vice-Chairman of Surgery
 University of Southern California
Director of Trauma
Division of Emergency Surgery and Surgical Intensive Care Unit
Los Angeles County and University of Southern California
Medical Center
Sierra Madre, California
Chapter 33: Colon and Rectal Trauma

Christopher J. Dente, MD, FACS

Assistant Professor of Surgery
Emory University School of Medicine
Associate Director of Trauma
Grady Memorial Hospital
Atlanta, Georgia
Chapter 16: Surgeon-Performed Ultrasound in Acute Care Surgery
Chapter 34: Abdominal Vascular Injury

Lawrence N. Diebel, MD
Professor of Surgery
Department of Surgery
Wayne State University School of Medicine
Detroit, Michigan
Chapter 31: Stomach and Small Bowel

Jay Doucet, MD, MSc, FRCSC, FACS

Associate Professor of Clinical Surgery
Director
Surgical Intensive Care Unit
University of California, San Diego
San Diego, California
Chapter 55: Principles of Critical Care

Joseph A. DuBose, MD
Major
USAF MC
 University of Maryland Medical System
R Adams Cowley Shock Trauma Center
Air Force/C-STARS
Baltimore, Maryland
Chapter 25: Lung, Trachea, and Esophagus

James M. Ecklund, MD, FACS

Chairman
Department of Neurosciences
Inova Fairfax Hospital
Medical Director
Neurosciences
Inova Health System
Professor of Surgery
Uniformed Services University
Professor of Neurosurgery
George Washington University
Professor of Neurosurgery
Virginia Commonwealth University, School of Medicine – Inova
Campus Falls Church, Virginia
Chapter 19: Injury to the Brain

Thomas J. Esposito, MD, MPH

Professor and Chief
Division of Trauma, Surgical Critical Care & Burns
Department of Surgery
Director
Injury Analysis & Prevention Programs
Loyola University Burn & Shock Trauma Institute
Loyola University Stritch School of Medicine
Maywood, Illinois
Chapter 2: Epidemiology

Timothy C. Fabian, MD, FACS

Harwell Wilson Professor and Chairman
 Department of Surgery
University of Tennessee Health Sciences Center
Memphis, Tennessee
Chapter 29: Liver and Biliary Tract

Reginald Fayssoux, MD
Eisenhower Medical Center
Rancho Mirage, California
Chapter 23: Vertebrae and Spinal Cord

David V. Feliciano, MD
Attending Surgeon, Atlanta Medical Center
Atlanta, Georgia
Attending Surgeon, Medical Center of Central Georgia
Macon, Georgia
Professor of Surgery
Mercer University School of Medicine
Macon, Georgia
Adjunct Professor of Surgery
Uniformed Services University of the Health Sciences
Bethesda, Maryland
Chapter 22: Neck
Chapter 34: Abdominal Vascular Injury
Chapter 38: Trauma Damage Control

Kevin F. Fitzpatrick, MD
Physiatrist
Inova Fairfax Hospital
Falls Church, Virginia
Major
U.S. Army Medical Corps
Walter Reed Army Medical Center
Washington, District of Columbia
Chapter 51: Rehabilitation
Eric R. Frykberg, MD, FACS
Professor of Surgery
University of Florida College of Medicine
Chief
Division of General Surgery
Shands Jacksonville Medical Center
Jacksonville, Florida
Chapter 8: Disaster and Mass Casualty

Larry M. Gentilello, MD
Professor of Surgery
University of Texas
Texas
Chapter 42: Alcohol and Drugs

James B. Haenel, RRT

Surgical Critical Care Specialist
Department of Surgery
Denver Health Medical Center
Denver, Colorado
Chapter 57: Respiratory Insufficiency

David J. Hak, MD
Professor
Department of Orthopaedic Surgery
Denver Health Medical Center
University of Colorado School of Medicine
Denver, Colorado
Chapter 40: Lower Extremity

Daithi S. Heffernan, MD, AFRCSI

Department of Surgery
Division of Trauma and Surgical Critical Care
Rhode Island Hospital
Assistant Professor of Surgery
 Brown University
Providence, Rhode Island
Chapter 47: Wounds, Bites, and Stings

David N. Herndon, MD
Jesse H. Jones Distinguished Chair in Burn Surgery
Professor of Surgery
Chief of Staff
Shriners Hospitals for Children
University of Texas Medical Branch
Galveston, Texas
Chapter 48: Burns and Radiation

Asher Hirshberg, MD, FACS

Professor of Surgery
SUNY Downstate College of Medicine
Director
Emergency Vascular Surgery
Kings County Hospital Center
Brooklyn, New York
Chapter 27: Trauma Laparotomy: Principles and Techniques

John B. Holcomb, MD, FACS

Vice Chair and Professor of Surgery
Chief
Division of Acute Care Surgery
Director
Center for Translational Injury Research
Jack H. Mayfield, M.D. Chair in Surgery
University of Texas Health Science Center
Houston, Texas
Chapter 52: Modern Combat Casualty Care

David B. Hoyt, MD
Executive Director
 American College of Surgeons
Chicago, Illinois
Chapter 4: Trauma Systems, Triage, and Transport

John P. Hunt, MD, MPH

Professor of Surgery
Louisiana State University Health Science Center
New Orleans, Louisiana
Chapter 1: Kinematics

Kenji Inaba, BS, MS, MD, FRCSC, FACS

Assistant Professor of Surgery
University of Southern California
Medical Director
Surgical Critical Care Fellowship Program
Division of Trauma, Emergency Surgery and
Surgical Intensive Care Unit
Los Angeles and University of Southern California Medical Center
Los Angeles, California
Chapter 33: Colon and Rectal Trauma

Donald Jenkins, MD
Consultant
Division of Trauma, Critical Care and General Surgery
Associate Professor of Surgery
College of Medicine
Medical Director
Trauma Center
Mayo Clinic
Rochester, Minnesota
Chapter 52: Modern Combat Casualty Care

Jay Johannigman, MD
Professor of Surgery
University of Cincinnati College of Medicine
 Cincinnati, Ohio
Chapter 52: Modern Combat Casualty Care

Jeffrey L. Johnson, MD
Associate Professor of Surgery
University of Colorado Denver
Denver, Colorado
Chapter 57: Respiratory Insufficiency

Gregory J. Jurkovich, MD
Professor of Surgery
University of Washington
Chief of Trauma
Harborview Medical Center
Seattle, Washington
Chapter 6: Acute Care Surgery

Jeffry L. Kashuk, MD, FACS

Associate Professor of Surgery
University of Colorado
Denver Health Medical Center
Trauma, Acute Care Surgery and Surgical Critical Care
Denver, Colorado
Chapter 13: Postinjury Hemotherapy and Hemostasis

Aditya K. Kaza, MD
Assistant Professor of Surgery
University of Utah and Primary Children’s Medical Center
Salt Lake City, Utah
Chapter 50: Organ Procurement for Transplantation

Robert M. Kellman, MD, FACS

Professor and Chair
SUNY Upstate Medical University
Syracuse, New York
Chapter 21: Face
Patrick D. Kilgo, MS
Senior Associate Faculty
Department of Biostatistics
Emory University School of Public Health
Atlanta, Georgia
Chapter 5: Injury Severity Scoring and Outcomes Research

M. Margaret Knudson, MD
Professor of Surgery
University of California, San Francisco
San Francisco, California
Chapter 37: Trauma in Pregnancy

Rosemary A. Kozar, MD
Professor of Surgery
The University of Texas Medical School at Houston
Houston, Texas
Chapter 58: Gastrointestinal Failure

Nathaniel S. Kreykes, MD
Surgeon
Pediatric Surgical Associates, LTD
Minneapolis, Minnesota
Chapter 43: The Pediatric Patient

Kenneth A. Kudsk, MD
Professor of Surgery
University of Wisconsin-Madison
Madison, Wisconsin
Chapter 60: Nutritional Support and Electrolyte Management

Anna M. Ledgerwood, MD
Professor of Surgery
Wayne State University School of Medicine-Trauma
Medical Director
Detroit Receiving Hospital