The Surgical clinics of North America
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A knowledge of the principles of ultrasound physics and instrumentation allows the surgeon to maintain proper ultrasound techniques and obtain the best possible image. Furthermore, when these principles are understood, artifacts and pitfalls of imaging are avoided.
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The management of trauma and hemorrhagic shock in the pregnant patient involves unique considerations owing to extensive alterations in physiology. In the third trimester of pregnancy, emergent delivery by cesarean section should be started within 4 minutes after the initiation of CPR for both maternal and fetal benefits. ⋯ Postpartum hemorrhage is managed by a succession of pharmacologic and surgical maneuvers prior to resorting to hysterectomy, particularly in a woman of low parity. Hepatic rupture and abdominal gestation are unique conditions to pregnancy that require damage control through a close partnership between the obstetrician and the surgeon.
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With the growing understanding of the pathophysiology of exsanguination has come the evolution of extraordinary surgical techniques designed to improve survival. As the success of damage control has grown, so has its acceptance in the traditional surgical community. Our challenge now is to scientifically define patient selection, refine intraoperative techniques, and acquire a greater clinical and basic science understanding of the physiology of exsanguination and reperfusion injury in resuscitation. In these efforts, overall survival should continue to increase and morbidity should continue to decrease.
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Surg. Clin. North Am. · Aug 1996
ReviewThe complexities of managing severe burns with associated trauma.
A high incidence of severe inhalation injuries can be expected in the combined injury patient. The initial management remains attention to the ATLS priorities of airway, breathing, and circulation, with prompt and safe transfer to a regional center of excellence. The treatment of either the burn or the associated injuries may be compromised by their combined presence, and a team approach is essential to their optimal management. ⋯ The management of inhalation injury and ARDS is at an exciting turning point in history, and we now have in hand and use many techniques that allow salvage of these mortal conditions. Pain management is essential to humane care and requires frequent assessment and patient control to be effective. Rehabilitation of the burn and trauma patient starts on the day of injury and requires team dedication to the areas of greatest morbidity early in the planning of surgical priorities and physical therapy.