Anesthesiologists, offering airway expertise and experience in resuscitation, are uniquely qualified to be involved in both the initial evaluation and subsequent management of trauma patients.
Due to rising global geopolitical instability in the form of natural disasters and terrorism, anesthesiologists not normally involved in trauma care may be called on to participate in large-scale casualty events outside the operating room.
Acute trauma life support (ATLS) provides a systematic approach to the evaluation and emergent treatment of the trauma patient, and a vital framework for the care of the trauma patient.
Trauma research is accelerated during times of military conflict.
The effects of pain and the attendant stress response are most often detrimental to the trauma patient. Methods of pain relief range from simple continuous or on-demand intravenous (IV) opioids to more sophisticated techniques such as regional or neuraxial blocks. Use of adjuvant drugs, such as dexmedetomidine, gabapentin, or celecoxib, may decrease opioid dose and improve analgesia.
Providing care to the trauma patient can be one of the most challenging situations encountered by an anesthesiologist. The urgency of the event, often in a setting with little or no advance notice, places special burdens on the care team. Given the unpredictable nature of trauma, the anesthesiologist may be faced with caring for these patients in settings ranging from a level 1 academic hospital center with a complete array of specialists and capabilities, to a small rural hospital with limited resources, where the anesthesiologist may be the only physician present. Adding to these complexities is the emerging awareness of the special burdens imposed by the scenario of mass casualties. Prior to September 11, 2001, medical centers planned for large traumatic events on the scale of an airline crash at the airport or an industrial accident involving dozens of injured patients arriving over a brief period of time. Now with heightened awareness as a result of events such as the World Trade Tower attacks and natural disasters such as Hurricane Katrina and the more recent earthquake in Haiti, it is critical that all medical personnel including anesthesiologists become familiar with the evaluation and care of the trauma patient.
To better understand the challenges of evaluating the trauma patient, it is important to appreciate the evolution of trauma care over the history of modern medicine. Although trauma has been a major cause of morbidity throughout history, until quite recently, most progress in the area of trauma care was closely tied to the experience and expertise gained by providing care to the casualties of war. By examining the progress made in these arenas, coupled with the insights gained over the past few decades by investigators in the evaluation and care of the trauma patient, the anesthesiologist will be better positioned to contribute as a member of the trauma team.
Trauma remains one of the most common causes of death in modern society.1 In the history of modern medicine, research and advancement in the ...