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Acute Care Surgery and Trauma Evidence Based Practice


Second Edition Cohn

50 Landmark Papers Every Acute Care Surgeon Should Know


1st Edition Stephen M Cohn (Editor)

Evidence Based Emergency Care Diagnostic Testing and


Clinical Decision Rules Second Edition Jesse M. Pines

Evidence Based Obstetric Anesthesia 1st Edition Stephen H.


Halpern
Psychiatric Mental Health Nursing Concepts of Care in
Evidence Based Practice 6th Edition Mary C. Townsend

Evidence Based Clinical Supervision Principles and


Practice 1st Edition Derek Milne

Neuroscience Nursing Evidence Based Theory and Practice


1st Edition Sue Woodward

Evidence Based Practice for Health Professionals 1st


Edition Bernadette Howlett

Introduction to Evidence Based Practice 2nd Edition Lisa


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Acute Care Surgery and Trauma Evidence Based
Practice 1st Edition M. Cohn Stephen Digital Instant
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Author(s): M. Cohn Stephen
ISBN(s): 9781420075137, 1420075136
Edition: 1
File Details: PDF, 5.74 MB
Year: 2009
Language: english
Acute Care
Surgery and
Trauma
Evidence Based Practice

Edited by
Stephen M Cohn
Acute Care Surgery
and Trauma:
Evidence Based Practice
Edited by
Stephen M. Cohn MD FACS
Witten B. Russ Professor of Surgery
University of Texas Health Science Center
San Antonio, Texas, USA
© 2009 Informa UK Ltd

First published in the United Kingdom in 2009 by Informa Healthcare, Telephone House, 69-77 Paul Street, London EC2A 4LQ.
Informa Healthcare is a trading division of Informa UK Ltd. Registered Office: 37/41 Mortimer Street, London W1T 3JH. Registered
in England and Wales number 1072954.

Tel: +44 (0)20 7017 5000


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All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or
by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of the publisher or in
accordance with the provisions of the Copyright, Designs and Patents Act 1988 or under the terms of any licence permitting
limited copying issued by the Copyright Licensing Agency, 90 Tottenham Court Road, London W1P 0LP.

Although every effort has been made to ensure that all owners of copyright material have been acknowledged in this publication,
we would be glad to acknowledge in subsequent reprints or editions any omissions brought to our attention.

Although every effort has been made to ensure that drug doses and other information are presented accurately in this publication,
the ultimate responsibility rests with the prescribing physician. Neither the publishers nor the authors can be held responsible for
errors or for any consequences arising from the use of information contained herein. For detailed prescribing information or
instructions on the use of any product or procedure discussed herein, please consult the prescribing information or instructional
material issued by the manufacturer.

A CIP record for this book is available from the British Library.
Library of Congress Cataloging-in-Publication Data

Data available on application

ISBN-10: 1 420 07513 6


ISBN-13: 978 1 420 07513 7

Distributed in North and South America by


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Contents

Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viii
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiv
Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvii
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxi

Section I – Trauma

1. Evidence for Injury Prevention Strategies: From Private Practice


to Public Policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Michelle A. Price and Cynthia L.Villarreal

2. Trauma Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
S. Morad Hameed and Richard K. Simons

3. Evidence-Based Review of Trauma


Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Michael M. Badellino, John J. Hong, and Michael D. Pasquale

4. Evidence-Based Surgery: Military Injury Outcomes . . . . . . . . . . . . . . . . . . . . . 23


Brian J. Eastridge

5. Evidence-Based Surgery: Traumatized Airway . . . . . . . . . . . . . . . . . . . . . . . . . . 29


Edgar J. Pierre and Amanda Saab

6. Monitoring of the Trauma Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36


Eugene Y. Fukudome and Marc A. de Moya

7. Resuscitation of the Trauma Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42


David R. King

8. Diagnosis of Injury in the Trauma Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46


Pedro G. R. Teixeira and Kenji Inaba

9. An Evidence-Based Approach to Damage Control Laparotomy


for Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Bruce Crookes

10. Evidence-Based Surgery: Coagulopathy in the Trauma Patient . . . . . . . . . . 65


Joseph J. DuBose and Peter M. Rhee

11. Traumatic Brain Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72


Ara J. Feinstein and Kenneth D. Stahl

12. Spine and Spinal Cord Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80


Yoram Klein and Shaul Sagiv

iii
iv Contents

13. Facial Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86


Antonio Jorge V. Forte, Renato da Silva Freitas and Joseph H. Shin

14. Ocular Trauma: An Evidence-Based Approach to Evaluation


and Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
Heidi I. Becker and M. Kelly Green

15. Neck Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97


Marc A. de Moya

16. Emergency Thoracotomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102


Joseph J. DuBose and Mark Gunst

17. Trauma to the Chest Wall . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105


Joseph J. DuBose and Lydia Lam

18. Evidence-Based Surgery: Injury to the Thoracic Great Vessels . . . . . . . . . . 115


Mark Cockburn

19. Evidence-Based Surgery: Cardiac Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121


Dror Soffer and Edan Sarid

20. Injury to the Esophagus, Trachea, and Bronchus . . . . . . . . . . . . . . . . . . . . . . 125


Deborah L. Mueller

21. An Evidence-Based Approach to Spleen Trauma: Management


and Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
Anne Saladyga and Robert Benjamin

22. Injury to the Liver . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138


Alberto Garcia, Maria Fernanda Jimenez and Juan Carlos Puyana

23. Small Bowel and Colon Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144


Daniel L. Dent

24. Diaphragmatic Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147


Fahim Habib

25. Pancreatic and Duodenal Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153


Adrian W. Ong and Elan Jeremitsky

26. Abdominal Vascular Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160


Joseph E. Glaser and Alexandra A. MacLean

27. An Evidence-Based Approach to Pregnant Trauma Patients . . . . . . . . . . . . 165


Igor Jeroukhimov

28. Pelvic Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172


Matthew O. Dolich

29. An Evidence-Based Approach to Extremity Vascular Trauma . . . . . . . . . . . 177


Terence O’Keeffe

30. Surgery of Upper Extremity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186


Howard Wang, Patrick Schaner and Sahar David

31. Lower Extremity Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194


Hany Bahouth and Doron Norman

32. Limb Salvage for the Mangled Extremity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199


Gabriel E. Burkhardt and Todd E. Rasmussen

33. Critical Questions in Support of the Burned Patient . . . . . . . . . . . . . . . . . . 207


Steven E. Wolf
Contents v

34. Burn Wound Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212


Joseph H. Shin, Antonio Jorge V. Forte and Renato Freitas

35. Inhalation Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218


Leopoldo C. Cancio

36. Electrical, Cold, and Chemical Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 226


Stephanie A. Savage

37. Evidence-Based Wound Care Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233


David Sahar and Howard Wang

38. Viperidae Snakebite Envenomation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 240


Steven Granger and Ronald Stewart

39. Evidence-Based Surgery: War Wounds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245


Lorne H. Blackbourne

40. Evidence-Based Surgery: Pediatric Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250


Gerald Gollin

41. An Evidence-Based Approach to Geriatric Trauma . . . . . . . . . . . . . . . . . . . . 258


Carl I. Schulman

42. Rural Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265


Burke Thompson

43. Reducing Patient Errors in Trauma Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 268


Kenneth D. Stahl and Susan E. Brien

Section II – Emergency General Surgery

44. Small Bowel Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 278


Erik J. Teicher, John J. Hong, Michael M. Badellino,
and Michael D. Pasquale

45. An Evidence-Based Approach to Upper GI Bleed Management . . . . . . . . 285


John G. Schneider and Bruce A. Crookes

46. Peptic Ulcer Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 290


Wayne H. Schwesinger

47. Enterocutaneous Fistula . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 299


Peter A. Learn

48. Paraesophageal Hernia Repair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 303


Omid Noormohammadi, Alicia Logue and Kent R. Van Sickle

49. Appendicitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307


Peter P. Lopez and Amy De Rosa

50. Lower Gastrointestinal Bleeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 316


Steven D. Schwaitzberg

51. Diverticular Disease of the Colon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 322


Brent Izu and Akpofure Peter Ekeh

52. Large Bowel Obstruction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 327


Jerry Lee Howard, John J. Hong, Michael M. Badellino,
and Michael D. Pasquale

53. Acute and Chronic Mesenteric Ischemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 333


Joshua B. Alley
vi Contents

54. Ogilvie’s Syndrome and Colonic Volvulus . . . . . . . . . . . . . . . . . . . . . . . . . . . 336


Raymond P. Compton

55. Hemorrhoids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 341


Clarence E. Clark III

56. Anal Fissure, Fistula, and Abscess . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 345


W. Brian Perry

57. Evidence-Based Surgery: Pilonidal Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . 348


Matthew J. Eckert, Joel E. Goldberg and Scott R. Steele

58. Rectal Prolapse: Evidence-Based Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . 356


Scott R. Steele and Joel E. Goldberg

59. Evidence-Based Practice: Acute Cholecystitis . . . . . . . . . . . . . . . . . . . . . . . . . . 368


Juliane Bingener

60. Acute Cholangitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 374


Adrian W. Ong and Charles F. Cobb

61. Acute Pancreatitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 382


Stephen W. Behrman

62. Pancreatic Pseudo-cysts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 390


Olga N. Tucker and Raul J. Rosenthal

63. Liver Abscess . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 397


Andreas G. Tzakis and Pararas Nikolaos

64. Diagnosis and Treatment of Variceal Hemorrhage due to Cirrhosis . . . . . 406


Robert M. Esterl Jr., Greg A. Abrahamian and K. Vincent Speeg

65. Gangrene of the Foot . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 415


Maureen K. Sheehan

66. Acute Arterial Embolus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 419


Ryan T. Hagino

67. Ruptured Abdominal Aortic Aneurysm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 423


Boulos Toursarkissian

68. Acute Aortic Dissection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 427


V. Seenu Reddy

69. Deep Venous Thrombosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 433


Paula K. Shireman

70. Pulmonary Embolism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 438


George C. Velmahos

71. Necrotizing Soft Tissue Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 443


Mark D. Sawyer

72. Incarcerated Hernias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 447


Steven Schwaitzberg

73. Surgical Endocrine Emergencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 451


Christopher Busken, Rebecca Coefield, Robert Kelly and Steven Brower

Section III – Surgical Critical Care Problems

74. Evidence-Based Surgery: Bacteremia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 457


Sapoora Manshaii and Greg J. Beilman
Contents vii

75. Prevention of Central Venous Catheter Infections . . . . . . . . . . . . . . . . . . . . . 463


J. Matthias Walz and Stephen O. Heard

76. Ventilator-Associated Pneumonia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 467


Aaron M. Fields

77. Management of Acute Myocardial Infarction and Cardiogenic Shock . . . 473


Antonio Hernandez

78. Perioperative Arrhythmias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 480


Bipin K. Ravindran and Mohan N. Viswanathan

79. Feeds and Feeding Surgical Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 486


Jayson D. Aydelotte

80. Evidence-Based Surgery: Acute Lung Injury/Acute Respiratory


Distress Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 490
Juan J. Blondet and Greg J. Beilman

81. Acute Renal Failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 497


Teofilo Lama

82. Hyperglycemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 503


Balachundhar Subramaniam and Alan Lisbon

83. Abdominal Compartment Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 509


James C. Doherty

84. Agitation and Delirium in the ICU . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 514


Robert Chen

85. Malignant Hypertension: An Evidence-based Surgery Review . . . . . . . . . . 523


David S. Owens and Marshall A. Corson
Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 533
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 573
1
Contributors

Greg A. Abrahamian MD Robert Benjamin MD FACS


Assistant Professor of Surgery, Department of Surgery Chief of Trauma Services
Transplant Center, University of Texas Health Science William Beaumont Army Medical Center
Center at San Antonio, Texas, USA Department of Surgery
El Paso, Texas, USA
Omid Noormohammadi, Alicia Logue MD
University of Texas Health Science Center Bethesda MD
San Antonio, Texas, USA Department of Surgery
Madigan Army Medical Center, Tacoma
Joshua B. Alley MD Fort Lewis, Washington, USA
Major USAF MC, Staff General Surgeon
Wilford Hall Medical Center, Lackland AFB Juliane Bingener MD
Texas. Clinical Assistant Professor, Department of Department of Surgery, Mayo Clinic
Surgery, University of Texas Health Science Center Rochester, Minnesota, USA
San Antonio, Texas, USA
COL Lorne H. Blackbourne MD FACS
Jayson D. Aydelotte MD U.S. Army Institute of Surgical Research
Director of Trauma, Department of Surgery Fort Sam Houston
Walter Reed Army Medical Center San Antonio, Texas, USA
Washington, DC, USA
Juan J. Blondet MD
Michael M. Badellino MD Postdoctoral Fellow, Department of Surgery
Associate Professor of Surgery University of Minnesota
Penn State College of Medicine Minneapolis, Minnesota, USA
Program Director, General Surgery Residency
Col. W. Brian Perry MD USAF MC
Lehigh Valley Health Network
Wilford Hall Medical Center, Lackland AFB
Allentown, Pennsylvania, USA
San Antonio, Texas, USA
Hany Bahouth MD BSC Susan E. Brien MD MEd CSPQ FRCSC CPE
General and Trauma Surgeon, Director Associate Director, Professional Affairs, Royal College
Acute Care Surgery, Rambam Health Campus of Physicians and Surgeons of Canada
Haifa, Israel Ottawa, Ontario, Canada
Heidi I. Becker MD Steven Brower MD
Assistant Professor Division of General Surgery
Department of Ophthalmology, University of Texas Memorial Health Medical Center
Health Science Center at San Antonio Savannah, Georgia, USA
San Antonio, Texas, USA
Gabriel E. Burkhardt MD Capt USAF MC
Stephen W. Behrman MD FACS Vascular Surgery Resident, Wilford Hall United States
Associate Professor of Surgery, Department of Surgery Air Force Medical Center, Lackland Air Force Base
The University of Tennessee Health Science-Center The University of Texas Health Science Center
Memphis, Tennessee, USA at San Antonio, San Antonio, Texas, USA

Greg J. Beilman MD FACS Christopher Busken MD


Professor of Surgery, Department of Surgery Division of General Surgery
University of Minnesota Memorial Health Medical Center
Minneapolis, Minnesota, USA Savannah, Georgia, USA

viii
Contributors ix

Leopoldo C. Cancio MD FACS James C. Doherty MD MPH


Colonel, Medical Corps, U.S. Army, U.S., Army Institute Director of Trauma Surgery and Critical Care
of Surgical Research, Fort Sam Houston Advocate Christ Medical Center
San Antonio, Texas, USA Oak Lawn, Illinois
Clinical Assistant Professor of Surgery, University of
Robert Chen MD FRCPC
Illinois College of Medicine, Chicago, Illinois, USA
Attending Anaesthetist and Intensivist
Assistant Professor Matthew O. Dolich MD FACS
St. Michael’s Hospital, Department of Anaesthesia Associate Clinical Professor, Department of Surgery
University of Toronto, University of California, Irvine
Toronto, Canada, USA Orange, California, USA
Clarence E. Clark III MD
Joseph J. DuBose MD
Chief Resident, General Surgery
Division of Acute Care Surgery, Trauma and Surgical
Department of Surgery
Critical Care, Wilford Hall Medical Center
University of Texas Health Science Center San Antonio
Lackland AFB, Texas
and Wilford Hall Medical Center
Clinical Instructor, Trauma and Surgical Critical Care
San Antonio, Texas, USA
Division of Trauma and Surgical Critical Care
Charles F. Cobb MD Los Angeles County, University of Southern
Associate Professor of Surgery, Drexel University California Hospital
College of Medicine, Allegheny General Hospital Los Angeles, California, USA
Department of Surgery
Pittsburgh, Pennsylvania, USA COL Brian J. Eastridge MD FACS
Director, Joint Trauma System
Mark Cockburn MD U.S. Army Institute of Surgical Research
New Rochelle, New York, USA Fort Sam Houston, San Antonio, Texas, USA
Rebecca Coefield MD
Matthew J. Eckert MD
Division of General Surgery
Department of Surgery, Madigan Army Medical Center
Memorial Health Medical Center
Fort Lewis, Washington, USA
Savannah, Georgia, USA
Raymond P. Compton MD FACS Akpofure Peter Ekeh MD
Paris Surgical Specialists, Associate Professor
Chief of Surgery, Henry County Medical Center Wright State University
Paris, Tennessee, USA Department of Surgery, Boonshoft School of Medicine
Dayton, Ohio, USA
Marshall A. Corson MD
Associate Professor of Medicine Robert M. Esterl Jr. MD
Head, Section of Cardiology Medical Center Professor of Surgery, Department of Surgery
Division of Cardiology Transplant Center, University of Texas Health Science
University of Washington Medical Center Center at San Antonio, Texas, USA
Seattle, Washington, USA
Ara J. Feinstein MD MPH
Bruce A. Crookes MD FACS Ryder Trauma Center, Jackson Memorial Hospital
Assistant Professor of Surgery, Division of Trauma Division of Trauma and Surgical Critical Care
Burns and Critical Care, Department of Surgery DeWitt Daughtry Family Department of Surgery
University of Vermont College of Medicine Miami, Florida, USA
Burlington, Vermont, USA
Aaron M. Fields MD
Marc A. de Moya MD FACS
Assistant Program Director
Assistant Professor of Surgery
Critical Care Fellowship, Staff Intensivist
Harvard Medical School
Staff Anesthesiologist, United States Air Force
Division of Trauma, Emergency Surgery
Wilford Hall Medical Center
and Surgical Critical Care, Massachusetts General Hospital
Lackland AFB, Texas, USA
Boston, Massachusetts, USA
Amy P. De Rosa DO Antonio Jorge V. Forte MD Resident
Resident Surgeon Plastic Surgery, Section of Plastic Surgery
MCRMC: Department of General Surgery Department of Surgery
Michigan State University Yale University School of Medicine
East Larsing, Michigan, USA New Haven, Connecticut, USA

Daniel L. Dent MD Renato Freitas MD PhD


Associate Professor, Division of Trauma and Emergency Adjunct Professor of Plastic Surgery
Surgery, University of Texas Health Science Center Federal University of Parana
San Antonio, Texas, USA Curitiba, Brazil
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Microbiology - Solution Manual
Summer 2025 - College

Prepared by: Dr. Miller


Date: August 12, 2025

Quiz 1: Critical analysis and evaluation


Learning Objective 1: Research findings and conclusions
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Learning Objective 2: Current trends and future directions
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Learning Objective 3: Ethical considerations and implications
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Learning Objective 4: Current trends and future directions
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Learning Objective 5: Statistical analysis and interpretation
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Important: Critical analysis and evaluation
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Remember: Learning outcomes and objectives
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Important: Interdisciplinary approaches
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Remember: Study tips and learning strategies
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Problem-solving strategies and techniques
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Part 2: Research findings and conclusions
Definition: Best practices and recommendations
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Study tips and learning strategies
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Example 12: Learning outcomes and objectives
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 13: Diagram/Chart/Graph]
Note: Practical applications and examples
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 14: Diagram/Chart/Graph]
Remember: Key terms and definitions
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Critical analysis and evaluation
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 16: Diagram/Chart/Graph]
Important: Experimental procedures and results
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Problem-solving strategies and techniques
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Key Concept: Statistical analysis and interpretation
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Practice Problem 19: Key terms and definitions
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Unit 3: Experimental procedures and results
Important: Experimental procedures and results
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Practice Problem 21: Learning outcomes and objectives
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Learning outcomes and objectives
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Note: Assessment criteria and rubrics
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Note: Practical applications and examples
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Best practices and recommendations
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Practical applications and examples
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Case studies and real-world applications
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 28: Critical analysis and evaluation
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Definition: Learning outcomes and objectives
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Quiz 4: Current trends and future directions
Practice Problem 30: Practical applications and examples
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Comparative analysis and synthesis
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Definition: Theoretical framework and methodology
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Learning outcomes and objectives
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Current trends and future directions
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Remember: Ethical considerations and implications
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Practice Problem 36: Literature review and discussion
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Statistical analysis and interpretation
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Current trends and future directions
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Research findings and conclusions
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 40: Diagram/Chart/Graph]
Introduction 5: Current trends and future directions
Example 40: Fundamental concepts and principles
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Example 41: Study tips and learning strategies
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Practice Problem 42: Historical development and evolution
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
[Figure 43: Diagram/Chart/Graph]
Definition: Fundamental concepts and principles
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Example 44: Critical analysis and evaluation
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Important: Literature review and discussion
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Literature review and discussion
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 47: Diagram/Chart/Graph]
Definition: Statistical analysis and interpretation
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Current trends and future directions
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Remember: Problem-solving strategies and techniques
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Conclusion 6: Literature review and discussion
Definition: Key terms and definitions
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Study tips and learning strategies
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Study tips and learning strategies
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 53: Diagram/Chart/Graph]
Example 53: Interdisciplinary approaches
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
[Figure 54: Diagram/Chart/Graph]
Example 54: Learning outcomes and objectives
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 55: Experimental procedures and results
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Example 56: Assessment criteria and rubrics
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Interdisciplinary approaches
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 58: Diagram/Chart/Graph]
Key Concept: Case studies and real-world applications
• Research findings and conclusions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 59: Diagram/Chart/Graph]
Important: Case studies and real-world applications
• Research findings and conclusions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Lesson 7: Learning outcomes and objectives
Example 60: Practical applications and examples
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Theoretical framework and methodology
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Remember: Best practices and recommendations
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Example 63: Comparative analysis and synthesis
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Remember: Key terms and definitions
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Note: Problem-solving strategies and techniques
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Note: Research findings and conclusions
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Important: Key terms and definitions
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Example 68: Case studies and real-world applications
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 69: Experimental procedures and results
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Topic 8: Learning outcomes and objectives
Key Concept: Interdisciplinary approaches
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Key Concept: Critical analysis and evaluation
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 72: Diagram/Chart/Graph]
Example 72: Assessment criteria and rubrics
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Example 73: Research findings and conclusions
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Example 74: Ethical considerations and implications
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Statistical analysis and interpretation
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Note: Experimental procedures and results
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Note: Assessment criteria and rubrics
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Best practices and recommendations
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 79: Learning outcomes and objectives
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 80: Diagram/Chart/Graph]
Results 9: Critical analysis and evaluation
Example 80: Interdisciplinary approaches
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Statistical analysis and interpretation
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Important: Experimental procedures and results
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Problem-solving strategies and techniques
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Interdisciplinary approaches
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Study tips and learning strategies
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Learning outcomes and objectives
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 87: Diagram/Chart/Graph]
Definition: Current trends and future directions
• Research findings and conclusions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Remember: Best practices and recommendations
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Ethical considerations and implications
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Review 10: Practical applications and examples
Practice Problem 90: Research findings and conclusions
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Experimental procedures and results
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Definition: Research findings and conclusions
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 93: Diagram/Chart/Graph]
Definition: Best practices and recommendations
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Assessment criteria and rubrics
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Remember: Statistical analysis and interpretation
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Fundamental concepts and principles
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
[Figure 97: Diagram/Chart/Graph]
Important: Ethical considerations and implications
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Note: Comparative analysis and synthesis
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Interdisciplinary approaches
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Abstract 11: Problem-solving strategies and techniques
Note: Historical development and evolution
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Practice Problem 101: Statistical analysis and interpretation
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 102: Study tips and learning strategies
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 103: Learning outcomes and objectives
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Key terms and definitions
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Example 105: Statistical analysis and interpretation
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 106: Interdisciplinary approaches
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Definition: Best practices and recommendations
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Research findings and conclusions
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Definition: Best practices and recommendations
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Module 12: Ethical considerations and implications
Remember: Best practices and recommendations
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Critical analysis and evaluation
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Note: Historical development and evolution
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
[Figure 113: Diagram/Chart/Graph]
Note: Statistical analysis and interpretation
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 114: Diagram/Chart/Graph]
Important: Assessment criteria and rubrics
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Definition: Key terms and definitions
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 116: Diagram/Chart/Graph]
Remember: Statistical analysis and interpretation
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Problem-solving strategies and techniques
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Practical applications and examples
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Ethical considerations and implications
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice 13: Research findings and conclusions
Example 120: Problem-solving strategies and techniques
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
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