Initial evaluation and management

Thomas E. Grissom, Christopher Stephens, Robert Sikorski

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Severely injured trauma patients challenge the healthcare system at all levels. Trauma patient care is resource intensive and frequently requires coordination across multiple specialties, especially with multiple injuries and multi-organ system involvement. Although frequently referred to as a “surgical disease,” trauma resuscitation benefits from a multi-disciplinary approach. The anesthesiologist's role in the management of these patients can be a significant contributor to improved care – from initial resuscitation to the rehabilitative phase. While anesthesiologists practicing in designated trauma centers are more likely to be involved in the initial care of the trauma patient, an understanding of the early evaluation, management, and resuscitation of these patients will aid in later interactions and provide an understanding of management priorities during the first and subsequent surgical procedures. Successful perioperative care of these patients requires a good understanding of these basics, supplemented by preparation, flexibility, and the ability to react quickly to changing circumstances. In the United States, very few anesthesiologists consider trauma their primary specialty. However, recommendations for “Level 1” trauma center status, made by the American College of Surgeons (ACS) Committee on Trauma (COT), require the presence of an experienced anesthesiologist and the immediate availability of an open operating room (OR) as core standards for certification. With expanded trauma care being delivered by emergency medicine physicians, US anesthesiologists may not be as readily consulted for early airway management and their initial interaction may not occur until the patient presents to the OR. The European model has taken a different approach, with anesthesiologists frequently working in the prehospital environment or serving as the leader of a hospital's “trauma team.” This variable exposure to early trauma evaluation and management creates a need for ongoing education of providers that covers many recent innovations in trauma care. These include technologies for rapid volume resuscitation, “damage control” surgical techniques, and diagnostic modalities such as focused assessment with sonography for trauma (FAST), rapid computed tomography (CT), and angiography.

Original languageEnglish (US)
Title of host publicationEssentials of Trauma Anesthesia
PublisherCambridge University Press
Pages16-27
Number of pages12
ISBN (Electronic)9781139061339
ISBN (Print)9781107602564
DOIs
StatePublished - Jan 1 2012
Externally publishedYes

ASJC Scopus subject areas

  • General Medicine

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