Author/Editor		Miklič, M; Špiler, J
Title		Regionalna in splošna anestezija v nujni medicinski pomoči
Translated title		Regional nad general anaesthesia in emergency medicine
Type		članek
Source		In: Bručan A, Gričar M, editors. Urgentna medicina: izbrana poglavja 2. Zbornik 3. mednarodni simpozij o urgentni medicini; 1996 jun 26-29; Portorož. Ljubljana: Slovensko združenje za urgentno medicino,
Publication year		1996
Volume		str. 275-80
Language		slo
Abstract		Some operations must be done immediately or at least in 24 hours. In those situations we talk about urgent anesthesiology. Time for preoperative care is limited. Trauma is one of the major part of urgent anesthesiology. Appropriate management of traumatizated patients by the anesthesiologist significantly affect its morbidity and survival. Treatment begins in the emergency room with care for airway, breathing, intravascular resuscitation with crystalloid solutions and prevention of hypothermia. As soon as possible, we corrigate anemia and coagulopathy. Monitoring is very important for succesful work. General anesthesia is required for most traumatized patients, particularly those with multiple injuries. Regional anesthesia is useful when there are isolated limb injuries and for pain relief in the postoperative period. Hypovolemia and a full stomach put traumatized patient at risk for hypotension and pulmonary aspiration during induction of anesthesia. Therefore, a "rapid - sequence" induction with an I.V. agent, preoxygenation, and cricoid presssure is indicated in most cases for intubation. If neck injury is suspected, head must be held in neutral position by axial traction. Succinylcholine is the most useful muscle relaxant for a rapid onset of paralysis. It is very important to titrate all I.V. or inhalational anesthetic agents. Nitrous oxide is rarely useful in the trauma setting. Care for oxygenation, hemodynamic stability, protection against increased ICP and treatment of coagulopathy and anemia continue. Emergence is undertaken only on patient with and adequate level of conciousness, hemodynamic stability and without need to be mechanically ventilated. All others shoud be transported to ICU for postoperative management.
Descriptors		EMERGENCY MEDICAL SERVICES ANESTHESIA, GENERAL ANESTHESIA, CONDUCTION