The Surgical clinics of North America
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Surg. Clin. North Am. · Aug 2012
ReviewManagement of complex extremity injuries: tourniquets, compartment syndrome detection, fasciotomy, and amputation care.
Historically, complex extremity injuries, otherwise known as mangled extremities, have been difficult management problems. This is especially true in multiply-injured patients where many priorities exist and where amputation is considered a failure of limb salvage. Over the past decade, advances in the total management of complex extremity injuries, from the placement of life-saving and limb-saving tourniquets in the prehospital setting to the advancement of prosthetics and rehabilitation months to years later, have resulted in superb functional results regardless of whether limb salvage or amputation is undertaken.
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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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The philosophy of damage control surgery has developed tremendously over the past 10 years. It has expanded outside the original boundaries of the abdomen and has been applied to all aspects of trauma care, ranging from resuscitation to limb-threatening vascular injuries. In recent years, the US military has taken the concept to a new level by initiating a damage control approach at the point of injury and continuing it through a transcontinental health care system. This article highlights many recent advances in damage control surgery and discusses proper patient selection and the risks associated with this management strategy.
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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
Review Historical ArticleLong-range critical care evacuation and reoperative surgery.
Long-range critical care aeromedical evacuation has significantly contributed to the unprecedented survival during recent military operations. With advances in critical care, patients with increased injury severity and overall complexity are routinely evacuated while resuscitation is ongoing. Additional specialty teams now provide advanced pulmonary rescue therapies for the most critically ill patients. As part of the continuum of trauma care, an overseas fixed facility provides follow-on emergency surgical critical care to optimize patient outcomes before final evacuation to the continental United States.