Trauma is the leading cause of death during the first four decades of life. Since the 1970s, organized systems for trauma care, including a prehospital emergency medical system and a network of hospitals designated as trauma centers, have been developed. The model of the trauma system and its efficacy have been reviewed. Fundamental to the trauma system is its recognition in the field and the transportation to a trauma center of patients with more serious injuries. Each trauma center has to treat at least 240 severe trauma patients per year to increase experience. It is cost-effective that less severely injured patients be treated in nontrauma center's acute care facilities, according to the inclusive system model. The effectiveness of trauma systems has been investigated by comparing postsystem with presystem trauma care with three methods: panel evaluation of preventable death rates, comparison of observed survival with expected probability of survival derived from large trauma registries, and evaluation of population-based general databases. These studies have demonstrated a decrease in preventable death rate and an increase in survival after system implementation. All these studies have been classified as providing weak class III evidence. However, with a large sample size and when properly designed, they generate important information regarding appropriateness of care delivered. Concentration of severely injured patients in trauma centers is associated with better outcomes. Population-based investigations provide the strongest evidence regarding effects of the trauma system on patient outcomes, other than survival outcome measures because long-term functional status may be more appropriate.
Spinal fusion, also called spondylodesis or spondylosyndesis, is a neurosurgical or orthopedic surgical technique that joins two or more vertebrae. Surgeons use supplementary bone tissue—either from the patient (autograft) or a donor (allograft)—or artificial bone substitutes in conjunction with the body's natural bone growth (osteoblastic) processes to fuse two or more adjoining vertebrae.
Spinal fusion is done most commonly in the lumbar region of the spine, but it is also used to treat cervical and thoracic problems. The indications for lumbar spinal fusion are controversial. People rarely have problems with the thoracic spine because there is little normal motion in the thoracic spine. Spinal fusion in the thoracic region is most often associated with spinal deformities, such as scoliosis and kyphosis.
Cardiothoracic anesthesiology is a subspeciality of the medical practice of anesthesiology devoted to the preoperative, intraoperative, and postoperative care of adult patients undergoing cardiothoracic surgery and related invasive procedures.It deals with the anesthesia aspects of care related to surgical cases such as open heart surgery, lung surgery, and other operations of the human chest. These aspects include perioperative care with expert manipulation of patient cardiopulmonary physiology through precise and advanced application of pharmacology, resuscitative techniques, critical care medicine, and invasive procedures. This also includes management of the cardiopulmonary bypass (heart-lung) machine, which most cardiac procedures require intraoperatively while the heart undergoes surgical correction.
Critical care helps people with life-threatening injuries and illnesses. It might treat problems such as complications from surgery, accidents, infections, and severe breathing problems. It involves close, constant attention by a team of specially-trained health care providers. Critical care usually takes place in an intensive care unit (ICU) or trauma center.
Monitors, intravenous (IV) tubes, feeding tubes, catheters, breathing machines, and other equipment are common in critical care units. They can keep a person alive, but can also increase the risk of infection.
Many patients in critical care recover, but some die. Having advance directives in place is important. They help health care providers and family members make end-of-life decisions if you are not able to make them.
Patients requiring intensive care may require support for instability (hypertension/hypotension), airway or respiratory compromise (such as ventilator support), acute renal failure, potentially lethal cardiac arrhythmias, or the cumulative effects of multiple organ failure, more commonly referred to now as multiple organ dysfunction syndrome. They may also be admitted for intensive/invasive monitoring, such as the crucial hours after major surgery when deemed too unstable to transfer to a less intensively monitored unit.