Trauma

Stanford Hospital does not get a lot of trauma. Fortunately, there are not a lot of gunshot or stab wounds, and we're in close proximity to other major trauma centers. But as a resident, it is important for me to see and experience trauma cases. A drunk woman in her twenties is involved in a motor vehicle accident. She is minimally responsive, intubated, and rushed to the scanner where a CT shows an epidural hematoma as well as multiple facial fractures. Upon seeing this, she is taken straight up to the operating rooms for an emergency craniotomy and evacuation of hematoma, and I'm called to come and anesthetize this case.

Traumas cause a release of epinephrine for me because I don't have the time to investigate, prepare, and plan the anesthesia. By the time I arrived in the room, the patient was being moved over to the operating table. I had to quickly survey the scene, figure out what I needed, and make a quick judgment about the patient's health. Although the patient already had good IV access and an endotracheal tube, I had to pop in an arterial line, begin my anesthetic, and figure out what I needed in terms of drips, blood, and other medications. Because of the patient's young age and lack of other medical problems, the case went smoothly, but it reminded me of the necessity of efficient evaluation and response as well as continuous communication with the surgeons and nurses. It also gave me awareness that trauma patients may have other undiagnosed injuries, some of which (like a pneumothorax) could be fatal if undiagnosed. Vigilance and constant reassessment are absolutely essential.

Image of epidural hematoma shown under Creative Commons Attribution Share-Alike License, from Wikipedia.