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Principles of Anesthesiology Nursing IV Trauma Anesthesia Management Jeffrey Groom, PhD, CRNA, ARNP Interim Director

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Principles of Anesthesiology Nursing IV Trauma Anesthesia Management Jeffrey Groom, PhD, CRNA, ARNP Interim Director

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    2. Trauma Team Management

    3. Trauma & Anesthesia Management

    4. Trauma & Anesthesia Management TRAUMA TRIAGE - Physiologic AVPU = responsive to voice, pain, or unresponsive GCS < 12 Evidence of poor perfusion (skin pallor, cool extremities, weak distal pulses, cyanosis/mottling, etc.) Heart rate: peds : < 80/min or > 160/min adult : < 60/min or > 130/min Systolic BP < 90 mmHg Respiratory rate <10 > 30, or respiratory distress, or apnea Capillary refill > 2 seconds (evaluated on warm body part)

    5. Trauma & Anesthesia Management TRAUMA TRIAGE - ANATOMIC Penetrating Injuries (ex., Gunshot Wounds, Stab Wounds) to Head, Neck, Torso, Extremities (above the elbow and knee) Flail Chest Fractures - More Than One Fracture Involving Humerus and/or Femur Pelvic Fractures Paralysis or Evidence of a Spinal Cord Injury Amputation Above Wrist or Ankle Burns When Combined with Other Major Injuries High Voltage Electrical Injury

    6. Trauma & Anesthesia Management TRAUMA TRIAGE – MECHANISM of INJURY Ejection from Motor Vehicle Extrication > 20 min with an injury Falls > 20 feet Unrestrained Passenger in Vehicle Roll Over Pedestrian, Motorcyclist or Pedalcyclist Thrown or Run Over

    9. A Simple Approach

    10. A Simple Approach

    11. START Triage Algorithm

    14. Trauma & Anesthesia Management Extremity Thermal Electrical Multitrauma

    15. Thermal Injury Assessment

    16. Trauma & Anesthesia Management Head Trauma Open vs Closed Immediate vs Delayed Concussion Contusion Intracranial & Intracerebral bleeds Herniation Intracranial Pressure

    20. Trauma & Anesthesia Management Spinal Trauma Cervical Thoracic Lumbar Etiology Blunt trauma Compression Penetrating Management Xray and MRI

    22. Airway and C-Spine

    24. Trauma & Anesthesia Management Facial Trauma Facial Eye Mouth Neck Trauma C-spine Trachea Soft tissue

    25. Trauma & Anesthesia Management Thoracic and Abdominal Open vs. Closed Vascular vs. Nonvascular Associated Spinal Injury Examine all sides/back of patient

    28. Preanesthesia History Info from and about the scene Info about the accident or injury Past medical/surgical history Allergies, meals, meds, immunizations Substances of abuse: ETOH -Cocaine -Meth Marijuana -Inhalants -Opioids

    29. Physical Examination Primary & Secondary Survey Particular focus on: AIRWAY- face, mouth, neck RESPIRATORY- chest, diaphragm CARDIAC- chest, bleeding, IV access NEURO- ?LOC, GCS scores, pupils, motor LABS: SMAC, Type & Cross, ABG C-spine, CXR, CAT, MRI

    30. MONITORING Standard Monitors: EKG -BP -SaO2 -Temp Urine -EtCO2 -NMB -A-line Secondary Monitors: ICP -CVP -PA cath -LABs Room set up - Trauma cart Monitors -Airway -Warmers -Lines

    32. Intra-op Trauma Management Intra-Op Problems Multi-system Injury Massive Transfusions Hypothermia Prolonged Procedures Hypoxemia - Acidosis Cardiac Arrest

    33. EMERGENCE- ? Extubate, Post-op Pain PACU vs. ICU “ROAD TRIP” Post-op Trauma Management

    34. Trauma Team Management

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