Table of Contents
SECTION 1 • TRIAGE AND INITIAL STABILIZATION OF THE PATIENT
Chapter 1
TRIAGE OF THE EMERGENCY PATIENT
Tommaso Rosati, Roberta Troia
Principles of triage..……………………….1
Targeted clinical history collection...1
Clinical assessment..…………………..1
Supporting point-of-care diagnostics.………………………………………3
Categorization..…………………………….3
Initial stabilization..……………………..4
Chapter 2
ANALGESIA AND ANESTHESIA FOR CRITICALLY ILL PATIENTS
Thaleia Stathopoulou, Dario A. Floriano
Analgesia..……………………………………9
Pain recognition and assessment....9
Pain management..……………………..10
Sedation/anxiolysis..……………………..12
General anesthesia..……………………..13
Premedication..………………………….13
Induction..………………………………….14
Maintenance..…………………………….15
Cardiovascular support..……………..15
Recovery..………………………………….16
SECTION 2 • SURGICAL APPROACHES
Chapter 3
ABDOMINAL APPROACHES
Simona Vincenti, Matteo Rossanese
Midline celiotomy..………………………..19
Parapreputial caudal celiotomy..…….20
Paracostal/lateral abdominal approach.…………………………………….20
Chapter 4
THORACIC APPROACHES
Matteo Rossanese, Simona Vincenti
Median sternotomy………………………….……………………………………..23
Intercostal thoracotomy..……………….25
Transdiaphragmatic thoracotomy..….28
SECTION 3 • TUBE PLACEMENT AND STAPLING/SEALING DEVICES
Chapter 5
TUBE PLACEMENT
Anna Frykfors von Hekkel, Rhiannon Strickland
FEEDING TUBES..…………………………31
Nasoesophageal/nasogastric tubes..31
Esophagostomy tubes..………………….32
Gastrostomy tubes..………………………34
Enterostomy tubes..………………………37
Tube feeding guideline..…………………37
Tube feeding procedure..……………….37
THORACOSTOMY TUBES/DRAINS..….38
ABDOMINAL DRAINS..……………………41
CYSTOSTOMY TUBES..…………………..43
Chapter 6
STAPLERS AND VESSEL-SEALING DEVICES
Rhiannon Strickland, Anna Frykfors von Hekkel
STAPLING DEVICES..……………………..47
Thoracoabdominal staplers..………….47
Gastrointestinal anastomosis staplers.……………………………………..49
Endoscopic gastrointestinal anastomosis staplers.……………………..50
VESSEL-SEALING DEVICES..…………..51
SECTION 4 • SURGICAL WOUND MANAGEMENT
Chapter 7
BITE WOUNDS
Alison Moores
General overview..…………………………53
Cervical wounds..…………………………53
Thoracic wounds..…………………………54
Wounds to other areas..…………………55
Wound contamination..………………….55
Chapter 8
BURN INJURIES
Rachel Williams
Clinical presentation and diagnosis...65
Treatment..…………………………………..66
Postoperative management..………….68
Outcome..……………………………………69
Chapter 9
PENETRATING INJURIES
Marie Burneko, David E. Holt
Gunshot wounds..…………………………71
Impalement injuries..…………………….72
Porcupine quills..………………………….73
Grass awns..………………………………..75
Penetrating wounds: Treatment, Postoperative management, Outcome…………………………………..75
Chapter 10
DEGLOVING AND SHEARING INJURIES
Ricardo De Sousa, Filippo Cinti
Clinical presentation and diagnosis...79
Treatment..…………………………………..79
Postoperative management..………….82
Outcome..……………………………………83
SECTION 5 • GASTROINTESTINAL SURGICAL EMERGENCIES
Chapter 11
GASTROINTESTINAL EMERGENCIES
Filippo Cinti, Benito de la Puerta, Sarah van Rijn
Obstructive pharyngal sialocele..…….85
Penetrating injuries to the pharynx..…88
Esophageal foreign body or trauma....92
Gastrointestinal foreign body..………..96
Intussusception..………………………….110
Gastric dilatation-volvulus..……………112
Rectal prolapse..…………………………..118
Chapter 12
SPLENIC AND PANCREATIC EMERGENCIES
Adrien Aertsens, Stephen Martin
Splenic torsion..……………………………125
Pancreatic abscess..……………………..129
Chapter 13
BILIARY DISEASE
Karla Lee
Gallbladder mucocele..…………………..135
Colelithiathis..………………………………138
Neoplasia..…………………………………..139
Pancreatitis..………………………………..139
Trauma..………………………………………140
Surgical techniques for treatment of biliary disease.…………………….140
Chapter 14
HEPATIC SURGICAL EMERGENCIES
Sara D. S. Janssens, Anne Kummeling
Liver lobe torsion..…………………………147
Liver abscess..……………………………..149
Liver trauma..……………………………….151
Liver tumors..……………………………….151
SECTION 6 • ABDOMINAL CAVITY SURGICAL EMERGENCIES
Chapter 15
ABDOMINAL HERNIAS
Filippo Cinti, Paolo Buracco
TRUE ABDOMINAL HERNIAS..…………159
Umbilical hernias..………………………..159
Inguinal and scrotal hernias..………….161
Femoral hernias..………………………….166
TRAUMATIC AND INCISIONAL ABDOMINAL HERNIAS.………………….168
Traumatic hernias..……………………….170
Incisional hernias and evisceration....174
PERINEAL HERNIAS..……………………..177
Chapter 16
PERITONITIS
Rosario Vallefuoco, Mark Longley
Septic peritonitis..…………………………193
Bile peritonitis..…………………………….198
Hemoperitoneum..………………………..201
Pneumoperitoneum..…………………….205
SECTION 7 • URINARY SURGICAL EMERGENCIES
Chapter 17
UROABDOMEN
Natalie Kovak, Christiana Fischer
Clinical presentation..……………………211
Initial patient stabilization..…………….211
Diagnosis..…………………………………..212
Treatment..…………………………………..214
Complications and outcomes..……….215
Chapter 18
TRAUMA OR PROLAPSE OF THE URINARY TRACT
Marie Burneko, Lillian R. Aronson
RENAL AND URETERAL TRAUMA..……219
Renal injury..………………………………..219
Ureteral injury..……………………………..220
BLADDER TRAUMA..………………………223
URETHRAL TRAUMA..…………………….225
URETHRAL PROLAPSE..………………….227
Chapter 19
URINARY TRACT OBSTRUCTION
Lillian R. Aronson, Marie Burneko
Ureteral obstruction..…………………….233
Urethral obstruction..…………………….241
SECTION 8 • REPRODUCTIVE SURGICAL EMERGENCIES
Chapter 20
GENITAL EMERGENCIES
Erin Gibson, Rachel Williams
FEMALE GENITAL EMERGENCIES..…..253
Dystocia..…………………………………….253
Uterine torsion..…………………………….256
Uterine prolapse..…………………………257
Vaginal prolapse..…………………………258
Pyometra..…………………………………..259
MALE GENITAL EMERGENCIES..………261
Prostatic cysts and abscesses..………261
SECTION 9 • RESPIRATORY SURGICAL EMERGENCIES
Chapter 21
UPPER AIRWAY EMERGENCIES
Lynda Rutherford
EMERGENCY STABILIZATION OF PATIENTS WITH UPPER AIRWAY DISEASE………………………………267
BRACHYCEPHALIC OBSTRUCTIVE AIRWAY SYNDROME.………………267
LARYNGEAL DISEASE..…………………..274
Laryngeal paralysis..………………………275
TRACHEAL DISEASE..…………………….278
Temporary tracheostomy..……………..278
Permanent tracheostomy..…………….281
Tracheal and laryngeal trauma..………283
Tracheal resection and anastomosis..284
Tracheal collapse..………………………..286
Chapter 22
THORACIC EMERGENCIES
Ben Mielke, Matteo Rossanese
EMERGENCY STABILIZATION OF PATIENTS WITH LOWER AIRWAY AND PLEURAL DISEASE…………291
GENERAL TECHNIQUES..……………….292
Pyothorax..…………………………………..296
Pneumothorax..…………………………….299
Hemothorax..……………………………….305
Lung lobe torsion..…………………………307
Diaphragmatic rupture/hernia..……….309
Chapter 23
CHEST WALL EMERGENCIES
Ben Kaye
Thoracic trauma..………………………….317
Rib fractures..……………………………….319
Flail chest..…………………………………..322
Penetrating thoracic injury..……………325
SECTION 10 • CARDIAC AND VASCULAR SURGICAL EMERGENCIES
Chapter 24
PERICARDIAL DISEASE
Matteo Rossanese, Daniel J. Brockman
Clinical presentation and diagnosis...331
Treatment..…………………………………..332
Postoperative management..………….334
Outcome..……………………………………335
Chapter 25
PATENT DUCTUS ARTERIOSUS
Matteo Rossanese, Daniel J. Brockman
Clinical presentation and diagnosis...337
Treatment..…………………………………..339
Postoperative management..………….341
Outcome..……………………………………342
SECTION 11 • ORAL AND MAXILLOFACIAL SURGICAL EMERGENCIES
Chapter 26
DENTOALVEOLAR EMERGENCIES
Ingrid Tundo, Boaz Arzi
Dental trauma..…………………………….343
Periodontal trauma..……………………..345
Chapter 27
MAXILLOFACIAL TRAUMA AND TEMPOROMANDIBULAR JOINT EMERGENCIES
Ingrid Tundo, Boaz Arzi
Maxillofacial trauma..…………………….351
Temporomandibular joint emergencies.……………………………………..359
SECTION 12 • ORTHOPEDIC EMERGENCIES
Chapter 28
SEPTIC ARTHRITIS
Marie Burneko
Clinical presentation and diagnosis...365
Treatment..…………………………………..366
Outcome..……………………………………367
Chapter 29
OPEN FRACTURE MANAGEMENT
Anna Massie
Clinical presentation and diagnosis...371
Treatment..………………………………….373
Postoperative management..………….375
Outcome..……………………………………375
Chapter 30
ELBOW AND HIP LUXATION
Anna M. Massie
Elbow luxation...…………………………….377
Coxofemoral luxation..……………………378
SECTION 13 • OPHTHALMIC SURGICAL EMERGENCIES
Chapter 31
EYELID LACERATIONS
Maria-Christine Fischer
Simple eyelid lacerations..……………..383
Complicated eyelid lacerations..……..384
Chapter 32
GLOBE PROPTOSIS
Maria-Christine Fischer
Clinical presentation and diagnosis...387
Treatment..…………………………………..387
Postoperative management..………….388
Outcome..……………………………………389
Chapter 33
ENUCLEATION
Maria-Christine Fischer
Clinical presentation and diagnosis...391
Treatment..…………………………………..392
Postoperative management..………….394
Outcome..……………………………………394