Appendix A: Trauma Anesthesia Checklist

BEFORE PATIENT ARRIVAL

- Room temperature > 30˚C
- Warm IV line
- Machine check
- Airway equipment check
- Emergency medication check
- Blood Bank notified to have blood available per unit SOP

PATIENT ARRIVAL

- Patient identified for surgery as soon as possible
- Blood Bank notified to deliver blood per unit SOP
- Ensure large bore IV or CVC access
- Monitors (SaO2, BP, ECG)
- Pre-oxygenation

INDUCTION

- Sedative hypnotic (Ketamine vs. Propofol)
- Neuromuscular blockade (Rocuronium vs. succinylcholine)

INTUBATION

(Per Airway Management CPG)

- (+) ETCO2
- Place orogastric tube

ANESTHETIC

- Consider TIVA
- (Volatile anesthetic and/or benzodiazepine) + narcotic
- Insert additional IV access and/or arterial line if needed

RESUSCITATION

(per Damage Control Resuscitation CPG)

- Send baseline labs, type and cross if not yet done
- Follow MAP trends
- Goal FFP: PRBC: Plt 1:1:1 if Massive Transfusion. Use Cold Stored Whole Blood (if available)
- Activate walking blood bank to obtain Fresh Whole Blood (if needed)
- Goal urine output 0.5-1.0 mL/kg/hr
- Consider TXA if <3 hours from injury and at risk for hemorrhagic shock
- Consider calcium 1 gm
- Consider hydrocortisone 100 mg
- Consider vasopressin 2-4 IU + 0.04 IU/min
- Administer appropriate antibiotics
- Special considerations for TBI as indicated in Severe Head Injury CPG

CLOSING/POST-OPERATIVE

- Low volume ventilation per Acute Respiratory Failure CPG