Anesthetic Management of The Trauma Patient

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Anesthetic Management of The Trauma Patient
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Baseline Prior To OR

• BP 90/40 HR 130s Intubated CV
• Left chest ant post wounds/ left calf wound
• Right CT with 400cc blood returned
• Decreased right breath sounds
• Aggressive Resuscitation Underway

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Initial Status After OR Arrivalfor Thoracotomy
and Ex-Lap

• BP 30/15 HR 106 SaO2 98
• Resuscitation continuing
• Multiple IV Access attained
• Right rad A- line
• Right 16g and 18g iv
• Left 16g iv
• Right 16g IJ with CVP monitoring

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Monitors Equipment

• Arterial and NIBP Blood Pressure
• Central Venous Pressure (CVP)
• ECG a.k.a. EKG with ST analysis (standard)
• SaO2 FiO2 Anes. gas monitor
• Vent monitors (RR/PIP/Vt/IE)
• Altan Dean Rapid Infuser

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Anesthetic Agents

• Initially
• 100 Oxygen and Midzolam (Versed) with
  Cisatracurium (Nimbex) for muscle relaxation.
• Patients vital signs would not tolerate any
  additional anesthetics.
  

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Course of Events
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Fluid Resuscitated
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Blood Gas Analysis
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Blood Gas AnalysisPost-OP
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Hemoglobin and Hematocrit

• Hemoglobin -protein that carries oxygen in
  blood -normally saturated 95-100 -Normal
  10-14g/dl
• Hematocrit -measures red cell mass,
  anemia, hydration. -normal 42-52

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Hemoglobin Hematocrit Trend
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Coagulation

• PT used to monitor coumadin, Vit. K def, Factor
  def., DIC
• PTT used to monitor heparin therapy.
• Fibrinogen protein that converts to fibrin to
  make clot
• INR for monitoring oral anticoagulants,
  interantional standard value.

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Coagulopathy
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Immediate Post-Op Course

• Vitals (HR 143 BP 85mmHg(mean) Pox 98
• H/H (9.7/27.2)
• ABG 7.43/38/54
• Critical Cond. Continuous vigorous volume
  replacement
• Pt. on ventilator in SICU