Summary

In study session VII you have learnt

• The abdomen and extremities are frequently injured following trauma, are major site for posttraumatic bleeding.
• Early death from abdominal trauma most commonly results from uncontrolled hemorrhage, and late death is most commonly attributable to sepsis.
• Abdominal trauma is usually divided into penetrating and nonpenetrating. Penetrating abdominal injuries are usually obvious with entry marks on the abdomen or lower chest. Blunt abdominal trauma is a compression of the abdominal cavity against fixed object solid organs, especially spleen and liver, are most commonly injured following blunt abdominal trauma.
• The liver is the most commonly injured solid organ following penetrating trauma and the second most commonly injured organ following blunt trauma. The spleen is the most commonly injured abdominal organ following blunt trauma, and is also frequently injured following penetrating trauma to the left thorax or abdomen. Hypotension from hemorrhage is the most common initial finding.
• Renal injury is suspected with hematuria, fractures of lower posterolateral ribs, or flank pain and tenderness.
• Patients with abdominal vascular injury usually present with profound hemorrhagic shock. The large-bore IV catheters are preferably located in the upper extremities to avoid fluid loss to the abdomen.
• Explorative laparatomy is done for diagnosis and definitive treatment of abdominal trauma.
• Preparation of laparatomy starts from initial assessment and resuscitation phase in which anesthetist should involve on survey of ABCs .and prepare for rapid sequence induction and while inserting large bore IV catheter and checking fluid and blood preparation
• Awake traumatized patients demonstrating signs of hypovolemia are generally best induced with etomidate, 0.1-0.2 mg/kg or ketamine 0.5 - 1mg/kg, because thiopental and propofol may cause profound hypotension in hypovolemic patients.
• Spinal anesthesia is contraindicated in the unstable abdominal trauma patient because it is impractical (the patient may not be able to assume the lateral or sitting position for drug placement), takes time to set up, and can result in several deleterious side effects, such as sympathectomy-mediated hypotension, local anesthetic-induced seizures, total spinal anesthesia, or cardiac arrest.
• Extremity and other injuries place the patient at risk for various discomfort and complications such as pain, hemorrhage, crush syndrome, amputation, acute compartment syndrome fat embolism and sepsis.
• Perioperative considerations for orthopedic trauma includes; degree of urgency, full stomach, uncleared spines, positioning injuries, hypothermia, major blood loss, tourniquet problems with injury to underlying nerves, muscle, blood vessels, fat embolism after long-bone fractures with delayed emergence, deep venous thrombosis, compartmental syndrome and severe postoperative pain