Trauma Anesthesia

642 Pages·2008·19.17 MB·English

by  Charles Smith

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T A
R A U M A N E S T H E S I A
Injuriesareestimatedtobecomethenumber-onecauseofdeathformenand
womenundertheageof45bytheyear2020.Traumapatientspresentunique
challengestoanesthesiologists.Acuteinjuriesrequireresource-intensivecare
andareoftencomplexcases,especiallywhencoupledwithunderlying,pre-
existing medical conditions. Anesthesiologists are involved with trauma
patientsbeginningwithairwayandshockresuscitation,continuingwithintra-
operativecareduringsurgery,andextendingontopainmanagementandcrit-
icalcarepostoperatively.Thisnewreferencefocusesonabroadspectrumof
traumaticinjuriesandtheproceduresanesthesiologistsperformtoadequately
carefortraumapatientsperioperatively,surgically,andpostoperatively.Spe-
cialemphasisisgiventotheassessmentandtreatmentofcoexistingdisease.
Numerous tables and more than 300 illustrations showcasing various tech-
niquesofairwaymanagement,shockresuscitation,echocardiography,anduse
ofultrasoundfortheperformanceofregionalanesthesiaintraumaprovide
aninvaluablereferencefortheanesthesiologist.
Dr. Charles E. Smith is board-certified in anesthesiology and in periopera-
tivetransesophagealechocardiography,hasexpertiseintraumacare,andhas
publishedextensivelyontopicsintraumaanesthesia.
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T A
R AU MA N E S T H E S IA
Edited by
C E. S
HARLES MITH
MetroHealthMedicalCenter
Associate Editor
J J. C
OHN OMO
MetroHealthMedicalCenter
iii
CAMBRIDGEUNIVERSITY PRESS
Cambridge, New York, Melbourne, Madrid, Cape Town, Singapore, São Paulo
Cambridge University Press
The Edinburgh Building, Cambridge CB2 8RU, UK
Published in the United States of America by Cambridge University Press, New York
www.cambridge.org
Information on this title: www.cambridge.org/9780521870580
© Charles E. Smith 2008
This publication is in copyright. Subject to statutory exception and to the provision of
relevant collective licensing agreements, no reproduction of any part may take place
without the written permission of Cambridge University Press.
First published in print format 2008
ISBN-13 978-0-511-41388-9 eBook (EBL)
ISBN-13 978-0-521-87058-0 hardback
Cambridge University Press has no responsibility for the persistence or accuracy of urls
for external or third-party internet websites referred to in this publication, and does not
guarantee that any content on such websites is, or will remain, accurate or appropriate.
Every effort has been made in preparing this publication to provide accurate and up-to-
date information that is in accord with accepted standards and practice at the time of
publication. Nevertheless, the authors, editors, and publisher can make no warranties that
the information contained herein is totally free from error, not least because clinical
standards are constantly changing through research and regulation. The authors, editors,
and publisher therefore disclaim all liability for direct or consequential damages resulting
from the use of material contained in this publication. Readers are strongly advised to pay
careful attention to information provided by the manufacturer of any drugs or equipment
that they plan to use.
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C
ONTENTS
page vii
Foreword:AdolphH.(Buddy)Giesecke,MD[Anesthesia]
Foreword:MarkA.Malangoni,MD[Surgery] ix
Preface xi
Acknowledgments xiii
Contributors xv
1. MechanismsandDemographicsinTrauma 1
PedroBarbieri,DanielH.Gomez,PeterF.Mahoney,PabloPratesi,and
ChristopherM.Grande
2. TraumaAirwayManagement 9
WilliamC.Wilson
3. ShockManagement 55
RichardP.Dutton
4. EstablishingVascularAccessintheTraumaPatient 69
MatthewA.Joy,DonnMarciniak,andKasiaPetelenz-Rubin
5. MonitoringtheTraumaPatient 81
ElizabethA.Steele,P.DavidSøran,DonnMarciniak,andCharlesE.Smith
6. FluidandBloodTherapyinTrauma 101
MaximNovikov,andCharlesE.Smith
7. MassiveTransfusionProtocolsinTraumaCare 121
JohnE.Forestner
8. BloodLoss:DoesItChangeMyIntravenousAnesthetic? 133
KenJohnson,andTalmageD.Egan
9. PharmacologyofNeuromuscularBlockingAgentsandTheirReversal
inTraumaPatients 142
Fran¸coisDonati
10. AnesthesiaConsiderationsforAbdominalTrauma 155
WilliamC.Wilson
11. HeadTrauma–AnesthesiaConsiderationsandManagement 172
PaulTenenbein,M.SeanKincaid,andArthurM.Lam
12. IntensiveCareUnitManagementofPediatricBrainInjury 187
RobertCohn,MarounJ.Mhanna,ElieRizkala,andDennisM.Super
13. SurgicalConsiderationsforSpinalCordTrauma 202
TimothyMoore
14. AnesthesiaforSpinalCordTrauma 213
M.SeanKincaid,andArthurM.Lam
15. MusculoskeletalTrauma 225
HeatherA.Vallier,andMarkD.Jenkins
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16. AnestheticConsiderationsforOrthopedicTrauma 245
RobertM.Donatiello,AndrewD.Rosenberg,andCharlesE.Smith
17. CardiacandGreatVesselTrauma 260
NazBigeAydin,MichaelC.Moon,andInderjitGill
18. AnesthesiaConsiderationsforCardiothoracicTrauma 279
MarkA.GerhardtandGlennP.Gravlee
19. IntraoperativeOne-LungVentilationforTraumaAnesthesia 300
GeorgeW.KanellakosandPeterSlinger
20. BurnInjuries(CriticalCareinSevereBurnInjury) 314
CharlesJ.Yowler
21. AnesthesiaforBurns 322
JessicaAnneLovich-Sapola
22. FieldAnesthesiaandMilitaryInjury 343
PeterF.MahoneyandCraigC.McFarland
23. EyeTraumaandAnesthesia 360
MartinDauberandStevenRoth
24. PediatricTraumaandAnesthesia 367
JocelynLoy
25. TraumaintheElderly 391
JeffreyH.Silverstein
26. TraumainPregnancy 402
JohnR.Fisgus,KalpanaTyagaraj,andSohailKamranMahboobi
27. OralandMaxillofacialTrauma 417
KetanP.ParekhandCecilS.Ash
28. DamageControlinSevereTrauma 431
MichaelJ.A.ParrandUlrikeBuehner
29. HypothermiainTrauma 445
EldarSøreideandCharlesE.Smith
30. ITACCSManagementofMechanicalVentilationinCriticallyInjuredPatients 465
MaureenMcCunn,AnneJ.Sutcliffe,WalterMauritz,andtheInternationalTrauma
AnesthesiaandCriticalCareSociety(ITACCS)CriticalCareCommittee
31. TraumaandRegionalAnesthesia 471
ShaliniDhirandSuganthaGanapathy
32. UltrasoundProceduresinTrauma 499
PaulSoedingandPeterHebbard
33. UseofEchocardiographyandUltrasoundinTrauma 514
ColinRoyseandAlistairRoyse
34. PharmacologicManagementofAcutePaininTrauma 528
ShaliniDhir,VeerabadranVelayutham,andSuganthaGanapathy
35. PosttraumaChronicPain 544
DavidRyanandKutaibbaTabbaa
36. TraumaSystems,Triage,andTransfer 569
JohnJ.Como
37. Teams,TeamTraining,andtheRoleofSimulationinTraumaTraining
andManagement 579
PaulBarach
Index 591
Colorplatesfollowpage 294
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F
OREWORD
Dr.CharlesE.Smithhasbeeninspiringimprovedanesthesiafor traumatized patient. This book discusses the established and
thevictimsoftraumaticinjuryformanyyears,havingspentthe the controversial concepts. Also discussed is a new protocol-
majorityofhiscareeratMetroHealthMedicalCenter,Cleve- driven,multidisciplinaryapproachtomassivetransfusion.This
land, Ohio, which is the city’s major trauma center. He has approach,whichrequirescooperationbetweenthebloodbank,
regularlyservedaslecturerinrefreshercoursesfortheInterna- thetraumasurgeons,andanesthesiologists,takestheguesswork
tionalTraumaAnesthesiaandCriticalCareSociety(nowcalled outofmassivetransfusion.Nolongerdowehavetostandat
InternationalTraumaCare).Heisaproductiveauthorofinno- the OR table and ponder, “Is it time for platelets and fresh
vative research in the care of the traumatized patient. These frozenplasma?”Thesecollaborativedecisionshavebeenmade
attributes easily qualify him to be editor of a multi-authored in advance, and all we have to do is to activate the proto-
comprehensivebookontraumaanesthesia,towhichheisalso col and administer whatever comes in the incremental allot-
amajorcontributor.Hisinvitedchapterauthorsaresimilarly ments.
qualified. The result is an authoritative, readable, and educa- Patientsnowexpecttoberelievedofsignificantpain,and
tionalresourceforthestudent,resident,orpractitionerwishing painisconsideredthefifthvitalsign.Significantadvanceshave
tostayabreastofarapidlychangingfield. beenmadeinthetechniquesforreliefofacutetraumaticand
Epochalchangeshaveoccurredinthepracticeofanesthesi- postoperativepain.Entireteamsofpeoplearenowdedicated
ologyinthelasttenyears.Improvedmonitors,saferdrugs,and tothispractice.Nobodyquestionsthevalueofpainrelief,but
better-trained anesthesiologists, nurse anesthetists, and anes- it comes with some risk. A multimodal approach appears to
thesia assistants have all reduced the morbidity and mortal- accomplishthegoalandsimultaneouslyminimizetherisks.
ity of anesthesia. Anesthesia has become safer. Safer anesthe- Thermal injuries, brain injuries, and spinal cord injuries
sia improves the outcome of traumatic injuries. Our surgical arespecializedformsoftraumathatareoccasionallyneglected.
colleagues have contributed to the improvements in trauma Notsointhistext.Thepublichealthimplicationsarepresented
care.Innovationsinthecareofseriousfractures,useofdam- along with the practical considerations for safe clinical man-
agecontrolinabdominalinjuries,andimprovedcareofburns agement.Thepracticalconsiderationsareimportantbecause,
havereducedmorbidityandmortality.Dr.Smithhasincluded for example, drugs and procedures that may be beneficial in
allofthelatestinnovationsinthistext.Despitetheadvances, themanagementoforthopedicinjuriesarecontraindicatedin
theimportanceoftraumaasacauseofdisabilityandlostlife neurologic injuries. We must be able to recognize these con-
remainsand,infact,whenexpressedasaproportiontooverall flictswhentheyoccurtogetherinthesamepatientandcreate
mortalityinyoungpeople,isincreasinginimportance. ananestheticplanthatwillbenefitthepatient.
Throughout history significant advances have been made Dr. Smith and his invited authors have done a magnifi-
in anesthetic care during times of war. The war in Iraq is no cent job of pulling together the diverse concepts of the man-
exception,andthelessonslearnedinthatconflictareincluded. agement of the traumatized patient and presenting us with a
Thetechnologyofvascularaccesshasgreatlyimproved.Ultra- valuableresourcefortheanesthesiologist.Althoughdirectedat
sonic localization of major veins for central access is a major theanesthesiologist,thetextisusefulforemergencymedicine
advance greatly enhancing safety for the patient. The tech- physicians,surgeons,orthopedists,and,infact,anyhealthcare
nique of intraosseous infusion was once painful and cum- professional who deals with trauma. Congratulations to the
bersome to establish, such that it was considered a circus entiregroupofauthors!
stuntandnotofmuchpracticalvalue.Newlydesignedequip-
ment has revolutionized the technique. It is now fast, pain- AdolphH.(Buddy)GieseckeMD,EmeritusProfessor
less, convenient, and effective in any patient with difficult IV AnesthesiologyandPainManagement
access.Havingestablishedvascularaccess,thechoiceandvol- UniversityofTexasSouthwesternMedicalCenter
umeoffluidtherapyiscriticaltosurvivalandoutcomeofthe Dallas,Texas
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