Critical care clinics
-
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.
-
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.
-
Critical care clinics · Jan 1990
ReviewPerioperative anesthetic management of the pediatric trauma patient.
The object of this article is to provide the anesthesiologist with an approach to the perioperative management of pediatric trauma. The initial focus is on planning and initial stabilization and transport. ⋯ The anesthetic management of the head-injured patient is focused upon the control of intracranial pressure, and the major method for control is hyperventilation to reduce the CO2. Head trauma patients often have injuries to other body systems, which may account for both their ventilatory and their circulatory problems.
-
Critical care clinics · Jan 1990
ReviewGeneral anesthesia: management considerations in the trauma patient.
Endotracheal intubation and mechanical ventilation are vital components of the resuscitation of the most seriously injured patients and those suffering from multisystem trauma. Therefore, general anesthesia administered both intravenously and endotracheally becomes the anesthetic of choice for most of this patient population. ⋯ Monitoring techniques include the basic noninvasive monitoring set forth in the American Society of Anesthesiologist's standards, as well as invasive cardiac monitoring via arterial catheters and pulmonary artery catheters. Attention to detail in the recovery room will continue the success of a well-conducted general anesthetic for the trauma patient.
-
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.