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Principles and Practice of Trauma Care
SK Kochar
CHAPTER 1:
Essential Trauma Care
TRAUMA SYSTEMS
Quality Improvement Systems
Trauma Center Facilities
ANNEXURE
Resource Matrix
Level IV, Level III, Level II, Level I
CHAPTER 2:
Prehospital Trauma Care
CHAPTER 3:
Wound Ballistics
CHAPTER 4:
Management of Ballistics Injuries
INJURING AGENT
Blast Injuries
Causation of Injuries in a Blast
The Effect of Blast Wave—The Primary Injury
Effect of the Flying Missiles—The Secondary Injuries
Effect of Blast Wind—The Tertiary Injury
Gunshot Injuries
Biomechanics of Gunshot Wounds
Management of Bomb Blast Injuries
Management of Blast Injury Lung
Management of Abdominal Injuries
Shell Wounds
Management of Gunshot Wounds
Role of Skeletal Stability
Techniques for Skeletal Stability
Fracture Fixation—Damage Control Orthopedics
Compartment Syndrome
Management of Shot Gun Wounds
CHAPTER 5:
Injury Severity Score
INTRODUCTION
Patient Care
Scientific Tool
Administrative and Assessment Goals
Trauma Care Research
Classification of Scoring Systems
Anatomical Scores
Physiological Scores
Combined Physiological and Anatomical Scores
Anatomical Scoring Systems
Physiological Scoring Systems
Combined Physiological and Anatomical Scores
Evaluation of Trauma Outcome
CHAPTER 6:
Management Protocols in Polytrauma
FIRST PRIORITIES PROTOCOLS
SECONDARY SURVEY
History
Systemic Physical Examination
Head
Neck
Chest
Abdomen
Musculoskeletal and Peripheral Vascular Assessment
Neurologic Assessment
TERTIARY SURVEY
Decision Making
CHAPTER 7:
Trauma Care: Echelon Concept and Its Relevance
FIRST ECHELON OF CARE
Care Under Fire
Tactical Field Care
Checklist for Management Plan
SECOND ECHELON OF CARE
Departmental SOPs
General
Battlefield Trauma Life Support9
Primary Survey
Airway
Breathing
Circulation
Disability of Neurological Function
Exposure
Secondary Survey
Head
Chest
Abdomen
Pelvic, Genitourinary, Rectal Examination
Limbs
Drugs
Casualty Notification
An Evaluation
The Faculty
The Facility
Capability
Relevance for Civilian Set-up
THIRD ECHELON OF CARE
Departmental SOP's
Management Protocols
Protocol A
Protocol B
FOURTH ECHELON OF CARE
Options for Developing Countries
EDITORIAL
Prehospital Devices, Dressings and Drugs
Hemostatic Dressings
Needle Thoracostomy
Intraosseous Access
Pain Medication and Antibiotics
IV Fluid
Permissive Hypotension
CHAPTER 8:
Damage Control
INTRODUCTION
Why Damage Control
Patient Selection and Indication
Preoperative
Intraoperative
Damage Control Procedure
Post Damage Control Complications
Reoperation
CONCLUSION
CHAPTER 9:
Neck Injuries
ANATOMY
Mechanism of Injury
Signs and Symptoms
Initial Evaluation
Clinical Clearance of Cervical Spine Injury
RADIOLOGICAL EVALUATION
Management of Penetrating Neck Wounds
Mandatory Exploration
Selective Observation
Specific Injuries Management
Vascular Injuries
Injuries to the Larynx and Trachea
MANAGEMENT
Surgical Management
Surgical Exploration of the Neck
CHAPTER 10:
Spinal Trauma
HISTORICAL REVIEW AND INTRODUCTION
Definition of Spinal Cord Injury
Incidence
Etiology
BIOMECHANICS OF SPINE INJURY
Mechanism of Spine Injuries
Pathophysiological Changes in Spinal Cord Following Injury
Biology of Acute SCI
Biology of Acute SCI Involves both Primary and Secondary Injury Mechanisms10-15
Management at the Site of Accident
Conscious Patient
Unconscious Patient
Positioning of the Patient
Transportation of the Patient
Aims of Evaluation of Spine Injured Patients are:
Early Management at the Site/Casualty
Investigations
Medical Management
Spinal Injury: Thoracolumbar Spine
Surgical Treatment
Historical Review
The Anterior Cervical Procedures Carried Out are:
The Posterior Stabilization Procedures Available are:
Hart Shill
Merits of Instrumentation
Complications
Anterior Procedures
Posterior Procedures
Both Anterior and Posterior
Prognosis
CONCLUSION
CHAPTER 11:
Head Injury
HISTORICAL REVIEW AND INTRODUCTION
Epidemiology
Incidence
Age Incidence
Sex Incidence
Causes
Mechanism of Head Injury
Other Factors Responsible for Different Types of Traumatic Brain Injury
Pathophysiology of Head Injury
Evaluation of Head Injured Patients
Clinical Evaluation
Evaluation and Management at the Site/Primary Hospital Care—Management Plan
Primary Survey
Resuscitation
Airway
Breathing and Oxygenation
Circulation Support and Control of Hemorrhage
Documentation
Disability Detection
Exposure and Evaluation of Extremity Injuries
Fluid Administration
Evaluation of Head Injured Patients in Hospital (Secondary Survey)
Neurological Evaluation
Limitation of GCS
Post-traumatic or Antigrade Amnesia (PTA)
Significance of PTA
Retrograde Amnesia
Examination of Pupil
Corneal Reflex
Oculocephalic Reflex
Cold Caloric Test (Vestibulo-ocular Reflex)
Mechanism
Examination of Motor System
Examination of the Sensory System
Examination of Reflexes
Clinical Grouping of Patients after Evaluation
Clinical Diagnosis of Intracranial Hematoma (ICH)
Differential Diagnosis of Head Injury Patients
Conditions Leading to Deterioration in Head Injured Patients While Under Treatment
Definitive Care
Criteria for Admission to Hospital with Head Injury
Criteria for Neurological Consultation
HEAD INJURY
Investigations
CT Scan Head
Indication of CT Scan
Follow-up CT Scans
Finding on CT Scan
MRI Head
Management
Medical Management
Protocol for Severe Head Injury
PaO2 to be Mentained at 100 mm Hg and PaCO2 at 35–45 mm Hg
Dos for Head Injury Patients
Don'ts for Head Injury Patients
Indications for Controlled Ventilation
Indications for Tracheostomy
ICP Monitoring
Indications
Methods
Indications for Surgery
Surgery for Head Injury
The Myth of Six Burr Holes (Three on Each Side)
Surgery in Chronic Head Injury
Poor Prognostic Factors in Head Injury
Outcome in Head Injury Patients (Glasgow Outcome Scale)
Prevention of Head Injury
Primary Prevention
Secondary Prevention
Tertiary Prevention
CONCLUSION
CHAPTER 12:
Thoracic Trauma: General Consideration
INCIDENCE
Mechanism of Injury
Classification
Initial Evaluation and Management
Prehospital Care
Hospital Care
Respiratory distress may be due to:
Circulatory collapse/instability may be due to:
Resuscitation
Current Indications and Contraindications for EDT7
Indications
Contraindications
Complications of EDT
Acute indications for thoracotomy are:
Tube Thoracostomy Technique
Incisions
Anterolateral Thoracotomy
Left Posterolateral Thoracotomy
Right Posterolateral Thoracotomy
Book Thoracotomy
CHAPTER 13:
Injuries of Chest Wall
FLAIL CHEST
Pathophysiology
Diagnosis
Management
Stability of Chest Wall
Indications for Ventilation in a Flail Chest Patients
Elements of Treatment of Flail Chest without Mechanical Ventilation
Outcome and Complications
Long-term Sequelae
Role of Surgery
Sternal Fracture
Treatment
CHAPTER 14:
Injuries of Lungs and Pleura
PLEURA
PULMONARY PARENCHYMA
Pneumothorax
Open Pneumothorax
Tension Pneumothorax
Uncomplicated Pneumothorax
HEMOTHORAX
Diagnosis
Management
POST-TRAUMATIC EMPYEMA
PULMONARY CONTUSION
Pathophysiology
Diagnosis
Management
PULMONARY LACERATION
Complications
CHAPTER 15:
Injuries of Diaphragm
CHAPTER 16:
Abdominal Trauma: A Decision Making
DIAGNOSTIC LAPAROSCOPY
Rigid Sigmoidoscopy
DECISION MAKING
EVALUATION OF BLUNT TRAUMA
EVALUATION OF PENETRATING ABDOMINAL INJURIES (PAIs)
Selective Nonoperative Management (SNOM) of SW
Anterior Abdomen
Posterior Abdomen (Back)
Selective Nonoperative Management (SNOM) of GSW
Anterior Abdomen
Back and Buttocks
Transpelvic GSW
Management of Asymptomatic Left Thoracoabdominal Penetrating Injuries
Primary Repair Vs Colostomy for Colon Injury
Prophylactic Antibiotics for Penetrating Abdominal Injuries
Exploratory Laparotomy for Abdominal Trauma
Intra-abdominal Hematomas
Abdominal Drains
Abdominal Closure
Nontherapeutic Laparotomies
Missed Abdominal Injuries
CHAPTER 17:
Management of Hepatic Trauma
INCIDENCE AND MECHANISM OF INJURY
ANATOMY
Classification of Hepatic Trauma
Diagnosis
CT scan findings include the following:
Management
Resuscitation
Determination of Operation Need
Exposure
Management of Actively Bleeding Liver
Debridement
Viable Omental Pack
Hepatic Resection
Juxtahepatic Venous Injuries
Drains
Selective Hepatic Artery Ligation
Perihepatic Mesh Encasement
Hemostatic Products
Complications
Nonoperative Management
Selection Criteria for Nonoperative Protocol
Penetrating Injuries
INTERVENTION RADIOLOGY
CHAPTER 18:
Injuries of Spleen
INTRODUCTION
Classification
ANATOMY
Physiology
Diagnosis
Radiological Evaluation
CT Scan (Figs 18.1 and 18.2)
ANGIOGRAPHY
Clinical Examination
Management
Splenectomy
Splenorrhaphy
Splenic Autotransplantation in Human
Functional Ability of Regenerated Splenic Tissue
Does Reimplanted Spleen Protect Against Infection
Nonoperative Management
Angiography and Embolization
CHAPTER 19:
Injuries of Pancreas
INCIDENCE AND MECHANISM OF INJURY
DIAGNOSIS
Blunt Abdominal Trauma
Penetrating Injuries
MANAGEMENT
Complications
Fistula
Abscess
Pancreatitis
Pseudocyst
Postoperative Hemorrhage
Wound Sepsis
Exocrine and Endocrine Insufficiency
Death
CHAPTER 20:
Injuries of Stomach
PATHOPHYSIOLOGY
DIAGNOSIS
MANAGEMENT
Blunt Gastric Injury
Mucosal/Submucosal Lacerations
Devascularization Injury
Perforation
Penetrating Injuries
CHAPTER 21:
Injuries of Duodenum
CLASSIFICATION
Diagnosis
Investigations
CT Findings in Duodenum Injuries3a
Management
Intramural Hematoma (Grades I and II)
Lacerations—Grades I, II and Selected III
Lacerations—Grades III, IV and V
Mortality and Morbidity
CHAPTER 22:
Injuries of Small Intestines
MECHANISM OF INJURY
CLASSIFICATION
Diagnosis
CT Findings of Bowel or Mesenteric Injury12a
Bowel Discontinuity
EXTRALUMINAL
Oral Contrast Material
Extraluminal Air
Intramural Air
Bowel-Wall Thickening
Bowel-Wall Enhancement
Mesenteric Infiltration
Intraperitoneal and Retroperitoneal Fluids
Management
Perforations
Mural Damage without Perforation
Mesenteric Hematoma
COMPLICATIONS
CHAPTER 23:
Injuries of Colon and Rectum
COLONIC INJURIES
Pathophysiology
Classification
Diagnosis
Management
Historical Perspective
Shock
Fecal Contamination
Associated Injuries
Interval from Injury to Repair
Mechanism of Injury
Severity of Colon Injury
Anatomical Location
Exposure and Exploration
Methods of Repair
Colostomy
Nonoperative Management
RECTAL INJURIES
Diagnosis
Management
CHAPTER 24:
Renal, Ureter and Bladder Injuries
RENAL INJURIES
Introduction
Etiology
Pathology
Classification
Diagnosis
Management
Surgery for Renal Trauma
Complications
Trauma in Pregnancy
URETERIC INJURIES
Introduction
Causes
Classification
Mechanism of Injury
Presentation
Evaluation
Management
Percutaneous Nephrostomy (PCN)
Intubation
Endoscopic Dilatation
Surgical Procedures
BLADDER INJURIES
Introduction
Classification
Clinical Features
Diagnosis
Management
Extraperitoneal Rupture
Intraperitoneal Rupture
CHAPTER 25:
Genital Injuries
INTRODUCTION
Investigations
Management
Injury to the Penis
Degloving Injuries of the Penis
Penile Amputation
Strangulating Injury of the Penis
Injuries to the Scrotum
Testicular Trauma
Epididymis Injury
Vas deferens Injuries
Urethral Injuries
Female Genital Injuries
Animal Bites of the Male External Genitalia
CHAPTER 26:
Vascular Injuries
INTRODUCTION
HISTORICAL BACKGROUND
ETIOLOGY
ANATOMICAL CLASSIFICATION
SEQUELAE OF VASCULAR INJURIES
CLINICAL ASSESSMENT
Special Investigations
GENERAL PRINCIPLES OF VASCULAR REPAIR
Endovascular Treatment of Vascular Injuries
EXTREMITY VASCULAR INJURIES
Introduction
Clinical Features
Investigations
Management
First Aid
Operative Principles
Complications
Outcome
THORACIC VASCULAR INJURIES
Penetrating Thoracic Trauma
Blunt Thoracic Trauma
ABDOMINAL VASCULAR INJURIES
Midline Supramesocolic Hematoma/Hemorrhage
Midline Inframesocolic Hematoma/Hemorrhage
Lateral Perirenal Hematoma/Hemorrhage
Lateral Pelvic Hematoma/Hemorrhage
Portal/Retrohepatic Hematoma/Hemorrhage
IATROGENIC INJURIES
VENOUS INJURIES
CHAPTER 27:
Pelvic Trauma
INTRODUCTION
Basic Issues
Pelvic Stability
Mechanical Forces
Radiographic Evaluation
Associated Hemorrhage
Diagnosis
Management
Control of Hemorrhage
Management of Associated Injuries
Stabilization of Fracture Pelvis
CHAPTER 28:
Pediatric Trauma
EPIDEMIOLOGY
SPECIFIC INJURIES
Central Nervous System Injuries
Metabolic Demand
Mild Head Injury
Severe Head Injury
Spinal Cord Injury
Neck Injuries
Thoracic Injuries
Traumatic Asphyxia
Abdominal Injuries
Abdominal Wall Bruising
Gastric Injuries
Penetrating Duodenal Injuries
Small Intestinal Injury
Rectal Injuries
Solid Organ Injury Management
Splenic Injuries
Hepatic Injury
Pancreatic Injury
Renal Injury
Vascular Injuries
Penetrating Injuries
Orthopedic Injuries
Air Bag Injuries
Burns
Child Abuse: Possibility of Abuse
ACUTE CARE
Prehospital Care
Initial Assessment and Resuscitation
Airway for Normal Breathing
Breathing
Assess Child's Hemodynamic Status and Circulation
Control Hemorrhage
Assess for Shock
Normal Vital Signs
Vascular Access
Fluid Resuscitation
DIAGNOSTIC MODALITIES
Assessment of Blunt Abdominal Trauma in Children
BATTERED BABY
SHAKEN BABY SYNDROME
SUMMARY
INDEX
TOC
Index
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