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Anesthesiology Clinics

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https://read.qxmd.com/read/30711238/modern-day-trauma-care-for-the-anesthesiologist
#1
EDITORIAL
Maureen McCunn, Mohammed Iqbal Ahmed, Catherine M Kuza
No abstract text is available yet for this article.
March 2019: Anesthesiology Clinics
https://read.qxmd.com/read/30711237/perioperative-care-of-the-trauma-patient-new-concepts-since-wartime-learning
#2
EDITORIAL
Lee A Fleisher
No abstract text is available yet for this article.
March 2019: Anesthesiology Clinics
https://read.qxmd.com/read/30711236/the-use-of-point-of-care-ultrasonography-in-trauma-anesthesia
#3
REVIEW
Davinder Ramsingh, Venkat Reddy Mangunta
Caring for the trauma patient requires an in-depth knowledge of the pathophysiology of trauma, the ability to rapidly diagnose and intervene to reverse the derangements caused by shock states, and an aptitude for the use of advanced monitoring techniques and perioperative point-of-care ultrasonography (P-POCUS) to assist in diagnosis and delivery of care. Historically, anesthesiology has lagged behind in wholly embracing this technology. P-POCUS has the potential to allow the trauma anesthesiologist to diagnose numerous injuries, quickly guide the placement of central vascular catheters and invasive monitors, and assess the efficacy of interventions...
March 2019: Anesthesiology Clinics
https://read.qxmd.com/read/30711235/pain-management-in-trauma-in-the-age-of-the-opioid-crisis
#4
REVIEW
Jessica Lynn Gross, Alison R Perate, Nabil M Elkassabany
It is imperative to find the balance between pain control and addressing the opioid epidemic. Opioids, although effective in the acute pain management, have multiple side effects and can lead to dependence, abuse, overdose, or death. Physicians should identify patients who abuse opioids, using their states' prescription drug-monitoring programs and use screening tools to identify patients at increased risk of developing opioid dependence. Multimodal analgesic plans, incorporating regional techniques, and nonopioid medications should be employed to reduce the amount of opioids received by patients...
March 2019: Anesthesiology Clinics
https://read.qxmd.com/read/30711234/enhanced-recovery-after-surgery-are-the-principles-applicable-to-adult-and-geriatric-acute-care-and-trauma-surgery
#5
REVIEW
Mandeep Singh, Reza Askari, Matthias Stopfkuchen-Evans
The incorporation of enhanced recovery after surgery (ERAS) fundamentals into perioperative medicine has improved the patient care experience and hastened recovery time while reducing hospital costs. Research studies have shown that incorporating ERAS principles in the adult or geriatric acute care surgery populations minimizes time to resumption of preoperative activity and reduces hospital length of stay. ERAS principles are widely applicable to these patient cohorts and may be applicable in trauma patients...
March 2019: Anesthesiology Clinics
https://read.qxmd.com/read/30711233/viscoelastic-monitoring-to-guide-the-correction-of-perioperative-coagulopathy-and-massive-transfusion-in-patients-with-life-threatening-hemorrhage
#6
REVIEW
Kevin P Blaine, Marc P Steurer
The resuscitation of patients with traumatic hemorrhage remains a challenging clinical scenario. The appropriate and aggressive support of the patient's coagulation is of critical importance. Conventional coagulation assays present several shortcomings in this setting. The integration of viscoelastic monitoring in clinical practice has the potential to result in significant improvements. In order to be successful, the provider must understand basics of the methodology, read outs, and the limitations of the technique...
March 2019: Anesthesiology Clinics
https://read.qxmd.com/read/30711232/trauma-airway-management-induction-agents-rapid-versus-slower-sequence-intubations-and-special-considerations
#7
REVIEW
Stephen R Estime, Catherine M Kuza
Trauma patients who require intubation are at higher risk for aspiration, agitation/combativeness, distorted anatomy, hemodynamic instability, an unstable cervical spine, and complicated injuries. Although rapid-sequence intubation is the most common technique in trauma, slow-sequence intubation may reduce the risk for failed intubation and cardiovascular collapse. Providers often choose plans with which they are most comfortable. However, developing a flexible team-based approach, through recognition of complicating factors in trauma patients, improves airway management success...
March 2019: Anesthesiology Clinics
https://read.qxmd.com/read/30711231/future-trends-in-trauma-care-through-the-lens-of-the-wounded-how-lessons-from-the-battlefield-may-be-used-at-home
#8
REVIEW
Matthew D'Angelo, Matthew Welder, Ravi Chauhan, Michel J Kearns
The coordinated terrorist attacks of 2001 thrust the United States and its allies to war. Through an evolving battlefield, the paradigm of large fixed medical facilities advanced to become nimble surgical and resuscitative platforms, able to provide care far forward. Innovations like tactical combat casualty care, evacuation, fresh whole-blood administration, freeze-dried plasma, and forward surgical care military medicine helped reduce combat mortality to its lowest levels in history. Through the account of a young wounded marine wounded in Iraq, this article examines how innovations on the battlefield saved casualties and explores how these techniques may be applied at home...
March 2019: Anesthesiology Clinics
https://read.qxmd.com/read/30711230/novel-methods-for-hemorrhage-control-resuscitative-endovascular-balloon-occlusion-of-the-aorta-and-emergency-preservation-and-resuscitation
#9
REVIEW
Kazuhide Matsushima, Bianca Conti, Ravi Chauhan, Kenji Inaba, Richard P Dutton
Hemorrhage is the leading cause of preventable death after trauma. Junctional and extremity hemorrhage can be temporized with direct pressure and tourniquet application, but noncompressible torso hemorrhage has traditionally required operative or angiographic intervention. Retrograde endovascular balloon occlusion of the aorta (REBOA) can temporize patients with hemorrhage below the diaphragm long enough to enable definitive surgery. REBOA is increasingly available in US trauma centers but prospective, randomized demonstration of efficacy is not yet available...
March 2019: Anesthesiology Clinics
https://read.qxmd.com/read/30711229/hospital-planning-and-response-to-an-active-shooter-incident-preparing-for-the-n-1
#10
REVIEW
Kevin B Gerold
Changing patterns of violence in the United States and around the world are increasingly manifest as acts of mass violence and acts of terrorism. Preventing such attacks, reducing harms, and maintaining operations following such events requires the bolstering of key infrastructure facilities, such as hospitals, and developing response plans capable of detecting and withstanding such attacks. Attacks occurring in a hospital or clinic present unique challenges that differ from workplaces or schools. This article provides an overview of active shooter incidents occurring within health care facilities, and the fundamental knowledge on how to respond and manage these challenging situations...
March 2019: Anesthesiology Clinics
https://read.qxmd.com/read/30711228/the-anesthesiologist-s-response-to-hurricane-natural-disaster-incidents-hurricane-harvey
#11
REVIEW
Christopher T Stephens, Jaime Ortiz, Evan G Pivalizza
From personal experience and available resources, such as the American Society of Anesthesiologists Committee on Trauma and Emergency Preparedness templates from the manual for department procedures, the authors describe the primarily flooding impact of Hurricane Harvey in their area of Texas. They review the necessary analysis, development, and implementation of logistics; staffing and relief models; coordination with hospital partners; and dissemination of the planned procedures. The authors emphasize the commitment of anesthesiologists to patient care and rescue efforts outside of the operating room...
March 2019: Anesthesiology Clinics
https://read.qxmd.com/read/30711227/the-lifetime-effects-of-injury-postintensive-care-syndrome-and-posttraumatic-stress-disorder
#12
REVIEW
Meghan B Lane-Fall, Catherine M Kuza, Samir Fakhry, Lewis J Kaplan
Postintensive care syndrome (PICS) is a heterogeneous syndrome marked by physical, cognitive, and mental health impairments experienced by critical care survivors. It is a syndrome that bears significant human and health care costs. Additional research is needed to identify risk factors and diagnostic, preventative, and treatment strategies for PICS. Trauma intensive care unit patients are particularly vulnerable to posttraumatic stress disorder, which shares some of the adverse long-term consequences of PICS and also requires additional research into effective preventative and management strategies...
March 2019: Anesthesiology Clinics
https://read.qxmd.com/read/30711226/advanced-trauma-life-support-%C3%A2-update-2019-management-and-applications-for-adults-and-special-populations
#13
REVIEW
Samuel M Galvagno, Jeffry T Nahmias, David A Young
As the principal operating room resuscitationists, anesthesiologists must be familiar with the principles of Advanced Trauma Life Support® , 10th edition. This edition recommends a highly structured approach to trauma patients and endorses several advances in trauma resuscitation. There are less stringent guidelines for crystalloid administration, references to video-assisted laryngoscopy, suggested use of viscoelastic methods to guide transfusion decisions, and other changes reflecting recent advances. This article discusses trauma team approach to resuscitation, greater focus on special populations, de-emphasis of spinal immobilization in favor of restriction of spinal motion, and other updates and technical advances...
March 2019: Anesthesiology Clinics
https://read.qxmd.com/read/30711225/pediatric-traumatic-brain-injury-and-associated-topics-an-overview-of-abusive-head-trauma-nonaccidental-trauma-and-sports-concussions
#14
REVIEW
Erik B Smith, Jennifer K Lee, Monica S Vavilala, Sarah A Lee
Pediatric traumatic brain injury (TBI) uniquely affects the pediatric population. Abusive head trauma (AHT) is a subset of severe pediatric TBI usually affecting children in the first year of life. AHT is a form of nonaccidental trauma. Sports-related TBI resulting in concussion is a milder form of TBI affecting older children. Current recommended perioperative management of AHT and sports concussions relies on general pediatric TBI guidelines. Research into more specific pediatric TBI screening and management goals is ongoing...
March 2019: Anesthesiology Clinics
https://read.qxmd.com/read/30711224/gender-disparities-in-trauma-care-how-sex-determines-treatment-behavior-and-outcome
#15
REVIEW
Evie G Marcolini, Jennifer S Albrecht, Kinjal N Sethuraman, Lena M Napolitano
Trauma data bank and other research reveal sex disparities in trauma care. Risk-taking behaviors leading to traumatic injury have been associated with sex, menstrual cycle timing, and cortisol levels. Trauma patient treatment stratified by sex reveals differences in access to services at trauma centers as well as specific treatments, such as venous thromboembolism prophylaxis and massive transfusion component ratios. Trauma patient outcomes, such as in-hospital mortality, multiple organ failure, pneumonia, and sepsis are associated with sex disparities in the general trauma patient...
March 2019: Anesthesiology Clinics
https://read.qxmd.com/read/30711223/recognizing-preventable-death-is-there-a-role-of-survival-prediction-algorithms
#16
REVIEW
Oliver C Radke, Catherine Heim
Monitoring the quality of trauma care is important but particularly challenging. Preventable death assessment aims to identify those cases where the patient's death would have not occurred if the patient had been treated differently. Determination of preventable death in trauma care is often based on calculated probability of survival, commonly by using the Trauma and Injury Severity Score (TRISS). TRISS is not suited for identifying all cases with opportunities for improvement. Combined with other methods such as morbidity and mortality conferences, however, it might be a valid approach if a complete review of all trauma deaths is not feasible at an institution...
March 2019: Anesthesiology Clinics
https://read.qxmd.com/read/30390791/preoperative-patient-evaluation-practicing-evidence-based-cost-effective-medicine
#17
EDITORIAL
Zdravka Zafirova, Richard D Urman
No abstract text is available yet for this article.
December 2018: Anesthesiology Clinics
https://read.qxmd.com/read/30390790/preoperative-evaluation-is-it-time-to-view-it-as-a-component-of-perioperative-optimization
#18
EDITORIAL
Lee A Fleisher
No abstract text is available yet for this article.
December 2018: Anesthesiology Clinics
https://read.qxmd.com/read/30390789/optimizing-preoperative-anemia-to-improve-patient-outcomes
#19
REVIEW
Brittany N Burton, Alison M A'Court, Ethan Y Brovman, Michael J Scott, Richard D Urman, Rodney A Gabriel
Anemia is a decrease in red blood cell mass, which hinders oxygen delivery to tissues. Preoperative anemia has been shown to be associated with mortality and morbidity following major surgery. The preoperative care clinic is an ideal place to start screening for anemia and discussing potential interventions in order to optimize patients for surgery. This article (1) reviews the relevant literature and highlights consequences of preoperative anemia in the surgical setting, and (2) suggests strategies for screening and optimizing anemia in the preoperative setting...
December 2018: Anesthesiology Clinics
https://read.qxmd.com/read/30390788/preoperative-evaluation-of-the-pediatric-patient
#20
REVIEW
Allison Basel, Dusica Bajic
The article reviews frequently encountered preoperative concerns with a goal of minimizing complications during administration of pediatric anesthesia. It is written with general anesthesiologists in mind and provides a helpful overview of concerns for pediatric patient preparation for routine and nonemergent procedures or interventions. It covers unique topics for the pediatric population, including gestational age, respiratory and cardiovascular concerns, fasting guidelines, and management of preoperative anxiety, as well as the current hot topic of the potential neurotoxic effects of anesthetics on the developing brain...
December 2018: Anesthesiology Clinics
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