Demanding surgical situations require expert advice from pioneers in the field as well as from those on the front lines of trauma care. Practical and evidence-based, Current Therapy of Trauma and Surgical Critical Care, 2nd Edition, draws on the experience of Drs. Juan A. Asensio and Donald D. Trunkey to offer a comprehensive, contemporary summary of the treatment and post-operative management of traumatic injuries. In this blog post, you will be able to download free PDF e-book copy of Current Therapy of Trauma and Surgical Critical Care 2nd Edition PDF.
Oxygen administration has a vital role in the management of critically ill patients [1, 2]. However, supraphysiological oxygen tension in the blood and/or tissue, hyperoxemia, has been reported to affect mortality and intensive care unit (ICU) length of stay in different diseases [1, 3,4,5], such as traumatic brain injury [6, 7], post-cardiac arrest syndrome [8, 9], and post-cardiac surgery . Moreover, various studies revealed that unnecessarily high fraction of inspired oxygen (FiO2) was also associated with increased mortality of critically ill patients [11, 12], including sepsis [13, 14].
Findings This cohort study examined mortality among 108 patients in a surgical intensive care unit who required continuous renal replacement therapy. When 7 or more days of therapy were required, patients preparing to undergo liver transplant had an in-hospital mortality of 59.1%; patients in a general surgical group had a mortality of 100%.
Importance Continuous renal replacement therapy (CRRT) benefits patients with renal failure who are too hemodynamically unstable for intermittent hemodialysis. The duration of therapy beyond which continued use is futile, particularly in a population of patients admitted to and primarily cared for by a surgical service (hereinafter referred to as surgical patients), is unclear.
The UK HealthCare trauma program is an American College of Surgeons accredited Level 1 Trauma Center. Our Trauma Center is one of only three Level 1 centers serving the needs of Kentuckians. Our trauma center physicians, nurses and staff are committed to providing timely, excellent and cost-effective care for patients with complex, multi-system trauma or single-system trauma requiring specialized surgical services. See our Trauma Program Office »
The surgical critical care service provides consultative services for surgical patients in the intensive care units, giving experience in hemodynamic monitoring, ventilator management, nutritional support, sepsis, and organ failure. The section is actively involved in cardiogenic, hemorrhagic and septic shock research, investigation of L-arginine metabolism after trauma, and lymphatic function in shock states.
ACS is typically only seen in critically ill patients and will likely be a diagnosis made in the ICU setting rather than in the emergency department. Clinical suspicion for abdominal compartment syndrome should be high in patients with penetrating abdominal trauma or surgical patients following extensive abdominal surgery. Patients may present with abdominal pain and distension. However, this is not a sensitive or specific finding. Patients in the ICU setting may present with a wide array of organ failure, not limited to the abdomen, which can make the diagnosis difficult.
Abstract:Cardiothoracic surgical intensive care has developed in response to advances in cardiothoracic surgery. The invention of the cardiopulmonary bypass machine facilitated a motionless and bloodless surgical field and made operations of increasing complexity feasible. By the mid-1950s, the first successful procedures utilizing cardiopulmonary bypass took place. This was soon followed by the establishment of postoperative recovery units, the precursors to current cardiothoracic surgical intensive care units. These developments fostered the emergence of a new medical specialty: the discipline of critical care medicine. Together, surgeons and intensivists transformed the landscape of acute, in-hospital care. It is important to celebrate these achievements by remembering the individuals responsible for their conception. This article describes the early days of cardiothoracic surgery and cardiothoracic intensive care medicine.Keywords: history of medicine; cardiothoracic surgery; intensive care medicine; cardiopulmonary bypass
Journal of Intensive Care is an open access journal encompassing all aspects of intensive care medicine, such as intensive and critical care, trauma and surgical intensive care, pediatric intensive care, acute and emergency medicine, perioperative medicine, resuscitation, infection control and organ dysfunction. In addition, the journal encourages submissions considering the different cultural aspects of intensive care practice.
S. Rob Todd received his Bachelor of Business Administration degree in Finance from The University of Texas at Austin in 1992. He then matriculated from Texas Tech University Health Sciences Center with a Doctorate of Medicine in 1996. He remained at Texas Tech University where he completed his General Surgery residency in 2001. He followed that with a Fellowship in Trauma and Surgical Critical Care from Oregon Health & Science University in 2003. In 2003, he joined The University of Texas Medical School at Houston as an Assistant Professor. His primary clinical responsibilities included trauma surgery, surgical critical care, and emergency general surgery (Acute Care Surgery). In 2006, he joined The Methodist Hospital (Houston, Texas) as an Acute Care Surgeon where he was Medical Director of the Surgical Intensive Care Unit and Associate Program Director of the Residency in General Surgery. In 2011, he was recruited to New York University School of Medicine (New York, New York) as an Acute Care Surgeon where he served as Chief of Trauma and Emergency Surgery for Bellevue Hospital Center. Dr. Todd was recruited to Baylor College of Medicine (Houston, Texas) in 2014, where he served as Professor of Surgery and Chief of Acute Care Surgery. He was also Chief of General Surgery, Chief of the Ginni and Richard Mithoff Trauma Center, and Medical Director of the Trauma Surgical Intensive Care Unit. In 2019, Dr. Todd was recruited to Grady as Senior Vice President and Chief, Acute Care Surgery.
The prescription of fluid therapy is one of the most common medical acts in hospitalized patients but many of the aspects of this practice are surprisingly complex. It is time to introduce fluid stewardship in your ICU. To avoid fluid-induced harm, we recommend a careful evaluation of the chosen solution and a phase-wise approach to its administration, taking into account the clinical course of the disease or surgical procedure. Fluids should be prescribed with the same care as any other drug and every effort should be made to avoid their unnecessary administration.
In critically ill patients, in order to restore cardiac output, systemic blood pressure and renal perfusion an adequate fluid resuscitation is essential. Achieving an appropriate level of volume management requires knowledge of the underlying pathophysiology, evaluation of volume status, and selection of appropriate solution for volume repletion, and maintenance and modulation of the tissue perfusion. Numerous recent studies have established a correlation between fluid overload and mortality in critically ill patients. Fluid overload recognition and assessment requires an accurate documentation of intakes and outputs; yet, there is a wide difference in how it is evaluated, reviewed and utilized. Accurate volume status evaluation is essential for appropriate therapy since errors of volume evaluation can result in either in lack of essential treatment or unnecessary fluid administration, and both scenarios are associated with increased mortality. There are several methods to evaluate fluid status; however, most of the tests currently used are fairly inaccurate. Diuretics, especially loop diuretics, remain a valid therapeutic alternative. Fluid overload refractory to medical therapy requires the application of extracorporeal therapies.
When the diagnosis of placenta accreta spectrum is made in the previable period, it is important to include counseling about the possibility of pregnancy termination for maternal indications given the significant risks of maternal morbidity and mortality 48. However, there are currently no data to support the magnitude of risk reduction, if any. Further, pregnancy termination in the setting of suspected placenta accreta spectrum also carries risk, and the complexities of counseling should be undertaken by health care providers who are experienced in these procedures. Readers are referred to ACOG's Practice Bulletin No. 135, Second Trimester Abortion, for more information on medical and surgical considerations if termination is pursued.
Close monitoring of volume status, urine output, ongoing blood loss, and overall hemodynamics is critically important during these cases. Frequent and ongoing dialogue between surgical, anesthesia, and intraoperative nursing staff are recommended to ensure all are continuously apprised of current status, ongoing blood loss, and expectations about future blood loss. Use of hemorrhage checklists also are strongly encouraged given their ability to ensure all options are considered and no details are neglected because of the focus on surgical activities. Ongoing attention to blood loss, hemoglobin, electrolytes, blood gas, and coagulation parameters is key and can inform, in near real time, objective needs for replacement. There have been no controlled studies of the best ratios for blood product replacement in obstetrics. However, data from other surgical disciplines support the use of a 1:1:1 to 1:2:4 strategy of packed red blood cells: fresh frozen plasma: platelets Table 2 69 70. The use of autologous cell-saver technology is an option, particularly now given that theoretical concerns regarding safety and risks from fetal blood and other debris have been reduced with current filtering technologies 71 72 73. 2b1af7f3a8