Critical care clinics
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Critical care clinics · Jan 1990
ReviewMilitary medicine: trauma anesthesia and critical care on the battlefield.
This article presents a few of the basic guidelines that must be considered once a decision is made to provide anesthesia and advanced surgical care in the battlefield--or in civilian catastrophes (for example, terrorist incidents, and man-made or natural disasters) that resemble the battlefield. However, it must be stressed that the most central consideration in battlefield anesthesia is the selection, training, and experience of the battlefield anesthesiologist. There are strict guidelines for providing safe anesthesia under the dire circumstances of war or similar civilian circumstances; the properly trained and experienced TA/CCS, however, will be best able to deliver battlefield anesthesia and to improvise equipment and agents for its safest delivery in those circumstances.
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The five components integral to modern, sophisticated airway management in trauma patients include equipment, pharmacologic adjuncts, manual techniques, physical circumstances, and patient profile. Although there is a finite number of pieces and types of equipment, pharmacologic adjuncts, and manual techniques, the last two components are variable. ⋯ We believe that the commonly used airway management algorithms are a poor substitute for a conceptual understanding of the basic principles of the five components of airway management, although these decision trees may be useful as learning tools. The construction of a truly complete decision tree is virtually impossible because of the high number of individual patient profiles.
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Fluid management of the traumatized patient begins with assessment of volume status via palpation of pulses; evaluation of mental status; and measurement of urine output, arterial blood pressure, and central pressures. Intravascular line placement and choice of initial resuscitation fluids should be individualized to the clinical situation, although in most situations a crystalloid solution continues to be the initial fluid of choice. ⋯ Parenteral fluids may be divided into two groups: crystalloids and colloids. The indications, complications, and controversies surrounding various resuscitation modalities have been reviewed.
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Critical care clinics · Jan 1990
ReviewRegional anesthesia: management considerations in the trauma patient.
From peripheral nerve blocks to central neuraxis blocks, regional anesthesia offers a wide range of options for the comprehensive management of trauma victims. Experience during wars and with mass casualties has proven the safety and efficiency of regional techniques. In this article, authors review the merit of these techniques to advance the quality of patient care. They also suggest the need to improve the selection of techniques, ranging from the prehospital phase to long-term rehabilitation.
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Critical care clinics · Jan 1990
ReviewTrauma anesthesia and critical care: the concept and rationale for a new subspecialty.
Proper care of the severely injured patient will require the development of a new anesthesia specialist. The trauma anesthesiologist, like the cardiovascular anesthesiologist, must become thoroughly familiar with one disease. The anesthesiologist who manages patients with traumatic disease must become an expert in critical care, high-risk anesthesia practice, and emergency resuscitation of the trauma patient. An outline for a fellowship in trauma anesthesia and critical care is included.