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4 - Establishing Vascular Access in the Trauma Patient

Published online by Cambridge University Press:  18 January 2010

By
Matthew A. Joy ,
Donn Marciniak  and
Kasia Petelenz-Rubin
Edited by
Charles E. Smith
Matthew A. Joy
Affiliation:
Department of Anesthesiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
Donn Marciniak
Affiliation:
Department of Anesthesiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
Kasia Petelenz-Rubin
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. Describe in a structured approach the advantages and disadvantages of various types of intravascular access and infusion devices in the trauma patient.

  2. Present practical guidelines for the establishment of central venous access in the critically injured patient.

  3. Describe in detail the technique for insertion of various central access sites, with current standard of care recommendations in the trauma patient.

  4. Describe the relevancy of peripheral arterial cannulation in the trauma setting.

  5. Present current recommendations regarding intraosseous access in the trauma patient.

INTRODUCTION

Advanced Trauma Life Support (ATLS) guidelines recommend that, in the initial management of hemorrhagic shock, prompt access must be obtained [1]. This is best accomplished by the insertion of two large-caliber (16 G angiocaths or larger) peripheral intravenous (IV) catheters before consideration is given to central venous catheters, or venous cutdowns [1]. Obviously, the condition of the arriving trauma patient, that is, massive extremity injury and extent of the injury, may not allow for any reasonable peripheral venous access for IV insertion. This chapter reviews the management of intravascular access in the trauma patient in the hospital setting where definitive care is to be provided. The main areas to be covered include venous access as well as arterial access in critically injured patients. Clinical experience and evidence-based medicine is balanced to provide a framework for guiding the management of patients from a vascular access standpoint.

PERIPHERAL INTRAVENOUS (PIV) CATHETERS

Prior to arrival in the emergency department, PIV cannulation has usually been performed in the field by prehospital personnel [1, 2].

Type
Chapter
Information
Trauma Anesthesia , pp. 69 - 80
Publisher: Cambridge University Press
Print publication year: 2008

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References

American College of Surgeons Committee on Trauma. ATLS: Advanced Trauma Life Support for Doctors, 7th edition. Chicago: American College of Surgeons Committee on Trauma, 2004.
Westfall, MD, Price, KR, Lambert, M, Himmelman, K, Kacey, D, Dorevitch, S, Mathews, J. Intravenous access in the critically ill trauma patient: A multicentered, prospective, randomized trial of saphenous cutdown and percutaneous femoral access. Ann Emerg Med 1994;23(3):541–5.CrossRefGoogle ScholarPubMed
Revell, M, Porter, K, Greaves, I. 2. Fluid resuscitation in prehospital trauma care: A consensus view (review). Emerg Med J 2002;19:494–8.CrossRefGoogle Scholar
Comunale, M. A Laboratory evaluation of the level 1 rapid infuser (H1025) and the Belmont Instrument Fluid Management System (FMS 2000) for RapidTransfusion Anesth Analg 2003;97:1064–9.CrossRefGoogle ScholarPubMed
Roche, M, Gauthier, L. Rapid transfusion of packed red blood cells: Effect of dilution, pressure and catheter size. Ann Emerg Med 1993;22(10):1551–5.CrossRefGoogle Scholar
Abraham, E, Shapiro, M, Podolsky, S. Central venous catheterization in the emergency setting. Crit Care Med 1983;11(7):515–7.CrossRefGoogle ScholarPubMed
Pappas, P, Brathwaite, CE, Ross, SE. Emergency central venous catheterization during resuscitation of trauma patients. Am Surg 1992;58(2):108–11.Google ScholarPubMed
Scalea TM, Sinert R, Duncan AO, Rice P, Austin R, Kohl L, Trooskin SZ, Talbert S. Percutaneous central venous access for resuscitation in trauma. In Biros, MH, ed. Academic Emergency Medicine, Vol 1, Society for Academic Emergency Medicine, Lansing, MI. 1994, pp 525–31.Google Scholar
Duffy, BJ. The clinical use of polyethylene tubing for intravenous therapy. Ann Surg 1949;130:929.CrossRefGoogle ScholarPubMed
Mangiante, EC, Hoots, AV, Fabian, TC. The percutaneous common femoral vein catheter for volume replacement in critically injured patients. J Trauma 1988;28(12):1644–9.CrossRefGoogle ScholarPubMed
Emerman, CL, Bellon, EM, Lukens, TW, May, TE, Effron, D. A prospective study of femoral versus subclavian vein catheterization during cardiac arrest. Ann Emerg Med 1990;19(1):26–30.CrossRefGoogle ScholarPubMed
Swanson, RS, Uhlig, PN, Gross, PL, McCabe, CJ. Emergency intravenous access through the femoral vein. Ann Emerg Med 1984;13(4):244–7.CrossRefGoogle ScholarPubMed
Durbec, O, Viviand, X, Potie, F, Vialet, R, Albanese, J, Martin, C. A prospective evaluation of the use of femoral venous catheters in critically ill adults. Crit Care Med 1997;25(12):1986–9.CrossRefGoogle ScholarPubMed
Joynt, GM, Kew, J, Gomersall, CD, Leung, VYF, Liu, EKH. Deep venous thrombosis caused by femoral venous catheters in critically ill adult patients. Chest 2000;117:178–83.CrossRefGoogle ScholarPubMed
Merrer, J, De, Jonghe B, Golliot, F, Lefrant, J-Y, Raffy, B, Barre, E, Rigaud, J-P, Casciani, D, Misset, B, Bosquet, C, Outin, H, Brun-Buisson, C, Nitenberg, G. Complications of femoral and subclavian venous catheterization in critically ill patients. JAMA 2001;286(6):700–7.CrossRefGoogle ScholarPubMed
Centers for Disease Control and Prevention. Guideline for Hand Hygiene in Health-Care Settings: Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Morb Mortal Wkly Rep 2002; 51:RR-16. www.cdc.gov/mmwr/PDF/rr/rr5116.pdf (last accessed June 8, 2006).
Grady, O' NP, Alexander, M, Patchen, Dellinger E, Gerberding, JL, Heard, SO, Maki, DG, Masur, H, McCormick, RD, Mermel, , Pearson, ML, Raad, II, Randolph, A, Weinstein, RA. Guidelines for the Prevention of Intravascular Catheter-Related Infections, Centers for Disease Control. Morb Mortal Wkly Rep 2002;51:RR-10. www.cdc.gov/mmwr/pdf/rr/rr5110.pdf (last accessed July 9, 2006).Google Scholar
Berenholtz, SM, Pronovost, PJ, Lipsett, PA, Hobson, D, Earsing, K, Farley, JE, Milanovich, S, Garrett-Mayer, E, Winters, BD, Rubin, HR, Dorman, T, Perl, TM. Eliminating catheter-related bloodstream infections in the intensive care unit. Crit Care Med 2004;32(10):2014–20.CrossRefGoogle ScholarPubMed
McGee, DC, Gould, MK. Preventing complications of central venous catheterization. N Engl J Med 2003;348(12):1123–33.CrossRefGoogle ScholarPubMed
Bowdle, TA. Complications of invasive monitoring. Anesthesiol Clin N Am 2002;20:571–88.CrossRefGoogle ScholarPubMed
Ng S. The femoral vein. In Latto IP, Ng WS, Jones PL, Jenkins BJ, ed. Percutaneous Central Venous and Arterial Catheterisation, 3rd edition. Philadelphia: W.B. Saunders, 2000, pp 211–21.
Polderman, KH, Girbes, AJ. Central venous catheter use. Part 1: Mechanical complications. Intensive Care Med 2002;28(1):1–17.CrossRefGoogle ScholarPubMed
Butterworth JF, IV. Central venous cannulation. In Butterworth, JF, ed. Atlas of Procedures in Anesthesia and Critical Care. Philadelphia: W.B. Saunders Company, 1992, pp 95–9.Google Scholar
Jobes, DR, Schwartz, AJ, Greenhow, , et al. Safer jugular vein cannulation: Recognition of arterial puncture and preferential use of the external jugular route. Anesthesiology 1983;59:353–5.CrossRefGoogle ScholarPubMed
Augoustides, JG, Diaz, D, Weiner, J, Clarke, C, Jobes, DR. Current practice of internal jugular venous cannulation in a university anesthesia department: Influence of operator experience on success of cannulation and arterial injury. J Cardiothorac Vasc Anesth 2002;16(5):567–71.CrossRefGoogle Scholar
Seldinger, SI. Catheter replacement of the needle in percutaneous arteriography; a new technique. Acta Radiol 1953;39:368–76.CrossRefGoogle ScholarPubMed
Scott, WL, Collier, P. The vessel dilator for central venous catheter placement: Forerunner for success or vascular misadventure?Intensive Care Med 2001;16:263–9.CrossRefGoogle Scholar
Oropello, JM, Leibowitz, AB, Manasia, A, Del, Guidice R, Benjamin, E. Dilator-associated complications of central vein catheter insertion: Possible mechanisms of injury and suggestions for prevention. J Cardiothorac Vasc Anesth 1996;10(5):634–7.CrossRefGoogle Scholar
Lobato, EB, Gravenstein, N, Paige, GB. Dilator-associated complications of central vein catheter insertion: Possible mechanisms of injury and suggestions for prevention (Letters to the Editor). J Cardiothorac Vasc Anesth 1997;11(4):539–40.CrossRefGoogle Scholar
Bailey, PL, Whitaker, EE, Palmer, LS, Glance, LG. The accuracy of the central landmark used for central venous catheterization of the internal jugular vein. Anesth Analg 2006;102:1327–32.CrossRefGoogle ScholarPubMed
Steele, R, Irvin, C. Central line mechanical complication rate in emergency medicine patients. Acad Emerg Med 2001;8:204–7.CrossRefGoogle ScholarPubMed
Eisen, , Narasimhan, M, Berger, JS, Mayo, PH, Rosen, MJ, Schneider, RF. Mechanical complications of central venous catheters. J Intensive Care Med 2006;21:40–6.CrossRefGoogle ScholarPubMed
Aoki, H, Mizobe, T, Nozuchi, S, Hatanaka, T, Tanaka, Y. Vertebral artery pseudoaneurysm: A rare complication of internal jugular vein catheterization. Anesth Analg. 1992;75(2):296–8.CrossRefGoogle ScholarPubMed
Maddali, MM, Badur, RS, Rajakumar, MC, Valliattu, J. Pseudoaneurysm of the innominate artery: A delayed iatrogenic complication after internal jugular vein catheterization. J Cardiothorac Vasc Anesth 2006;20(6):853–5.CrossRefGoogle ScholarPubMed
Aubaniac, R. L'injection intraveineuse sous-claviculaire Avantages et technique. Presse Med 1952;60:1456.Google Scholar
Grant, JP. Anatomy and physiology of venous system vascular access: Implications. J Parenter Enteral Nutr 2006;30(1):S7–12.CrossRefGoogle ScholarPubMed
Defalque, RJ. Subclavian venipunture: A review. Anesth Analg Curr Res 1968;47:677–82.CrossRefGoogle Scholar
Ruesch, S, Walder, B, Tramer, MR. Complications of central venous catheters; internal jugular versus subclavian access – a systematic review. Crit Care Med 2002;30(2):454–9.CrossRefGoogle ScholarPubMed
Lorente, L, Henry, C, Martin, MM, Jimenez, A, Mora, ML. Central venous catheter-related infection in a prospective and observational study of 2595 catheters. Crit Care 2005;9(6):R631–5.CrossRefGoogle Scholar
Nagashima, G, Kikuchi, TTsuyuzaki, H, Kawano, R, Tanaka, H, Nemoto, H, Taguchi, K, Ugajin, K. To reduce catheter-related bloodstream infections: Is the subclavian route better than the jugular route for central venous catheterization?J Infect Chemother. 2006;12(6):363–5.CrossRefGoogle Scholar
Tan, BK, Hong, SW, Huang, MH, Lee, ST. Anatomic basis of safe percutaneous subclavian venous catheterization. J Trauma. 1999;48(1):82–6.CrossRefGoogle Scholar
Agee, KR, Balk, RA. Central venous catheterization in the critically ill patient. Crit Care Clin 1992;8(4):677–86.CrossRefGoogle ScholarPubMed
Ferguson, M, Max, M, Marshall, W. Emergency department infraclavicular sublavian vein catherization in patients with multiple injuries and burns. South Med J 1988;81(4):433–5.CrossRefGoogle Scholar
Timsit, JF. Central venous access in intensive care unit patients: Is the subclavian vein the royal route?Intensive Care Med 2002;28:1006–8.CrossRefGoogle ScholarPubMed
Mansfield, PF, Hohn, DC, Fornage, BD, Gregurich, MA, Ota, DM. Complications and failures of subclavian vein catheterization. N Engl J Med 1994;331(26):1735–8.CrossRefGoogle ScholarPubMed
Sznejder, JI, Zveibel, FR, Bitterman, H, Weiner, P, Bursztein, S. Central vein catheterization: Failure and complications by 3 percutaneous approaches. Arch Int Med 1986;146(2):259–61.Google Scholar
Fortune, JB, Feustel, P. Effect of patient position on size and location of the subclavian vein for percutaneous puncture. Arch Surg. 2003;138:996–1000.CrossRefGoogle ScholarPubMed
Thompson, EC, Calver, . Safe subclavian vein cannulation. Am Surg 2005;71(2):180–3.Google ScholarPubMed
Moran, SG, Peoples, JB. The deltopectoral triangle as a landmark for percutaneous infraclavicular cannulation of the subclavian vein. Angiology 1993;44(9):683–6.CrossRefGoogle ScholarPubMed
Porzionato, A, Montisci, M, Manani, G. Brachial plexus injury following subclavian vein catheterization: A case report. J Clin Anesth 2003;15:582–6.CrossRefGoogle ScholarPubMed
Land, RE. The relationship of the left subclavian vein to the clavicle. J Thorac Cardiovasc Surg 1972;63(4):564–8.Google ScholarPubMed
Land, RE. Anatomic relationships of the right subclavian vein. Arch Surg 1971;102:178–80.CrossRefGoogle ScholarPubMed
Goedecke, A, Keller, C, Moriggle, B, Wenzel, V, Bale, R, Deibl, M, Moser, P, Lirk, P. An anatomic landmark to simplify subclavian vein cannulation: The “deltoid tuberosity.”Anesth Analg 2005;100:623–8.Google Scholar
Tan, BK, Wong, CH, Ng, R, Huang, M, Lee, ST. A modified technique of percutaneous subclavian venous catheterization in the oedematous burned patient. Burns 2005;31:505–9.CrossRefGoogle ScholarPubMed
Gordon, LH, Brown, M, Brown, OW, Brown, EM. Alternative sites for continuous arterial monitoring. South Med J 1984;77(12);1498–1500.CrossRefGoogle ScholarPubMed
Cohn, JN. Blood pressure measurements in shock. J Am Med Assoc 1967;199(13):972–76.CrossRefGoogle Scholar
Gardner, RM. Direct blood pressure measurement dynamic response requirements. Anesthesiology 1981;54:227–36.CrossRefGoogle ScholarPubMed
Slogoff, S, Keats, AS, Arlund, C. On the safety of radial artery cannulation. Anesthesiology 1983;59(1):42–7.CrossRefGoogle ScholarPubMed
Dahl, MR, Smead, WL, McSweeney, TD. Radial artery cannulation: A comparision of 15.2- and 4.45 cm catheters. J Clin Monitor 1992;8(3):193–7.CrossRefGoogle Scholar
Kim, JM, Arakawa, K, Bliss, J. Arterial cannulation: Factors in the development of occlusion. Anesth Analg 1975;54:836–41.CrossRefGoogle ScholarPubMed
Gurman, GM, Kriemerman, S. Cannulation of big arteries in critically ill patients. Crit Care Med 1985;13(4):217–20.CrossRefGoogle ScholarPubMed
Martin, C, Saux, P, Papazain, L, Goutin, F. Long-term arterial cannulation in ICU patients using the radial artery or dorsalis pedis artery. Chest 2001;119(3):901–6.CrossRefGoogle ScholarPubMed
Youngberg, J, Miller, ED. Evaluation of percutaneous cannulations of the dorsalis pedis artery. Anesthesiology 1976;44(1):80–3.CrossRefGoogle ScholarPubMed
Chopra, PS, Kroncke, GM, Dacumos, GC, Young, WP, Kahn, DR. Use of the ulnar artery for monitoring arterial blood pressures and blood gases. Ann Thorac Surg 1973;15(5):541–3.CrossRefGoogle ScholarPubMed
Scheer, BV, Perel, A Pfeiffer. Clinical review: Complications and risk factors of peripheral arterial catheters used for haemodynamic monitoring in anaethesia and intensive care medicine. Crit Care 2002;6(3):198–204.CrossRefGoogle Scholar
Frezza, EE, Mezghebe, H. Indications and complications of arterial catheter use in surgical or medical intensive care units: Analysis of 4932 patients. Am Surg 1998;64(2):127–31.Google ScholarPubMed
Bryan-Brown, CW, Kwun, KB, Lumb, PD, Pia, RLG, Azer, S. The axillary artery catheter. Heart Lung 1983;12(5):492–7.Google ScholarPubMed
Muralidhar, K. Complications of femoral artery pressure monitoring. J Cardiothorac Vasc Anesth 1998;12:128–9.CrossRefGoogle Scholar
Soderstrom, CA, Wasserman, DH, Dunham, CM, Caplan, ES, Cowley, RA. Superiority of the femoral artery for monitoring. A prospective study. Am J Surg 1982:144:309–12.CrossRefGoogle ScholarPubMed
Bedford, RF. Wrist circumference predicts the risk of radial-arterial occlusion after cannulation. Anesthesiology 1978;48:377–8.CrossRefGoogle ScholarPubMed
Green, JA, Tonkin, MA. Ischemia of the hand in infants following radial or ulnar artery catheterization. Hand Surg 1999;4:151–7.CrossRefGoogle ScholarPubMed
Kahler, AC, Mirza, FZ. Alternative arterial catheterization using the ulnar artery in critically ill pediatric patients. Pediatr Crit Care Med 2002;3(4):370–4.CrossRefGoogle ScholarPubMed
Okeson, GC, Wulbrecht, PH. The safety of brachial artery puncture for arterial blood sampling. Chest 1998;114:748–51.CrossRefGoogle ScholarPubMed
Hoencamp, R, Ulrich, C, Verschuren, SAJ, Baalan, JM. Prospective comparative study on the hemodynamic and functional consequences of arterial monitoring catheters in intensive care patients on the short and long term. J Crit Care 2006;21:193–6.CrossRefGoogle Scholar
Lorente, L, Santacreu, R, Martin, MM, Jimenez, A, Mora, M. Arterial catheter-related infection of 2,949 catheters. Crit Care 2006:10(3):R83 EPUB.Google ScholarPubMed
Fowler, R, Gallagher, JV, Isaacs, SM, Ossman, E, Pepe, P, Wayne, M. The role of Intraosseous vascular access in the out-of-hospital environment (resource document to NAEMSP position statement). Prehosp Emerg Care 2007;11:63–6.CrossRefGoogle Scholar
Hazinski, MF, Nadkarni, VM, Hickey, RW et al. 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Part 7.2: Management of cardiac arrest. Circulation. 2005;112 [Suppl I]:IV-58–IV-66.Google Scholar
Day, MW. Using a sternal intraosseous device in adults. Nursing 1999;12:22–3.CrossRefGoogle Scholar
Waisman, M, Waisman, D. Bone marrow infusion in adults. J Trauma 1997;42(2):288–93.CrossRefGoogle ScholarPubMed
Frascone, R, Kaye, K, Dries, D, Solem, L. Successful placement of an adult sternal intraosseous line through burned skin. J Burn Care Rehabil 2003;24:306–8.CrossRefGoogle ScholarPubMed
Brown, C, Wiklund, L, Bar-Joseph, G, Miller, B, Bircher, N, Paradis, N, Menegazzi, J, Planta, M, Kramer, GC, Gisvold, SE. Future directions for resuscitation research. IV. Innovative advanced life support pharmacology. Resuscitation 1996;33(2):163–77.CrossRefGoogle ScholarPubMed
Calkins, MD, Fitzgerald, G, Bentley, TB, Burris, D. Intraosseous infusion devices: A comparison for potential use in special operations. J Trauma 2000;48(6):1068–74.CrossRefGoogle ScholarPubMed
Day, MW. Act FAST with intraosseous. Nursing 2003;33(11):50–2.CrossRefGoogle ScholarPubMed
Graham, AS, Ozment, C, Tegtmeyer, K, Lai, S, Braner, DAV. Central venous catheterization. N Engl J Med 2007;356(21):e21. Videos in Clinical Medicine. http://content.nejm.org/cgi/video/356/21/e21/ (last accessed June 8, 2007).CrossRefGoogle ScholarPubMed
Mann, S, Jones, RI, Millar-Craig, MW, Wood, C, Gould, BA, Raftery, EB. The safety of ambulatory intra-arterial pressure monitoring: A clinical audit of 1000 studies. Int J Cardiol 1984;5:585–97.CrossRefGoogle ScholarPubMed
Clemente, C. Anatomy. A Regional Atlas of the Human Body, 3rd edition. Baltimore, MD: Urban & Schwarzenberg, 1987.Google Scholar
Marino, P. The ICU Book, 3rd edition. Philadelphia, PA: Lippincott Williams & Wilkins, 2007.Google Scholar

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  • Establishing Vascular Access in the Trauma Patient
    • By Matthew A. Joy, Department of Anesthesiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, Donn Marciniak, Department of Anesthesiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, Kasia Petelenz-Rubin, 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/CBO9780511547447.007
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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 Dropbox.

  • Establishing Vascular Access in the Trauma Patient
    • By Matthew A. Joy, Department of Anesthesiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, Donn Marciniak, Department of Anesthesiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, Kasia Petelenz-Rubin, 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/CBO9780511547447.007
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.

  • Establishing Vascular Access in the Trauma Patient
    • By Matthew A. Joy, Department of Anesthesiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, Donn Marciniak, Department of Anesthesiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, Kasia Petelenz-Rubin, 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/CBO9780511547447.007
Available formats
×