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5 - Monitoring the Trauma Patient

Published online by Cambridge University Press:  18 January 2010

By
Elizabeth A. Steele ,
P. David Søran ,
Donn Marciniak  and
Charles E. Smith
Edited by
Charles E. Smith
Elizabeth A. Steele
Affiliation:
Department of Anesthesiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
P. David Søran
Affiliation:
Department of Anesthesiology, Stanford University Medical Center, Stanford, California
Donn Marciniak
Affiliation:
Department of Anesthesiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
Charles E. Smith
Affiliation:
Department of Anesthesiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
Charles E. Smith
Affiliation:
Case Western Reserve University, Ohio
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Summary

Objectives

  1. List the basic guidelines for monitoring of patients receiving anesthesia.

  2. Evaluate options, functions, use, and problems associated with monitoring devices, particularly in the trauma setting.

  3. Interpret the information provided by monitoring devices.

INTRODUCTION

In 1986, the American Society of Anesthesiologists (ASA) prepared and approved “Standards for Basic Anesthetic Monitoring” [1]. This document outlines the responsibilities of the anesthesiologists in assessing patients' vital signs throughout the anesthetic period. Similar guidelines have been published by the Australian and New Zealand College of Anaesthetists (ANZCA) and The Royal College of Anesthetists [2, 3]. Both the Royal College and the ASA note that, in extreme circumstances, provision of life-saving measures takes precedence over application of monitors. Nonetheless, monitoring is intended to improve the quality of care and outcome for patients, and every attempt should be made to appropriately monitor the trauma patient.

All anesthesia providers have an obligation to carefully assess their patients receiving any form of anesthetic. Basic principles include monitoring the physiologic variables of oxygenation, ventilation, circulation, and temperature. Oxygenation can be assessed with pulse oximetry, inhaled and exhaled gas analysis, and blood gas analysis. Ventilation is assured by end-tidal carbon dioxide measurement, listening to the patient's breath sounds, and monitoring the ventilator. Circulation is assessed by electrocardiogram and blood pressure measurements, whether noninvasively by a cuff or invasively by an intraarterial catheter. Circulation can also be monitored invasively through echocardiography and pulmonary artery catheter measurements. Urine output provides a rough estimate of tissue perfusion and thus is another monitor for circulation.

Type
Chapter
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Trauma Anesthesia , pp. 81 - 100
Publisher: Cambridge University Press
Print publication year: 2008

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References

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  • Monitoring the Trauma Patient
    • By Elizabeth A. Steele, Department of Anesthesiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, P. David Søran, Department of Anesthesiology, Stanford University Medical Center, Stanford, California, Donn Marciniak, Department of Anesthesiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, Charles E. Smith, Department of Anesthesiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
  • Edited by Charles E. Smith, Case Western Reserve University, Ohio
  • Book: Trauma Anesthesia
  • Online publication: 18 January 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547447.008
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  • Monitoring the Trauma Patient
    • By Elizabeth A. Steele, Department of Anesthesiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, P. David Søran, Department of Anesthesiology, Stanford University Medical Center, Stanford, California, Donn Marciniak, Department of Anesthesiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, Charles E. Smith, Department of Anesthesiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
  • Edited by Charles E. Smith, Case Western Reserve University, Ohio
  • Book: Trauma Anesthesia
  • Online publication: 18 January 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547447.008
Available formats
×

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To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Monitoring the Trauma Patient
    • By Elizabeth A. Steele, Department of Anesthesiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, P. David Søran, Department of Anesthesiology, Stanford University Medical Center, Stanford, California, Donn Marciniak, Department of Anesthesiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, Charles E. Smith, Department of Anesthesiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
  • Edited by Charles E. Smith, Case Western Reserve University, Ohio
  • Book: Trauma Anesthesia
  • Online publication: 18 January 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547447.008
Available formats
×