Post on 14-Jan-2017
transcript
-Can only concentrate on one patient-Acts as supportive psychotherapist for surgeons
Hates chaos
Characteristics of an
anesthesiologist
no conflict of interests
AirwayManagement-Respiratory Insuffency:
RR <6 / >29-GCS <9
-Hypoxia: Sat < 90%
-Hemodynamic Instability: BP <90
Zeile 1 Zeile 2 Zeile 3 Zeile 40
2
4
6
8
10
12
Spalte 1Spalte 2Spalte 3
Effects of Muscle Relaxants
HyperkalemiaOxygen consuming
Long-term duration
Laryngoscopy #1
Laryngoscopy #2(+/- Bougie)
Laryngoscopy #3(Attending)
Laryngeal Mask Surgical Airway
ConfirmationCapnography
RSI
Calcium and Tranexamic Acid
Avoid Hypocalcemia < 0,9
TXA: Early Administration 1g/10 min followed by 1g/8h
Strategiesfor
rising ICPHyperventilation Mannitol
Hypertone NaCl 7,5%Normoxie
NormocapnieNormotonie
CCP > 50
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Taha SK et al. Effect of suxamethonium vs rocuronium on onset of oxygen desaturation during apnoea following rapid sequence induction. Anaesthesia. 2010 Apr;65(4):358-61
Wagner CE et al. Etomidate Use and Postoperative Outcomes among Cardiac Surgery Patients. Anesthesiology 2014; 579-89
Wang X et al. Ketamine does not increase intracranial pressure compared with opioids. J Anesth 2014
Futier E et al. A trial of intraoperative low-tidal-volume ventilation in abdominal surgery. NEJM 2013
Errando CL et al. Awareness with recall during general anaesthesia: a prospective observational evaluation of 4001 patients. British Journal of Anaesthesia 101 (2): 178–85 (2008)
Turner J et al. (2000) A randomised controlled trial of prehospital intravenous fluid replacement therapy in serious trauma. Health Technol Assess 4:1-57
Kozek-Langenecker S (2007) Monitoring hemostasis in emergency medicine. Yearb Intensive Care Emerg Med 848-859
References IIShakur H et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2) Lancet 2010; 376:23-32
Simonova G1 et al. Cyanoacrylate tissue adhesives - effective securement technique for intravascular catheters: in vitro testing of safety and feasibility. Anaesth Intensive Care. 2012 May;40(3):460-6.
Wilkinson JN et al. Tissue adhesive as an alternative to sutures for securing central venous catheters. Anaesthesia. 2007 Sep;62(9):969-70.
Kwan I et al. (2003) Timing and volume of fluid administration for patients with bleeding. Cochrane Database Syst Rev
Bickell Wh et al. (1994) Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries. NEJM 331:1105-1109
Annane D1 et al. Effects of fluid resuscitation with colloids vs crystalloids on mortality in critically ill patients presenting with hypovolemic shock: the CRISTAL randomized trial. JAMA. 2013 Nov 6;310(17):1809-17.
John A. Myburgh et al. Hydroxyethyl Starch or Saline for Fluid Resuscitation in Intensive Care. NEJM 2012; 367:1901-1911Richard PD. Damage Control Anesthesia. International TraumaCare (ITACCS) Fall 2005
Perner A. Et al. Hydroxyethyl Starch 130/0.42 versus Ringer's Acetate in Severe Sepsis. NEJM 2012; 367:124-134
Brunkhorst FM et al. Intensive Insulin Therapy and Pentastarch Resuscitation in Severe Sepsis (VISEP) NEJM 2008;358:125-39