Trauma

Authors:

Panchamia Rohan K.

Malhotra Jaideep K.

Slepian Ralph L.

A 31-year-old male sustained multiple stab wounds to the left upper quadrant of the abdomen and to the left hemithorax. Vital signs were blood pressure, 85/60 mm Hg; heart rate (HR), 130 beats per minute; respiratory rate, 32 breaths per minute; and temperature, 34.5 °C (94.1 °F). His hematocrit was 27%. He was emergently brought to the operating room for exploratory laparotomy and possible thoracotomy.

A.1.	How is trauma classified?
A.2.	What injuries are associated with thoracic trauma?
A.3.	What injuries are associated with cardiac trauma?
A.4.	What is the pathophysiology of acute pericardial tamponade?
A.5.	What are the anesthetic implications of cardiac tamponade?
A.6.	What is the definition of massive hemothorax? What are the signs and symptoms of hemothorax?
A.7.	What are the indications for thoracotomy to treat hemothorax?
A.8.	How are pneumothoraces categorized?
A.9.	What is an occult pneumothorax?
A.10.	If the patient has a widened mediastinum on the chest radiograph, what are your concerns?
A.11.	What is focused abdominal sonography for trauma (FAST) examination?
A.12.	Define shock.
A.13.	What are the four types of shock?
A.14.	What are the signs and symptoms of hypovolemic shock?
A.15.	What is the pathophysiology of hypovolemic shock?
A.16.	How is hemorrhage classified?
A.17.	What is the initial treatment of hemorrhagic shock?
A.18.	Would you choose crystalloid, colloid, or blood products to treat hemorrhagic shock?

B.1.	What premedication would you order?
B.2.	What preoperative testing would you order?

C.1.	How would you monitor this patient?
C.2.	How would you induce general anesthesia?
C.3.	What technique could you use if one-lung ventilation was indicated?
C.4.	What agents would you choose to maintain anesthesia?
C.5.	What neuromuscular blocking agent would you choose?
C.6.	What can be done to decrease the incidence of accidental intraoperative awareness?
C.7.	Five minutes after tracheal intubation, the peak airway pressure increased from 20 to 40 cm H₂O. What are the possible causes?
C.8.	How would you make a diagnosis of tension pneumothorax?
C.9.	What is the treatment of tension pneumothorax?
C.10.	The patient's blood loss continued, and the hematocrit was 18%. What type of blood would you give if the type and crossmatch were not completed?
C.11.	What are the complications associated with any blood transfusion?
C.12.	What is considered a massive transfusion (MT)? What scoring systems can be used to predict the need for massive transfusion protocol (MTP) in patients with trauma?
C.13.	What is acute coagulopathy of trauma (ACT)?
C.14.	What are the complications associated with MT?
C.15.	Can the shift of the oxygen-hemoglobin dissociation curve be quantified?
C.16.	How is hypothermia defined? How can it be prevented and treated?
C.17.	What are the adverse effects of hypothermia?
C.18.	What are the guidelines for the ratio of plasma/platelet transfusion to packed red blood cells (pRBCs) in MT?
C.19.	If a patient were a member of the Jehovah's Witness religious group, would you give a blood transfusion?
C.20.	If a child is a Jehovah's Witness and has hemorrhagic shock, what would you do?
C.21.	What concentrated factors and hemostatic agents are available for bleeding patients?
C.22.	What is thromboelastometry? How can it guide transfusion?

D.1.	What is acute respiratory distress syndrome (ARDS)? What is acute lung injury?
D.2.	How is ARDS treated?
D.3.	You are called to see this patient in the postanesthesia care unit (PACU) because of oliguria. How would you evaluate and treat this patient?
D.4.	If this patient had a crush injury and low urine output, what other concerns might you have? What if the patient has dark or "tea-colored" urine?

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Case Studies ⬇

Medical Disease and Differential Diagnosis ⬆ ⬇

Preoperative Evaluation and Preparation ⬆ ⬇

Intraoperative Management ⬆ ⬇

Postoperative Management ⬆