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Anesthetic Management of The Trauma Patient

Anesthetic Management of The Trauma Patient. Baseline Prior To OR. BP 90/40 | HR 130s | Intubated CV Left chest ant & post wounds/ left calf wound Right CT with 400cc blood returned Decreased right breath sounds Aggressive Resuscitation Underway.

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Anesthetic Management of The Trauma Patient

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  1. Anesthetic Management of The Trauma Patient

  2. Baseline Prior To OR • BP 90/40 | HR 130s | Intubated CV • Left chest ant & post wounds/ left calf wound • Right CT with 400cc blood returned • Decreased right breath sounds • Aggressive Resuscitation Underway

  3. Initial Status After OR Arrivalfor Thoracotomy and Ex-Lap • BP 30/15 | HR 106 | SaO2 98 % • Resuscitation continuing • Multiple IV Access attained • Right rad A- line • Right 16g and 18g iv • Left 16g iv • Right 16g IJ with CVP monitoring

  4. Monitors & Equipment • Arterial and NIBP Blood Pressure • Central Venous Pressure (CVP) • ECG a.k.a. EKG with ST analysis (standard) • SaO2 | FiO2 | Anes. gas monitor • Vent monitors (RR/PIP/Vt/I:E) • Altan Dean Rapid Infuser

  5. Anesthetic Agents • Initially: • 100% Oxygen and Midzolam (Versed) with Cisatracurium (Nimbex) for muscle relaxation. • ** Patient’s vital signs would not tolerate any additional anesthetics.

  6. Course of Events

  7. Fluid Resuscitated

  8. Blood Gas Analysis

  9. Blood Gas AnalysisPost-OP

  10. Hemoglobin and Hematocrit • Hemoglobin: -protein that carries oxygen in blood -normally saturated 95-100% -Normal 10-14g/dl • Hematocrit: -measures red cell mass, anemia, hydration. -normal 42-52%

  11. Hemoglobin & Hematocrit Trend

  12. Coagulation • PT: used to monitor coumadin, Vit. K def, Factor def., DIC • PTT: used to monitor heparin therapy. • Fibrinogen: protein that converts to fibrin to make clot • INR: for monitoring oral anticoagulants, interantional standard value.

  13. Coagulopathy

  14. Immediate Post-Op Course • Vitals (HR 143* BP 85mmHg(mean) Pox 98% • H/H (9.7/27.2) • ABG: 7.43/38/54 • Critical Cond. Continuous vigorous volume replacement • Pt. on ventilator in SICU

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