Anesthesia for Trauma dictated slides 1-24

Anesthesia for Trauma: 

Anesthesia for Trauma Maribeth Massie, CRNA, MS, PhD(c) University of New England Master of Science in Nurse Anesthesia Program

OVERVIEW: 

OVERVIEW “It’s not the speed which kills, it’s the sudden stop”

Epidemiology of Trauma: 

Epidemiology of Trauma ~8% worldwide death rate Leading cause of death in Americans from 1- 45 years of age MVC’s leading cause of death Blunt > penetrating Often drug abusers, acutely intoxicated, HIV and Hepatitis carriers

Epidemiology of Trauma: 

Epidemiology of Trauma “Golden Hour” First hour after injury 50% of patients die within the first seconds to minutes  extent of injuries 30% of patients die in next few hours  major hemorrhage Rest may die in weeks  sepsis, MOSF

When Do Trauma Patients Die?: 

When Do Trauma Patients Die? % of Deaths Severe Head or CV Injury Major Torso or Head Injury Infection and MSOF

Pre-hospital Care: 

Pre-hospital Care ABC’S Initial assessment and BLS in trauma GO TEAM: role of CRNA’s at Maryland Shock Trauma Center Resuscitation Reduction of fractures Extrication of trapped victims Amputation Uncooperative patients

Trauma Triage: 

Trauma Triage Goal : Right Patient to the Right Hospital at the Right Time OVER Triage : Minimally injured pts Trauma Centers Result : Overburdens the system, no ill effect on pt care Not SO bad… UNDER Triage : Severely injured pts Non-Trauma Centers Result : Hospitals may not be equipped to treat the pt and pt care may suffer Can be VERY BAD!

Initial Management Plan: 

Initial Management Plan Airway maintenance with C spine protection  RSI Breathing: ventilation and oxygenation Circulation with hemorrhage control  lg. bore IV CBC, electrolytes, urinalysis, PT/PTT, lactate, baseline ABG; T&C Life-threatening bleeding: chest, abdomen, retroperitoneum, thighs, outside body Hypotensive discrimination Bleeding now stopped  closed femur fracture Sustained response to fluids Bleeding ongoing splenic rupture Transient response to fluids, intolerant of meds

Initial Management Plan: 

Initial Management Plan Disability Exposure CXR, lateral C-spine, CT/MRI, extremity X-rays 12 lead EKG FAST: f ocused a ssessment s onography in t rauma Rapid search for free intraperitoneal air, pericardial fluid, pneumothorax DPL: diagnostic peritoneal lavage  old

Initial Assessment: 

Initial Assessment Primary Survey: AIRWAY ALWAYS ASSUME A CERVICAL SPINE INJURY EXISTS UNTIL PROVEN OTHERWISE Provide MANUAL IN-LINE NECK STABILIZATION Jaw-thrust maneuver