Management of Chest Trauma. A Practical Guide

I. Introduction

 

1. Centers of Excellence, Health Systems and Regionalization

2. Introduction, Definitions, and Significance of Chest Trauma

3. Initial Resuscitation of the Chest Trauma Patient

 

II. Chest Wall Injury

4. Acute Rib Fractures

5. The Flail Chest

6. Non-union and Costal Cartilage Injury

7. Sternal Fracture

8. Clavicle and Scapula Fractures

9. Non-surgical Aids in Fracture Healing

10. Anesthesia Considerations

 

III. Thoracic Organ Injury

 

11. Cardiac Injury

12. Aorta and Great Vessel Injury

13. Esophageal Injury

14. Tracheal and Pulmonary Injury

15. Thoraco-Abdominal and Combined Injuries

 

IV. Critical Care

 

16. Principles of ICU Resuscitation and Team-based Care

17. Coagulopathy Management and VTE Prophylaxis

18. ICU Monitoring

19. Ventilator Management

20. Respiratory Adjuncts

21. Lung Rescue and ECMO

22. Approaches to Analgesia

23. Advanced Acute Pain Management

24. Physical Therapy and Rehabilitation

25. Role of Advanced Practice Providers

26. Conflict Mediation

V. Disaster and Mass Casualty Events

 

27. Blast Injury, Blast Lung, and Pulmonary Aspiration

28. Thoracic Crush Injury after Natural and Man-made Disaster

29. Toxic Agent Exposure(s)

30. Local Facility Role in National Disaster and the Ethics of Resource Allocation

75% of patients who die from trauma have injuries to the chest. The care of the chest trauma patient can be incredibly complex, require multiple specialty and sub-specialty services, and may require interventions available only at quaternary referral centers.

 

This book provides a comprehensive, state-of-the-art overview of chest trauma. The text reviews all aspects of chest wall, intra-thoracic organ, and great vessel injury management, with each section of the book structured anatomically to explore specific treatment options.

 

 

Since injury care alone is insufficient in guiding the totality of care, the fourth section is dedicated to inpatient critical care. Topics covered in this section include principles of ICU resuscitation, coagulopathy management, ICU monitoring, ventilator management, and advanced acute pain management. 

 

With the increase in violent extremism around the world, including the use of non-conventional weapons, as well as the plethora of natural and man-made disasters, disaster and mass casualty events is the timely subject of the book's final section. Specific topics tackled in this section include blast injury, blast lung, pulmonary aspiration, thoracic crush injury after natural and man-made disasters, toxic agent exposures, the role of the local facility during a national disaster, and the ethics of resource of allocation. The text also features over 100 high-yield illustrations, photographs, and tables. 

Adam M. Shiroff, MD, FACS

Director, Penn Center for Chest Trauma

Associate Professor of Surgery

Perelman School of Medicine

University of Pennsylvania

Philadelphia, PA

USA

 

Mark J. Seamon, MD.

Director of Research, Director of Education

Professor of Surgery

Division of Traumatology, Surgical Critical Care & Emergency Surgery

Perelman School of Medicine at the University of Pennsylvania

 

Lewis J. Kaplan, MD, FACS, FCCM, FCCP

Professor of Surgery

Perelman School of Medicine

University of Pennsylvania

Section Chief, Surgical Critical Care

Medical Director, Surgical ICU

Corporal Michael J Crescenz VAMC

Philadelphia, PA

USA

 

Dr. Shiroff is a trauma, critical are and emergency general surgeon at the Perelman School of Medicine at the University of Pennsylvania. He also serves as the Director of the Penn Center for Chest Trauma in Philadelphia, PA. Dr. Shiroff gained his undergraduate degree in Biology and graduated with Honors from the University of Michigan in 1998. He obtained his medical degree at Jefferson Medical College (2002) and finishing residency in General Surgery at Christiana Care Health System (2007) in Newark, DE. Following this Dr. Shiroff was fellowship trained in Surgical Critical Care at Penn (2007) with an additional year of Trauma and Emergency Surgery training (2009). Following fellowship Dr. Shiroff joined the faculty at Rutger Health in New Brunswick, NJ and rose to Trauma Program Director then moving to Division Chief at Jersey Shore University Medical Center. In 2015 Dr. Shiroff was recruited back to Penn and established the Penn Center for Chest Trauma. Dr. Shiroff has become a internationally recognized expert in chest wall injury, is past president and board of directors member of the Chest Wall Injury Society, and see's patients from around the world with complex chest wall injuries. His interests follow this same vein and he has worked with industry partners in the development and testing of instruments, and the teaching of advanced chest wall surgery. He is an innovated in the area of minimally invasive chest wall surgery. Most recently Dr. Shiroff has completed his business degree from the Kenan-Flagler Business School at the University of North Carolina.

 

Dr. Seamon received his undergraduate from Wesleyan University, Middletown, Connecticut and received his medical degree from University of Pittsburgh School of Medicine. He completed his residency at Temple University Hospital, Philadelphia, Pennsylvania. Dr. Seamon also completed a Trauma and Surgical Critical Care Fellowship at the University of Pennsylvania, Philadelphia and is board certified in surgery and surgical critical care. As Penn Trauma faculty member, Dr. Seamon is interested in and well-published in the clinical management of complex penetrating injuries and outcomes from extreme injury.

 

Dr. Kaplan is a general, trauma and critical care surgeon at the Perelman School of Medicine at the University of Pennsylvania and also serves as the Section Chief of Surgical Critical Care at the Corporal Michael J Crescenz VA Medical Center in Philadelphia, PA. 

Dr. Kaplan received his undergraduate BA from Franklin and Marshall College in Lancaster, PA (1984) and his MD from the Rutgers School of Medicine in Piscataway, NJ (1988).  General Surgery residency was completed at the Medical College of PA including a two-year cardiothoracic surgery research program (1988-1995).  He subsequently undertook a Fellowship in Surgical Critical Care at the University of Pittsburgh Medical Center (1996-1997) and then joined the faculty at MCP and Hahnemann University Hospital in Philadelphia, PA where he directed the SICU and the Surgical Critical Care (SCC) fellowship. Seven years later he was recruited to Yale University to establish an Emergency General Surgery service for the Division of Trauma and Surgical Critical Care.  He then assumed leadership in the Yale-New Haven Hospital ICU and the SCC and Acute Care Surgery fellowships.  After eleven years, he was recruited back to Philadelphia into his current roles. Dr. Kaplan serves in leadership positions in several professional societies and is a past-President of the Society of Critical Care Medicine (2020-2021).   He sits on multiple editorial boards including those of the Journal of Trauma and Acute Care Surgery, Critical Care Medicine, and Surgical Infections and reviews for a host of others.  A durable interest in Tactical Emergency Medical Services is underscored by serving as a surgeon embedded in a regional SWAT team.  Dr. Kaplan's clinical interests include acid-base physiology, mechanical ventilation, transfusion, surgical infections, sepsis, and acute kidney injury.