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  • Acute care surgery includes trauma, emergency general surgery, surgical critical care, elective general surgery, and surgical rescue.

  • The need for expeditious source control is imperative whether we are dealing with a trauma patient with a ruptured spleen or the emergency general surgery patient with a perforated viscus.

  • Treat the patient empirically. Determining a specific diagnosis or injury is not the immediate goal.

  • Secure the airway, initiate fluid/blood resuscitation, and administer early broad-spectrum antibiotics if sepsis is in the clinical picture.

  • In any critically ill patient, resuscitate the patient according to Advanced Trauma Life Support guidelines.

Every important hospital should have on its resident staff of surgeons at least one who is well trained and able to deal with any emergency that may arise.

Dr. William S. Halsted


Over the past decade, a new paradigm in the management of acutely ill surgical patients has emerged, emphasizing surgeons trained in trauma, emergency general surgery (EGS), and surgical critical care.1 The need has been established for a specialized group of surgeons to care for patients with time-sensitive surgical disease of high acuity, at any time of the day or night.2 This need comes at a time when we are experiencing an ever-increasing volume of EGS patients. Emergency conditions accounted for more than one-third of all general surgery admissions and over 2.6 million hospitalizations in 2010.3,4

As estimated by the Centers for Disease Control and Prevention, nearly 35 million hospital discharges occur annually in the United States.5 Forty-one percent are emergent, 25% urgent, 24% elective, and 10% unknown. Furthermore, 10 of the most common diagnoses are within the scope of practice of the acute care surgeon (Table 8-1). An important diagnosis on the list is complication of medical or surgical care; this accounts for more than 1 million hospital discharges yearly. Patients who have sustained a major complication of medical or surgical care may be the most vulnerable of our patients. Time-dependent intervention is critical to ensuring an optimal outcome for these patients.

TABLE 8-1:2005 Hospital Discharge Diagnoses

To address this need, the specialty of acute care surgery (ACS) was proposed by the American Association for the Surgery of Trauma (AAST). ACS, as initially presented, was composed of trauma, surgical critical care, and emergency surgery. We have added and redefined the components of ACS as to now encompass ...

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