Anesthesia for Trauma : New Evidence and New Challenges

Description

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