Trauma

Learning objectives

Assessment of the injury severity score of trauma
Immediate treatment of trauma
Anesthetic management of trauma

Definition and mechanisms

Defined as a body wound resulting from a sudden physical injury from impact, violence, or accident
Minor, serious, life-threatening, or potentially life-threatening injuries
Blunt or penetrating wound
The severity of trauma is classified according to the injury type, the physical location of the injury, and how many injuries there are
Immediately life-threatening injuries:
- Airway obstruction
- Tension pneumothorax
- Open pneumothorax
- Cardiac tamponade
- Massive hemothorax
- Flail chest
Delayed/hidden injuries:
- Thoracic aortic disruption
- Tracheobronchial disruption
- Myocardial contusion
- Traumatic diaphragmatic tear
- Esophageal disruption
- Pulmonary contusion

Complications

Hemorrhage
Infection
Sepsis
Multi-organ failure

Injury severity score

Individual body regions are assigned an abbreviated injury scale (AIS) score
The three most severely injured body regions then have their score squared and added together to produce the AIS score

Abbreviated injury scale	Injury
1	Minor
2	Moderate
3	Serious
4	Severe
5	Critical
6	Unsurvivable

Immediate treatment

Cardiovascular reuscitation
Cervical collars:
- May increase secondary neurological injury, intracranial pressure
- May worsen intubation conditions
Secure the airway
Proactive early treatment to counter the ‘lethal triad’ of acidosis, hypothermia, and coagulopathy
- Warm the OR
- Warmed IV line
- Rapid infuser with warming capability
Permissive hypotension and establishment of a massive transfusion protocol
Early treatment of anticipated coagulopathy with blood products
Other injuries, considerable pain, or distal ischemia may complicate the management

Anesthetic management

Fracture reduction requires general or regional anesthesia
Proximal fracture reduction or joint relocation performed under GA may require a small dose of a neuromuscular blocker to facilitate manipulation
Manipulation under anesthesia (MUA)
- Relocation of dislocated joints
- Correct fracture deformity
- Improve mobility of fixed joints
- Improve mobility after arthroplasty:
  - Internal fixation
  - Distal long bone fracture plating
  - Intramedullary nailing procedures
  - External fixation

$Trauma, full stomach, antacid, fractures, volume resuscitation, IV, IO acces, preoxygenation, RSI, endotracheal intubation, propofol, SVR, ketamine, TIVA, MAP, BP, arterial line, low lung volume ventilation, thromboprophylaxis$

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