Anesthesia Student Survival Guide.pdf - Index of

400 ● AnesthesiA student survivAl Guide
the trauma Arrest
Patients requiring CPR following trauma have an almost universally poor
prognosis. In particular, patients presenting with blunt trauma in cardiac arrest
have a mortality rate that approaches 100%. Patients who are young, otherwise
healthy, and receive hospital care within a short period of their injury tend to have
better outcomes. For any hope of survival, early intubation with appropriate oxygenation
and ventilation, as well as aggressive fluid management are required.
the trauma Airway
Emergency airway management of the trauma can be the single most challenging
aspect of anesthesia care, and proper preparation and multiple backup
plans are equally important. Airway damage, cervical spine injury, intoxication,
and coexisting injury can combine to create a situation requiring experience,
expertise, and luck! Fiberoptic intubation may be impossible due to airway
blood or patient combativeness. LMA placement may be complicated by a full
stomach. The patient may also come with a Combitube (see Chap. 9, Airway
Evaluation and Management) or endotracheal tube already in place.
One plan to manage the airway of a combative trauma patient may look
something like Fig. 25.1.
Figure 25.1 Sample plan to manage the airway of a combative trauma patient. RSI = rapid
sequence induction.