RT Book, Section
A1 Jabaley, Craig S.
A1 Bittner, Edward A.
A1 George, Edward
A2 Longnecker, David E.
A2 Mackey, Sean C.
A2 Newman, Mark F.
A2 Sandberg, Warren S.
A2 Zapol, Warren M.
SR Print(0)
ID 1144135063
T1 Evaluation and Anesthetic Management of the Trauma Patient
T2 Anesthesiology, 3e
YR 2017
FD 2017
PB McGraw-Hill Education
PP New York, NY
SN 9780071848817
LK accessanesthesiology.mhmedical.com/content.aspx?aid=1144135063
RD 2024/04/16
AB KEY  POINTSTraumatic  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.