Faculty Bibliography

PURPOSE OF REVIEW/OBJECTIVE:To examine current literature on thoracic trauma related to military combat and to explore its relevance to the civilian population. RECENT FINDINGS/RESULTS:Damage control resuscitation (DCR) has improved the management of hemorrhaging trauma patients. Permissive hypotension below 110 mmHg and antifibrinolytic use during DCR is widely accepted, whereas the use of freeze-dried plasma and whole blood is gaining popularity. The Modified Physiologic Triaging Tool can be used for primary triage and it may have applications in civilian trauma systems. Although Tactical Combat Casualty Care protocol recommends the Cric-Key device for surgical cricothyroidotomies, other devices may offer comparable performance. Recommendations for regional anesthesia after blunt trauma are not well defined. Increasing amounts of evidence favor the use of extracorporeal membrane oxygenation for refractory hypoxemia and resuscitative endovascular balloon occlusion of the aorta (REBOA) for severe hemorrhage. REBOA outcomes are potentially improved by partial occlusion and small 7 Fr catheters. SUMMARY/CONCLUSIONS:The Global War on Terror has provided opportunities to better understand and treat thoracic trauma in military settings. Trauma registries and other data sources have contributed to significant advancements in the management of thoracic trauma in military and civilian populations.

PURPOSE OF REVIEW/OBJECTIVE:The percentage of people over the age of 65 is growing rapidly and anesthesiologists must develop a medical understanding that is comprehensive to meet the unique medical needs of this population. The changing physiology of an elderly population makes them extremely vulnerable to trauma and the administration of blood products. Although most of these cases involve orthopedic attention, it is not less dangerous as a blunt trauma case. RECENT FINDINGS/RESULTS:This article addresses some of the main concerns for the anesthesiologists of providing a hemostatic resuscitation in the geriatric population. Should blood that is new lead to better outcomes than blood that was collected more than 14 days from the injury? What role does patient frailty have in trauma and transfusion outcomes? Is the massive transfusion protocol safe for the geriatric population? As this subset of the population grows, the number of patients on anticoagulation therapy will grow. Knowledge of the bone marrow plays an important role in geriatric trauma. How does head trauma in the elderly differ from the younger patient? SUMMARY/CONCLUSIONS:The information in this article is by no means comprehensive. Nongeriatric trauma protocols are far from being validated. Applying these protocols to the geriatric protocols must be investigated in terms of safety and benefits.