Surgical critical care

Major advances in surgical critical care have led to a dramatic improvement in the postoperative management of trauma patients. Early diagnosis of extremity compartment syndrome through history, physical examination, and invasive monitoring has helped to increase limb salvage rates while decreasing morbidity and mortality. The second leading cause of death, blunt thoracic aortic injury, involves strict blood pressure control in an ICU setting in selected patients who are candidates for medical management. Vigilance is necessary to immediately identify patients who have failed medical management and have progression of their aortic injury to ensure immediate operative intervention. Blunt cerebrovascular injury may be undiagnosed in some patients, and monitoring in an ICU setting may be appropriate to help identify patients that progress to stroke or hematoma development. Appropriate care for trauma patients who are receiving prophylactic or therapeutic anticoagulation is necessary to promptly diagnose patients who develop bleeding, particularly those who may develop an intracerebral hemorrhage. The most optimal management of these critically ill patients involves a multisystem and multidisciplinary approach.