| Popis: |
Trauma is the leading cause of death in those under the age of 40 and is the third leading cause of death independent of age. Catastrophic perioperative complications are necessary to be prepared for in traumatic situations, and managing them is vital in the survival of mortally wounded patients. The most common causes of mortality in relation to trauma are hemorrhage, cardiopulmonary arrest, and multiple organ dysfunction. Common preventable causes of mortality include unintended extubation, surgical failures, missed injuries and poor examinations, and intravascular catheter-related complications (Teixeira et al. J Trauma 63(6):1338–1346, 2007; Teixeira et al. Arch Surg (Chicago, Ill.: 1960) 144(6):536–541, 2009). Patients with serious traumatic injuries have a significantly lower likelihood of mortality or morbidity when treated at a designated trauma center (MacKenzie et al. N Engl J Med 354(4):366–78, 2006). Most patients who die from traumatic injury perish in the first 4 h after the patient reaches a trauma center, so it is vital to quickly and succinctly provide the proper care (Demetriades et al. J Am Coll Surg 201(3):343–348, 2005; Demetriades et al. J Am Coll Surg 198(1):20–26, 2004). Few physicians specialize in trauma-related fields, and training must be obtained through experience and targeted programs. This lack of trauma-trained healthcare professionals, coupled with the increasing number of trauma patients, demands improvements in pre-arrival care as well as increased efficiency upon the arrival of the trauma patient. The preparation for trauma patients continues to develop to meet these demands such that the preparation of the traumatized patient is efficient and effective. The number of opportunities for specialists trained in trauma will also expand, and modern guidelines will be enhanced. This chapter addresses the perioperative management and care of common trauma-related pathologic situations, as well as catastrophic perioperative complications, in a body system organized manner. Additionally, we discuss the role of a diverse set of healthcare providers in the management of the traumatic patient and the initial responsibilities of the anesthesiologist on scene. |
