Trauma: Code Red-Companion to the RCSEng Definitive Surgical Trauma Skills Course

255 Pages·2018·16.851 MB·\255

by  Mansoor Ali Khan (Editor), Morgan McMonagle (Editor)

TRAUMA: CODE RED
COMPANION TO THE RCSEng DEFINITIVE
SURGICAL TRAUMA SKILLS COURSE

TRAUMA: CODE RED
COMPANION TO THE RCSEng DEFINITIVE
SURGICAL TRAUMA SKILLS COURSE
Edited by
Mansoor Khan, MBBS PhD FRCS FEBS FACS AKC
Surgeon Commander Royal Navy
Consultant Trauma and Military Surgeon
St Mary’s Hospital Major Trauma Centre
London, United Kingdom
Morgan McMonagle, MB BCh BAO MD FRCSI FACS
Consultant General
and
Trauma and Vascular Surgeon
St Mary’s Hospital Major Trauma Centre
London, United Kingdom
and The South/South West Hospital Group, Ireland
with
David M. Nott, OBE DSc MD FRCS DMCC
Professor of Conflict Surgery, Imperial College London
and
Consultant Vascular and Trauma Surgeon
St Mary’s Hospital Major Trauma Centre
London, United Kingdom
CRC Press
Taylor & Francis Group
6000 Broken Sound Parkway NW, Suite 300
Boca Raton, FL 33487-2742
© 2019 by Taylor & Francis Group, LLC
CRC Press is an imprint of Taylor & Francis Group, an Informa business
No claim to original U.S. Government works
Printed on acid-free paper
International Standard Book Number-13: 978-1-138-47701-8 (Pack/eBook and Paperback)
978-1-138-47702-5 (Hardback)
This book contains information obtained from authentic and highly regarded sources. While all reasonable efforts
have been made to publish reliable data and information, neither the author[s] nor the publisher can accept any legal
responsibility or liability for any errors or omissions that may be made. The publishers wish to make clear that any
views or opinions expressed in this book by individual editors, authors or contributors are personal to them and do
not necessarily reflect the views/opinions of the publishers. The information or guidance contained in this book is
intended for use by medical, scientific or health-care professionals and is provided strictly as a supplement to the
medical or other professional’s own judgement, their knowledge of the patient’s medical history, relevant manufac-
turer’s instructions and the appropriate best practice guidelines. Because of the rapid advances in medical science,
any information or advice on dosages, procedures or diagnoses should be independently verified. The reader is
strongly urged to consult the drug companies’ printed instructions, and their websites, before administering any
of the drugs recommended in this book. This book does not indicate whether a particular treatment is appropriate
or suitable for a particular individual. Ultimately it is the sole responsibility of the medical professional to make
his or her own professional judgements, so as to advise and treat patients appropriately. The authors and publishers
have also attempted to trace the copyright holders of all material reproduced in this publication and apologize to
copyright holders if permission to publish in this form has not been obtained. If any copyright material has not been
acknowledged please write and let us know so we may rectify in any future reprint.
Except as permitted under U.S. Copyright Law, no part of this book may be reprinted, reproduced, transmitted, or
utilized in any form by any electronic, mechanical, or other means, now known or hereafter invented, including
photocopying, microfilming, and recording, or in any information storage or retrieval system, without written
permission from the publishers.
For permission to photocopy or use material electronically from this work, please access www.copyright.com (http://
www.copyright.com/) or contact the Copyright Clearance Center, Inc. (CCC), 222 Rosewood Drive, Danvers, MA
01923, 978-750-8400. CCC is a not-for-profit organization that provides licenses and registration for a variety of
users. For organizations that have been granted a photocopy license by the CCC, a separate system of payment has
been arranged.
Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for
identification and explanation without intent to infringe.
Visit the Taylor & Francis Web site at
http://www.taylorandfrancis.com
and the CRC Press Web site at
http://www.crcpress.com
This book is dedicated to all those, especially the victims and their families, affected by the
mass terrorist atrocities that have occurred on UK soil in the past two decades, in particular
the London bombings of 7th July 2005, the Westminster Bridge attack of 22nd March 2017,
the Manchester Arena bombing of 22nd May 2017 and the London Bridge attack of 3rd June
2017. We must also give special mention to the dedicated first responders and pre-hospital
care providers (bystanders, fire service, police and ambulance crew) and hospital staff (clinical,
nursing and ancillary) whose enduring spirit never fails to rise to meet all challenges at any
time, well above and beyond the call of duty. It is this profound devotion and esprit de corps
that keeps a health service and society at large alive during times of crisis.
‘If you’re going through hell, keep going’
—Winston Churchill
Mansoor Khan
Morgan McMonagle
David M. Nott

Contents
Foreword by David Feliciano, MD .............ix 7 Damage Control for Severe Pelvic
Foreword by Bryan Cotton, MD, MPH .....xi Haemorrhage in Trauma ........................153
Preface ..............................................................xiii John H. Armstrong
Editors ................................................................xv
Contributors .................................................xvii 8 Trauma Laparotomy and Damage
Control Laparotomy .................................161
1 The Philosophy of Damage Control .......1
David M. Nott
Daniel Grabo, Patrick Reilly and
C. William Schwab 9 Abdominal Trauma ...................................171
Mansoor Khan
2 Ballistics and Blast Injury ..........................19
David M. Nott, Mansoor Khan and 10 Future of Trauma Surgery:
Morgan McMonagle Resuscitative Endovascular Balloon
Occlusion of the Aorta (REBOA) ..........215
3 Emergency Surgical Airway .....................45
Philip J. Wasicek, Thomas M. Scalea and
Morgan McMonagle
Jonathan J. Morrison
4 Thoracic Surgery ..........................................55
Index ...............................................................229
James V. O’Connor
5 Vascular Trauma ...........................................81
Morgan McMonagle
6 Fasciotomy of the Extremities .............139
Mark W. Bowyer
vii

Foreword
by David Feliciano, MD
While general surgery has become increasingly fragmented into subspecialties, trauma
remains the one area in which a broad-based knowledge of anatomy, evaluation, principles
of non-operative management and operative skills is mandatory. Working in such a surgical
field poses a unique problem for practising surgeons, fellows, residents and medical
students – i.e. how best to learn and then maintain the knowledge and skills necessary to
care appropriately for every injured patient arriving in the trauma room.
The Definitive Surgical Trauma Care (DSTC) course evolved from the ‘Guidelines for
Essential Trauma Care’ first developed by the International Association for the Surgery
of Trauma and Surgical Intensive Care/International Society of Surgery and published
by the World Health Organization in 2004. The goal of this document was to promote
‘inexpensive improvements in facility-based trauma care’, recognising the significant
disparities in trauma care between ‘high-income countries’ versus ‘middle- and low-
income countries’. The Definitive Surgical Trauma Skills course was subsequently
developed by the Royal College of Surgeons of England with the Royal Defence Medical
College and the Uniformed University of the Health Sciences in Bethesda, Maryland, USA.
The Definitive Surgical Trauma Skills Course is of great value as a one-stop source
for learning how to perform procedures and operations in all systems of the body.
Trauma: Code Red, this new text by Mansoor Khan and Morgan McMonagle from
St Mary’s Hospital Major Trauma Center in London, United Kingdom, can stand alone as
a consolidated textbook of trauma or be used as a companion to the RCSEng Definitive
Surgical Trauma Skills Course. The content is unique in that, following the introductory
chapters on damage control and ballistics, every other chapter is directed at definitive
and damage control approaches to clinical management. These include management of
the airway, injuries to the chest, abdomen, and pelvis, vascular injuries and fasciotomy of
the extremities, and, finally, a comprehensive review of the emerging role of resuscitative
endovascular balloon occlusion of the aorta (REBOA) in truncal trauma.
Each chapter, written by recognised authorities in the field of trauma, contains an
introductory outline, operative photographs complemented by instructional line
drawings, comprehensive line drawings describing techniques of exposure, pertinent
tables and a reading list. The reader will be rewarded with a highly practical textbook/atlas
of management that can be referred to in the trauma room or even in the operating room.
As trauma systems continue to improve around the world, there are more patients than
ever with life- and/or limb-threatening injuries arriving at trauma centres. Many of these
patients died in the field or during transit in the past. The practical skills highlighted in this
ix