Ortho Trauma

Now I'm back in the general OR pool and assigned to orthopedic trauma for two weeks. Ortho trauma has its own anesthetic concerns. Patients vary from the young, healthy, and foolish who get into a brawl or car accident to the old and medically ill who fall and have a hip fracture. Since cases are urgent, there's little time to get to know the patient and optimize them medically, so the anesthetic course can be a little rocky. For example, I had a young patient with a hip fracture who drank a bottle of whiskey every day and went into active alcohol withdrawal right when we started the case; we had to design a benzodiazepine heavy regimen to smooth the wake-up and prevent seizures. Another man who had been shot multiple times had extremely complex fractures that required many hours to fix. A woman found down and altered could not give a medical history so we went in not knowing much about her. A patient who had just eaten and was actively vomiting needed a washout of an open fracture before it became infected. Unfortunately, these patients are not happy to be in the hospital, and working with them can be challenging. Such is the life of an anesthesiologist at a trauma center.

Image of implants for right radius and ulna fracture is in the public domain, from Wikipedia.