Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-8448b6f56d-tj2md Total loading time: 0 Render date: 2024-04-18T22:41:46.029Z Has data issue: false hasContentIssue false

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
Get access

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

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Society of Anesthesiologists. Standards for Basic Anesthetic Monitoring, Approved by the ASA House of Delegates on October 21, 1986, and last amended on October 25, 2005. www.asahq.org.
Australian and New Zealand College of Anaesthetists. Recommendations on monitoring during anesthesia. ANZCA Professional Document PS18, 2000. www.medeserv.com.au/anzca.
Royal College of Anaesthetists. Guidelines for the provision of anaesthetic services, 1999. www.rcoa.ac.uk.
Cheney, FW. Changing trends in anesthesia-related death and permanent brain damage. ASA Newsletter 2002;66:6–8.Google Scholar
Webb, RK, Walt, JH, Runciman, WB, Williamson, JA, Cockings, J, Russell, WJ and Helps, S. The Australian Incident Monitoring Study. Which monitor? An analysis of 2000 incident reports. Anesth Intensive Care 1993;21:529–42.Google ScholarPubMed
Tremper K, Barker S. Monitoring of oxygen. In Lake, CL, Hines, RL, Blitt, CD. Ed. Clinical Monitoring: Practical Applications for Anesthesia and Critical Care. Philadelphia: W. B. Saunders, 2001, p 324.Google Scholar
Moller, JT, Pedersen, T, Rasmussen, LS, Jensen, PF, Pedersen, BD, Ravlo, O, Rasmussen, NH, Espersen, K, Johannessen, NW, Cooper, JB, et al. Randomized evaluation of pulse oximetry in 20,802 patients: I. Design, demography, pulse oximetry failure rate, and overall complication rate. Anesthesiology 1993;78:436–44.CrossRefGoogle ScholarPubMed
Moller, JT, Johannessen, NW, Espersen, K, Ravlo, O, Pedersen, BD, Jensen, PF, Rasmussen, NH, Rasmussen, LS, Pedersen, T, Cooper, JB, et al. Randomized evaluation of pulse oximetry in 20,802 patients: II. Perioperative events and postoperative complications. Anesthesiology 1993;78:445–53.CrossRefGoogle ScholarPubMed
Cote, CJ, Rolf, N, Liu, LM, Goudsouzian, NG, Ryan, JF, Zaslavsky, A, Gore, R, Todres, TD, Vassallo, S, Polaner, D, et al. A single-blind study of combined pulse oximetry and capnography in children. Anesthesiology 1991;74:980–7.CrossRefGoogle ScholarPubMed
Barker, SJ. Recent developments in oxygen monitoring. ASA Annual Meeting Refresher Course Lectures. 2006;320:1–6.Google Scholar
Shelley K, Shelley S. Pulse oximeter waveform: photoelectric plethysmography. In Lake, CL, Hines, RL, Blitt, CD, ed. Clinical Monitoring: Practical Applications for Anesthesia and Critical Care. Philadelphia: W. B. Saunders, 2001, p 427.Google Scholar
Al-Shaikh, B, Stacey, S. Essentials of Anaesthetic Equipment, 2nd edition. London: Churchill Livingstone, 2002, p 117.Google Scholar
Venkatesh, B, Brock, Clutton TH, Hendry, SP. A multiparameter sensor for continuous intra-arterial blood gas monitoring: A prospective evaluation. Crit Care Med 1994;22:588–94.CrossRefGoogle ScholarPubMed
Coule, LW, Truemper, EJ, Steinhart, CM, Lutin, WA. Accuracy and utility of a continuous intra-arterial blood gas monitoring system in pediatric patients. Crit Care Med 2001;29:420–6.CrossRefGoogle ScholarPubMed
Myles, PS, Buckland, MR, Weeks, AM, Bujor, M, Moloney, J. Continuous arterial blood gas monitoring during bilateral sequential lung transplantation. J Cardiothorac Vasc Anesth 1999;13:253–7.CrossRefGoogle ScholarPubMed
Eichorn, JH. Standards for patient monitoring during anesthesia at Harvard Medical School. J Am Med Assoc 1986;256:1017–20.CrossRefGoogle Scholar
Barker, L, Webb, RK, Runciman, WB, Walt, JH. The Australian Incident Monitoring Study. The oxygen analyzer: Applications and limitations – an analysis of 200 incident reports. Anaesth Intensive Care 1993;21:570–4.Google Scholar
Tremper K, Barker S. Monitoring of oxygen. In Lake, CL, Hines, RL, Blitt, CD, ed. Clinical Monitoring: Practical Applications for Anesthesia and Critical Care. Philadelphia: W. B. Saunders, 2001, p 315–16.Google Scholar
Keeling CD, Whorf TP. Atmospheric CO2 records from sites in the SIO air sampling network. Trends: A Compendium of Data on Global Change. Carbon Dioxide Information Analysis Center, Oak Ridge National Laboratory, U.S. Department of Energy, Oak Ridge, TN, 2005.
Gravenstein, J, Paulus, D, Hayes, T. Capnometric Methods: Gas Monitoring in Clinical Practice, 2nd edition. Boston: Butterworth-Heinemann, 1995, p 17.Google Scholar
Barash, P, Cullen, B, Stoelting, R. Clinical Anesthesia, 5th edition. Philadelphia: Lippincott, Williams & Wilkins, 2006, p 670.Google Scholar
Davis, P, Kenny, G. Basic Physics and Measurement in Anaesthesia, 5th edition. New York: Butterworth Heinemann, 2003, p 214.Google Scholar
Campbell, FA, McLeod, ME, Bissonnette, B, Swartz, JS. End tidal carbon dioxide measurement in infants and children during and after general anesthesia. Can J Anaesth 1994;41:107–10.CrossRefGoogle Scholar
Eichhorn, JH, Cooper, JB, Cullen, DJ, Maier, WR, Philip, JH, Seeman, RG: Standards for patient monitoring during anesthesia at Harvard Medical School. J Am Med Assoc 1986:256:1017–20.CrossRefGoogle ScholarPubMed
Eichhorn, JH. Prevention of intraoperative anesthesia accidents and related severe injury through safety monitoring. Anesthesiology 1989;70:572–7.CrossRefGoogle ScholarPubMed
Croswell, RJ, Dilley, DC, Lucas, WJ, Vann, WF Jr. A comparison of conventional versus electronic monitoring of sedated pediatric dental patients. Pediatr Dent 1995;17:332–9.Google ScholarPubMed
Cote, CJ, Liu, LM, Szyfelbein, SK, Firestone, S, Goudsouzian, NG, Welch, JP, Daniels, AL. Intraoperative events diagnosed by expired carbon dioxide monitoring in children. Can Anaesth Soc J. 1986;33:315–20.CrossRefGoogle ScholarPubMed
Baraka, AS, Aouad, MT, Jalbout, MI, Kaddoum, RN, Khatib, MF, Haroun-Bizri, ST. End-tidal CO2 for prediction of cardiac output following weaning from cardiopulmonary bypass. J Extra Corpor Techno 2004;36(3):255–7.Google ScholarPubMed
Ornato, JP, Garnett, AR, Glauser, FL. Relationship between cardiac output and the end-tidal carbon dioxide tension. Ann Emerg Med 1990;19(10):1104–6.CrossRefGoogle ScholarPubMed
Manecke, GR Jr, Popper, PJ. Esophageal stethoscope placement depth: Its effect on heart and lung sound monitoring during general anesthesia. Anesth Analg 1998;86:1276–9.Google ScholarPubMed
Klepper, ID, Webb, RK, Walt, JH, Ludbrook, GL, Cockings, J. The Australian Incident Monitoring Study. The stethoscope: applications and limitations – an analysis of 2000 incident reports. Anaesth Intensive Care 1993;21:575–8.Google Scholar
Watson, A, Visram, A. Survey of the use of oesophageal and precordial stethoscopes in current paediatric anaesthetic practice. Paediatr Anaesth 2001;11:437–42.CrossRefGoogle ScholarPubMed
Prielipp, RC, Kelly, JS, Roy, RC. Use of esophageal or precordial stethoscopes by anesthesia providers: are we listening to our patients?J Clin Anesth 1995;7:367–72.CrossRefGoogle ScholarPubMed
Barash, PG, Cullen, BF, Stoelting, RK. Clinical Anesthesia, 3rd edition. Philadelphia: Lippincott-Raven Publishers, 1997, pp 194–200.Google Scholar
Kaye, P, O'Sullivan, I. Myocardial contusion: Emergency investigation and diagnosis. Emerg Med J 2002;19:8–10.CrossRefGoogle ScholarPubMed
Potkin, RT, Werner, JA, Trobaugh GB, et al. Evaluation of noninvasive tests of cardiac damage in suspected cardiac contusion. Circulation 1983;66(3):627–33.CrossRefGoogle Scholar
Wittebole, X, Hantson, P. Electrocardiographic changes after head trauma. J Electrocardiol 2005;38:77–81.
Shah N, Bedford RF. Invasive and noninvasive blood pressure monitoring. In Lake, C, Hines, R, Blitt, C, ed. Clinical Monitoring: Practical Applications for Anesthesia and Critical Care. Philadelphia: W. B. Saunders, 2001, pp 181–203.Google Scholar
Janelle, GM, Gravenstein, N. An accuracy evaluation of the T-Line Tensymeter versus conventional invasive radial artery monitoring in surgical patients. Anesth Analg 2006;102:484–90.CrossRefGoogle ScholarPubMed
Belani, K, Ozaki, M, Hyson, J, Hartmann, T, Reyford, H, Martino, JM, Poliac, M, Miller, R. A new non invasive method to measure blood pressure. Anesthesiology 1999;91(3):686–92.CrossRefGoogle Scholar
Duan Y, Smith CE, Como JJ. Cardiothoracic trauma. In Wilson, WC, Grande, CM, Hoyt, DB, ed. Trauma Emergency Resuscitation Perioperative Anesthesia Surgical Management. New York: Informa Healthcare, 2007, Chapter 25, pp 469–99.Google Scholar
Levy, JH, Yegin, A. Anaphylaxis. What is monitored to make a diagnosis?Anesthesiol Clin N Am 2001;19:705–15.CrossRefGoogle ScholarPubMed
Palter MD, Cortes V. Secondary triage of the trauma patient. In Civetta, JM, Taylor, RW, Kirby, RR, ed. Critical Care, 3rd edition. Philadelphia: Lippincott-Raven, 1997, pp 1045–63.Google Scholar
Morgan, BC, Martin, WE, Hornbein, TF, Crawford, EW, Guntheroth, WG. Hemodynamic effects of positive pressure ventilation. Anesthesiology 1966;27:584–90.CrossRefGoogle Scholar
Jardin, F, Delorme, G, Hardy, A, Uvert, A B, Beuchet, A, Bourdarias, JP. Reevaluation of hemodynamic consequences of positive pressure ventilation: Emphasis on cyclic right ventricular afterloading by mechanical lung inflation. Anesthesiology 1990;72:966–70.CrossRefGoogle ScholarPubMed
Jardin, F, Farcot, JC, Gueret, P, Prost, JF, Ozier, Y, Bourdarias, JP. Cyclical changes in arterial pulse pressure during respiratory support. Circulation 1983;68:266–74.CrossRefGoogle Scholar
Michard, F, Teboul, JL. Using heart-lung interactions to assess fluid responsiveness during mechanical ventilation. Crit Care 2000;4:282–9.CrossRefGoogle ScholarPubMed
Teboul, J, Besbes, M, Andrivet, P, Axler, O, Douguet, D, et al. A bedside index assessing the reliability of pulmonary occlusion pressure measurements during mechanical ventilation with positive end expiratory pressure. J Crit Care 1995:7;22–9.CrossRefGoogle Scholar
Robotham, JL, Cherry, D, Mitzner, J, Rabson, L, Lixfeld, W, Bromberger-Barnea, B. A re-evaluation of the hemodynamic consequences of intermittent positive pressure ventilation. Crit Care 1983;11:783–93.CrossRefGoogle ScholarPubMed
Coriat, P, Vrillon, M, Perel, A, Baron, JF, et al. A comparison of systolic pressure variations and echocardiographic measurements of end-diastolic left ventricular size in patients after aortic surgery. Anesth Analg 1994:78;46–53.CrossRefGoogle Scholar
Kramer, A, Zygun, D, Hawes, H, Easton, P, Ferland, A. Pulse pressure variation predicts fluid responsiveness following coronary artery bypass surgery. Chest 2004;126(5):1563–68.CrossRefGoogle ScholarPubMed
Tavernier, B, Makhotine, O, Lebuffe, G, Dupont, J, Scherpereel, P. Systolic pressure variation as a guide to fluid therapy in patients with sepsis-induced hypotension. Anesthesiology 1998;89(6):1313–21.CrossRefGoogle ScholarPubMed
Perel, A, Pizov, R, Cotev, S. The systolic pressure variation is a sensitive indicator of hypovolemia in ventilated dogs subjected to graded hemorrhage. Anesthesiology 1987;67:498–502.CrossRefGoogle ScholarPubMed
Rooke, GA, Schwid, HA, Shapira, Y. The effects of graded hemorrhage and intravascular volume replacement on systolic pressure variation in humans during spontaneous mechanical variation. Anesth Analg 1995;80:925–32.Google Scholar
Preisman, S, DiSegni, E, Vered, Z, Perel, A. Left ventricular preload and function during graded hemorrhage and retransfusion in pigs: analysis of arterial pressure waveform and correlation with echocardiography. Br J Anaesth 2002;88:716–18.CrossRefGoogle ScholarPubMed
Berkenstadt, H, Friedman, Z, Preisman, S, Keidan, I, Livingstone, D, Perel, A. Pulse pressure and stroke volume variations during severe haemorrhage in ventilated dogs. Br J Anaesth 2005;94(6):721–6.CrossRefGoogle ScholarPubMed
Ornstein, E, Eidelman, L, Drenger, B, Elami, A, Pizov, R. Systolic pressure variation predicts the response to acute blood loss. J Clin Anesth 1998;10:137–40.CrossRefGoogle ScholarPubMed
Reuter, DA, Goepfert, MSG, Goresch, T, Schmoeckel, M, Kilger, E, Goetz, AE. Assessing fluid responsiveness during open chest conditions. Br J Anaesth 2005;94(3):318–23.CrossRefGoogle ScholarPubMed
Mark, JB. Monitoring with CVP and PAC. ASA Annual Meeting Refresher Course Lectures. 2006;322;1–6.Google Scholar
Varon AJ. Arterial, central venous, and pulmonary artery catheters. In Civetta, JM, Taylor, RW, Kirby, RR, ed. Critical Care, 3rd edition. Philadelphia: Lippincott-Raven, 1997. pp 847–65.Google Scholar
Moomey, CB, Fabia, TC, Croce, MA, et al. Determinants of myocardial performance after blunt chest trauma. J Trauma 1998;45:988–96.CrossRefGoogle ScholarPubMed
Rhodes, A, Bennet, ED. Early goal directed therapy: an evidence-based review. Crit Care Med. 2004;32:S448–50.CrossRefGoogle ScholarPubMed
Kumar, A, Anel, R, Bunnell, E, et.al. Pulmonary artery occlusion pressure and central venous pressure fail to predict ventricular filling volume, cardiac performance, or the response to volume infusion in normal subjects. Crit Care Med 2004;32:691–9.CrossRefGoogle ScholarPubMed
Thys, D, Hillel, Z, Schwartz, AJ. Textbook of Cardiothoracic Anesthesiology. New York: McGraw–Hill Companies, pp 632–37.
Sandham, JD, Hull, RD, Brant, RF. A randomized controlled trial of the use of pulmonary artery catheters in high risk surgical patients. N Engl J Med 2003;348(1):5–14.CrossRefGoogle ScholarPubMed
Shah, MR, Hasselblad, V, Stevenson, LW. Impact of pulmonary artery catheters in critically ill patients: meta analysis of randomized controlled trials. J Am Med Assoc 2005;294(13):1664–70.CrossRefGoogle Scholar
Bishop, MH, et al. Prospective randomized trial of survivor values of cardiac index, oxygen delivery, and oxygen consumption as resuscitation endpoints in severe trauma. J Trauma 1995;38(5):780–7.CrossRefGoogle ScholarPubMed
Friese, RS, Shafi, S, Gentilello, LM. Pulmonary artery catheter use is associated with reduced mortality in severely injured patients. Crit Care Med 2006;34(6):1597–1601.CrossRefGoogle ScholarPubMed
Otto, CM. Textbook of Clinical Echocardiography, 2nd edition. St Louis: W. B. Saunders, 2000, pp 59–79.Google Scholar
Tisherman, SA. Clinical Practice Guideline: Endpoints of Resuscitation. Eastern Association for the Surgery of Trauma. www.east.org
Sessler, D. Mild perioperative hypothermia. N Engl J Med 1997;336:1730–7.CrossRefGoogle ScholarPubMed
Nelson, EJ, Grissom, TE. Continuous gastric suctioning decreased measured esophageal temperature during general anesthesia. J Clin Monit 1996;12:429–32.CrossRefGoogle ScholarPubMed
Cork, RC, Vaughan, RW, Humphrey, LS. Precision and Accuracy of Intraoperative temperature monitoring. Anesth Analg 1983;62:211–14.CrossRefGoogle ScholarPubMed
Brain Trauma Foundation, American Association of Neurological Surgeons, Congress of Neurological Surgeons. Guidelines for the management of severe traumatic brain injury. Intracranial pressure thresholds. J Neurotrauma 2007;24(Suppl 1): S55–S8.
Saul, TG, Ducker, TB. Effects of intracranial pressure monitoring and aggressive treatment on mortality in severe head injury. J Neurosurg 1982;56:498–503.CrossRefGoogle Scholar
Brain Trauma Foundation, American Association of Neurological Surgeons, Congress of Neurological Surgeons. Guidelines for the management of severe traumatic brain injury. Cerebral perfusion thresholds. J Neurotrauma 2007;24(Suppl 1):S59–S64.
Intracranial Pressure Monitoring Technology. J Neurotrauma 2007;24(Suppl 1):S45–54.
Mahla M. Neurologic monitoring. In Cucchiara, RF, ed. Clinical Neuroanesthesia. New York: Churchill Livingstone, 1998, pp 125–76.Google Scholar
Ronne-Engstrom, E, Winkler, T. Continuous EEG monitoring in patients with traumatic brain injury reveals a high incidence of epileptiform activity. Acta Neurol Scand 2006;114:47–53.CrossRefGoogle ScholarPubMed
Deogaonkar, A, Gupta, R, DeGeorgia, M, Sabharwal, V, Gopakumaran, B, Schubert, A and Provencio, JJ. Bispectral Index monitoring correlates with sedation scales in brain-injured patients. Crit Care Med 2004;32:2545–6.CrossRefGoogle ScholarPubMed
Paul, DB, Rao, Umamaheswara GS. Correlation of bispectral index with Glasgow coma score in mild and moderate head injuries. J Clin Monit Comput 2006;20:399–404.CrossRefGoogle ScholarPubMed
Bevacqua, B, Kazdan, D. Is more information better? Intraoperative recall with a Bispectral Index Monitor in place. Anesthesiology 2003;99:507–8.CrossRefGoogle ScholarPubMed
Mychaskiw, G, Horowitz, M, Sachdev, V, Heath, BJ. Explicit intraoperative recall at a bispectral index of 47. Anesth Analg 2001; 92:808–9.CrossRefGoogle Scholar
Lovich-Sapola, J.SSEP and MEP Monitoring Anesthesia Protocol. Personal communication.
Mahla M, Black S, Cucchiara RF. Neurologic monitoring. In Miller, R, ed. Miller's Anesthesia. Philadelphia: Elsevier, 2005, pp 1511–550.Google Scholar
Coplin, WM, O'Keefe, GE, Grady, MS, Grant, GA, et al. Thrombotic, infectious, and procedural complications of the jugular bulb catheter in the intensive care unit. Neurosurgery 1997;41(1):101–9.CrossRefGoogle ScholarPubMed
Andrews, PJD, Dearden, NM, Miller, JD. Jugular bulb cannulation: Description of a cannulation technique and validation of a new continuous monitor. Br J Anaesth 1991;67:553–8.CrossRefGoogle ScholarPubMed
Edmonds, HL. Pro: All cardiac surgical patients should have intraoperative cerebral oxygenation monitoring. J Cardiothorac Vasc Anesth 2006;20:445–9.CrossRefGoogle ScholarPubMed
Latronico, N, Beindorf, AE, Rasulo, FA, Febbrari, P, et al. Limits of intermittent jugular bulb oxygen saturation monitoring in the management of severe head trauma patients. Neurosurgery 2001;48(2):454–6.Google Scholar
Murkin, JM, Adams SJ, Novick RJ, et al. Monitoring brain oxygen saturation during coronary bypass surgery: A randomized, prospective study. Anesth Analg 2007;104:51–8.CrossRefGoogle ScholarPubMed
Dunham, CM, et al: Correlation of noninvasive cerebral oximetry with cerebral perfusion in the severe heads injured patient: A pilot study. J Trauma 2002;52(1):40–6.Google ScholarPubMed
Dunham, CM, Ransom KJ, Flowers LL, et al. Cerebral hypoxia in severely brain injured patients is associated with admission Glasgow Coma Score, CT severity, cerebral perfusion pressure, and survival. J Trauma 2004;56(3):482–91.
Caplan, RA, Vistica, MF, Posner, KL, Cheney, FW. Adverse anesthetic outcomes arising from gas delivery equipment: A closed claims analysis. Anesthesiology 1997;87:741–8.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

  • 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
×

Save book to Dropbox

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.

  • 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
×

Save book to Google Drive

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
×