The Surgical Handbook

530 Pages·2020·36.181 MB·English

by  Michael Karsy, Hussam Abou-Al-Shaar, Jian Guan, Rebecca Y. Kim, Jeffrey B. Horn

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The Surgical Handbook
MichaelKarsy,MD,PhD,MSc
NeurosurgicalResident
DepartmentofNeurosurgery
UniversityofUtahMedicalCenter
SaltLakeCity,Utah
HussamAbou-Al-Shaar,MD
NeurosurgicalResident
DepartmentofNeurologicalSurgery
UniversityofPittsburghMedicalCenter
Pittsburgh,Pennsylvania
JianGuan,MD
Neurosurgeon
DepartmentofNeurosurgery
PacificNeuroscienceInstitute
Torrance,California
RebeccaKim,MD,MPH
Instructor
DepartmentofSurgery
MedicalCollegeofWisconsin
Milwaukee,Wisconsin
JeffreyB.Horn,MD
AssistantClinicalProfessor
DepartmentofAnesthesiology
UniversityofUtahMedicalCenter
SaltLakeCity,Utah
115illustrations
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Tomywife,Odessa,andchildren,PenelopeandPhilip,fortheircontinuedsupport.Toallmymentorsand
patientswhohavecontinuedtoteachmeeveryday.
–MichaelKarsy
Tomyparents,IzzatandLina,fortheirendlessloveandencouragement.Tomybrothersandmymentors
fortheircontinuoussupportandguidance.
–HussamAbou-Al-Shaar
Tomyparents,withoutwhomnoneofthiswouldbepossible.
–JianGuan
Tothestudentsandresidentswhoinspireusalltokeepteaching,learning,andaskingwhy.
–RebeccaKim
Tomybeautifulwife,Melissa,anddaughter,Charlotte,fortheirunwaveringsupportanddedicationto
ourfamily.Withouttheirloveandsupport,mylifewouldbetrivial.ToDr.MarkHarris,MD,MPH,forhis
mentorshipandresolutecollaborationonthispersonalandprofessionaljourney.
–JeffreyB.Horn
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Contents
Preface........................................................... xx
Acknowledgments............................................... xxi
Contributors ................................................... xxii
1 GeneralPerioperativeandOperativeManagement .................... 1
EditedbyJeffreyB.HornandMarkHarris
1.1 PerioperativeRisk.............................................................. 1
EmileeBorgmeierandJeffreyDillon
1.1.1 Overview ...................................................................... 1
1.1.2 AdverseEvents.................................................................. 1
1.1.3 PerioperativeManagement:WhoDoIOrderFurtherTestingfor?...................... 3
1.1.4 RiskCalculators................................................................. 5
1.2 PerioperativeMedicalOptimization............................................. 5
MichaelKarsy
1.3 FundamentalsofAnesthesiology................................................ 11
JeffreyB.Horn,MarkHarris,andStephenSams
1.3.1 StandardsforBasicAnesthesiaMonitoring.......................................... 11
1.3.2 AnesthesiaBasics................................................................ 14
1.3.3 NeuraxialAnesthesia ............................................................ 15
1.3.4 OtherAnesthesiaComplications................................................... 22
1.3.5 PostanestheticCareUnit(PACU)................................................... 26
1.3.6 AnesthesiaPostoperativeManagement............................................. 27
1.4 WoundClosureandInfection................................................... 32
MichaelKarsy
1.4.1 PreoperativeAntibiotics.......................................................... 32
1.4.2 SurgicalWoundClosure.......................................................... 36
1.4.3 PostoperativeFevers:CategoriesofCauses.......................................... 37
1.4.4 WoundInfection,Dehiscence,andManagement..................................... 37
1.5 SurgicalInstruments........................................................... 39
MichelleD.Ford
1.5.1 InstrumentCategories ........................................................... 39
1.5.2 QualitiesofSurgical-GradeStainlessSteel........................................... 44
1.5.3 InstrumentMaintenance......................................................... 44
1.5.4 SterilizationMethods............................................................ 44
1.5.5 Electrosurgery.................................................................. 45
References .................................................................... 46
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Contents
2 CriticalCareforSurgeons................................................. 49
EditedbyMilosBuhavac
2.1 OrganSystem–BasedAssessmentintheSICU ................................... 49
DorotheaRosenberger
2.1.1 Summary...................................................................... 49
2.1.2 CommonIndicationsforAdmissionstotheSICU .................................... 49
2.1.3 PathwaysofAdmissiontotheSICU................................................ 49
2.1.4 PhysiologicSystem–BasedAssessment............................................. 50
2.1.5 NeurologicSystem.............................................................. 50
2.1.6 CardiovascularSystem........................................................... 50
2.1.7 Pulmonary/RespiratorySystem................................................... 51
2.1.8 RenalandGenitourinarySystemwithFluidStatusandElectrolytes.................... 51
2.1.9 GastrointestinalandNutritionStatus.............................................. 51
2.1.10 Metabolic,EndocrineSystem..................................................... 51
2.1.11 Infection,HematologicSystem,Skin,andWoundHealing ............................ 52
2.1.12 SeverityofIllness:ScoringSystemsintheSICU ..................................... 52
2.2 NeurologicalMonitoring....................................................... 53
MichaelKarsyandGregoryW.J.Hawryluk
2.2.1 NeurologicalStatusinCriticallyIllPatients......................................... 53
2.2.2 MonitoringIndications.......................................................... 54
2.2.3 IntracranialPressureManagement................................................ 55
2.2.4 ElevatedIntracranialPressureManagement........................................ 56
2.2.5 OtherNeurologicalMonitors..................................................... 56
2.3 VentilatorManagement ....................................................... 57
MichaelKarsy
2.4 Hemodynamics ............................................................... 62
LandonBlumelandDavidDorsey
2.4.1 Importance.................................................................... 62
2.4.2 Prevalence..................................................................... 62
2.4.3 NoninvasiveBloodPressureMonitoringTechniques................................. 62
2.4.4 InvasiveMonitoringTechniques.................................................. 62
2.4.5 IndicationsforInvasiveHemodynamicMonitoring.................................. 63
2.4.6 TreatmentofHemodynamicDerangements ........................................ 63
2.4.7 AssessmentofVolumeStatusandVolumeResponsiveness............................ 63
2.4.8 AutoregulationandIndividualizedApproachtoHemodynamicManagement ........... 64
2.4.9 ConditionsNecessitatingElevatedMaps ........................................... 65
2.4.10 ConditionsNecessitatingLowerthanExpectedMAP................................. 65
2.4.11 WhenIsTreatment/ResuscitationAdequate? ....................................... 65
2.4.12 Shock......................................................................... 66
2.4.13 VasoactiveAgents .............................................................. 68
2.5 CardiacArrhythmiainSurgicalPatients......................................... 68
MichaelKarsy
2.5.1 Introduction................................................................... 68
2.5.2 Treatment..................................................................... 68
2.5.3 PerioperativeCardiacRiskAssessment............................................. 74
2.5.4 MyocardialInfarction ........................................................... 75
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Contents
2.6 NutritionoftheCriticalCareandPostsurgicalPatient ............................ 75
MichaelKarsy
2.6.1 NutritionOverview.............................................................. 75
2.6.2 EnteralNutrition................................................................ 76
2.6.3 ParenteralNutrition............................................................. 77
2.7 Fluids,Electrolytes,andAcid-BaseAbnormalities ................................ 77
MichaelKarsy
2.7.1 Fluids.......................................................................... 77
2.7.2 Electrolytes..................................................................... 79
2.7.3 Acid/BaseEvaluation............................................................. 81
2.8 HematologyandCoagulation................................................... 84
MichaelKarsy
2.8.1 Hematology.................................................................... 84
2.8.2 PlateletsandClottingFactors...................................................... 85
2.8.3 Transfusion..................................................................... 88
2.9 AcuteKidneyInjury............................................................ 89
MichaelKarsy
2.10 InfectionsintheSurgicalICU.................................................... 91
AdrienneCareyandEmilySpivak
2.10.1 NosocomialFeverandLeukocytosis................................................ 91
2.10.2 Catheter-RelatedBloodStreamInfection(CRBSI)..................................... 92
2.10.3 IndwellingCatheters............................................................. 93
2.10.4 Catheter-AssociatedUrinaryTractInfection(CA-UTI)................................. 93
2.10.5 Hospital-AcquiredPneumonia/Ventilator-AssociatedPneumonia ...................... 96
2.10.6 Clostridioides(formerlyClostridium)DifficileColitis ................................. 97
2.10.7 Candidemia .................................................................... 99
2.10.8 ComplicatedIntra-abdominalInfections,Peritonitis.................................. 99
2.10.9 NecrotizingFasciitis ............................................................. 100
2.10.10 PenicillinAllergy................................................................ 101
References .................................................................... 102
3 Trauma...................................................................... 105
EditedbyRebeccaKimandMilosBuhavac
3.1 AdvanceTraumaLifeSupport(ATLS)andGeneralApproachtoTrauma............. 105
MichaelKarsy,AustinCannon,AndreaWeitz,andMilosBuhavac
3.1.1 Epidemiology................................................................... 105
3.1.2 TriageandAssessment........................................................... 105
3.1.3 Imaging........................................................................ 109
3.2 SpecificInjuryPatternsinTrauma............................................... 111
MichaelKarsy,AustinCannon,AndreaWeitz,andMilosBuhavac
3.3 SpecificInjuryPatientGroupsinTrauma......................................... 117
MichaelKarsy,AustinCannon,AndreaWeitz,andMilosBuhavac
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