Anesthesiology clinics
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Anesthesiology clinics · Mar 2007
ReviewGeriatric trauma: special considerations in the anesthetic management of the injured elderly patient.
Modern society is characterized as having an ever enlarging population of older adults. There are more elderly patients, and the average age of this group is increasing. ⋯ Evaluation of the physiologic status of the geriatric patient should take into account the variability of the changes associated with advancing age. Care of the injured elderly patient requires thorough preoperative assessment and planning and the involvement of a multidisciplinary clinical team knowledgeable about and interested in the management of the elderly surgical patient.
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Novel nonsurgical approaches to bleeding control offer hope for improved management of the critical trauma-related coagulopathy and diffuse bleeding that often typify major trauma and pose challenges to surgeons and anesthetists. Although surgical treatment is the cornerstone of bleeding control, in selected patients angiographic embolization is increasingly used early in patient care to successfully manage arterial bleeding attributable to blunt solid organ injury or posterior pelvic ring disruption. Coagulopathic derangements in trauma occur early and require avoidance or correction of acidosis and hypothermia. If bleeding cannot be stopped by these measures, adjunctive use of fibrinogen or recombinant activated factor VII (rFVIIa) have the potential to correct systemic coagulopathy associated with massive blood loss and its management.
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Anesthesiology clinics · Mar 2007
ReviewTraining and assessment of trauma management: the role of simulation-based medical education.
Simulation-based medical education (SBME) offers a safe and "mistake-forgiving" environment to teach and train medical professionals. The diverse range of medical simulation modalities enables trainees to acquire and practice an array of tasks and skills. SBME offers the field of trauma training multiple opportunities to enhance the effectiveness of the education provided in this challenging domain. In this article, the authors describe the possible roles of simulated patients, skills trainers, computerized patient simulators, and web-based teaching in trauma training, and describe some practical aspects of using simulation for trauma training.
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Three important issues concerning homeostasis in the acute care of trauma patients that are related directly to the stress response are hyperglycemia, lactic acidosis, and hypothermia. Recently, there has been a resurgence of interest in investigating the effects of aggressive thermal and glucose concentration and volume resuscitation on outcomes in critically ill and trauma patients. Significant reason exists to question the "conventional wisdom" relating to current approaches to restoring homeostasis in this patient population.
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Anesthesiology clinics · Mar 2007
ReviewBattlefield anesthesia: advances in patient care and pain management.
Expeditionary maneuver warfare and the asymmetric battlefield have forced changes in the traditional methods with which we deliver anesthesia and surgery to the wounded. Although in many ways similar to how we have operated on the wounded for the past half century, new advances in diagnostic and therapeutic modalities and doctrinal shifts have changed the face of the battlefield hospital. In this article, the authors discuss these changes in regard to anesthetic care for surgical and pain management for wounded airmen, sailors, soldiers, and marines.