British Journal of Anaesthesia - current issue

British Journal of Anaesthesia - RSS feed of current issue
  1. Trauma team

    The introduction of trauma teams has improved patient outcome independently. The aim of establishing a trauma team is to ensure the early mobilization and involvement of more experienced medical staff and thereby to improve patient outcome. The team approach allows for distribution of the several tasks in assessment and resuscitation of the patient in a ‘horizontal approach’, which may lead to a reduction in time from injury to critical interventions and thus have a direct bearing on the patient's ultimate outcome. A trauma team leader or supervisor, who coordinates the resuscitation and ensures adherence to guidelines, should lead the trauma team. There is a major national and international variety in trauma team composition, however crucial are a surgeon, an Emergency Medicine physician or both and anaesthetist. Advanced Trauma Life Support training, simulation-based training, and video review have all improved patient outcome and trauma team performance. Developments in the radiology, such as the use of computed tomography scanning in the emergency room and the endovascular treatment of bleeding foci, have changed treatment algorithms in selected patients. These developments and new insights in shock management may have a future impact on patient management and trauma team composition.

  2. Haemodynamic changes in trauma

    Trauma is the leading cause of death during the first four decades of life in the developed countries. Its haemodynamic response underpins the patient's initial ability to survive, and the response to treatment and subsequent morbidity and resolution. Trauma causes a number of insults including haemorrhage, tissue injury (nociception) and, predominantly, in military casualties, blast from explosions. This article discusses aspects of the haemodynamic responses to these insults and subsequent treatment. ‘Simple’ haemorrhage (blood loss without significant volume of tissue damage) causes a biphasic response: mean arterial blood pressure (MBP) is initially maintained by the baroreflex (tachycardia and increased vascular resistance, Phase 1), followed by a sudden decrease in MAP initiated by a second reflex (decrease in vascular resistance and bradycardia, Phase 2). Phase 2 may be protective. The response to tissue injury attenuates Phase 2 and may cause a deleterious haemodynamic redistribution that compromises blood flow to some vital organs. In contrast, thoracic blast exposure augments Phase 2 of the response to haemorrhage. However, hypoxaemia from lung injury limits the effectiveness of hypotensive resuscitation by augmenting the attendant shock state. An alternative strategy (‘hybrid resuscitation’) whereby tissue perfusion is increased after the first hour of hypotensive resuscitation by adopting a revised normotensive target may ameliorate these problems. Finally, morphine also attenuates Phase 2 of the response to haemorrhage in some, but not all, species and this is associated with poor outcome. The impact on human patients is currently unknown and is the subject of a current physiological investigation.

  3. Abstracts of the Royal College of Anaesthetists Annual Congress 2014: The National Museum, Cardiff, UK, May 15-16, 2014
  4. Under pressure? Alopecia related to surgical duration
  5. Abstracts of the Anaesthetic Research Society Meeting: Radisson Blu Edwardian Hotel, Manchester, UK, May 1-2, 2014
  6. Preoperative evaluation of Montgomery tube: a stitch in time saves nine
  7. Arterial blood gases from central venous lines: a sign for malformation
  8. Virtual laryngoscopy and combined laryngoscopic-bronchoscopic approach for safe management of obstructive upper airways lesions
  9. Real-time ultrasound-guided epidural anaesthesia technique can be improved by new echogenic Tuohy needles: a pilot study in cadavers
  10. Malleable stylet in difficult intubation: a modified technique
  11. 'Do as you would be done by': the ethics of using outdated equipment in medical charity
  12. Acceptability of auricular vs frontal bispectral index values
  13. Critically ill patients admitted in post-anaesthesia care units: a survey of current practices in France
  14. Ferric carboxymaltose increases epoetin-{alpha} response and prevents iron deficiency before elective orthopaedic surgery
  15. Anaesthesia considerations in penetrating trauma

    Trauma and penetrating injury, mostly in the form of assault and self-inflicted gunshot and stab wounds, is a major contributor to mortality and morbidity in the modern world, specifically among younger populations. While the prevalence of this form of injury is drastically lower in the UK and Europe in comparison with the USA, it is still common enough to necessitate practising anaesthetists to have a good understanding and working knowledge of the principles in treating victims with penetrating injury. This review article aims to cover basic principles of attending to penetrating trauma victims starting at the pre-hospital level and continuing into the emergency department (ED) and the operating theatre. We will highlight major issues with regard to airway control, severe bleeding treatment, and emergency scene and ED procedures. We also suggest a work flow for treating life-threatening penetrating injury and review the major controversies in this field. Our perspective is based on the experience and procedures used at the University of Washington's Harborview Medical Center, the only level 1 trauma centre covering the states of Washington, Alaska, Montana, Idaho, and Wyoming in the USA. This region contains almost 11 000 000 persons over a surface area of more than 2 700 000 km2.