Trauma, Critical Care and Surgical Emergencies PDF

Preface

This book focuses on trauma, surgical critical care, and surgical emergencies. Each of these surgical subspecialties involves critically ill patients, who by virtue of their diseases require immediate attention by an expert surgeon as well as allocation of specific resources. Although trauma, surgical critical care, and surgical emergencies inherently complement each other, they were integrated into one surgical specialty, termed Acute Care Surgery, only recently following several evolutionary processes. First, trauma surgery became much less operative with the advent of computed tomography, interventional radiology, intravascular stenting, and improved resuscitation modalities. In addition, the incidence of penetrating trauma, the most common mechanism of injury requiring operative intervention, has sharply declined due to improved policing and more efficient drug control. Lastly, the philosophy of "total commitment" of the trauma surgeon, advocated by the American College of Surgeons Committee on Trauma, led to diminished involvement of other specialists in the management of trauma patients. As a result, trauma experts got more involved in the non-operative management of patients with extra-torso trauma. These practice trends shrunk the scope of trauma surgery and forced trauma surgeons, who only a decade ago used to be busy operating on almost all body areas, to look for other options to maintain their operative skills. The most natural option has been caring for surgical emergency patients, who like trauma victims, present with acute conditions requiring attention by an immediately available surgeon. The fusion of trauma surgery and emergency general surgery was facilitated by a second evolutionary process. Due to deteriorating reimbursements and changes in lifestyles, many general surgeons became more reluctant to take general surgery calls, which interfere with the more profitable elective operative schedule and which negatively impact quality of life. Third, surgical critical care developed into a highly specific, viable field, which attracted many trauma surgeons wishing to provide an entire spectrum of care to their patients. Consequently, a large number of institutions combined their trauma and surgical critical care fellowships and many hospitals are now requiring newly recruited attending to have both trauma and critical care qualifications.

Since an increasing number of trauma surgeons across the country combine trauma care with both surgical critical care and surgical emergencies, and as most surgical societies aggressively promote this concept, we believe that this book has a clear niche in the surgical literature. This textbook aims to provide a comprehensive and contemporary discussion of the three arms of acute care surgery. By providing a single resource where surgeons can find answers to most questions related to this subspecialty, we hope to improve the care of trauma, surgical critical care, and surgical emergency patients. We also hope that this book will assist trauma, critical care, and general surgeons in addressing the formidable challenges of managing acutely ill surgical patients. Finally, we believe that this textbook will be useful to surgical fellows, residents and medical students, as they develop into mature surgeons.

This textbook includes evidence-based analysis by leading experts in the field of cases representing fundamental clinical issues and controversies. Each of the 65 chapters starts with a case presentation, which is being followed as the chapter evolves. The authors review key points in an evidence-based fashion and correlate them to the presented case. Unless stated otherwise, the authors used the GRADE evidence classification system established the American College of Chest Physicians (see Appendix 1). This case- and evidence-based approach makes our book livelier and easier to read than the traditional textbook. It has three sections: Trauma Surgery edited by Dr. Reuven Rabinovici, Surgical Critical Care edited by Dr. Heidi Frankel, and Surgical Emergencies edited by Dr. Orlando Kirton.

We were proud to invite Dr. Erwin Hirsh and Dr. John Pryor to contribute to this book. Unfortunately, Dr. Hirshs unexpected death prevented him from completing his chapter on blunt splenic injury. We are forever grateful to Dr. Pryor, who died while on active duty in Iraq, for his most comprehensive chapter on acute cholecystitis. We dedicate our book to the memory of these two outstanding surgeons.

Finally, we would like to acknowledge the support we got from our families, mentors, and colleagues. We recognize that without their assistance this book would have not been possible.