Anaesthesia for Trauma

Quick Answer

Trauma is the leading cause of death in Australians aged 1-44 years, with major trauma requiring coordinated multidisciplinary care including damage control resuscitation (DCR) principles. Primary survey follows ABCDE approach with simultaneous resuscitation: Airway (c-spine control, intubation if GCS <8 or airway compromise), Breathing (100% O₂, exclude tension pneumothorax, chest decompression if needed), Circulation (2 large-bore IVs, crystalloid bolus 500-1000 mL, blood products if active bleeding, permissive hypotension SBP 80-90 mmHg until haemorrhage controlled), Disability (GCS, pupils, glucose), Exposure (remove clothing, prevent hypothermia). Massive transfusion protocol (MTP) activates for >150 mL/min blood loss or >50% blood volume loss, using 1:1:1 ratio (RBC:plasma:platelets), tranexamic acid 1 g IV within 3 hours of injury, and calcium replacement. Rapid sequence induction in trauma uses reduced propofol doses (1-2 mg/kg vs. 2-3 mg/kg due to hypovolaemia) or ketamine 1-2 mg/kg (maintains sympathetic tone, preferred in hypovolaemic patients), with succinylcholine 1.5 mg/kg or rocuronium 1.2 mg/kg. Spinal immobilization is maintained until cervical spine clearance (clinical assessment, CT scan) in all blunt trauma patients with altered consciousness or neck pain. Hypothermia prevention is critical (reduces coagulation enzyme activity 50% at 35°C), using forced-air warming, warmed fluids, increased ambient temperature. Indigenous trauma patients have higher injury rates from motor vehicle accidents and interpersonal violence, with increased risk of penetrating trauma; remote location creates transfer delays requiring telemedicine support and culturally safe communication with families during critical care. [1-10]