The Surgical clinics of North America
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Traumatic brain injury (TBI) involves significant damage of the brain parenchyma, and is the leading cause of morbidity and mortality after trauma. It is thus essential for all physicians involved in acute care medicine and surgery to have a thorough understanding of TBI. Management of the patient with TBI is a rapidly advancing field, characterized by an improved understanding of intracranial pathophysiology and decreasing overall mortality largely because of improved neurocritical and surgical care. This article summarizes the classification system, management approaches, and recent controversies in the care of mild, moderate, and severe TBI.
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Surg. Clin. North Am. · Aug 2012
ReviewImproving trauma care in the ICU: best practices, quality improvement initiatives, and organization.
Optimal care of critically ill trauma patients remains a challenge within modern medical systems. During the past decade, emerging technologies and organizational improvements have greatly advanced the care of these patients. The effective implementation of best practice initiatives has led to measurable improvement in outcomes while also reducing health care costs. Continued advances in the implementation of these initiatives and ICU organization are required, however, to insure that optimal care is provided to this unique patient population.
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Surg. Clin. North Am. · Aug 2012
Review Historical ArticleTowards hemostatic resuscitation: the changing understanding of acute traumatic biology, massive bleeding, and damage-control resuscitation.
During the past decade there has been a profound change in the understanding of postinjury coagulation. Concurrently, new data suggest that a resuscitative strategy to minimize large volumes of crystalloid while recreating whole is associated with reduced morbidity and mortality. This article outlines the history of resuscitation and transfusion practices in trauma, the changing understanding of coagulation and inflammation, and clinical data driving changes in resuscitative conduct. Finally, the current state of the science suggests future basic science and clinical investigation that will drive changes in transfusion and resuscitation in severely injured military personnel and civilian patients.
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Surg. Clin. North Am. · Aug 2012
ReviewGraduate medical education in trauma/critical care and acute care surgery: defining goals for a new workforce.
The increasing need for skilled emergency surgical providers, coupled with decreasing experience in emergency surgery among trainees, has led to significant shortages in the availability of such surgeons. In response to this crisis, surgical leaders have developed a comprehensive curriculum and a set of professional standards to guide the training of a new specialist: the acute care surgeon. This article reviews the development and goals for Fellowship training of this new specialty.