Trauma Surgery: Volume 1: Trauma Management, Trauma Critical Care, Orthopaedic Trauma and Neuro-Trauma PDF
Preview Trauma Surgery: Volume 1: Trauma Management, Trauma Critical Care, Orthopaedic Trauma and Neuro-Trauma
S. Di Saverio · G. Tugnoli · F. Catena L. Ansaloni · N. Naidoo Editors Trauma Surgery Volume 1 Trauma Management, Trauma Critical Care, Orthopaedic Trauma and Neuro-Trauma Foreword by Zsolt J. Balogh 123 Trauma Surgery S. Di Saverio (cid:129) G. Tugnoli (cid:129) F. Catena L. Ansaloni (cid:129) N. Naidoo Editors Trauma Surgery Volume 1: Trauma Management, Trauma Critical Care, Orthopaedic Trauma and Neuro-Trauma Foreword by Zsolt J. Balogh Editors Salomone Di Saverio Luca Ansaloni Trauma Surgery Unit Department of General Maggiore Hospital Regional and Emergency Surgery Trauma Center, AUSL Bologna Papa Giovanni XXIII Hospital Bologna, Italy Bergamo , Italy Gregorio Tugnoli Noel Naidoo Trauma Surgery Unit Department of Surgery Maggiore Hospital Regional Nelson R Mandela School of Medicine Trauma Center, AUSL Bologna University of KwaZulu-Natal Bologna, Italy Durban , South Africa Fausto Catena Department of Surgery Emergency and Trauma Surgery Port Shepstone Regional Hospital Department Durban , South Africa Maggiore Hospital of Parma Parma, Italy Videos can also be accessed at http://www.springerimages.com/ videos/978-88-470-5403-5 ISBN 978-88-470-5402-8 ISBN 978-88-470-5403-5 (eBook) DOI 10.1007/978-88-470-5403-5 Springer Milan Heidelberg New York Dordrecht London Library of Congress Control Number: 2013951145 © Springer-Verlag Italia 2014 This work is subject to copyright. 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Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) With deep gratitude I’d like to dedicate this work to the memory of my father, Tito, who recognized my inclinations early on, encouraged and supported me with wonderful enthusiasm and intelligence in my pursuit of a medical and surgical career. His constant presence in my youth, his optimism, his simple and honest life are for me still a source of pride and a never ending model for life, being a star from the sky, shining brightly to give me a safe and fatherly guidance! I also thank and dedicate to my mother, Gabriella, who has always been the beacon of light guiding me morally and culturally. She is a brilliant combination of religious faith and classical learning who supported me in my commitment to research and science. She remains my mentor in logic and humanities, sharing the wisdom of her beloved Greek and Latin masters. I am also grateful and dedicate to my devoted wife Omeshnie from South Africa, a professional nurse whom I met during my experience overseas as a trauma surgeon. She constantly supports me and every day she is sharing our life together with patience and love. Salomone To my mum and dad, for all they have done for me. To Luisa, Francesca and Alessandro, with all my love. To my young grandson Federico, with my best wishes for his future life. Gregorio To all world Emergency Surgeons: brave and good people Fausto Trauma Vol 1: To my beautiful and amazing wife Claudia and my family Trauma Vol 2: To my amazing parents Gina and Atchiah Naidoo and my family Noel Foreword It is a pleasure to see the result of the Italian group of editors’ (Di Saverio, Tugnoli, Catena, Ansaloni and Naidoo) exemplary effort to produce a landmark textbook about trauma care. They have pulled together the best of the academic trauma brother-/ sisterhood and well beyond to make this book as primarily an “Italian job” considering many world leaders among the authors practice on the Apennine Peninsula or have an ancestral claim there. Italy and Italian Trauma Care needs this fine example of a documented, well-organised approach for the further development of their trauma system and the recognition of trauma as a specialty within surgery and critical care. It is a common phrase that trauma is a leading cause of death and long term disability in the young, productive age groups. While this is still true, we need to acknowledge the enormous advances in polytrauma management during the last decades. Major trauma mortality in trauma centres is half of the figures compared to the mortality 20 years ago. This is even more significant in the context of the currently treated trauma population who tend to be slightly more severely injured but on average at least 10 years older. The overall trauma mortality in developed level-1 trauma centres is less than 3 % of all admissions and less than 9 % counting only the patients with injury severity score higher than 15. Trauma mortality review panels hardly find preventable trauma deaths in the developed trauma systems. These facts force us to look for clinically more vii viii Foreword relevant and improvable outcomes beyond the plummeting mortality, such as resource utilisation (~quaternary prevention) and quality of life among the survivors. Volume 1 of the T rauma Surgery textbook addresses some of the most important contributors of these outcomes (trauma systems, critical care, head injury and musculoskeletal trauma). Trauma system and head injury management remain the key determinants of mortality; head injury is still the leading cause of death in most geographic areas and organised trauma system/program has the biggest impact on the reduction of trauma mortality. Critical care including perioperative polytrauma management (initial resuscitation, damage control surgery, postoperative ongoing ICU care) is the most resource intensive component of the hospital phase. Optimal management recommended in this book is essential to prevent deadly and expensive complications such as thromboembolic disease, infections, organ dysfunctions and multiple organ failure. Musculoskeletal injuries including spine and pelvis are the most frequently operated on injuries; especially in blunt trauma, their optimal timing and methods of stabilisation are still commonly debated topics. It is concluded that these, not necessarily always life threatening injuries, are the major determinants of the functional outcome. This is relevant both to the survivors of major trauma and to the isolated limb injury patients. Suboptimal outcomes of these injuries result in long term or permanent disability, which is a major psychosocial and financial burden on the injured patient and on the entire society. Hopefully this book will promote the knowledge necessary to manage these complex patients through generations of trauma surgeons and other clinicians committed to the multidisciplinary management of the injured. Zsolt J. Balogh MD, PhD, FRACS(Ortho), FAOrthA, FACS John Hunter Hospital and University of Newcastle Newcastle, NSW, Australia Pref ace When in the summer of 2011 our small group of Acute Care and Trauma Surgeons, founder members of World Society of Emergency Surgery, had a joined meeting, we all together felt there was a strong need for improving education in the field of acute care and trauma surgery, especially for younger surgeons, or any doctor or professional, approach- ing for the first time this discipline and the complex manage- ment of trauma patients. This need is even stronger in these days, when the decreased surgical training opportunities, combined with the changes in epidemiology and severity of Trauma as well as the spreading use of Non-Operative man- agement, all these have been factors contributing to make the career of a Trauma Surgeon a field of “missed opportu- nities”. This is more evident if compared to the role that Trauma Sugery had in the past decades, when it has defi- nitely had a unique and peerless educational value. In the last decades, in fact, a “good performing” general surgeon would have never missed during his training a valuable experience in a trauma surgery service. We have therefore had the idea of writing a book of trauma surgery, aiming to offer a practical manual of pro- cedures, techniques and operative strategies, rather than pretending to be an excessively long, perhaps excruciating, textbook of trauma surgery. ix
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