Anesthesia for Trauma : New Evidence and New Challenges 9781493909087, 1493909088, 9781493909094, 1493909096

Table of contents :
Preface
Contents
List of Contributors
1: Initial Assessment and Management of the Trauma Patient
Pre-hospital and Triage
Primary Survey
Airway
Breathing
Circulation
Disability
Exposure/Environment
Reevaluation
Adjuncts to the Primary Survey
Monitoring
Imaging
Laboratory
Tubes
Secondary Survey
History
Physical Exam
Disposition from the Trauma Resuscitation Area
References
2: Airway Management in Trauma
Frequently Encountered Clinical Conditions
Full Stomach
The Agitated Uncooperative Patient
Airway Obstruction
Airway Evaluation in the Trauma Patient
Indications for Emergency Tracheal Intubation
Techniques of Airway Management
Airway Management in Specific Injuries
Head, Open Eye, and Contained Major Vessel Injuries
Cervical Spine Injury
Management of Direct Airway Injuries
Maxillofacial Injuries
Cervical Injuries
Thoracic Airway Injuries
References
3: Physiological Derangement of the Trauma Patient
General Physiological Changes Due to Trauma
Hemorrhage-Related Pathophysiological Changes
Stress-Related Physiological Changes
Pain-Related Physiological Changes
Systemic Inflammatory Response and Sepsis
Stages of the Immunoinflammatory Response to Traumatic Injury
Bacterial Translocation into Blood Circulation and Release of Endotoxin
Cytokine Formation and Release
Bone Marrow Changes
Acute Adrenal Insufficiency After Trauma
Enhanced Nitric Oxide Formation
Endocrine and Metabolism Changes
System-Specific Physiological Changes Due to Trauma
Head Injury
Chest Injury
Cardiac Injury
Abdominal Trauma and Digestive System Changes
Summary
References
4: Blood Transfusion and Coagulation Disorders
Introduction
Control of Hemorrhage
Support of Intravascular Volume
Choice of Fluids
Adjuvant Therapies
Late Resuscitation
Future Research
References
5: General Principles of Intraoperative Management of the Severe Blunt or Polytrauma Patient: The Resuscitative Phase
Case Entry Point
Goals and Objectives of Anesthesia Care for the Severe Trauma Patient in the Operating Room
Preparation
Rapid Infuser
Ultrasound Machine
Underbody Forced Air Warmer
Additional Essential Equipment
Goal-Directed Tests and Therapy for the Trauma Patient
Thromboelastography
Thromboelastometry
PFA-Platelet Function Analyzer
Goal-Directed Ventilation of the Severe Trauma Patient
Intraoperative Fluid Monitoring and Treatment with Pulse Pressure Variation
Monitors
Key Management Concerns in Our Patient
Volume Replacement While Waiting for Blood
Hemoglobin-Based Oxygen Carriers
Blood Pressure Management in Our Patient
Vasopressors in Our Patient
Antimicrobial Therapy in Our Patient
The Anesthesiologist and the Immune System: The New Frontier
Case Summary
References
6: Pain Control in Acute Trauma
Physiological and Psychological Consequences of Acute Pain
Management of Acute Pain in Trauma
Strategies of Pain Management and Guidelines from the WHO
Non-opioid Analgesics
Acetaminophen/Paracetamol
Non-steroidal Anti-inflammatory Drugs
COX-II Selective Inhibitors
Use of NSAIDs
Ketamine
Analgesic Adjuncts
Opioids
Regional Anesthesia in the Trauma Patient
Regional Anesthesia in Thoracic Trauma
Regional Anesthesia for Rib Fractures
Regional Anesthesia for Thoracic Surgery in Trauma
Thoracolumbar Epidurals for Abdominal Surgery in Trauma
Peripheral Nerve Blocks to the Abdomen
PVB for Abdominal Surgery
Transversus Abdominis Plane and Rectus Sheath Blocks
Regional Anesthesia for Trauma to the Extremities
Ultrasound-Guided Versus Nerve Stimulator-Guided Regional Anesthesia
Neuraxial Anesthesia for Lower Extremity Trauma
Single-Shot Peripheral Nerve Blocks Versus Peripheral Nerve Catheters
Regional Anesthesia for the Upper Extremity
Interscalene Brachial Plexus Block
Background and Indications
Risks and Contraindications
Performing the Block
Supraclavicular Brachial Plexus Block
Background and Indications
Risks and Contraindications
Performing the Block
Infraclavicular Brachial Plexus Block
Background and Indications
Risks and Contraindications
Performing the Block
Axillary Block
Intercostobrachial and Medial Brachial Cutaneous Nerve Blocks
Background and Indications
Risks and Contraindications
Performing the Block
Regional Anesthesia for the Lower Extremity
Lumbar Plexus Block
Background and Indications
Risks and Contraindications
Performing the Block
Femoral Nerve Block and ``3-in-1 Block´´
Background and Indications
Risks and Contraindications
Procedure
Sciatic and Popliteal Nerve Blocks
Background and Indications
Risks and Contraindications
Procedure
References
7: Chronic Pain in Trauma Patients
Introduction
Evaluation of Chronic Pain After Trauma
Complex Regional Pain Syndrome
Traumatic Brain Injury
Spinal Cord Injury
Phantom Limb Pain
Posttraumatic Abdominal Pain
Vertebral Fracture
Chronic Whiplash Syndrome
References
8: Brain Injuries: Perianesthetic Management
Historical Note
Scope of the Problem
Types of Injury
Skull Fractures
Intracranial Bleeding
Pathophysiology
Diagnosis
Risk Factors
Management of Traumatic Brain Injury
Guidelines
Conclusion
References
9: Anesthesia for Cervical Spinal Cord Injury
Incidence and Causes of Spinal Cord Injury
Classification of Spinal Cord Injury
Management of the Cervical Spinal Cord-Injured Patient
Cervical Spinal Immobilization After Injury
Airway Management in Cervical Spinal Cord Injury
Respiratory Management
Hemodynamic Management
Temperature Management
Thromboembolism
Gastrointestinal System
Steroids in the Treatment of Cervical Spinal Cord Injury and Therapeutic Hypothermia
Timing of Surgery
Surgical Interventions
Complications of Surgery of Relevance to Anesthesiologists
Neurophysiological Monitoring During Cervical Spinal Decompression with Fusion and Instrumentation
Pain Associated with Spinal Cord Injury
Anesthetic Technique Specific to Spinal Cord Injury
References
10: Anesthetic Assessment and Treatment of Facial and Ocular Trauma
Introduction
Epidemiology
Initial and Emergency Room Management
Examination
Airway Management
Associated Injuries
Dental Injuries
Vascular Injuries and Hemorrhage
Intraoperative Management
Submental Intubation
Retromolar Intubation
Airway Fire
Previous Facial Trauma
Vision
Nasal Injuries
Maxillary Injuries
Mandibular
Pediatrics
Pain Management
Regional Anesthesia
References
11: Thoracic and Abdominal Injuries
Thoracic Trauma
Resuscitation Phase
Urgent Thoracotomy
Bleeding
Pulmonary and Airway Injuries
Cardiac Injuries
Blunt Thoracic Aortic Injury
Great Vessel Injuries
Esophageal Injuries
Diaphragmatic Injuries
Delayed Thoracotomy
Thoracic Injuries Requiring Nonsurgical Management
Flail Chest and Pulmonary Contusion
Blunt Cardiac Injury (Myocardial Contusion)
Abdominal Injuries
Thoracoabdominal Trauma
Pelvic Injuries
Damage Control Surgery
Damage Control Resuscitation
References
12: Musculoskeletal Injuries and Microvascular Surgery
Musculoskeletal Injuries
Assessment of Injury
Microsurgery: A History
Microsurgery in Trauma
Anesthesia for Microvascular Surgery
Optimizing the Anesthetic for Flap Success
Hemodynamic Support
Intravascular Volume Status and Blood Viscosity
Intraoperative Hemodynamic Monitoring
Techniques in Microcirculation Perfusion Monitoring
Postoperative Considerations
References
13: Assessment and Physiology of Burns
Epidemiology
Classification of Burns
Chemical Burns
Electrical Burns
Inhalational Burns
Characterizing the Burn
Lund-Browder Chart
Rule of Nines
Palm Method
Cardiovascular and Hemodynamic Changes
Pulmonary Changes
Renal and Electrolyte Changes
Gastrointestinal Changes
Metabolic and Endocrine Changes
Hematologic and Immunologic Changes
Neurologic Changes
References
14: Management of Burns and Anesthetic Implications
Initial Management of Burns
Management of Airway and Inhalational Injuries
Burn Resuscitation
Wound Management
Nutritional Supplementation in Burn Patients
Anesthetic Management for the Burn Patient
Sepsis and Multiorgan Failure in the Burn Patient
Rehabilitation After Burns
Pain Control in Burn Patients
Conclusion
References
15: Perioperative Pediatric Anesthesia Trauma Considerations
Introduction
Special Pediatric Anatomical and Physiologic Characteristics
Airway
Circulation
Temperature Regulation
Initial Resuscitation and Primary Survey
A=Airway, B=Breathing
C=Circulation
D=Disability
E=Exposure/Environmental Control
Preoperative Evaluation and Intraoperative Management
Secondary Survey
Equipment
Monitors and Monitoring
Induction Agents
Neuromuscular Blockers
Fluids and Blood Replacement
Postoperative Care of Pediatric Trauma Patients
References
16: Trauma in the Pregnant Patient
Introduction
Types of Trauma
Patterns of Injury
Blunt Injury to the Abdomen
Penetrating Trauma
Pelvic Fracture
Causes of Maternal Trauma
Motor Vehicle Accidents
Falls
Assaults, Homicide, and Suicide
Burns and Electrical Injuries
Poisoning
Maternal and Fetal Outcomes Following Trauma
The Physiology of Pregnancy and Management of the Trauma Patient
Airway Management
Gastrointestinal Changes
Respiratory Changes
Cardiovascular Changes
Coagulation
Field Intervention and Resuscitation
Primary Survey
Fluid Resuscitation
Transfusion
Trauma-Induced Coagulopathy
Antifibrinolytics
Fibrinogen
Prothrombin Complex
Recombinant Factor VIIa
Anti-shock Garments
Secondary Survey
Maternal and Fetal Monitoring
Laboratory Tests
Imaging
Specific Management Issues
Traumatic Brain Injury
Spinal Cord Injuries
Respiratory Failure and Extracorporeal Lung Support
Analgesia
Thromboprophylaxis
Antibiotic and Tetanus Prophylaxis
Pregnancy-Related Management Issues
Fetal Delivery
Cardiac Arrest and Perimortem Cesarean Delivery
Anesthetic Management
Induction and Intubation
Maintenance of Anesthesia
Conclusion
References
17: Anesthesia for the Geriatric Trauma Patient
Background
Etiology of Geriatric Trauma
Physiological Considerations in the Elderly
Cardiovascular
Anesthetic Considerations
Pulmonary
Anesthetic Considerations
Renal
Anesthetic Considerations
Central Nervous System
Anesthetic Considerations
Pharmacologic Considerations
Initial Assessment of the Geriatric Trauma Patient
Triaging
Initial Management
Oxygenation and Ventilation
Cardiovascular Considerations
Temperature Considerations
Monitoring
Anesthetic Concerns for Specific Injuries
Orthopedic Injuries
Head Injuries
Thoracic Injuries
Summary
References
18: Trauma Critical Care
Introduction
Resuscitation and Intraoperative Phase
Damage Control Phase
Subacute Phase
Neurologic Issues
Cardiac Support
Respiratory Support
Renal Support
Infectious Disease and Antibiotic Issues
Nutrition, Electrolytes, and Prophylaxis
Palliative Care and End-of-Life Issues
Conclusion
References
19: Trauma Simulation
Introduction
Brief History of Simulation
What Is Trauma Simulation?
Example of Trauma Simulation Scenario: Penetrating Chest Trauma
Case Description
Learning Objectives
Simulation Environment
Case Narrative
Debriefing
What Is the Evidence?
Drawbacks of Medical Simulation
References
20: Civilian Trauma Systems
Requirements Specifically Related to Anesthesiologists
References
21: Modern Military Trauma
Pre-hospital Treatment
Hospital Treatment
Aeromedical Evacuation
Conclusion
References
22: Disaster Preparedness
Definitions
Victim Characteristics
Event Characteristics
Resource Characteristics
Response Sequence
Table-Top Exercises
References
23: Substance Abuse in Trauma and the Anesthesia Care Provider
Introduction
Trauma in the Intoxicated Patient
Specific Drugs
Alcohol
Cocaine
Methamphetamine
MDMA
Synthetic Cathinones
Synthetic Cannabinoid Receptor Agonists
Chemically Altered Cannabis
Inhaled Volatile Compounds
Heroin and Other Opioids
Identification and Treatment of Withdrawal
Treatment Options and Referral Sources
Conclusion
References
Index