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Robert M. Donatiello, Department of Anesthesiology, Hospital for Joint Diseases and Orthopedic Surgery, New York University Medical Center, New York,
Andrew D. Rosenberg, Department of Anesthesiology, Hospital for Joint Diseases and Orthopedic Surgery, New York University Medical Center, New York,
Charles E. Smith, Department of Anesthesiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
Discuss risk factors and complications of orthopedic trauma including advanced age, obesity, intoxication, compartmental syndrome, positioning injuries, and fat embolism.
Evaluate anesthetic concerns for patients with hip fracture, pelvic injury, and traumatic spinal cord injuries.
Review the options for postoperative pain control after orthopedic trauma including patient-controlled analgesia (PCA), epidural analgesia, and peripheral nerve blocks.
Almost 60 million people are injured in the United States annually, accounting for roughly one in six hospital admissions. There are as many as 148,000 deaths related to trauma each year in the United States . Unintentional injuries were the fifth leading cause of death in 2004 . The fund of knowledge gained from experiences and research work has given victims of trauma significant potential for survival. This is particularly so when considering orthopedic trauma and the anesthetic management of its victims.
This chapter breaks the surface of the choppy waters of orthopedic trauma anesthesia. By exploring the patients that present, and the scenarios by which they may be married to trauma, as well as concepts related to their care, the anesthesia practitioner may gain a new perspective on the management of patients who have suffered acute orthopedic injuries.
EARLY FRACTURE FIXATION
When assessing a multiple-injury patient, attention to all systems is in high order. Although acute cardiopulmonary, visceral, and neurologic trauma take precedence, it is of extreme importance that orthopedic injuries are fully evaluated (see Chapters 13 and 15).
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