Anesthetic Management of Shocked Post Traumatic Patient
Karim Hassan Elwany Abdel Rahman;
Abstract
rauma is still the most frequent cause of death in the first four decades of life, and it remains a major public health problem in every country, regardless of the level of socioeconomic development
Knowing the mechanism of injury is an important component in evaluation of traumatic patient status as we can predict injuries. Diagnostics of some injuries is mainly based on mechanism of trauma
The most common cause of death after trauma is brain injury followed by bleeding and shock. Shock is a clinical syndrome characterized by inadequate tissue perfusion that leads to decrease oxygen delivery to tissues and end-organ dysfunction. It can be classified into hypovolemic, cardiac, distributive and obstructive.
Anesthesiologist comes across many unique challenges providing anesthesia for emergency surgery in unprepared trauma patient. Patients maybe shocked and have full stomatch which increases the risk of aspiration.
Resuscitation should start at the site of trauma until patient is transferred to hospital. After arrival to the Emergency Department the seriously injured should be received by a trauma team that is responsible of airway management, care of breathing, circulation support using crystalliods or blood transfusion and neurological assessment until damage control surgery is done.
Induction and maintenance of anesthesia may produce profound hypotension and/or cardiac arrest in major trauma so the induction agents commonly used in trauma patients are etomidate and ketamine.
Rapid sequence induction is employed for newly admitted trauma patients using induction agents and neuromuscular blockers mainly succinylcholine or rocuronium to facilitate endotracheal intubation. If difficulty is anticipated, then awake intubation or the use of airway adjuncts.
All Patients should be minimally monitored by pulse oximeter, ECG, non-invasive blood pressure monitor, capnography, urinary catheter, tempretaure and central venous catheter.
Intraoperative administration of the suitable fluids and blood products is essential to mentain cardiovascular stability and maintain organ perfusion.
The patient is transferred to the Post Anesthesia Care Unit after the surgical procedure, anesthesia reversal, and extubation to be monitored and assessed.
Effective postoperative pain control is an essential component of the care of the surgical patient by using NSAIDs, opiods or regional anesthesia if needed.
Knowing the mechanism of injury is an important component in evaluation of traumatic patient status as we can predict injuries. Diagnostics of some injuries is mainly based on mechanism of trauma
The most common cause of death after trauma is brain injury followed by bleeding and shock. Shock is a clinical syndrome characterized by inadequate tissue perfusion that leads to decrease oxygen delivery to tissues and end-organ dysfunction. It can be classified into hypovolemic, cardiac, distributive and obstructive.
Anesthesiologist comes across many unique challenges providing anesthesia for emergency surgery in unprepared trauma patient. Patients maybe shocked and have full stomatch which increases the risk of aspiration.
Resuscitation should start at the site of trauma until patient is transferred to hospital. After arrival to the Emergency Department the seriously injured should be received by a trauma team that is responsible of airway management, care of breathing, circulation support using crystalliods or blood transfusion and neurological assessment until damage control surgery is done.
Induction and maintenance of anesthesia may produce profound hypotension and/or cardiac arrest in major trauma so the induction agents commonly used in trauma patients are etomidate and ketamine.
Rapid sequence induction is employed for newly admitted trauma patients using induction agents and neuromuscular blockers mainly succinylcholine or rocuronium to facilitate endotracheal intubation. If difficulty is anticipated, then awake intubation or the use of airway adjuncts.
All Patients should be minimally monitored by pulse oximeter, ECG, non-invasive blood pressure monitor, capnography, urinary catheter, tempretaure and central venous catheter.
Intraoperative administration of the suitable fluids and blood products is essential to mentain cardiovascular stability and maintain organ perfusion.
The patient is transferred to the Post Anesthesia Care Unit after the surgical procedure, anesthesia reversal, and extubation to be monitored and assessed.
Effective postoperative pain control is an essential component of the care of the surgical patient by using NSAIDs, opiods or regional anesthesia if needed.
Other data
| Title | Anesthetic Management of Shocked Post Traumatic Patient | Other Titles | المعاملة التخديرية لمريض الصدمة ما بعد الإصابة | Authors | Karim Hassan Elwany Abdel Rahman | Issue Date | 2017 |
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