Anesthesia for Trauma: New Evidence and New Challenges PDF
Preview Anesthesia for Trauma: New Evidence and New Challenges
Corey S. Scher Editor Anesthesia for Trauma New Evidence and New Challenges 123 Anesthesia for Trauma . Corey S. Scher Editor Anesthesia for Trauma New Evidence and New Challenges Editor CoreyS.Scher BellevueHospitalCenter NewYorkUniversity NewYork,NY,USA ISBN978-1-4939-0908-7 ISBN978-1-4939-0909-4(eBook) DOI10.1007/978-1-4939-0909-4 SpringerNewYorkHeidelbergDordrechtLondon LibraryofCongressControlNumber:2014944317 #SpringerScience+BusinessMediaNewYork2014 Thisworkissubjecttocopyright.AllrightsarereservedbythePublisher,whetherthewholeor part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations,recitation,broadcasting,reproductiononmicrofilmsorinanyotherphysicalway, andtransmissionorinformationstorageandretrieval,electronicadaptation,computersoftware, orbysimilarordissimilarmethodologynowknownorhereafterdeveloped.Exemptedfromthis legalreservationarebriefexcerptsinconnectionwithreviewsorscholarlyanalysisormaterial suppliedspecificallyforthepurposeofbeingenteredandexecutedonacomputersystem,for exclusiveusebythepurchaserofthework.Duplicationofthispublicationorpartsthereofis permitted only under the provisions of the Copyright Law of the Publisher’s location, in its currentversion,andpermissionforusemustalwaysbeobtainedfromSpringer.Permissionsfor usemaybeobtainedthroughRightsLinkattheCopyrightClearanceCenter.Violationsareliable toprosecutionundertherespectiveCopyrightLaw. Theuseofgeneraldescriptivenames,registerednames,trademarks,servicemarks,etc.inthis publicationdoesnotimply,evenintheabsenceofaspecificstatement,thatsuchnamesare exemptfromtherelevantprotectivelawsandregulationsandthereforefreeforgeneraluse. Whiletheadviceandinformationinthisbookarebelievedtobetrueandaccurateatthedateof publication, neither the authors nor the editors nor the publisher can accept any legal responsibilityforanyerrorsoromissionsthatmaybemade.Thepublishermakesnowarranty, expressorimplied,withrespecttothematerialcontainedherein. Printedonacid-freepaper SpringerispartofSpringerScience+BusinessMedia(www.springer.com) Preface Ikeeptimethroughaconglomerationofthemedia,themusicindustry,and film.Myfirstexposuretotraumawasthroughthenightlytelecastsofthewar inVietNambythepartnershipofChetHuntleyandDavidBrinkleyofNBC news.WalterCronkitewasalegendatthesametimeperiodandrepresented CBS. Both were responsible for the graphic images of the war; Night night after night, for years, I was mesmerized by the images of the wounded and dead.Thefilmindustryjoinedin,takingadvantageofthepoliticsofthewar andthestaggeringnumberoftheinjuredanddeadtomakeApocalypseNow, Born on the fourth of July, Platoon, Good Morning Viet Nam, and so on. Although these were just films, their closeness to reality put the trauma patients in my face. With the music and festival of Woodstock, I have neverbeenabletoturnback. Traumawasagainbroughtfrontandcenterastheseedofmedicalschool wasplantedinmymind.Traumawasclearlyaspecializedfieldofmedicine. Likemanyfieldsofmedicine,thereislittleconsensusonwhattodowiththe trauma patient. In our recent history, other causes of trauma such as 9/11, Hurricane Katrina, the Haitian Earthquake, and the Tsunamis of Thailand and Japan have challenged trauma providers. Each one of these disasters presented trauma providers new sets of problems never seen before. The ongoing and complex conflicts in the Middle East (The Hurt Locker, The Lone Survivor, Argo, and Zero Dark Thirty) brought explosive devices, rocket-propelled grenades, and suicide bombers that created injuries we haveneverseenandchallengedustothehighestlevelintermsofprevention andtreatment. Readersinprofessionalfieldslookattextbooksseekingrecipestohandle definedmedicalorlegalproblems.Theinitialintentofthisbookwastooffer recipes to the anesthesiologist for each type of trauma. As all authors describe in this book, no two traumas are alike, most traumas include multiple sites that change the rules for one site. From a clinical research perspective,itisalmostimpossibletofindacohortofpatientsthatmatchone another.Simplystated,aconsensusofpracticeisofferedineachchapter,but thescientific evidence maynotbestrong.Themassive transfusionprotocol in Dr. Dutton’s chapter is well subscribed to by clinicians throughout the countrywithquestionableevidence. We break trauma down into anatomical parts and try tooffer consensus. Thebookstartsoffwithoneofthemostimportanttopics:assessmentofthe v vi Preface trauma patient. Dr. Wilson’s systematic examination of the patient and gathering of data is the standard approach to the trauma patient (Advanced TraumaLifeSupport).Dr.Dutton’schapteronbloodandbloodproductsisin alignment with the recommendations of American Society of Anesthesiologists. That said, many trauma centers have not adopted these recommendations for complex reasons. My chapter offers a consensus on howtotakecareofthemultitraumapatient.Theevidenceisstrongbutgoes against the grain of an approach that dates back to the Civil War (Lincoln 2013).Therewillbemanynaysayerswhowillkeeptothecurrentparadigm theypracticefrom.Simplystated,traumaprovidersmaynotbuyintowhatis nownewevidence. At every national anesthesia meeting, exhibitors demonstrate the latest difficultairwaydevice.Dr.Capanhasaninternationalreputationforairway management. This is an area of enormous research and development in devicesthatdealwiththedifficultandtraumatizedairway.Itisconceivable that the conventional laryngoscope’s life span can now be measured. Dr. Capan fills in any possible deficit in the understanding of the challenging airwayinhischapterkeepinginmindnewwaystoassessthebadairwaywith newdevices. It is difficult to separate the traumatized airway from cervical spine injuries. Dr. Abramowicz, a national expert on neuroanesthesia, links the twowhileDr.Frost,awell-knownnameinthefieldofanesthesiaandbrain science,coversthebrainandthespinalcord.Itwouldbeunusualifanairway trauma did not include the brain and the spinal cord. Dr. Frost offers the newestevidenceonthebrain,asubjectthatseemstobewaxingandwaning eachyear. Dr. Wang wrote two crucial chapters on burns. Many level I trauma centers may not take care of severely burned patients. The criteria for a hospitaltohaveaburncenteraredifferentfromalevelItraumacenter.Itis not unusual that trauma centers do not provide burn skills; I have read it severaltimestogainanotherskillthatIammissinginmytraumarepertoire. Itisthelargesttopicasitmakesupwhatismissingintheanesthesiologist’s literature. Thereareseveralchapters,whichIcallfoundationchaptersforclinicians, thatdescribethephysiologicalchangesinthe bodywith severe trauma.Dr. Liuetal.havewrittenacomprehensivepieceonthephysiologicalderange- ment of the trauma patient. In his chapter on trauma simulation, civilian traumasystems,Dr.Choihaspresentedtheemergingworldofsimulationfor thecliniciansothatcriticaladvancedtraumalifesupportstepsarenotmissed duringtheassessmentandinitialtreatment. Therearethreepatientpopulationsthatgetspecialattention:thepediatric trauma (Dr. Fox), the pregnant (Dr. Fedson-Hack) trauma patient, and the complexgeriatricpatient,whosenumberincreases(Dr.Alrayshi).Inallthe threechapters,weseealongstreamofpatientsflowingintothetraumabay. The endless lineup of these three groups of patients makes these chapters a vitalandwonderfulwelcometothisbook. The persistent Middle East wars have exposed anesthesiologists to blast injuries from suicide bombers, rocket-propelled grenades, and a wide array Preface vii ofexplosivedevices.Themedicalcorpsofourarmedserviceshaveoutfitted our soldiers with Kevlar vests, and a medical pack that soldiers wear. Dr. Field’schapterontraumaonthemilitarymightbethemostcompellinginthe bookasnewtreatmentsforseveretraumatothearmsandlegsarediscussed. Dr.Boldt’schapteronmicrovascularsurgeryonextremitiesandwoundfrom warcomplementDr.Field’swork.Thesealltieinwellwiththe2013Boston Marathon attack when two pressure cookers exploded and killed 3 and wounded over 260 civilians. These events resulted in multiple amputations andleg-sparingoperations. Fromterroristblastinjuriestomotorvehicleaccidentstobarfights,facial traumaisalmostalwaysinvolved.Dr.Clebone’scomprehensivechapteron facial trauma breaks down a very complex topic into a systematic mode of making acomprehensivediagnosisand its invariablerelationship toairway trauma. The chapter moves the anesthesiologist to securing the airway in manners not usually performed, which makes this chapter essential for all membersofthetraumateam. Most of our penetrating trauma patients either are inebriated or test positive for an illicit substance like cocaine and heroin. Prescription pain killers, benzodiazepines and countless other possible substances. Dr. Bryson’schapteronsubstanceabuseisenlighteningastheinitialassessment ismaskedbythesesubstances.Thereisastronglinkbetweentraumaandthis chapter is eye-opening to the clinician. The anesthesiologist must consider the patient as abusing substances until the toxicology screen comes back. Treating for withdrawal must also be considered. The chapter is the most comprehensiveIhaveseenonthesubject. There is rarely a night that a national news station is not reporting on trauma whether from conflict or by accident. Dr. Kaye, a popular name in pain management,addresses paininhis superbly writtenchapter. There are recipesinhischapterthatareevidencebasedandcanbefollowed. Dr.RoccafortetiesmanyofthethemesofthebooktogetherwithCivilian TraumaSystems,DisasterManagementandCritical,Howdoweorganizeif another large-scale attack hits the United States. How are resources distributedandwhatisnewincriticalcareforthesepatients? The title ofthe book restates one ofthe oldest themes in medicine. New evidence asks the clinician to step away from concepts ingrained in their practiceandchangeit.Often,changeismade,andnewevidenceturnsoutto be false. The reader of this book is asked to step back and consider those clinical changes that may improve their practice. The more the clinicians changetheirpractice,themorelikelythattheevidencehasstayingpower. NewYork,NY CoreyS.Scher ThiSisaFMBlankPage Contents 1 InitialAssessmentandManagementoftheTraumaPatient 1 ChadT.WilsonandAnnaClebone 2 AirwayManagementinTrauma. . . . . . . . . . . . . . . . . . . . 15 LevonM.CapanandSanfordM.Miller 3 PhysiologicalDerangementoftheTraumaPatient. . . . . . 45 HenryLiu,HongYan,SethChristian,SantiagoGomez, FrankRosinia,MingbingChen,JuanTan, CharlesJ.Fox,andAlanDavidKaye 4 BloodTransfusionandCoagulationDisorders. . . . . . . . . 67 L.YvetteFouche´-WeberandRichardP.Dutton 5 GeneralPrinciplesofIntraoperativeManagementofthe SevereBluntorPolytraumaPatient:TheResuscitative Phase. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 CoreyS.Scher,IncaChui,andSanfordM.Miller 6 PainControlinAcuteTrauma. . . . . . . . . . . . . . . . . . . . . 107 ChristopherK.Merritt,OrlandoJ.Salinas,andAlanDavidKaye 7 ChronicPaininTraumaPatients. . . . . . . . . . . . . . . . . . . 131 LindsayR.Higgins,WhitneyK.Braddy,MichaelS.Higgins, andAlanDavidKaye 8 BrainInjuries:PerianestheticManagement. . . . . . . . . . . 145 ElizabethA.M.Frost 9 AnesthesiaforCervicalSpinalCordInjury. . . . . . . . . . . 167 ApoloniaE.AbramowiczandMariaBustillo 10 AnestheticAssessmentandTreatmentofFacialandOcular Trauma. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193 AnnaClebone 11 ThoracicandAbdominalInjuries. . . . . . . . . . . . . . . . . . . 211 LevonM.CapanandSanfordM.Miller 12 MusculoskeletalInjuriesandMicrovascularSurgery. . . . 253 DavidW.BoldtandZarahD.Antongiorgi ix
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