Essentials of Trauma Anesthesia 2nd Edition by Albert Varon, Charles Smith ISBN 9781108363709 1108363709

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ISBN 10: 1108363709
ISBN 13: 9781108363709
Author: Albert Varon, Charles Smith

Essentials of Trauma Anesthesia 2nd Edition Table of contents:

Section 1 Core Principles in Trauma Anesthesia

Chapter 1 Trauma Epidemiology, Mechanisms of Injury, and Prehospital Care

Trauma Epidemiology

Funding for Research

Prevention

Mechanisms of Injury

Falls

Transportation-related Injuries

Penetrating Trauma

Blasts or Explosions

Prehospital Care

Trauma Management in the Prehospital Phase

Airway and Ventilation Management

Breathing

Circulation

Disability/Exposure

Triage

Key Points

Further Reading

Chapter 2 Initial Evaluation and Management

Introduction

Before the Patient Arrives

Prehospital Coordination

Trauma Area Setup

Prioritizing Trauma Care

First Contact

Primary Survey

Resuscitation Phase

Secondary Survey

Additional Considerations

FAST Exam

CT Imaging

Angiography

Prioritization of Surgical Management

Teamwork and CRM in Trauma

Key Points

Further Reading

Chapter 3 Airway Management

Introduction

Airway

Equipment and Medications

RSI: anesthetic agents and NMBDs

Oxygenation and Cricoid Pressure

Cervical Spine Immobilization

ASA Difficult Airway Algorithm Modified for Trauma

Videolaryngoscopy

Tracheal Tube Introducers

Supraglottic Devices

Laryngeal Mask Airway

Laryngeal Tube Airway

Flexible Bronchoscopy

Surgical Airway

Penetrating Neck Injury

Key Points

Further Reading

Chapter 4 Shock, Resuscitation, and Fluid Therapy

Shock

Pathophysiology

Diagnosis and Recognition

Fluid Therapy

Timing and Rate of Fluid Administration

Fluid Alternatives for Small Volume Resuscitation

Resuscitation from Hemorrhage

Early Resuscitation

Late Resuscitation

Damage Control Hemostatic Resuscitation

Key Points

Further Reading

Chapter 5 Vascular Cannulation

Introduction

General Considerations

Factors Influencing Flow

Ultrasound-Guided Procedures

Venous Access

Peripheral Venous Access

Central Venous Access

Site of Venous Catheterization

Subclavian Vein

Landmark Technique

Ultrasound Technique

Internal Jugular Vein

Femoral Vein

Types of Central Venous Catheters

Small-Bore Multi-lumen Catheters

Large-Bore Single-Lumen Catheters (“Introducers”)

Large-Bore Multi-Lumen Catheters

Intraosseous (IO) Access

Arterial Access

Sites for Arterial Catheterization

Radial Artery

Axillary Artery

Femoral Artery

Dorsalis Pedis Artery

Brachial Artery

Key Points

Further Reading

Chapter 6 Blood Component Therapy and Trauma Coagulopathy

Introduction

Hemorrhagic Shock

Pathophysiology of Coagulopathy in Trauma

Blood Products

Blood Product Compatibility and Cross-matching

Approaches to Early Transfusion and Coagulopathy in Trauma

Empiric Transfusion Ratios

Goal-Directed Treatment of Coagulopathy

Organizational and Practical Aspects of Massive Transfusion

Role of Massive Transfusion Protocols

Activation and Scope of Massive Transfusion Protocols

Complications of Massive Transfusion

Procoagulant Adjuncts

Antifibrinolytics

Recombinant and Concentrated Clotting Factors

Fibrinogen Concentrate

The Anticoagulated Trauma Patient

A Pragmatic Approach to Transfusion and Coagulation in Trauma

Key Points

Further Reading

Chapter 7 General Anesthesia for Trauma

Introduction

Preoperative Preparation

Operating Room Setup

Monitoring

General Anesthesia

Airway Management and Anesthetic Agents (see also Chapter 3)

Aspiration Prophylaxis

Cervical Spine Precautions

Airway Compromise

Hypovolemia and Anesthetic Agents

Head Injury and General Anesthesia

Cardiac Injury and Anesthetic Agents

Anesthetic Agents and Burns

Maintaining Normothermia

General Anesthesia and Damage Control Surgery

Key Points

Further Reading

Chapter 8 Regional Anesthesia for Trauma

General Considerations

Regional Anesthesia: Concerns in the Trauma Patient

Obtaining Informed Consent

Hemodynamic Instability

Coagulation Status

Traumatic Nerve Injury

Risk of Infection

Compartment Syndrome

Fall Risk

Ultrasound in Regional Anesthesia

Physics of Ultrasound

Needle Approaches to Nerves

Short Axis – In-plane

Short Axis – Out-of-Plane

Long Axis – In-plane

Long Axis – Out-of-plane

Upper Extremity Blocks

Interscalene Block

Supraclavicular Block

Infraclavicular Block

Axillary Block

Elbow Block

Lower Extremity Blocks

Femoral Nerve Block

Adductor Canal Block

Lateral Femoral Cutaneous Nerve Block

Sciatic Nerve Blocks

Gluteal Approach

Lateral Popliteal Approach

Selection of Local Anesthetic and Catheter Placement for Peripheral Nerve Blocks

Local Anesthetic Toxicity

Neuraxial and Paravertebral Blocks

Subarachnoid Block

Epidural Block

Paravertebral Block

Key Points

Further Reading

Chapter 9 Monitoring the Trauma Patient

Introduction

Non-invasive Monitors

Pulse Oximetry

Non-invasive Blood Pressure Monitoring

Capnography

Electrocardiography

Temperature Monitoring

Transesophageal Echocardiography (TEE)

Awareness Monitoring

Neuromuscular Monitoring

Invasive Monitors

Arterial Catheter

Central Venous Catheter (CVC)

Pulmonary Artery Catheter

Cardiac Output

Venous Saturation

Dynamic Monitors of Fluid Bolus Responsiveness

Intracranial Pressure (ICP) Monitoring

Serum Markers of Tissue Perfusion and Oxygen Debt

Lactate

Base Deficit

Monitoring of Trauma Patients When Monitors Fail

Key Points

Further Reading

Chapter 10 Echocardiography in Trauma

Introduction

Indications for Echocardiography in Trauma Patients Requiring Non-cardiac Surgery

Clinical Applications of Echocardiography in Trauma Patients

Diagnostic Applications

Pneumothorax

Hemothorax

Pericardial Effusion and Cardiac Tamponade

Blunt Aortic Injury and Aortic Dissection

Hypovolemia, Myocardial Contusion (Injury to the Cardiac Myocardium), and Valvular Regurgitation

Monitoring Applications

Volume Status

Ventricular Function

Myocardial Ischemia and RWMAs

Valvular Lesions

Assessment of CO and Hemodynamic Monitoring

Intracardiac and Intrapulmonary Shunting

Pulmonary Emboli; Air and Fat Emboli Monitoring

Performance of the Perioperative Echocardiography Exam

Pre-cardiac Arrest State

Conclusions

Key Points

Further Reading

Chapter 11 Coagulation Monitoring of the Bleeding Trauma Patient

Introduction

Current Concepts of the Coagulation System

Assessment of Coagulation

1. Medical History

2. Clinical Presentation

3. Standard Laboratory Coagulation Tests

4. Bedside Point-of-Care (POC) Coagulation Tests

POC Monitoring of the Entire Coagulation Process

TEG and ROTEM

Sonoclot Coagulation and Platelet Function Analyzer

Simplified Interpretation for TEG/ROTEM Readouts

Standard Laboratory Coagulation Tests versus Viscoelastic Coagulation Tests in Trauma

Economic Aspects of the Utilization of POC Viscoelastic Coagulation Testing

Treatment of Coagulopathy

Conclusions

Key Points

Further Reading

Chapter 12 Postoperative Care of the Trauma Patient

Introduction

Disposition and Transport from the Operating Room (OR)

Secondary Resuscitation

Postoperative Pain Management and Sedation

Ventilator Management

Neurologic Considerations

Cardiovascular Concerns

Renal and Acid/Base Considerations

Gastrointestinal and Nutritional Support

Postoperative Infection and Sepsis

Key Points

Further Reading

Section 2 Anesthetic Considerations for Trauma

Chapter 13 Anesthetic Considerations for Adult Traumatic Brain Injury

Introduction

Epidemiology

Pathophysiology

Preoperative Considerations

Laboratory Investigations

Intraoperative Management

Oxygenation and Ventilation

Anesthetic Technique

Intraoperative Monitoring

Hemodynamic Management

Fluid Management

Anemia

Coagulopathy

Glucose Control

Therapeutic Hypothermia

Decompressive Craniectomy

Non-neurologic Surgery in Neurologically Injured Patients

Emergence from Anesthesia

Key Points

Further Reading

Chapter 14 Anesthetic Considerations for Spinal Cord Injury

Epidemiology

Etiology

Traumatic

Non-traumatic

Pathophysiology

Clinical Presentation and Classification of Spinal Cord Injury

Initial Assessment

Airway Management

Cardiovascular Management

Early Surgical Decompression

Therapeutic Hypothermia

Blood Loss Prevention

Intraoperative Spinal Cord Monitoring

Wake-up Test

Somatosensory Evoked Potentials

Motor Evoked Potentials

Electromyography

Clinical Application

Pharmacologic Agents in SCI Therapy

Key Points

Further Reading

Chapter 15 Anesthetic Considerations for Ocular and Maxillofacial Trauma

Introduction

Ocular Trauma

Mechanisms of Ocular Trauma

Preoperative Evaluation of the Patient with Eye Injury

Intraocular Pressure

The Oculocardiac Reflex

Anesthetic Management

Induction Agents

Neuromuscular Blocking Agents

Maintenance of Anesthesia (see also Chapter 7)

Emergence of Anesthesia

Maxillofacial Trauma

Mechanisms of Maxillofacial Trauma

Classification of Facial Trauma

Preoperative Assessment

Emergency Airway Management in Maxillofacial Trauma (see also Chapter 3)

Preoxygenation and Tracheal Intubation

Bleeding from Maxillofacial Injuries

Anesthetic Management in Elective Maxillofacial Repair

Surgical Considerations

Airway Considerations

Anesthetic Considerations

Key Points

Further Reading

Chapter 16 Anesthetic Considerations for Chest Trauma

Introduction

Mechanism of Injury

Pathophysiology

Pulmonary Contusion

Rib Fractures/Flail Chest

Tracheobronchial Injury

Pneumothorax

Hemothorax

Vascular Air Embolism After Chest Trauma

One-lung Ventilation

Cardiac Injuries

Tamponade

Emergency Department Thoracotomy

Traumatic Aortic Injury

Key Points

Further Reading

Chapter 17 Anesthetic Considerations for Abdominal Trauma

Introduction

Anatomic Considerations

Mechanisms of Injury

Preoperative Evaluation and Management (See Also Chapter 2)

Early Involvement

History

Physical Exam of the Abdomen

Diagnostic Studies

Hemodynamic Instability in the Preoperative Period

Intraoperative Management

Airway

Breathing

Circulation

Monitoring (See Chapter 9)

Drugs

Induction Agents

Neuromuscular Relaxants

Maintenance of Anesthesia

Exploratory Laparoscopy

Exploratory Laparotomy

Surgical Approach

Anesthetic Considerations

Damage Control Laparotomy

Surgical Considerations

Anesthetic Considerations

Re-exploration Surgery

Release of Abdominal Compartment Syndrome

Anesthetic Considerations

Other Indications for Urgent Re-exploration after Abdominal Trauma

Definitive Repair Surgery

Surgical and Anesthetic Considerations for Specific Abdominal Injuries

Intraperitoneal Injuries

Retroperitoneal Injuries

Great Vessel Injuries

Anesthetic Considerations for Angiographic Embolization

Advantages of Angiographic Embolization

Interventional Radiology Techniques

Possible Complications

Resuscitative Endovascular Balloon Occlusion of the Aorta

Key Points

Further Reading

Chapter 18 Anesthetic Considerations for Musculoskeletal Trauma

Introduction

Choice of Anesthetic Technique

Regional Anesthesia for Musculoskeletal Trauma (See Also Chapter 8)

General Anesthesia for Musculoskeletal Trauma (See Also Chapter 7)

Perioperative Preparation for Orthopedic Trauma Surgery

Pain Management

Regional Anesthesia (See Also Chapter 8)

Femur Fracture Management

Pelvic Fracture Management

Two or More Mechanically Unstable Fractures

Hip Dislocation

Open Fractures

Traumatic Amputation

Vascular Injury

Fat Embolism

Compartment Syndrome

Crush Injuries

Key Points

Further Reading

Section 3 Anesthetic Management in Special Trauma Populations

Chapter 19 Anesthetic Management of the Burn Patient

Introduction

Epidemiology

Pathophysiology of Burn Injuries

Electrical and Chemical Burns

Smoke Inhalation

Pharmacology Considerations in Severe Burn Injuries

Initial Management of the Burn Patient

Special Considerations During Intrahospital Transport of Burn Patients

Anesthetic Management

Monitoring

Airway Management

Anesthetic Drugs

Regional Anesthesia

Intraoperative Fluid Management

Extubation

Postoperative Period

Key Points

Further Reading

Chapter 20 Anesthetic Management of the Pediatric Trauma Patient

Introduction

Initial Assessment and Resuscitation

Primary Survey

Airway and Breathing

Circulation

Neurologic Function

Secondary Survey

Anesthetic Management

Preoperative Evaluation and Preparation

Induction and Intubation

Intubation Technique

Induction Agents

Neuromuscular Blocking Drugs

Maintenance of Anesthesia

Intraoperative Fluid Management

Postoperative Care

Key Points

Further Reading

Chapter 21 Anesthetic Management of the Geriatric Trauma Patient

Introduction

Etiology of Trauma in the Elderly

Age-Related Changes in Physiology

Cardiovascular Function

Anesthetic Concerns

Respiratory Function

Anesthetic Concerns

Renal Function

Anesthetic Concerns

Central Nervous System Function

Anesthetic Concerns

Pharmacologic Changes

Anesthetic Concerns

Preoperative Evaluation

Intraoperative Management

Airway

Breathing

Circulation

Intraoperative Monitoring

Temperature Control

Anesthesia for the Most Common Injuries in the Elderly

Orthopedic Trauma

Surgical Considerations

Anesthetic Considerations

Hip Fractures

Surgical Considerations

Anesthetic Considerations

Splenic Trauma

Chest Trauma and Rib Fractures

Closed Head Trauma

Anesthetic Considerations

Outcomes of the Geriatric Trauma Patient

Key Points

Further Reading

Chapter 22 Anesthetic Management of the Pregnant Trauma Patient

Introduction

Mechanisms of Injury

Blunt Trauma

Penetrating Trauma

Burns

Complications

Obstetric Issues

Placental Abruption

Uterine Rupture

Fetal Outcome

Primary Survey

Imaging

Anesthetic Perioperative and Intraoperative Management

History

Physical Examination

Anesthesia Technique

Premedication

Positioning

Induction of Anesthesia

Airway Management

Resuscitation and Transfusion

Resuscitation

Transfusion Ratios

Disseminated Intravascular Coagulation

Antifibrinolytics

Laboratory Evaluation

Rh(D) Isoimmunization in an Rh(D)-Negative Mother (Rh Sensitization)

Advanced Cardiac Life Support

Emergency Cesarean Delivery During Cardiac Arrest

Fetal Heart Rate Monitoring after Trauma

Multidisciplinary Management

Key Points

Further Reading

Index

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