In the U.S., trauma is the leading cause of death for patients younger than 40 years old, and up to a third of all hospital admissions are related to trauma. Management of trauma patients can be especially challenging due to the intensive resource requirements and multiple injuries to various body systems. In a trauma center, the anesthesiologist often becomes involved as soon as the patient arrives to the ED trauma bay, beginning with airway and resuscitation management and possibly proceeding through the operating room, then postoperatively to the intensive care unit.
The anesthesiologist must have an understanding of the design of the trauma system and what the surgical priorities are. Trauma patients are unique in that their history is limited, they are frequently have full stomachs and cervical spine instability, and are often intoxicated. The advanced trauma life support (ATLS) course from the American College of Surgeons is a widely recognized framework for caring for injured patients, with emphasis on the ABCDE mnemonic: airway, breathing, circulation, disability, and exposure.
The anesthesiologist is especially qualified in airway management, and ensuring an open airway and adequate respiration is of utmost importance to avoid cerebral hypoxia and death. Rapid sequence induction should be performed and an endotracheal intubation must be confirmed by capnometry. Intubation should be performed using in-line cervical stabilization, and a surgeon who is proficient at cricothyroidotomy should be readily available. A bougie, Glidescope, or LMA may be necessary to manage a difficult airway.
Managing bleeding is a priority, and shock is presumed to be from hemorrhage until proven otherwise. Administration of fluids including blood products via large bore intravenous catheters is critical in increasing cardiac output and blood pressure in a hypovolemic trauma patient. Emergency surgery may be necessary to diagnose or control active bleeding. The anesthesiologist can ensure the patient receives warming fluids rapidly, and assist in increasing the room temperature and covering the patient with warm blankets. Maintaining cerebral perfusion may be critical in patients with severe traumatic brain injury and intracranial hemorrhage. Invasive monitors such as arterial lines, central lines, and pulmonary artery catheters may be necessary but should not delay the aforementioned resuscitation priorities.
Patients of all ages and backgrounds can suffer trauma, and because of its prevalence, many anesthesiologists will have to care for trauma patients. Because of their appropriate and specific type of training, anesthesiologists are ideally suited to care for these patients.
