Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Trauma to the eye and orbit

Trauma surgeons and emergency physicians are frequently confronted with evaluating and managing severe eye injuries, most of which will require immediate consultation and referral to an ophthalmologist. Herein, we describe the breadth and depth of traumatic ocular emergencies that may be encountered and an approach for evaluating and managing these complex injuries. Timely diagnosis and care are critical for achieving the best outcomes. When facial fractures…

Maxillofacial trauma

Maxillofacial trauma is frequently encountered by both trauma and plastic surgeons but fortunately rarely results in fatality. Maxillofacial trauma is readily apparent upon arrival to the emergency room. Such injuries should not be a distraction to the surgeon during initial evaluation and resuscitation. The exception is airway maintenance. Advanced Trauma Life Support directives should be closely followed as a standard procedure. Airway and breathing In trauma,…

Spinal cord injury, blunt and penetrating, neurogenic and spinal shock

Spinal cord injury (SCI) is a traumatic event that causes transient or permanent loss of normal sensory, motor, or autonomic function. The long-term sequelae can be devastating due to the financial burden as well as the psychological effects and physical dependency it places on the patient. There is an initial traumatic injury to the spinal cord from the impact that causes hemorrhages in the white and…

Traumatic brain injury: Imaging, operative and nonoperative care, and complications

Traumatic brain injury (TBI) represents a major burden to trauma centers and the health care infrastructure. Heart disease, cancer, and stroke remain the leading cause of mortality year after year in the United States and in various locations abroad. Unlike TBI, these diseases generally affect a much older population with fewer life years lost. TBI on the other hand is most prevalent in the age group…

Traumatic brain injury: Pathophysiology, clinical diagnosis, and prehospital and emergency center care

Traumatic brain injury (TBI) is defined as an injury to the brain caused by an external force to the head that results in disruption of the normal function of the brain. It can be a direct or indirect injury due to penetrating or blunt forces. Mild injuries can result in only a headache or brief change in mental state, while severe injuries can result in death…

Endpoints of resuscitation

Background Shock has been defined in a multitude of ways, but they all come down to inadequate tissue perfusion, and the diagnosis is made at the bedside using clinical judgment. Early identification of the type of shock, understanding of the cause, and institution of early treatment and supportive care including thoughtful patient-tailored fluid resuscitation using a combination of endpoints are recommended. The goal is to restore…

Interventional radiology management during intermediate and long-term phases of trauma care

Interventional radiology (IR) is a critical collaborative clinical service for all levels of trauma activation. IR services require 24/7 availability at Level I and II trauma centers with a 30-minute response time for emergent patient evaluation and interventions as outlined in the American College of Surgeons Trauma Manual. Activation and consultation of interventional services occur in three distinct phases during the continuum of trauma care: (1)…

Interventional radiology: Diagnostic and therapeutic roles

One of the most preventable causes of death in abdominal and pelvic trauma is arterial hemorrhage that goes untreated or unrecognized. Currently, interventional radiology has undergone many advances, particularly in noninvasive imaging and conventional angiography, resulting in the ability to both recognize and treat critical, life-threatening arterial hemorrhage quickly. Interventional radiology also extends beyond angiography as computed tomography (CT)-guided percutaneous interventions and other imaging-guided techniques also…

Role of radiology in initial trauma evaluation

Radiology testing in the trauma setting including radiography, fluoroscopy, ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) has increased substantially in the emergency room and trauma setting over the last decade. The use of CT, which is most concerning because of expense and radiation dose, increased 330% from 1996 to 2007 such that almost one quarter of all CT scans are performed in the…

Focused assessment with sonography for the trauma patient

Introduction The use of Focused Assessment With Sonography in Trauma (FAST) in management of the trauma patient has become increasingly widespread over the past three decades. Serial improvements in ultrasound technology, its portability, and the quality of the images have facilitated rapid and reliable diagnostic images during the initial resuscitation in the emergency room. Confirmation of the acceptance, and importance, of its use was highlighted by…

Resuscitative thoracotomy

Emergency department thoracotomy (EDT) remains a formidable tool within the trauma surgeon’s armamentarium. Since its introduction during the 1960s, the use of this procedure has ranged from sparing to liberal. At many urban trauma centers, this procedure has found a niche as part of the resuscitative process. Because of improvements in emergency medical services systems, many critically injured patients now arrive in extremis, prompting trauma surgeons…

REBOA: Resuscitative endovascular balloon occlusion of the aorta

Traumatic injury causes more than 5 million deaths annually, accounting for approximately 9% of all deaths worldwide. From 1999 to 2015 in the United States, injury was responsible for 21% of all years of potential life lost prior to age 70 years, followed by malignant neoplasms (19%) and heart disease (14%). Hemorrhage accounts for approximately 40% of all trauma deaths, more than 80% of all trauma…

Resuscitation fluids

Fluids have been administered intravenously, subcutaneously, and per rectum since the 1600s. The modern description of the circulatory system in 1638 by William Harvey allowed the concept to slowly progress. William O’Shaughnessy theorized that patients suffering from volume loss secondary to cholera would benefit from restoration of blood to its natural specific gravity by replacing its “deficient saline.” This became the first concept of contemporary intravenous…

Airway management: What every trauma surgeon should know, from intubation to cricothyroidotomy

The concept of immediate and appropriate airway management spans all disciplines of medicine. Achieving, protecting, and maintaining the airway have been well recognized as the initial steps necessary in resuscitation of the critically ill or injured patient. The basic premise of the Advanced Trauma Life Support for Doctors Course (ATLS) is that all resuscitations should follow the mnemonic ABCDE: A irway, B reathing, C irculation, D…

Common prehospital complications and pitfalls in the trauma patient

The evolution of prehospital care in this country has an interesting and continually evolving record. Although there is recorded history of wagons and carts being used to transport the sick and injured as early as 900 ace , the term “ambulance” was not used until introduced by Queen Isabella of Spain in the early 15th century. Even at that time, it referred more to military field…

Wound ballistics: What every trauma surgeon should know

Accounting for 16.4% of all injury deaths in the United States, 39,733 people died from firearm injuries in 2017. Of these firearm deaths, 60% were suicides and 36.6% were homicides. Wounds caused by firearms will be encountered not only in urban areas but also rural areas, where hunting occurs. Wounds encountered in a military environment have unique characteristics that are clinically important and distinct from those…

Prehospital care of biologic agent–induced injuries

On a busy Baghdad bridge spanning the great Tigris River coursing through Iraq from north to south, a crowd of people intermingled in their bidirectional flow. Most were hurrying to and from the nearby market on the east side of the river below. Some were carrying parcels; others had infant children in their arms or on their backs. Someone shouted something; it was never determined who…

Injuries from explosives

Explosives have been used in every major conflict in which the United States has been involved and today are the primary mechanism of injury among U.S. combatants ( Fig. 1 ). Explosives, most notably improvised explosive devices (IEDs), are also commonly used against civilian targets. After a bomb attack on civilian populations, scene responders are responsible for triage and transport decisions, and then hospital personnel must…

Mass casualty events: The role of hospitals and trauma systems

Introduction Large-scale events like the destruction of the Twin Towers in New York City, Hurricane Katrina in New Orleans, and the COVID-19 pandemic have focused the attention of surgeons on the challenges posed by mass casualty events (MCEs). Even though trauma surgeons play a key role in the medical response to such events, education and training for MCEs are still not included in the formal curriculum…

Prehospital fluid resuscitation: What type, how much, and controversies

Overview Fluid resuscitation is a vital treatment in the care of hypotensive trauma patients suffering from shock. Restoration of effective circulating blood volume improves oxygen delivery, thereby diminishing the untoward effects of shock at the cellular and organ level. The logistics of prehospital care, however, make this challenging. Consideration must be given to variables such as vascular access and the value of the resuscitation fluid. Debate…