This article was chosen for discussion as the 8th edition of atls has important changes of interest to anesthesiologists

Military experience states multiple studies show a decrease mortality in 1:1 transfusion practice. Overall mortality of 30 percent with military transfusion guidelines.

Civilian data gathered from 467 massive transfusion patients from 16 level 1 trauma centers between July 2005-June 2006 showed variable survival range from 41-74 percent by center. The plasma :pRBC ranged from 0:2.89 and platelets :pRBC 0-2.5. High plasma :pRBC (>1:2) and high platelet :pRBC (<1:2) transfusion ratios decreaesd truncal hemorrhage and icu ventilator and hospital free days.

Good points:

• Good points:

• 1) The article goes over the new guidelines in trauma patients which is relevant to anesthesia practice.

• Difficult airway is addressed and also the adjuncts that can be used.

• It addresses how either crystalloid is acceptable which was a question in the past.

• For blunt thoracic aortic trauma, it states the superiority of endovascular stenting under local and regional anesthesia and avoiding thoractomy, one lung ventilation, aortic cross clamping/bypass.

• It states that avoidance of thoracotomy minimizes postoperative pain and associated respiratory compromise and also cross clamping of aorta reduces blood pressure shifts and blood loss with minimal organ ischemia time. This is beneficial as it states the option of endovascular stenting being superior and more beneficial in numerous ways.

• This article also states the superiority of 1:1:1 transfusion of pRBC, plasma, and platelets and has positive outcomes and should be adopted as mortality rates have been shown to decrease.

Bad points:

• Bad points:

• It should address the entire difficult airway algorithm and not just the different adjuncts available. It does not talk about the glidescope as adjunct for c-spine injuries or an awake fiberoptic intubation being an option.

• This article should go into more detail about the types of patients that had the endovascular stenting done and which patients still had to have a thoracotomy.

• It does not state the new guidelines for identifying c-spine injuries after trauma.

It identifies the importance of difficult airway and to actually evaluate the airway before RSI.

• It identifies the importance of difficult airway and to actually evaluate the airway before RSI.

• The new guidelines are useful as they are placing emphasis on the difficult airway in trauma care and offering adjuncts.

• It also states that a c-spine is adequate for ruling out cervical spine injury and MRI is not necessary

• This article also has solid data about transfusion guidelines and resuscitation which can be helpful in our massive transfusions.

• This article also states the importance of avoiding thoracotomy if possible as endovascular stenting has been so beneficial for blunt aortic trauma. Again, the risks are far greater for a thoracotomy then with endovascular stenting.