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Subspecialty

Trauma Anesthesia

Hemorrhage control, damage control resuscitation.

Trauma anesthesia demands rapid assessment, parallel processing, and damage-control resuscitation. Permissive hypotension, balanced transfusion (1:1:1), early TXA, and avoiding the lethal triad (acidosis, hypothermia, coagulopathy) save lives.

Key concepts

Massive transfusion protocol

Activate early — 1:1:1 RBC:FFP:platelets, TXA 1 g over 10 min then 1 g over 8 h (within 3 h of injury), 1 g calcium per 4 units RBC.

Damage-control resuscitation

Permissive hypotension (SBP 80–90) in non-TBI patients until hemorrhage controlled; avoid dilutional coagulopathy from crystalloid.

Hypothermia

Fluid warmers, forced-air warming, ambient room temperature — coagulopathy worsens dramatically below 35°C.

Difficult airway

Full stomach + potential c-spine + facial trauma + hypotension — RSI with ketamine (1–2 mg/kg) + roc (1.2 mg/kg) is workhorse.

Monitoring

  • Arterial line (when feasible)
  • Large bore peripheral / RIC introducer
  • Rapid infuser
  • Point-of-care labs (TEG, ABG)

Common drugs

KetamineEtomidateRocuroniumNorepinephrineCalcium chlorideTranexamic acidCryoprecipitate

Clinical pearls

1If hemorrhaging — blood, not crystalloid.
2Recheck the patient continually; trauma is a moving target.
3Communicate clearly with surgical team about pressure goals.

References & Further Reading

  1. 1
    GuidelineOpen source

    Panchal AR, et al. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for CPR and ECC. Circulation. 2020;142(16_suppl_2):S366-S468.

  2. 2
    Journal

    Holcomb JB, Tilley BC, Baraniuk S, et al. Transfusion of Plasma, Platelets, and Red Blood Cells in a 1:1:1 vs a 1:1:2 Ratio and Mortality in Patients With Severe Trauma: PROPPR Randomized Clinical Trial. JAMA. 2015;313(5):471-482.

  3. 3
    Textbook

    Gropper MA, Miller RD, Cohen NH, et al., eds. Miller's Anesthesia. 9th ed. Philadelphia: Elsevier; 2020.

  4. 4
    Textbook

    Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC, Ortega R, Sharar SR, Holt NF. Clinical Anesthesia. 8th ed. Philadelphia: Wolters Kluwer; 2017.

Citations are provided to direct further study. Always check the most current edition of guidelines and society recommendations — the information in this chapter is a teaching summary, not primary source material.