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Surgical Critical Care and Emergency Surgery: Clinical Questions and Answers Surgical Critical Care and Emergency Surgery Clinical Questions and Answers Second Edition Edited by Forrest “Dell” Moore, MD, FACS Vice Chief of Surgery Associate Trauma Medical Director John Peter Smith Health Network/Acclaim Physician Group Fort Worth, TX, USA Peter Rhee, MD, MPH, FACS, FCCM, DMCC Professor of Surgery at USUHS, Emory, and Morehouse Chief of Surgery and Senior Vice President of Grady Atlanta, GA, USA Gerard J. Fulda, MD, FACS, FCCM Associate Professor, Department of Surgery Jefferson Medical College, Philadelphia, PA Chairman Department of Surgery Physician Leader Surgical Service Line Christiana Care Health Systems, Newark, DE, USA This second edition first published 2018 © 2018 by John Wiley & Sons Ltd Edition History John Wiley & Sons Ltd (1e, 2012) All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by law. Advice on how to obtain permission to reuse material from this title is available at http://www.wiley.com/go/permissions. The right of Forrest “Dell” Moore, Peter Rhee, and Gerard J. Fulda, to be identified as the authors of the editorial in this work has been asserted in accordance with law. Registered Office(s) John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, USA John Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK Editorial Office 9600 Garsington Road, Oxford, OX4 2DQ, UK For details of our global editorial offices, customer services, and more information about Wiley products visit us at www.wiley.com. Wiley also publishes its books in a variety of electronic formats and by print‐on‐demand. 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You should consult with a specialist where appropriate. Further, readers should be aware that websites listed in this work may have changed or disappeared between when this work was written and when it is read. Neither the publisher nor authors shall be liable for any loss of profit or any other commercial damages, including but not limited to special, incidental, consequential, or other damages. Library of Congress Cataloging‐in‐Publication Data Names: Moore, Forrest “Dell”, editor. | Rhee, Peter, 1961– editor. | Fulda, Gerard J., editor. Title: Surgical critical care and emergency surgery : clinical questions and answers / edited by Forrest “Dell” Moore, Peter Rhee, Gerard J. Fulda. Description: 2e. | Hoboken, NJ : Wiley, 2017. | Includes bibliographical references and index. | Identifiers: LCCN 2017054466 (print) | LCCN 2017054742 (ebook) | ISBN 9781119317982 (pdf ) | ISBN 9781119317951 (epub) | ISBN 9781119317920 (pbk.) Subjects: | MESH: Critical Care–methods | Surgical Procedures, Operative–methods | Wounds and Injuries–surgery | Emergencies | Critical Illness–therapy | Emergency Treatment–methods | Examination Questions Classification: LCC RD93 (ebook) | LCC RD93 (print) | NLM WO 18.2 | DDC 617/.026–dc23 LC record available at https://lccn.loc.gov/2017054466 Cover Design: Wiley Cover Images: (Background) © Paulo Gomez/Hemera/Gettyimages; (Inset image) © jacoblund/Gettyimages Set in 10/12pt Warnock by SPi Global, Pondicherry, India Printed in the UK by Bell & Bain Ltd, Glasgow. 10 9 8 7 6 5 4 3 2 1 v Contents Contributors ix About the Companion Website xv Part One Surgical Critical Care 1 1 Respiratory and Cardiovascular Physiology 3 Marcin Jankowski, DO and Frederick Giberson, MD 2 Cardiopulmonary Resuscitation, Oxygen Delivery, and Shock 15 Filip Moshkovsky, DO, Luis Cardenas, DO and Mark Cipolle, MD 3 ECMO 23 Andy Michaels, MD 4 Arrhythmias, Acute Coronary Syndromes, and Hypertensive Emergencies 33 Rondi Gelbard, MD and Omar K. Danner, MD 5 Sepsis and the Inflammatory Response to Injury 51 Juan C. Duchesne, MD and Marquinn D. Duke, MD 6 Hemodynamic and Respiratory Monitoring 59 Stephen M. Welch, DO, Christopher S. Nelson, MD and Stephen L. Barnes, MD 7 Airway and Perioperative Management 69 Stephen M. Welch, DO, Jeffrey P. Coughenour, MD and Stephen L. Barnes, MD 8 Acute Respiratory Failure and Mechanical Ventilation 79 Adrian A. Maung, MD and Lewis J. Kaplan, MD 9 Infectious Disease 89 Yousef Abuhakmeh, DO, John Watt, MD and Courtney McKinney, PharmD 10 Pharmacology and Antibiotics 97 Michelle Strong, MD and CPT Clay M. Merritt, DO 11 Transfusion, Hemostasis, and Coagulation 109 Erin Palm, MD and Kenji Inaba, MD 12 Analgesia and Anesthesia 121 Marquinn D. Duke, MD and Juan C. Duchesne, MD vi Contents 13 Delirium, Alcohol Withdrawal, and Psychiatric Disorders 129 Peter Bendix, MD and Ali Salim, MD 14 Acid‐Base, Fluid, and Electrolytes 135 Joshua Dilday, DO, Asser Youssef, MD and Nicholas Thiessen, MD 15 Metabolic Illness and Endocrinopathies 145 Andrew J. Young, MD and Therese M. Duane, MD 16 Hypothermia and Hyperthermia 153 Raquel M. Forsythe, MD 17 Acute Kidney Injury 159 Remigio J. Flor, MD, Keneeshia N. Williams, MD and Terence O’Keeffe, MD 18 Liver Failure 169 Muhammad Numan Khan, MD and Bellal Joseph, MD 19 Nutrition Support in Critically Ill Patients 177 Rifat Latifi, MD and Jorge Con, MD 20 Neurocritical Care 189 Herb A. Phelan, MD 21 Thromboembolism 199 Herb A. Phelan, MD 22 Transplantation, Immunology, and Cell Biology 209 Leslie Kobayashi, MD and Emily Cantrell, MD 23 Obstetric Critical Care 219 Gerard J. Fulda, MD and Anthony Sciscione, MD 24 Pediatric Critical Care 227 Erin M. Garvey, MD and J. Craig Egan, MD 25 Envenomations, Poisonings, and Toxicology 239 Michelle Strong, MD 26 Common Procedures in the ICU 253 Joanelle A. Bailey, MD and Adam D. Fox, DO 27 Diagnostic Imaging, Ultrasound, and Interventional Radiology 261 Keneeshia N. Williams, MD, Remigio J. flor, MD and Terence O’Keeffe, MD Part Two Emergency Surgery 273 28 Neurotrauma 275 Faisal Shah Jehan, MD and Bellal Joseph, MD 29 Blunt and Penetrating Neck Trauma 287 Leslie Kobayashi, MD and Barret Halgas, MD Contents 30 Cardiothoracic and Thoracic Vascular Injury 299 Leslie Kobayashi, MD and Amelia Simpson, MD 31 Abdominal and Abdominal Vascular Injury 307 Leslie Kobayashi, MD and Michelle G. Hamel, MD 32 Orthopedic and Hand Trauma 317 Brett D. Crist, MD and Gregory J. Della Rocca, MD 33 Peripheral Vascular Trauma 327 Amy V. Gore, MD and Adam D. Fox, DO 34 Urologic Trauma and Disorders 337 Jeremy Juern, MD and Daniel Roubik, MD 35 Care of the Pregnant Trauma Patient 345 Ashley McCusker, MD and Terence O’Keeffe, MD 36 Esophagus, Stomach, and Duodenum 359 Matthew B. Singer, MD and Andrew Tang, MD 37 Small Intestine, Appendix, and Colorectal 371 Vishal Bansal, MD and Jay J. Doucet, MD 38 Gallbladder and Pancreas 385 Matthew B. Singer, MD and Andrew Tang, MD 39 Liver and Spleen 393 Cathy Ho, MD and Narong Kulvatunyou, MD 40 Incarcerated Hernias 403 Cathy Ho, MD and Narong Kulvatunyou, MD 41 Necrotizing Soft Tissue Infections and Other Soft Tissue Infections 409 Jacob Swann, MD and LTC Joseph J. DuBose, MD 42 Obesity and Bariatric Surgery 415 Gregory Peirce, MD and LTC Eric Ahnfeldt, DO 43 Thermal Burns, Electrical Burns, Chemical Burns, Inhalational Injury, and Lightning Injuries 423 Joseph J. DuBose, MD and Jacob Swann, MD 44 Gynecologic Surgery 431 K. Aviva Bashan‐Gilzenrat, MD 45 Cardiovascular and Thoracic Surgery 439 Jonathan Nguyen, DO and Bryan C. Morse, MS, MD 46 Pediatric Surgery 453 Matthew Martin, MD, Aaron Cunningham, MD and Mubeen Jafri, MD 47 Geriatrics 465 K. Aviva Bashan‐Gilzenrat, MD and Bryan Morse, MS, MD vii viii Contents 48 Telemedicine and Telepresence for Surgery and Trauma 477 Kalterina Latifi, MS and Rifat Latifi, MD 49 Statistics 483 Alan Cook, MD 50 Ethics, End‐of‐Life, and Organ Retrieval 491 Allyson Cook, MD and Lewis J. Kaplan, MD Index 501 ix Contributors Yousef Abuhakmeh, DO Emily Cantrell, MD CPT MC, US Army General Surgery Resident William Beaumont Army Medical Center El Paso, TX, USA Trauma and Acute Care Surgery Fellow Division of Trauma, Surgical Critical Care Burns and Acute Care Surgery UCSD Medical Center San Diego, CA, USA LTC Eric Ahnfeldt, DO Chairman, Military Committee for American Society of Metabolic and Bariatric Surgery Director Metabolic and Bariatric Surgery Program Director General Surgery Residency William Beaumont Army Medical Center El Paso, TX, USA Luis Cardenas, DO Joanelle A. Bailey, MD Director of Outcomes Research, Surgical Service Line Christiana Care Health System Newark, DE, USA Resident In Surgery Rutgers New Jersey Medical School Newark, NJ, USA Medical Director, Surgical Critical Care Program Director, Surgical Critical Care Fellowship Christiana Care Health System Newark, DE, USA Mark Cipolle, MD Jorge Con, MD Trauma Medical Director Scripps Mercy Hospital San Diego, CA, USA Director Trauma, eHealth and International Research Fellowship Westchester Medical Center Valhalla, NY, USA Stephen L. Barnes, MD Alan Cook, MD Professor of Surgery & Anesthesia Division Chief of Acute Care Surgery University of Missouri School of Medicine MU Health Columbia, MO, USA Clinical Assistant Professor Department of Surgery University of Arizona Phoenix Campus Chandler Regional Medical Center Chandler, AZ, USA K. Aviva Bashan‐Gilzenrat, MD Allyson Cook, MD Assistant Professor of Surgery Division of Acute Care Surgery Morehouse School of Medicine Grady Health Atlanta, GA, USA Surgical Critical Care Fellow Stanford University Stanford, CA, USA Vishal Bansal, MD Peter Bendix, MD Department of Surgery Section of Trauma and Acute Care Surgery University of Chicago Medicine Chicago, IL, USA Jeffrey P. Coughenour, MD Associate Professor of Surgery & Emergency Medicine Division of Acute Care Surgery University of Missouri School of Medicine MU Health Columbia, MO, USA x Contributors Brett D. Crist, MD Juan C. Duchesne, MD Associate Professor Department of Orthopaedic Surgery Vice Chairman of Business Development Director Orthopaedic Trauma Service Director Orthopaedic Trauma Fellowship University of Missouri Columbia, MO, USA Professor of Surgery Section Chief Trauma Department of Tulane Surgery TICU Medical Director Norman McSwain Level I Trauma Center New Orleans, LA, USA Aaron Cunningham, MD Trauma Medical Director North Oaks Medical Center Clinical Instructor of Surgery, Tulane University Clinical Assistant Professor of Surgery Louisiana State University New Orleans, LA, USA General Surgery Resident Oregon Health Sciences University Portland, OR, USA Omar K. Danner, MD Chief of Surgery for MSM Grady Memorial Hospital Associate Professor of Surgery Director of Trauma Department of Surgery Morehouse School of Medicine Atlanta, GA, USA Gregory J. Della Rocca, MD Associate Professor Department of Orthopaedic Surgery University of Missouri Columbia, MO, USA Marquinn D. Duke, MD J. Craig Egan, MD Chief, Division of Pediatric Surgery Director, Pediatric Surgical Critical Care Phoenix Children’s Hospital Phoenix, AZ, USA Remigio J. Flor, MD CPT MC, USARMY General Surgery Residency William Beaumont Army Medical Center El Paso, TX, USA Raquel M. Forsythe, MD CPT MC, US Army General Surgery Resident William Beaumont Army Medical Center El Paso, TX, USA Assistant Professor of Surgery and Critical Care Medicine University of Pittsburgh Medical Center Presbyterian Hospital Pittsburgh, PA, USA Jay J. Doucet, MD Adam D. Fox, DO Professor of Surgery Head, Division of Trauma, Surgical Critical Care Burns & Acute Care Surgery University of California San Diego Health, San Diego CA, USA Assistant Professor of Surgery Section Chief, Trauma Division of Trauma Surgery and Critical Care Rutgers NJMS Associate Trauma Medical Director NJ Trauma Center University Hospital, Newark, NJ, USA Joshua Dilday, DO Therese M. Duane, MD Professor of Surgery, University of North Texas, Chief of Surgery and Surgical Specialties, John Peter Smith Health Network, Fort Worth, TX, USA LTC Joseph J. DuBose, MD Associate Professor of Surgery, Uniformed Services University of the Health Sciences Associate Professor of Surgery, University of Maryland R Adams Cowley Shock Trauma Center University of Maryland Medical System Baltimore, MD, USA Gerard J. Fulda, MD Associate Professor, Department of Surgery Jefferson Medical College, Philadelphia, PA, US Chairman Department of Surgery Physician Leader Surgical Service Line Christiana Care Health Systems, Newark, DE, USA Erin M. Garvey, MD Pediatric Surgery Fellow Phoenix Children’s Hospital Phoenix, AZ, USA Contributors Rondi Gelbard, MD Marcin Jankowski, DO Assistant Professor of Surgery Associate Medical Director, Surgical ICU Associate Program Director Surgical Critical Care Fellowship Emory University School of Medicine Atlanta, GA, USA Department of Surgery Division of Trauma and Surgical Critical Care Hahnemann University Hospital Drexel University College of Medicine Philadelphia, PA, USA Frederick Giberson, MD Research Fellow Division of Trauma, Critical Care Emergency General Surgery, and Burns Department of Surgery University of Arizona Tucson, AZ, USA Clinical Assistant Professor of Surgery Jefferson Health System Philadelphia, PA, USA Program Director, General Surgery Residency Vice Chair of Surgical Education Christiana Care Health System Newark, DE, USA Amy V. Gore, MD Resident In Surgery Rutgers New Jersey Medical School Newark, NJ, USA Barret Halgas, MD Faisal Shah Jehan, MD Bellal Joseph, MD Professor of Surgery Vice Chair of Research Division of Trauma, Critical Care Emergency General Surgery, and Burns Department of Surgery University of Arizona Tucson, AZ, USA CPT MC, US Army General Surgery Resident William Beaumont Army Medical Center El Paso, TX, USA Jeremy Juern, MD Michelle G. Hamel, MD Lewis J. Kaplan, MD Trauma and Acute Care Surgery Fellow Division of Trauma, Surgical Critical Care Burns and Acute Care Surgery UCSD Medical Center San Diego, CA, USA Cathy Ho, MD Acute Care Surgery Fellow Banner University Medical Center Tucson, AZ, USA Kenji Inaba, MD Associate Professor of Surgery Emergency Medicine and Anesthesia Division of Trauma and Critical Care LAC + USC Medical Center University of Southern California Los Angeles, CA, USA Mubeen Jafri, MD Assistant Professor of Surgery Oregon Health Sciences University Portland, OR, USA Associate Professor of Surgery Medical College of Wisconsin Milwaukee, WI, USA Associate Professor of Surgery Perelman School of Medicine, University of Pennsylvania Department of Surgery Division of Trauma, Surgical Critical Care and Emergency Surgery Section Chief, Surgical Critical Care Philadelphia VA Medical Center Philadelphia, PA, USA Leslie Kobayashi, MD Associate Professor of Clinical Surgery Division of Trauma, Surgical Critical Care Burns and Acute Care Surgery UCSD Medical Center San Diego, CA, USA Narong Kulvatunyou, MD Associate Professor Program Director Surgical Critical Fellowship/ Acute Care Surgery Fellowship University of Arizona Health Science Center Department of Surgery, Section of Trauma, Critical Care & Emergency Surgery Tucson, AZ, USA xi