Thoracic Surgery for the Acute Care Surgeon 9783030484927, 9783030484934

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Thoracic Surgery for the Acute Care Surgeon
 9783030484927, 9783030484934

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Table of contents :
Series Foreword
Preface
Contents
Low-Resource Environments
Epidemiology and Global Disparities
Diagnosis
History
Physical Exam
Labs
Imaging
Chest Radiography
Ultrasound
Pulmonary Exam
Pneumothorax
Pulmonary Edema/Consolidation
Pleural Effusion
Cardiac Function
Extended Focused Assessment with Sonography in Trauma (eFAST)
Computed Tomography
Diagnostic Modality Pitfalls
Management
Pain
Anesthesia
Blood Transfusion
Tube Thoracostomy
Indications
Procedure
Management
Pitfalls and Challenges
Thoracotomy
Indications
Procedure
Management
Pitfalls and Challenges
Pericardial Drainage and Pericardiectomy
Indications
Procedure
Management
Pitfalls and Challenges
Tracheostomy and Cricothyroidotomy
Indications
Procedure
Management
Pitfalls and Challenges
Conclusion
References
Part I: Acute Surgery Thoracic Emergencies
Esophageal Rupture
Introduction
Etiology
Presentation
Diagnosis
Physical Examination
Imaging
Plain Radiographs
Contrasted Esophagography
Computerized Tomography
Endoscopy
Thoracentesis
Management
Initial Management
Nonoperative and Hybrid Approaches to Management
Endoscopic Management
Endoscopic Stenting
Endoscopic Clipping and Suturing
Endoscopic VAC
Operative Management
Surgical Approach
Management of Intrathoracic Esophageal Rupture
Video-Assisted Thoracoscopic Surgery (VATS)
Thoracotomy
Primary Repair
Buttressed Repair with Autologous Tissue
Exclusion
Resection
Postoperative Management
Sepsis
Nutrition
Drains and Wound Care
Stent Migration
Complications and Outcomes
Leak
Stricture/Stenosis
Mortality
Conclusions
References
Incarcerated Hiatal Hernia
Introduction
Clinical Presentation
Diagnosis and Preoperative Work-up
Surgical Treatment
Technique of Laparoscopic Repair
Management of Acute Presentations
Conclusions
References
Pulmonary Embolism
Introduction
Pathophysiology
Classification
Diagnosis
Clinical Decision Rules
PERC
Wells Score
Geneva Score
D-Dimer
Diagnostic Imaging
Venous Duplex
Chest Radiography
Radionucleotide (V/Q) Scan
Pulmonary Angiogram
CT Scan
MRI
V/Q Single-Photon Emission Computed Tomography
Cardiac/Hemodynamic Evaluation
Troponin
Natriuretic Peptides
Electrocardiogram
CT
ECHO
Prognostication
Management
Medical Therapy
Anticoagulation
Thrombolysis
Inhaled Nitric Oxide
Catheter-Directed Therapy
Catheter-Directed Thrombolysis
Catheter-Directed Embolectomy
Surgery
Extracorporeal Life Support (ECLS)
Prevention
Conclusion
References
Empyema and Effusions
Pleural Empyema
Introduction
Epidemiology and Pathogenesis
Diagnosis
Classification
Treatment
Pleural Effusion
Introduction
Plural Space Physiology
Evaluation of Plural Effusion
Treatment
References
Pericarditis and Pericardial Effusions
Acute Pericarditis
Epidemiology
Etiology
Clinical Presentation and Diagnosis
Management
Post-Cardiac Injury Syndrome
Idiopathic, Viral and Immune-Mediated Acute Pericarditis
Recurrent Pericarditis
Uremic Pericarditis
Purulent Pericarditis
Tuberculous Pericarditis
Pericardial Neoplasms
Prognosis
Constrictive Pericarditis
Etiology
Clinical Presentation and Diagnosis
Management
Cardiac Tamponade
Etiology
Clinical Presentation and Diagnosis
Management
Pericardial Procedures
Pericardiocentesis
Pericardiotomy and Pericardial Biopsy
Pericardioscopy
Pericardiectomy
References
Necrotizing Lung Infections
Introduction
Bacteriology and Other Causative Organisms
Diagnosis
Treatment and Surgical Indications
Conclusion
References
Incidental Pulmonary Nodule
Part 1: Incidental Finding on Imaging
Identification and Prediction Models
Part 2: Intraoperative Pulmonary Lesion
Bullous Disease
Lung Masses
Chronic Effusion/Trapped Lung
Pleural Plaques
Traumatic Pulmonary Pseudocyst
Cavitary Lung Lesions
Empyema
Empyema Necessitans
Massive Hemoptysis
Congenital Pulmonary Sequestration
References
Chylothorax
Introduction
Anatomy
Etiology
Diagnosis
Imaging
Treatment
Non-surgical Management
Surgical Management
Thoracic Duct Embolization
Video-Assisted Thoracoscopic Ligation
Thoracotomy
Transabdominal Approaches
Complications
Conclusion
References
Part II: Trauma
Rib Fractures and Chest Wall Injury
Demographics, Epidemiology and Clinical Significance
Chest Wall Injury Biomechanics
Sternal Fractures
Chest Wall Trauma Scoring Systems
Organ Injury Scale
Rib Fracture Score
Chest Trauma Score
Rib Score
Clinical Rib Score
Surgical Management
Patient Positioning and Incision
Exposition and Fracture Reduction
Sternal Fracture ORIF
Rib and Sternal Fracture Nonunions
Chest Wall Injury Reconstruction
References
Pneumothorax and Hemothorax
Incidence and Etiology
Chest Wall Injury
Associated Injuries
Physical Examination and Initial Management
Radiographic, Sonographic, and Laboratory Evaluation
Specific Injuries
Open Chest Wound
Pneumothorax
Etiology and Presentation
Diagnosis
Management
Hemothorax
Etiology and Presentation
Management
Further Reading
Pulmonary Contusions and ARDS
Definition of ARDS
Pathophysiology
Respiratory Monitoring
Compliance
Elastance
Transpulmonary Pressure
Driving Pressure
Mechanical Ventilation in ARDS Patients
Controlled Ventilation
VT Selection
PEEP Selection
Recruitment Maneuvers
Pronation
Assisted Ventilation
Extracorporeal Membrane Oxygenation (ECMO)
Pulmonary Contusion
ARDS: Medical Management
Fluid Balance and Administration
Pain Management and Muscle Paralysis
Steroids
Vasodilating Agents
Β2 Agonists
Vitamins and Statins
Aspirin
Summary
References
Tracheal and Bronchial Injury
Epidemiology
Clinical Presentation
Diagnostic Evaluation
Imaging
Bronchoscopy
Exploration
Management
Airway Control
Exposure
Repair
Tracheostomy
Conclusions
References
Lung Injury
Introduction
Blunt Injury
Evaluation
Management
Operative Intervention
Penetrating Injury
Evaluation
Management
Operative Intervention
References
Cardiac Injury
History
Demographics and Etiology
Prehospital Issues
Emergency Center Presentation and Management
Echocardiography
Electrocardiogram
Subxiphoid Window
Emergency Department Thoracotomy
Operative Approach
Pericardial Injury
Postoperative Care
Screening for Blunt Cardiac Injury
Electrocardiogram
Troponin
Echocardiography
Other Studies
Patient Management in BCI
Summary
References
Blunt Thoracic Aortic Injury in Thoracic Surgery for the Acute Care Surgeon
Introduction
Presentation and Workup
Management: Medical
Open Repair
Management-Endovascular Repair
When Is Open Repair Indicated in the Age of TEVAR?
Is TEVAR the Answer for All Injuries?
Conclusion
References
Thoracic Vascular Trauma
Introduction
Diagnosis
Innominate Artery Injury
Subclavian–Axillary Artery Injury
Carotid Artery
Internal Jugular Vein
Pulmonary Artery
Pulmonary Veins
Venous Injury
Final Comments
References
Diaphragm
Introduction
Anatomy
Diagnosis and Grading of Diaphragm Injuries
Surgical Repair
Repair During Exploratory Laparotomy
Laparoscopic Repair
Thoracoscopic Repair
Complex Diaphragm Injuries
Complications
Conclusion
References
Part III: Special Considerations
Acute Care Pediatric Thoracic Surgical Conditions
Esophageal Rupture
Presentation
Diagnosis
Treatment
Nonsurgical Treatment
Surgical Intervention
Caustic Ingestion
Presentation
Diagnosis and Initial Management
Nonsurgical Treatment, Including Alternative and Adjuvant Treatments
Surgical Treatment
Tracheal Foreign and Esophageal Bodies
Airway Foreign Bodies
Diagnosis and Initial Management
Procedural Intervention
Post-Procedural Care
Esophageal Foreign Bodies
Diagnosis and Initial Management
Nonoperative Management, Including Alternative and Adjuvant Treatments
Procedural Intervention
Button Batteries
Spontaneous Pneumothorax
Epidemiology and Presentation
Assessment
Nonoperative Management
Operative Intervention
Postoperative Considerations
Parapneumonic Effusion and Empyema
Epidemiology and Presentation
Medical Management
Surgical and Procedural Intervention
Tube Thoracostomy
Surgical Cortical Debridement
Complications
Pediatric Thoracic Trauma and Acute Surgical Care
Epidemiology
Anatomy and Physiology of the Pediatric Thorax
Pathophysiology of Thoracic Injuries
Life-Threatening Chest Injuries in the Unstable Patient
Tension Pneumothorax
Open Pneumothorax (“Sucking Chest Wound”)
Massive Hemothorax
Flail Chest
Cardiac Tamponade
Potentially Lethal Chest Injuries in the Stable Patient
Pulmonary Contusion With or Without Flail Chest
Myocardial Contusion
Traumatic Aortic Rupture
Traumatic Diaphragmatic Rupture
Tracheobronchial Tree Injuries
Trachea
Bronchus
Esophageal Trauma
Subcutaneous Emphysema
Crushing Injury to the Chest (Traumatic Asphyxia)
References
Surgical Consideration of Bacteria, Fungi, and Parasites
Introduction
Lung Abscess
Background
Diagnosis
Treatment
Pulmonary Tuberculosis
Background
Diagnosis
Treatment
Invasive Pulmonary Aspergillosis
Background
Diagnosis
Treatment
Hydatidosis
Background
Diagnosis
Treatment
Conclusion
References
Travel and Transport
Physiology and Limitations of Air and Ground Transport
Confined Spaces
Lighting
Noise, Vibration, Turbulence, G-Loading
Temperature
Gas Laws
Available Monitoring and Equipment
Imaging
Choice of Appropriate Transport Mode
Ground EMS
HEMS
Fixed Wing
Critical Care Air Transport Team
Commercial Airliner
Complications During Transport
Pneumothorax
Hemothorax
Chest Tube Management
Pneumomediastinum
Tracheobronchial Bleeding
Cardiac Tamponade
Loss of Airway
Management of Specific Injuries During Transport
Flail Chest and Pulmonary Contusion
Tracheobronchial Injuries
Esophageal Injuries
Damage Control, the Open Chest
Special Considerations During Transport
Pain Control
Respiratory Therapy
Fluid Management
ECMO/ECLS
Interfacility Transport
Safety of Transport
References

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