Preoperative Assessment of the Acute Critically Ill Trauma Patient in the Emergency Department

Abstract

Trauma is a leading cause of morbidity and mortality worldwide. In the initial evaluation of the acute critically ill trauma patient, time is of the utmost importance, as is a rational, complete, and logical multidisciplinary evaluation. We will review the role of the anesthesiologist, the perioperative care physician, in the management of the trauma patients, aiming at specific goals considered critical in the ED setting. A rational approach to secure the airway is a priority in the acute critically ill trauma patients, often at risk for hypoxemia and acute lung injury: the most recent guidelines on airway management will be reviewed. Acute lung injuries deserve an aggressive and dynamic management: according to the most recent positions, the role and place of ultrasound (US) in the acute care of the traumatized patient will be discussed. Hemodynamic instability is the rule, and a rational approach managing hemorrhagic shock will be discussed, addressing in particular the role of static and dynamic parameters and again the role of US. This includes management of hemorrhagic hypovolemic shock and its sequelae (among them, coagulopathy, hemodilution, hypothermia, electrolyte abnormalities, and acid-base derangements), as well as other etiologies of shock after severe trauma. Acute traumatic coagulopathy is an emerging hot topic in the trauma setting: most recent theories will be reported and discussed, to provide the reader an updated approach managing the critically ill bleeding trauma patient.