CTTraumaAug05 - Anesthesia for Cardiothoracic Trauma...

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Unformatted text preview: Anesthesia for Cardiothoracic Trauma Charles E. Smith, MD Department of Anesthesia MetroHealth Medical Center Case Western Reserve University Cleveland, Ohio Email: csmith@metrohealth.org Objectives Incidence Pathophysiology Specific injuries ATLS Provider Manual Trauma Leading cause of death, ages 1 - 44 yrs 60 million injuries annually in USA 30 million require medical care 3.6 million require hospitalization 9 million are disabling 300 k = permanent; 8.7 million= temporary Costs are staggering: > $100 billion annually, or 40% of health care $ Cardiothoracic Injuries Accounts for 20% trauma deaths in US Contributing factor in additional 25% Immediate deaths: massive injury heart, great vessels, lungs Early deaths: airway, hypoxia, hemorrhage, tamponade, aspiration Pathophysiology Respiratory insufficiency + hypoxia chest wall injury, rib fx, flail, airway hemothorax, pneumo, contusion, aspiration Hemodynamic collapse + shock massive hemothorax cardiogenic shock: tamponade or blunt cardiac mediastinal shock: tension pneumo Siegel JH et al: Trauma: Emergency Surgery + Critical Care, 1987:2 Devitt: CJA 1991;38:506. Incidence of injuries in patients presenting Blunt Chest Injuries Incidence 25 50 75 R i b F x C o n t u s i o n P n e u m o H e m o F l a i l D i a p h C a r d i a c A o r t a A i r w a y % Besson + Saegesser 1983; Switzerland, N= 1485 chest injuries Blunt Chest Trauma: Extra-thoracic Injuries Incidence 25 50 C e r e b C o n c C e r e b C o n t S k u l l F x F a c i a l F x S p i n e U p p e r E x t L o w e r E x t P e l v i s A b d o m e n % Initial Evaluation History of traumatic event: mechanism of injury: mva, mca, assault, fall, blasts, pedestrian struck, gsw, stab energy exchange: speed of vehicle, distance of fall,...
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CTTraumaAug05 - Anesthesia for Cardiothoracic Trauma...

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