Trauma and the Anaesthetist

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Trauma and the Anaesthetist

• Dr. Margaret Coleman
• Consultant Anaesthetist
• Mid-Western Regional Hospitals
• Limerick

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Normal looking airway-may result in hypoxic
death

• head injury, hypovolemia, hypoxia, drugs
• Hypoxia and hypercarbia
• Decreased level of consciousness
• Hypoxia

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Trauma and the Anaesthetist

• Airway Cervical Spine Control
• Breathing
• Circulation
• Disability
• Environment

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Normal c-spine
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C5-6 INJURY
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Severe c-spine injury (motorbike vs wall)
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Beware of the normal lateral c-spine x-ray
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Immobilisation of the cervical spines
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Airway management and intubation

• More difficult in trauma patients - blood
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  - vomit
• - teeth
• - guinness
• Take collar off manual in-line immobilization
• Pre-oxygenate use proper sized mask- DONT take
  mask off, or need to start again!

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Immobilisation of the cervical spines
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Immobilisation of the cervical spines
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Airway management and intubation

• Suction
• Rapid sequence induction with cricoid pressure
• Range of laryngoscopes and endotracheal tube
  sizes
• Gum elastic Bougie

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Cut endotracheal tube-railroaded over a bougie
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Breathing

• Shock respiratory distress very poor
  prognosis
• gt70 Mortality
• Cardiac arrest commonly occurs after intubation

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The Big Five of Chest Trauma

• Tension pneumothorax
• Flail Chest
• Massive hemothorax
• Open Pneumothorax
• Cardiac tamponade

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• Any chest injury requiring intubation
• or going to theatre
• consider prophyactic chest drain

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• Use Larger Chest tubes in trauma
• 36French, drains blood and air
• May need a drain in anterior chest also

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Watch your back!
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Open pneumothorax cover on three sides
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Cardiac tamponade - radio antenna!
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Circulation

• 30-40 blood loss before there is any drop in
  Blood Pressure!
• Heart rate gt120bpm 30-40 blood loss
• 40 loss results in confusion and decreased
  consciousness

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Circulation

• Hartmanns x 2 litres
• 16G x 2 / large central line
• Blood - O-negative
• Type specific
• Cross matched

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Invasive monitoring very useful
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Sources of massive blood loss

• Chest massive hemothorax
• Abdomen liver, spleen, retroperitoneal vessels
• Pelvis

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Pelvic binding to close the open-book
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D-disability

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Beware lumbo-saccral spine damage
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E-Environment

• Keep the patient WARM-not always easy
• Coagulopathy
• Shivering causes pain, tachycardia
• Increases in oxygen demand

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E-Environment

• Keep covered, Bair Hugger is best
• Increase temperature in room
• Fluid warmers, low gas flows
• Tin foil is only good for turkeys!

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E-Environment

• Pressure point protection very important
• Outstretched arms get over stretched
• Watch for the anaesthetists tangled mess on
  transfer
• Patients can become very unstable on transfer

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• Nursing plays a large and varied role in severe
  trauma management
• Situation always changing, new problems may arise
• ANTICIPATION and PREPARATION are key to success

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Thank You