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KEY POINTS
Traumatic injury is a heterogeneous entity associated with significant worldwide morbidity and mortality. The development of trauma care systems and a consistent approach to patient evaluation and treatment have led to marked outcome improvements. All anesthesiologists should be familiar with these basic principles and are well qualified to participate in key aspects of trauma patient care.
Assessment and establishment of airway patency takes priority in the initial stage of patient evaluation. Emergency airway management is a complex task that mandates an organized approach to reduce the likelihood of associated complications. Furthermore, considerations unique to trauma patients can complicate endotracheal intubation and often require a modified response to the difficult and failed airway.
Hypovolemic shock due to hemorrhage is often encountered, and its treatment is a core concept. However, other etiologies of shock must be considered, including obstructive shock that may be rapidly fatal if left untreated. Laboratory markers of systemic perfusion improve as shock is reversed and can be used to both provide prognostic insight and gauge the efficacy of resuscitation.
The overall focus of patient care has shifted away from vigorous initial resuscitation and now emphasizes the importance of early hemorrhage control and judicious goal-directed resuscitation. These and other damage control strategies directly impact intraoperative management.
Coagulopathy is a common sequela of traumatic injury that develops as a consequence of innate inflammatory responses, physiologic derangements, and iatrogenic influences. Prevention and correction of coagulopathy can be accomplished by the early administration of plasma, treatment of underlying causes, and use of antifibrinolytics.
The intraoperative phase of trauma patient care presents numerous challenges and varies widely with each injury pattern. As in all other phases, preparation and organization are paramount. Continuation of damage control resuscitation and efforts to reduce postoperative complications are key elements of management.
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Traumatic injury is a pandemic disease with disparate patterns across nations, age groups, and socioeconomic strata. The World Health Organization has estimated that injury accounts for 12% of the worldwide disease burden and 9% of all deaths annually, with higher mortality rates among low- and middle-income countries.1 The young are preferentially affected as trauma is the leading cause of death worldwide for those aged 15-44 years.2 In the United States, unintentional injury is similarly the most common cause of death between ages 1 and 44 and accounts for nearly half of all mortality for those aged 15-24.3 The morbidity and financial impact of injury are more difficult to quantify, but the annual cost of unintentional injuries has been estimated at over $790 billion in the United States alone.4
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The role of anesthesiologists in the care of trauma patients varies widely across the world. For example, the European pre–hospital care model differs from the United States model in that ambulances are staffed with a physician, who is frequently an anesthesiologist.5,6 Additionally, European anesthesiologists have been generally ...