Principles of Anesthesiology Nursing IV Trauma

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Principles of Anesthesiology Nursing IVTrauma
Anesthesia Management Jeffrey Groom, PhD, CRNA,
ARNPInterim Director Associate
ProfessorAnesthesiology Nursing ProgramSchool
of Nursing Florida International University
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Trauma Team Management
1. Communication 2. Prioritization 3.
Choreography 4. Safety 5. Protocols
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Trauma Anesthesia Management
http//www.itaccs.com
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Trauma Anesthesia Management

• TRAUMA TRIAGE - Physiologic
• AVPU responsive to voice, pain, or unresponsive
  
• GCS lt 12
• Evidence of poor perfusion (skin pallor, cool
  extremities, weak distal pulses,
  cyanosis/mottling, etc.)
• Heart rate peds lt 80/min or gt 160/min adult
  lt 60/min or gt 130/min
• Systolic BP lt 90 mmHg
• Respiratory rate lt10 gt 30, or respiratory
  distress, or apnea
• Capillary refill gt 2 seconds (evaluated on warm
  body part)

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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
  InvolvingHumerus 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

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Trauma Anesthesia Management

• TRAUMA TRIAGE MECHANISM of INJURY
• Ejection from Motor Vehicle
• Extrication gt 20 min with an injury
• Falls gt 20 feet
• Unrestrained Passenger in Vehicle Roll Over
• Pedestrian, Motorcyclist or PedalcyclistThrown
  or Run Over

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Triage Tag Characteristics

• Two sided
• Three basic components

• Tear Off Sections
• Main Body
• Peel-off Stickers

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Nerve Agent Antidote Kit (NAAK) Mark I Kit 2 mg
Atropine 600 mg Parlidoxime (2-PAM)
Organophosphate nerve agentstabun (GA), sarin
(GB), soman (GD), and cyclosarin (GF)
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A Simple Approach
The Triage Tag
SimpleTriageAndRapidTreatment
A Tag is placed on each patient once they have
been assessed. The tag displays the patients
current status and advises those providing
treatment with one of the four possible treatment
priorities
Minor Delayed Immediate Deceased
There are a variety styles and sizes of Triage
Tags
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A Simple Approach
The Triage Tag
SimpleTriageAndRapidTreatment
Each tab is distinctly color-coded allowing fast
patient priority identification from a distance
DECEASED
IMMEDIATE
DELAYED
MINOR
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START Triage Algorithm
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Pediatric Trauma
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Trauma Anesthesia Management

• Extremity
• Thermal
• Electrical
• Multitrauma

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Thermal Injury Assessment
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Trauma Anesthesia Management

• Head Trauma
• Open vs Closed
• Immediate vs Delayed
• Concussion
• Contusion
• Intracranial Intracerebral bleeds
• Herniation
• Intracranial Pressure

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Facial Trauma Cervical Spine InjuryAirwayC-sp
ine

• Primary injury - immediate from bruising or
  penetrating objects
• Secondary injury - hypoxia or decreased perfusion
• - Caused by swelling, hypoxia, or hypotension

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Mechanism of Injury Physical Exam Serial
Neurological Assessment CT/MRI Head and Neck
Injury
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• Head Trauma
• Airway 1
• C-spine precautions
• Do no harm
• Impalements /Fragments
• Drainage
• Serial monitoring
• ICP Control
• Prevention
• Intervention
• Brain protection
• Airway 1

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Trauma Anesthesia Management

• Spinal Trauma
• Cervical
• Thoracic
• Lumbar
• Etiology
• Blunt trauma
• Compression
• Penetrating
• Management
• Xray and MRI

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Airway and C-Spine
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Helmet Removal vs. Stabilize
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Trauma Anesthesia Management

• Facial Trauma
• Facial
• Eye
• Mouth
• Neck Trauma
• C-spine
• Trachea
• Soft tissue

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Trauma Anesthesia Management

• Thoracic and Abdominal
• Open vs. Closed
• Vascular vs. Nonvascular
• Associated Spinal Injury
• Examine all sides/back of patient

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Needle Decompression of Tension Pneumothorax
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ALWAYS Check BACK SIDES
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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

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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

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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

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Intra-op Trauma Management

• Anesthesia Care Plan

• General vs. Regional vs. MAC
• Induction Agents -
• DOSE more important than agent
• Etomidate vs. Ketamine, STP, Propofol
• Opioids Benzos
• Inhaled Agents N2O
• Muscle Relaxant - SUX vs. Nondepols

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Intra-op Trauma Management

• Intra-Op Problems
• Multi-system Injury
• Massive Transfusions
• Hypothermia
• Prolonged Procedures
• Hypoxemia - Acidosis
• Cardiac Arrest

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Post-op Trauma Management

• EMERGENCE-
• ? Extubate, Post-op Pain
• PACU vs. ICU
• ROAD TRIP

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Trauma Team Management
1. Communication 2. Prioritization 3.
Choreography 4. Safety 5. Protocols
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