Introduction
Battlefield anesthesia primarily describes a state of balanced
anesthesia using adequate amounts of anesthetic agents to
minimize cardiovascular instability, amnesia, analgesia, and a
quiescent surgical
...
Introduction
Battlefield anesthesia primarily describes a state of balanced
anesthesia using adequate amounts of anesthetic agents to
minimize cardiovascular instability, amnesia, analgesia, and a
quiescent surgical field in a technologically austere environment.
Adapting anesthetic techniques to battlefield conditions requires
flexibility and a reliance on fundamental clinical skills. While
modern monitors provide a wealth of data, the stethoscope may
be the only tool available in an austere environment. Thus, the
value of crisp heart sounds and clear breath sounds when caring
for an injured service member should not be underestimated.
In addition, close collaboration and communication with the
surgeon is essential.
Airway
Many methods for securing a compromised airway exist,
depending on the condition of the airway, the comorbid state of
the patient, and the environment in which care is being rendered.
When a definitive airway is required, it is generally best secured
with direct laryngoscopy and an endotracheal tube (ETT), firmly
secured in the trachea.
Indications for a Definitive Airway
Apnea/airway obstruction/hypercarbia.
Impending airway obstruction: facial fractures, retropharyngeal
hematoma, and inhalation injury.
Excessive work of breathing.
Shock (bp < 80 mm Hg systolic).
Glasgow Coma Scale (GCS) < 8. (See Appendix 2.)
Persistent hypoxia (SaO2 < 90%).
9.2
Emergency War Surgery
Secondary Airway Compromise Can Result From
Failure to recognize the need for an airway.
Inability to establish an airway.
Failure to recognize an incorrectly placed airway.
Displacement of a previously established airway.
Failure to recognize the need for ventilation.
Induction of General Anesthesia
The Anesthesia Provider Must Evaluate the Patient for
Concurrent illness and current state of resuscitation.
Airway — facial trauma, dentition, hyoid-to-mandibular
symphysis length, extent of mouth opening.
Cervical spine mobility (preexistent and trauma related).
Additional difficult airway indicators.
ο Immobilization.
ο Children.
ο Short neck/receding mandible.
ο Prominent upper incisors.
Rapid Sequence Intubation Checklist
Equipment.
ο Laryngoscope, blades, and batteries (tested daily).
ο Suction, O2 setup.
ο Endotracheal tubes and stylet.
ο Alternative tubes (oro, nasopharyngeal, LMA [laryngeal
mask airway]).
ο IV access items.
ο Monitors — pulse ox, ECG, BP, end-tidal CO2.
ο Positive pressure ventilation (Ambu bag or anesthesia
machine).
Drugs.
ο Narcotics.
ο Muscle relaxants.
ο Anxiolytics and amnestics.
ο Induction agents and sedatives.
ο Inhalation agents.
Narcotics.
ο Fentanyl, 2.0–2.5 µg/kg IV bolus, then titrate to effect.
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