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 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

4. 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

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

6. Course of Events

7. Fluid Resuscitated

8. Blood Gas Analysis

9. Blood Gas Analysis Post-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