142_Dutton_FA - Trauma Anesthesia 142 P age 1 R ic h a r d...

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Trauma Anesthesia Richard P. Dutton M.D., M.B.A. Baltimore, Maryland 142 Page 1 Overview Trauma anesthesia is practiced by many, but the specialty of few. Like other areas of medicine, specialization in trauma patients yields experience and insight that contribute to better patient outcomes. This refresher course will present lessons learned about this population over three decades of dedicated practice, and review the scientific evidence which supports today’s standard of care and the promising therapies of tomorrow. Admission and Triage Pre-hospital and emergency care are important components of anesthesia practice in many parts of the world, including much of Europe. Work force issues and the rise of Emergency Medicine in the past two decades have taken most American anesthesiologists away from the Emergency Department (ED), to the detriment of severely injured patients. Participation of anesthesiologists on the Trauma Team enables early effective airway management, precise resuscitation, comprehensive analgesia and sedation, and rapid access to the operating room (OR). While certification as a “Level One” trauma center by the American College of Surgeons requires the presence of an anesthesiologist in the hospital at all times, 1 the greatest benefit is achieved when this individual is present in the ED at the time of patient admission. The term “The Golden Hour” was coined to emphasize the importance of rapid diagnosis and therapy for trauma patients. While there is nothing magical about the 60 minute mark (the term was originally presented in the lay press, without scientific support) it is clear that the speed of treatment has an important effect on outcome in many conditions caused by trauma, especially airway emergencies, ongoing hemorrhage, and acute neurologic injury. Even when the anesthesiologist can not be physically present in the ED when the patient arrives, understanding the basics of trauma will allow for informed decisions regarding OR access and emergency patient management. Risk to the patient from delay of surgery may be substantial; the frequent need to expedite surgery—without consideration for optimizing chronic medical conditions—is the most important difference between trauma anesthesia and other sub-specialties. Anesthesiologists caring for trauma patients must be familiar with the tenets of the Advanced Trauma Life Support (ATLS) course of the American College of Surgeons. 2 This is a basic curriculum that provides a common language and choreography for the first minutes of diagnosis and treatment of the trauma patient. Airway, Breathing, and Circulation make up the “ABCs” of ATLS. Airway patency and adequacy of oxygenation and ventilation are assessed first and then corrected if inadequate, generally by rapid sequence endotracheal intubation (see below). Circulation is assessed by looking for the signs and symptoms of shock: pallor, diaphoresis, alterations in mental
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This note was uploaded on 12/16/2011 for the course BIOLOGY 101 taught by Professor Mr.wallace during the Fall '11 term at Montgomery College.

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142_Dutton_FA - Trauma Anesthesia 142 P age 1 R ic h a r d...

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