Pediatric Trauma
36 PEDIATRIC TRAUMA
David A. Partrick M.D., Denis D. Bensard M.D.
1. What is the leading cause of death in children in the United States?
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Injuries cause more death and disability in children from ages 1 to 18 years than all other causes combined. Unintentional injury deaths account for 65% of all injury deaths in children under 19 years of age. Each year, approximately 20,000 children and teenagers die as a result of injury and 50,000 children suffer permanent disabilities. Each year, nearly one child in four receives medical treatment for an injury. The estimated annual cost is $15 billion.
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Burns
35 BURNS
Paulus C. Bauling MBChB, M.Med., FACS
1. Why is it essential to have sound clinical knowledge of urgent and emergent burn care?
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The events of September 11, 2001, have vividly underlined the fact that wars, plane crashes, nuclear and industrial accidents, and many other potential disasters can produce large numbers of burn-injured victims in an instant
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Basic Care Of Hand Injuries
34 BASIC CARE OF HAND INJURIES
Michael J.V. Gordon M.D., Lawrence L. Ketch M.D.
1. What are the goals of hand repair?
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Functional considerations override cosmesis in the treatment of hand trauma. There are no minor hand injuries. Initial diagnosis and management determine the final result; expert secondary repair cannot overcome primary errors in diagnosis or decision making.
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Facial Lacerations. Controversies
CONTROVERSIES
14. What controversies exist regarding the care and repair of facial lacerations?
Facial Lacerations
33 FACIAL LACERATIONS
Lawrence L. Ketch M.D.
1. What distinguishes facial from other lacerations?
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Appearance is clearly of primary importance. Quality of the final result depends on strict adherence to basic principles of wound management and painstaking technique. Copious irrigation, judicious debridement, gentle tissue handling, meticulous hemostasis, and minimization of sutures combined with early stitch removal are critical to an optimal result. Fine suture and sharp instruments should be used; eversion of the wound margin with layered closure, obliteration of dead space, and lack of tension are mandatory.
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Extremity Vascular Injuries
32 EXTREMITY VASCULAR INJURIES
Kyle H. Mueller M.D., William H. Pearce M.D.
1. What are the “hard signs” of arterial injury?
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* Distal circulatory deficit: ischemia or diminished or absent pulses
* Bruit
* Expanding or pulsatile hematoma
* Arterial (pulsatile) bleeding
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Lower Urinary Tract Injury & Pelvic Trauma
31 LOWER URINARY TRACT INJURY AND PELVIC TRAUMA
Fernando J. Kim M.D., Siam Oottamasathien M.D.
1. What are the causes of bladder injury?
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Iatrogenic manipulation and penetrating or blunt trauma. Because of the rich detrusor blood supply, bladder injury is usually accompanied by hematuria. Other signs may include suprapubic pain, inability to void, or incomplete recovery of catheter irrigation.
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Upper Urinary Tract Injuries
30 UPPER URINARY TRACT INJURIES
Fernando J. Kim M.D., Siam Oottamasathien M.D.
1. What is the most common type of renal trauma in the United States, blunt or penetrating?
Show answer
Blunt, by far.
2. Do most kidney injuries require surgery?
Show answer
No. Fewer than 2% of blunt injuries require surgery, and many penetrating injuries can also be treated nonoperatively.
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Pelvic Fractures
29 PELVIC FRACTURES
Steven J. Morgan M.D., Wade R. Smith M.D.
1. What are the first steps in the evaluation and treatment of a patient with pelvic trauma?
Show answer
The ABCs (airway, breathing, and circulatory assessment). The answer to this first trauma question is always the same. Trauma patients with displaced pelvic fractures have a high incidence of associated injuries to the head, chest, and abdomen.
Trauma To The Colon & Rectum. Rectal Trauma
RECTAL TRAUMA
9. How do rectal injuries occur?
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Similar to colon injuries, most rectal injuries result from penetrating trauma. Blunt pelvic fractures should be assessed with a strong suspicion for rectal (and urethral) injury.
Trauma To The Colon & Rectum. Colon Trauma
28 TRAUMA TO THE COLON AND RECTUM
W. Andrew Lawrence M.D., Jon M. Burch M.D.
COLON TRAUMA
1. How do most colon injuries occur?
Show answer
Nearly all (> 95%) colon injuries are caused by penetrating trauma from gunshot, stab, iatrogenic, or sexual injury. Blunt colonic trauma is rare and usually results from seat belts during motor vehicle accidents.
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Pancreatic & Duodenal Injury
27 PANCREATIC AND DUODENAL INJURY
Caesar M. Ursic M.D.
1. How common are pancreatic injuries?
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The pancreas is not commonly injured because of its protected retroperitoneal position, and thus accounts for only 8% of all penetrating and 2% of all blunt visceral injuries.
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Splenic Trauma
26 SPLENIC TRAUMA
David J. Ciesla M.D., Ernest E. Moore M.D.
1. What is the physiologic role of the spleen?
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In fetal development, the spleen serves as a major site for hematopoiesis. In early childhood the spleen produces immunoglobulin M (IgM) and tuftsin. The spleen also functions as a filter, allowing resident macrophages to remove abnormal red blood cells (RBCs), cellular debris, and encapsulated and poorly opsonized bacteria.
Hepatic & Biliary Trauma. Biliary Tract Injury
BILIARY TRACT INJURY
22. Why are complications associated with bile duct leaks?
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Bilomas (i.e., collections of bile) frequently become infected and may result in lethal peritonitis. Biliopleural fistula, a communication between the biliary system and pleural cavity, persists because of the relative negative pressure in the thorax and may result in a bile empyema.
Hepatic & Biliary Trauma. Operative Management Of Liver Injury
OPERATIVE MANAGEMENT OF LIVER INJURY
11. How are acute liver injuries classified?
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Liver wounds are generally graded on a scale of I to VI according the depth of parenchymal laceration and involvement of the hepatic veins or retrohepatic portion of the inferior vena cava. Optimal methods of obtaining hemostasis vary with the severity of the injury.
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Abernathy’s Surgical Secrets, Updated Edition (Book w / Student Consult)
Author / s: Harken Alden H., Abernathy Charles, Moore Ernest Eugene
Year: 2004
Pages: 473
Publishers: Elsevier Mosby; 5th Bk & Acc edition
ISBN: 0323034160
