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

Initial Status After OR Arrival for Thoracotomy and Ex-Lap BP 30/15 | HR 106 | SaO 2 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

Monitors & Equipment Arterial and NIBP Blood Pressure Central Venous Pressure (CVP) ECG a.k.a. EKG with ST analysis (standard) SaO 2 | FiO 2 | Anes. gas monitor Vent monitors (RR/PIP/Vt/I:E) Altan Dean Rapid Infuser

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

Course of Events

Fluid Resuscitated

Blood Gas Analysis

Blood Gas Analysis Post-OP

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

Hemoglobin & Hematocrit Trend

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.

Coagulopathy

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