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Opioid Trauma Case Study

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As with most trauma patients, this patient should be considered a to have a full stomach. Therefore, the prudent approach for the anesthetist would be to plan for a rapid sequence induction, using a short-acting muscle relaxant such as succinylcholine. The patient’s clinical picture indicates that there is still some occult bleeding and she remains hypotensive despite resuscitation. Therefore, versed, propofol, and large amounts of inhalational agent should be avoided. Small doses of versed can worsen hypotension. Inhalational agent such as Desflurane or Sevoflurane should be kept to less than 1 MAC. Opioids, ketamine and etomidate in decreased doses are better choices when attempting to optimize intubating conditions. According to Barash (2013), …show more content…

In addition to the pelvic ring injury and associated hemorrhage, visceral injuries may also occur. Patients may have posterior or perineal wounds or rectal trauma that are treated with a colostomy. Extra-peritoneal bladder tears are repaired. The trauma patient above is noted to have blood in her vaginal vault and foley catheter. Therefore, the anesthetist can safely assume that she sustained colon and bladder damage secondary to the pelvic fracture. As a result, the patient will undergo emergent external fixation requiring a team approach to help mange the care of this complex, and critically ill …show more content…

Therefore, the prudent approach for the anesthetist would be to plan for a rapid sequence induction, using a short-acting muscle relaxant such as succinylcholine. The patient’s clinical picture indicates that there is still some occult bleeding and she remains hypotensive despite resuscitation. Therefore, versed, propofol, and large amounts of inhalational agent should be avoided. Small doses of versed can worsen hypotension. Inhalational agent such as Desflurane or Sevoflurane should be kept to less than 1 MAC. Opioids, ketamine and etomidate in decreased doses are better choices when attempting to optimize intubating conditions. According to Barash (2013), metabolic disturbances in the acute trauma patient cannot reliably prevent recall. However, scopolamine, (0.6 mg), and midazolam, if the patient can tolerate it, given before airway management may decrease the likelihood of this complication. Intraoperative use of the bispectral index (BIS) monitor and, whenever possible, titrating anesthetics to bispectral bispectral index levels < 60 may prevent recall in trauma

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