Anesthesiologists are involved: Anesthesiologists are involved



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Anesthesiologists are involved:

  • Anesthesiologists are involved:

  • beginning with airway and resuscitation management in the emergency department (ED) and proceeding through the operating room (OR) to the intensive care unit (lCU).

  • Critical care and pain management specialists see trauma patients as a large fraction of their practice.

  • in European practice anesthesiologist working in the prehospital environment, as an ED director, or as leader of a hospital's trauma team.



  • The presence of an experienced anesthesiologist and the immediate availability of an open OR are both core resource standards for accreditation of a "level 1" trauma center.



***Anesthesia for trauma patient is different from routine OR practice:

  • ***Anesthesia for trauma patient is different from routine OR practice:

  • Most urgent cases occur during off-hours

  • Small hospital-military and humanitarian practice,auster condition (Resources avibility)

  • limitation in Patient information

  • Full stomach-intoxicate-cervical spine instability

  • Multiple positioning-multiple procedure-need to consider priorities in management

  • Occult injuries such as tension Pneumothorax can be manifested at unexpected times

  • Multiple injury



The advanced trauma life support (ATLS) course of the American College of Surgeons is the most popular training program for trauma physicians

  • The advanced trauma life support (ATLS) course of the American College of Surgeons is the most popular training program for trauma physicians

  • ATLS:

  • Based on primary survey that means:

  • simultaneous diagnostic and therapeutic activities intended to identify and treat life and limb-threatening injuries, beginning with the most immediate.

  • This focus on urgent problems is first captured by the " Golden hour“ catch phrase and is one of the most important lessons of ATLS.



ATLS begins with the ABCDE :

  • ATLS begins with the ABCDE :

  • airway, breathing, circulation, disability, and exposure and secondary survey.

  • adequate open airway and acceptable respiratory mechanics is of primary Importance because hypoxia is the most immediate threat to life.

  • Trauma patients are at risk for airway obstruction and inadequate respiration for the reasons listed later.



cause of obstructed airway or inadequate ventilation in trauma patients:

  • cause of obstructed airway or inadequate ventilation in trauma patients:

  • Airway Obstruction:

  • Direct injury to the face, mandible, or neck

  • Hemorrhage in the nasophrynx, sinuses, mouth, or upper airway

  • Diminished consciousness secondary to traumatic brain injury, intoxication, or analgesic medications

  • Aspiration of gastric contents or a foreign body (e.g., dentures)

  • Misapplication of oral airway or endotracheal tube (esophageal intubation)

  • Inadequate Ventilation

  • Diminished respiratory drive secondary to traumatic brain injury, shock, intoxication, hypothermia, or over sedation

  • Direct injury to the trachea or bronchi

  • Pneumothorax or hemothorax

  • Chest wall injury

  • Aspiration

  • Pulmonary contusion

  • Cervical spine injury

  • Bronchospasm secondary to smoke or toxic gas inhalation



Endotracheal intubation must be immediately confirmed by :

  • Endotracheal intubation must be immediately confirmed by :

  • capnometry for patients who have vital signs; esophageal intubation or endotracheal tube dislodgement is common

  • Patients in cardiac arrest may have very low end-tidal CO2 values;

  • direct laryngoscopy should be performed if there is any question about the location of the endotracheal tube.

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