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Published:
19.12.2024
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Copyright
2nd Edition
Copyright © 2020 American College of Surgeons
633 N. Saint Clair Street
Chicago, IL 60611-3211
Previous editions copyrighted 2010 by the American College of Surgeons.
Copyright enforceable internationally under the Bern Convention and the Uniform Copyright Convention. All rights reserved. This manual is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the American College of Surgeons.
The American College of Surgeons, its Committee on Trauma, and contributing authors have taken care that the doses of drugs and recommendations for treatment contained herein are correct and compatible with the standards generally accepted at the time of publication. However, as new research and clinical experience broaden our knowledge, changes in treatment and drug therapy may become necessary or appropriate. Readers and participants of this course are advised to check the most current product information provided by the manufacturer of each drug to be administered to verify the recommended dose, the method and duration of administration, and contraindications. It is the responsibility of the licensed practitioner to be informed in all aspects of patient care and determine the best treatment for each individual patient.
The American College of Surgeons, its Committee on Trauma, and contributing authors disclaim any liability, loss, or damage incurred as a consequence, directly or indirectly, of the use and application of any of the content of this edition of ASSET.
Advanced Surgical Skills for Exposure in Trauma® and the acronym ASSET® are marks of the American College of Surgeons.
Printed in the United States of America.
Table of Contents
Chapter 1 Vascular Trauma: General Principles
Chapter 2 Operative Exposure of Vascular Injuries to the Upper Extremity
Chapter 4 Operative Exposure of Vascular Injuries of the Lower Extremity: Beyond the Bifurcation
Chapter 5 Injuries to the Extremities: Compartment Syndrome and Fasciotomy
Chapter 6 Surgical Airway: Cricothyroidotomy
Chapter 7 Operative Exposure in Neck Trauma: Exposure of the Carotid Artery and Jugular Vein
Chapter 8 Operative Exposure in Neck Trauma: Exposure of the Trachea and Esophagus in the Neck
Chapter 9 Operative Exposure in Neck Trauma: Exposure of the Vertebral Artery in the Neck
Chapter 10 Operative Exposure in Thoracic Trauma: Incisions
Chapter 11 Operative Exposure in Thoracic Trauma: Exposure of Injuries to the Heart
Chapter 12 Operative Exposure in Thoracic Trauma: Exposure of Injuries to the Trachea and Esophagus
Chapter 13 Operative Exposure in Thoracic Trauma: Exposure of Pulmonary and Hilar Injuries
Chapter 14 Operative Exposure in Thoracic Trauma: Exposure of the Great Vessels
Chapter 15 Operative Exposure in Abdominal Trauma: Trauma Laparotomy
Chapter 16 Operative Exposure in Abdominal Trauma: Exposure of Liver Injuries
Chapter 17 Operative Exposure in Abdominal Trauma: Exposure of the Spleen and Splenic Injuries
Chapter 18 Operative Exposure in Abdominal Trauma: Exposure of the Pancreas and Duodenum
Chapter 19 Operative Exposure in Abdominal Trauma: Exposure of the Distal Aorta and Iliac Vessels
Chapter 20 Operative Exposure in Abdominal Trauma: Exposure of Kidney, Ureter, and Bladder Injuries
Chapter 22 Introduction to Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA)
Chapter 23 Operative Exposure in Cranial Trauma: Damage Control Surgical Techniques
Chapter 24 Damage Control Management of Eye Injuries
Chapter 25 Operative Exposure in Thermal Injury
Chapter 26 Emergency Cesarean Section: Uterine Exposure and Infant Extraction
Chapter 28 Damage Control Orthopaedics: Fracture Management
Chapter 29 Upper Extremity Amputations
Chapter 30 Lower Extremity Amputations
Foreword
Since its inception in 2010, the Advanced Surgical Skills for Exposure in Trauma (ASSET) course has been a valuable resource to support surgical training for the complex operative intervention required for critically injured patients. The ASSET course provides the opportunity to learn the exposure to manage complex sources of life-threatening hemorrhage and reinforces damage control principles. Given the rarity of these injuries, this program is valuable for surgical residents, fellows, and experienced surgeons alike. It has proven especially valuable for military surgeons preparing for deployment.
This second edition provides the option for either a one- or two-day curriculum and adds several new modules including: damage control neurosurgery and orthopaedics, upper and lower extremity amputations, and emergency cesarean section and management of postpartum hemorrhage. As we, the Committee on Trauma, continue to work toward the goal of zero preventable deaths from injury across the globe, we encourage all surgeons to advance their education through this important program.
I want to acknowledge and thank all of the contributors who volunteered their time and talents to this exciting 2nd edition of the ASSET Course.
Eileen Bulger, MD, FACS, Chair, ACS Committee on Trauma
Second Edition Contributors
American College of Surgeons Committee on Trauma
Eileen Bulger, MD, FACS
COT Chair
Professor of Surgery, University of Washington
Chief of Trauma, Harborview Medical Center
Seattle, WA
David B. Hoyt, MD, FACS
Executive Director
Chicago, IL
Editorial Board
Neil G. Parry, MD, FACS, FRCSC
Surgical Skills Committee, Chair, American College of Surgeons
Professor of Surgery and Critical Care Medicine, Schulich School of Medicine and Dentistry, Western University Trauma Director, London Health Sciences Centre
London, ON
Col (ret.) Mark W. Bowyer, MD, FACS, DMCC, FRCS(Glasg), USAF
ASSET International Course Director, American College of Surgeons
Ben Eiseman Professor of Surgery, Surgical Director of Simulation, The Department of Surgery at Uniformed Services University of the Health Sciences & the Walter Reed National Military Medical Center
Bethesda, MD
Eric J. Kuncir, MD, MS, FACS
ASSET Course Director, American College of Surgeons
CAPT US Navy Retired
Clinical Professor of Surgery Creighton University Department of Surgery Division Chief, Trauma & Acute Care Surgery & Trauma Medical Director at CHI/Mercy-Bergan Hospital
Omaha, NE
Surgical Skills Committee
Neil G. Parry, MD, FACS, FRCSC (Committee Chair)
Col (ret.) Mark W. Bowyer, MD, FACS, DMCC, FRCS(Glasg), USAF (International Course Director)
Eric J. Kuncir, MD, MS, FACS (Course Director)
Hasan Alam, MD, MBBS, FACS
Megan Brenner, MD, MS, FACS
Clay Cothren Burlew, MD, FACS
Christopher J. Dente, MD, FACS
Julie A. Dunn, MD, MS, FACS
Paul T. Engels, MD, FACS, FRCSC
Deborah A. Kuhls, MD, FACS, FCCM, FRCST
Eric J. Kuncir, MD, MS, FACS
Sarvesh Logsetty, MD, FACS, FRCSC
Dany Westerband, MD, FACS
Jody Kaban, MD, FACS
Kenji Inaba, MD, FACS, FRCSC
Mark A. Jones, MD, FACS
Rohan N. Lall, MD, FACS, FRCSC
Stephanie Lueckel, MD, ScM, FACS
Matthew J. Martin, MD, FACS
Areti Tillou, MD, FACS
Dany Westerband, MD, FACS
Illustrator
Elizabeth N. Weissbrod, MA, CMI
Graphic Designer
Dan Noramczyk
- Contributors
Jameel Ali, MD, MMedEd, FACS, FRCSC
Rocco A. Armonda, MD, Col (ret) USA MC
John H. Armstrong, MD, FACS
Reza Askari, MD, FACS
Jeff Bailey, MD, FACS
Ron Barbosa, MD, FACS
Rodd Benfield, MD, FACS
David Blake, MD, MPH, FACS, DMCC
Kevin Bradley, MD, FACS, FCCM
Benjamin Braslow, MD, FACS
Adam Brooks, OBE, MBA, FRCSC
Michael T. Charlton, MD, FACS, FAAOS
Kent C. Choi, MD, MS, FACS
Mark Cipolle, MD, PhD, FACS, FCCM
Michael Coburn, MD
Ashley S. Coggins, MD
Jay N. Collins MD, FACS
Alisa Cross, MD, FACS
Corey Deflets, MD, FACS
Shad Derring, MD, COL(ret) USA
Larry Diebel, MD, FACS
Warren H. Dorlac, MD, FACS, DMCC, FRCS(Glasg)
Jay Doucet, MD, MSc, FACS, FRCSC, RDMS
Ehsan Dowlati, MS, MD
Juan Duchesne, MD, FACS, FCCP, FCCM
Travis Gerlach, MD, FACS
Laura N. Godat, MD, FACS
Daniel Grabo, MD, FACS
Justin Green, MD, FACS
Oscar Guillamondegui, MD, FACS
Jennifer Gurney, MD, FACS
Matthew Hannon, MD, FACS
David Harrington, MD, FACS
Tyler Harris, MD
Thorsten Hauer, MD
David F. Hubbard, MD
Elliot M. Jessie, MD, FACS
Laura Johnson, MD, FACS
Matt Kaminsky, MD, FACS, FRCSC
Jeff Kerby, MD, PhD, FACS
Leslie Kobayashi, MD, FACS
Hayato Kurihara, MD, FACS, FEBS(EmSurg)
Lydia Lam, MD
Ryan A. Lawless, MD, FACS
William Robert Leeper, MD, FACS, FRCSC, M.Ed.HP
Jason Lees, MD, FACS
Lillian F. Liao, MD, MPH, FACS
David Livingston, MD, FACS
Luis Llerena, MD, FACS
Joseph Love, DO, FACS
Charles Lucus, DO, MPH, FACS, FACOS, USARC
Robert V. Madlinger, MD
Mary McCarthy, MD, FACS
Leo Mercer, MD, FACS
Forrest O. Moore, MD, FACS
Laura Moore, MD, FACS
Jonathan J. Morrison, PhD, FRCSC
Kyle Mueller, MD
Nick Namias, MD, FACS
Mayur Narayan, MD, MPH, MBA, MHPE, FACS, FCCM, FICS
Chris J. Neal, MD, FAANS
Jamison S. Nielsen, DO, MBA, MCR, FACS, FAWM
Timothy Novosel, MD, FACS
Timothy Nunez, MD, FACS
Olliver Nunez-Cantu, MD, FACS
Brett Osborn, DO
Jason D. Pasley, DO, FACS
Andrew B. Peitzman, MD
Jon Perlstein, MD, FACS
Anne G. Rizzo, MD, FACS
Larry Roberts, MD, FACS
James B. Sampson, MD, RPVI, FACS, FSVS
Babak Sarani, MD, FACS
Sten Sarr, MD
Jack Sava, MD, FACS
Stacy Shackelford, MD
Jeffrey Shupp, MD, FACS
Richard Sidwell, MD, FACS
Ronald Simon, MD, FACS
Frederic L. Starr, MD, FACS
Matthew D. Tadlock, MD, FACS
Peep Talving, MD, PhD, FACS
Edward C.T.H. Tan, MD, PhD
Allison J. Tompeck, MD
Mbaga Walusimbi, MD, MS, MBA, FACS
Sandy Widder, MD, MHA, FACS, FRCSC
Tanya L. Zakrison, MD, MPH, FACS, FRCSC
First Edition Contributors
Editorial Board
Fred A. Luchette, MD, FACS, Chair
Mark W. Bowyer, MD, FACS, DMCC, Col, USAF, MC (Ret)
Patricia A. Byers, MD, FACS
Edward E. Cornwell, MD, FACS
Joseph Cuschieri, MD, FACS
Ronald I. Gross, MD, FACS
Deborah Kuhls, MD, FACS
Renato S. Poggetti, MD, FACS
Peter Rhee, MD, MPH, FACS, FCCM, DMCC
John T. Schulz III, MD, PhD, FACS
Surgical Skills Committee
John L. D. Atkinson, MD, FACS
Walter L. Biffl, MD, FACS
Joseph B. Cofer, MD, FACS
Raul Coimbra, MD, PhD, FACS
Francisco D. S. Collet de Silva, MD, PhD(med), FACS
Paul R. G. Cunningham, MB, BS, FACS
Brad M. Cushing, MD, FACS
Demetrios Demetriades, MD, FACS
Enrique A. Guzman Cottallat, MD, FACS
Jeffrey S. Hammond, MD, FACS
David arrington, MD, FACS
Sharon M. Henry, MD, FACS
Rao R. Ivatury, MD, FACS
Lenworth M. Jacobs, Jr., MD, FACS
Gregory J. Jurkovich, MD, FACS
Margaret Knudson, MD, FACS
John B. Kortbeek, MD, FACS
Sarvesh Logsetty, MD, FRCSC, FACS
Stephen Luk, MD, FACS
Douglas Lundy, MD, FACS
Robert C. Mackersie, MD, FACS
Mark A. Malangoni, MD, FACS
Joseph P. Minei, MD, MBA, FACS, FCCM
Frederick A. Moore, MD, FACS
Allen F. Morey, MD, FACS
Kimberly Nagy, MD, FACS
Neil Parry, MD, FACS
J. David Richardson, MD, FACS
Michael F. Rotondo, MD, FACS
Ajit Sachdeva, MD, FRCSC, FACS
Carol R. Schermer, MD, FACS
Ronald Simon, MD, FACS
Michael J. Sise, MD, FACS
David A. Spain, MD, FACS
Glen H. Tinkoff, MD, FACS
Alex B. Valadka, MD, FACS
Mary H. van Wijngaarden, MD, FACS
Matthew J. Wall, Jr., MD, FACS
David H. Wisner, MD, FACS
Illustrator
Elizabeth N. Weissbrod, MA, CMI
- Contributors
Juan A. Asensio, MD, FACS
David G. Burris, MD, FACS, DMCC, Col, MC, USA
W. Darrin Clouse, MD, FACS, Lt Col
Lawrence N. Diebel, MD, FACS
David Efron, MD, FACS
Adil Haider, MBBS, FACS
Elliott Haut, MD, FACS
Chatt A. Johnson, MD, FACS
Charles E. Lucas, MD, FACS
Norman E. McSwain, Jr., MD, FACS
Donald A. Risucci, PhD
Anne G. Rizzo, MD, FACS
Aurelio Rodriguez, MD, FACS
Jack A. Sava, MD, FACS
Thomas M. Scalea, MD, FACS
Shahid Shafi, MBBS, FACS
Thomas K. Varghese, Jr., MBBS, FACS
Dustin Zierold, MD, FACS, Lt Col, USAF, MC
Lisa Dang, MD, Capt, USAF, MC
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