Skip to main content
SpringerLink
Log in

Perioperative Management

  • Chapter
  • First Online:
Management of Musculoskeletal Injuries in the Trauma Patient

  • 1831 Accesses

Abstract

Every trauma patient poses a unique challenge to the health care provider. Injured patients present with a variety of difficulties, and their overall condition is complex. The underlying causes of existing or evolving problems are multifactorial, and the course of disease can be surprisingly dynamic. A targeted approach to assessing and managing patients is imperative to provide the best care to critically ill patients admitted to the trauma bay. A swift and accurate assessment of the patient’s condition provides the basis for proper and timely treatment that is focused on priorities. This chapter highlights aspects of the initial assessment and describes the complications frequently present in trauma patients. Primary treatment includes resuscitation and stabilization of the patient and aims to prevent secondary damage and complications. To achieve this, a combination of bleeding control, fluid administration, and blood component replacement is initially required. Close monitoring of the success of therapy and the early identification of severe complications such as trauma-related coagulopathy are integral parts of trauma management.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 159.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. American College of Surgeons—Trauma Programs. Advanced trauma life support. 2012 [updated 2 Apr 2012; cited 31 May 2012]; Available from: http://www.facs.org/trauma/atls/index.html.

  2. National Association of Emergency Medical Technicians (U.S.), Pre-Hospital Trauma Life Support Committee, American College of Surgeons, Committee on Trauma. PHTLS: prehospital trauma life support. 7th ed. St. Louis: Mosby Jems/Elsevier; 2011.

    Google Scholar 

  3. Reed MJ, Rennie LM, Dunn MJ, Gray AJ, Robertson CE, McKeown DW. Is the ‘LEMON’ method an easily applied emergency airway assessment tool? Eur J Emerg Med. 2004;11(3):154–7.

    Article  PubMed  Google Scholar 

  4. Weingart SD, Levitan RM. Preoxygenation and prevention of desaturation during emergency airway management. Ann Emerg Med. 2012;59(3):165–75.e1.

    Article  PubMed  Google Scholar 

  5. Weingart SD. Preoxygenation, reoxygenation, and delayed sequence intubation in the emergency department. J Emerg Med. 2011;40(6):661–7.

    Article  PubMed  Google Scholar 

  6. Mort TC. Preoxygenation in critically ill patients requiring emergency tracheal intubation. Crit Care Med. 2005;33(11):2672–5.

    Article  PubMed  Google Scholar 

  7. Paal P, Herff H, Mitterlechner T, von Goedecke A, Brugger H, Lindner KH, et al. Anaesthesia in prehospital emergencies and in the emergency room. Resuscitation. 2010;81(2):148–54.

    Article  PubMed  Google Scholar 

  8. Benumof J, Hagberg CA. Benumof’s airway management: principles and practice. 2nd ed. Philadelphia: Mosby; 2007.

    Google Scholar 

  9. Apfelbaum JL, Hagberg CA, Caplan RA, Blitt CD, Connis RT, Nickinovich DG, et al. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology. 2013;118(2):251–70.

    Article  PubMed  Google Scholar 

  10. American Society of Anesthesiologists. 2013. [cited 10 Aug 2013]; Available from: http://www.asahq.org/.

  11. Hasegawa K, Shigemitsu K, Hagiwara Y, Chiba T, Watase H, Brown 3rd CA, et al. Association between repeated intubation attempts and adverse events in emergency departments: an analysis of a multicenter prospective observational study. Ann Emerg Med. 2012;60(6):749–754.e2.

    Article  PubMed  Google Scholar 

  12. Mort TC. Emergency tracheal intubation: complications associated with repeated laryngoscopic attempts. Anesth Analg. 2004;99(2):607–13, table of contents.

    Article  PubMed  Google Scholar 

  13. Robitaille A, Williams SR, Tremblay MH, Guilbert F, Theriault M, Drolet P. Cervical spine motion during tracheal intubation with manual in-line stabilization: direct laryngoscopy versus GlideScope videolaryngoscopy. Anesth Analg. 2008;106(3):935–41, table of contents.

    Article  PubMed  Google Scholar 

  14. Maharaj CH, Buckley E, Harte BH, Laffey JG. Endotracheal intubation in patients with cervical spine immobilization: a comparison of macintosh and airtraq laryngoscopes. Anesthesiology. 2007;107(1):53–9.

    Article  PubMed  Google Scholar 

  15. Pott LM, Murray WB. Review of video laryngoscopy and rigid fiberoptic laryngoscopy. Curr Opin Anaesthesiol. 2008;21(6):750–8.

    Article  PubMed  Google Scholar 

  16. Houde BJ, Williams SR, Cadrin-Chenevert A, Guilbert F, Drolet P. A comparison of cervical spine motion during orotracheal intubation with the trachlight(r) or the flexible fiberoptic bronchoscope. Anesth Analg. 2009;108(5):1638–43.

    Article  PubMed  Google Scholar 

  17. Crosby ET. Airway management in adults after cervical spine trauma. Anesthesiology. 2006;104(6):1293–318.

    Article  PubMed  Google Scholar 

  18. Mihai R, Blair E, Kay H, Cook TM. A quantitative review and meta-analysis of performance of non-standard laryngoscopes and rigid fibreoptic intubation aids. Anaesthesia. 2008;63(7):745–60.

    Article  PubMed  CAS  Google Scholar 

  19. Diez C, Varon AJ. Airway management and initial resuscitation of the trauma patient. Curr Opin Crit Care. 2009;15(6):542–7.

    Article  PubMed  Google Scholar 

  20. Wahlen BM, Roewer N, Lange M, Kranke P. Tracheal intubation and alternative airway management devices used by healthcare professionals with different level of pre-existing skills: a manikin study. Anaesthesia. 2009;64(5):549–54.

    Article  PubMed  CAS  Google Scholar 

  21. Mosier JM, Stolz U, Chiu S, Sakles JC. Difficult airway management in the emergency department: GlideScope videolaryngoscopy compared to direct laryngoscopy. J Emerg Med. 2012;42(6):629–34.

    Article  PubMed  Google Scholar 

  22. Cooper R, Law J. Rigid and semirigid fiberoptic and video laryngoscopy and intubation. In: Hung O, Murphy M, editors. Management of the difficult and failed airway. New York: McGraw-Hill Medical; 2008.

    Google Scholar 

  23. Murphy M, Law J. Rigid and semirigid fiberoptic intubation. In: Walls R, Murphy M, Luten R, Schneider J, editors. Manual of emergency airway management. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2004.

    Google Scholar 

  24. Sakles J. Video laryngoscopy. In: Walls R, Murphy M, Luten R, Schneider J, editors. Manual of emergency airway management. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2004.

    Google Scholar 

  25. Sakles JC, Rodgers R, Keim SM. Optical and video laryngoscopes for emergency airway management. Intern Emerg Med. 2008;3(2):139–43.

    Article  PubMed  Google Scholar 

  26. NAEMT. Advanced medical life support: an assessment-based approach. 1st ed. St. Louis: Mosby/JEMS; 2011.

    Google Scholar 

  27. Abanador N, Hofer M, Kamper L, Rattunde H, Zentai C. The chest X-ray—a systematic teaching atlas. 1st ed. New York: Thieme Medical Publishers; 2007.

    Google Scholar 

  28. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based injury statistics query and reporting system (WISQARS). 2007. [cited 21 Oct 2012]; Available from: http://www.cdc.gov/injury/wisqars.

  29. Spahn DR, Bouillon B, Cerny V, Coats TJ, Duranteau J, Fernandez-Mondejar E, et al. Management of bleeding and coagulopathy following major trauma: an updated European guideline. Crit Care. 2013;17(2):R76.

    Article  PubMed  Google Scholar 

  30. Zentai C, Grottke O, Spahn DR, Rossaint R. Nonsurgical techniques to control massive bleeding. Anesthesiol Clin. 2013;31(1):41–53.

    Article  PubMed  Google Scholar 

  31. Kragh Jr JF, Walters TJ, Baer DG, Fox CJ, Wade CE, Salinas J, et al. Survival with emergency tourniquet use to stop bleeding in major limb trauma. Ann Surg. 2009;249(1):1–7.

    Article  PubMed  Google Scholar 

  32. Beekley AC, Sebesta JA, Blackbourne LH, Herbert GS, Kauvar DS, Baer DG, et al. Prehospital tourniquet use in Operation Iraqi Freedom: effect on hemorrhage control and outcomes. J Trauma. 2008;64(2 Suppl):S28–37; discussion S37.

    Article  PubMed  Google Scholar 

  33. Lakstein D, Blumenfeld A, Sokolov T, Lin G, Bssorai R, Lynn M, et al. Tourniquets for hemorrhage control on the battlefield: a 4-year accumulated experience. J Trauma. 2003;54(5 Suppl):S221–5.

    PubMed  Google Scholar 

  34. Brodie S, Hodgetts TJ, Ollerton J, McLeod J, Lambert P, Mahoney P. Tourniquet use in combat trauma: U.K. military experience. J Spec Oper Med. 2009;9(1):74–7.

    PubMed  Google Scholar 

  35. Kragh Jr JF, Littrel ML, Jones JA, Walters TJ, Baer DG, Wade CE, et al. Battle casualty survival with emergency tourniquet use to stop limb bleeding. J Emerg Med. 2011;41(6):590–7.

    Article  PubMed  Google Scholar 

  36. Swan Jr KG, Wright DS, Barbagiovanni SS, Swan BC, Swan KG. Tourniquets revisited. J Trauma. 2009;66(3):672–5.

    Article  PubMed  Google Scholar 

  37. Clasper JC, Brown KV, Hill P. Limb complications following pre-hospital tourniquet use. J R Army Med Corps. 2009;155(3):200–2.

    Article  PubMed  CAS  Google Scholar 

  38. Dayan L, Zinmann C, Stahl S, Norman D. Complications associated with prolonged tourniquet application on the battlefield. Mil Med. 2008;173(1):63–6.

    PubMed  Google Scholar 

  39. Scalea TM, DuBose J, Moore EE, West M, Moore FA, McIntyre R, et al. Western Trauma Association critical decisions in trauma: management of the mangled extremity. J Trauma Acute Care Surg. 2012;72(1):86–93.

    PubMed  Google Scholar 

  40. Kortbeek JB, Al Turki SA, Ali J, Antoine JA, Bouillon B, Brasel K, et al. Advanced trauma life support, 8th edition, the evidence for change. J Trauma. 2008;64(6):1638–50.

    Article  PubMed  Google Scholar 

  41. Bauer JR, Ray CE. Transcatheter arterial embolization in the trauma patient: a review. Semin Intervent Radiol. 2004;21(1):11–22.

    Article  PubMed  Google Scholar 

  42. Panetta T, Sclafani SJ, Goldstein AS, Phillips TF, Shaftan GW. Percutaneous transcatheter embolization for massive bleeding from pelvic fractures. J Trauma. 1985;25(11):1021–9.

    PubMed  CAS  Google Scholar 

  43. Geeraerts T, Chhor V, Cheisson G, Martin L, Bessoud B, Ozanne A, et al. Clinical review: initial management of blunt pelvic trauma patients with haemodynamic instability. Crit Care. 2007;11(1):204.

    Article  PubMed  Google Scholar 

  44. Velmahos GC, Chahwan S, Falabella A, Hanks SE, Demetriades D. Angiographic embolization for intraperitoneal and retroperitoneal injuries. World J Surg. 2000;24(5):539–45.

    Article  PubMed  CAS  Google Scholar 

  45. Velmahos GC, Toutouzas KG, Vassiliu P, Sarkisyan G, Chan LS, Hanks SH, et al. A prospective study on the safety and efficacy of angiographic embolization for pelvic and visceral injuries. J Trauma. 2002;53(2):303–8; discussion 8.

    Article  PubMed  Google Scholar 

  46. Vassiliu P, Sava J, Toutouzas KG, Velmahos GC. Is contrast as bad as we think? Renal function after angiographic embolization of injured patients. J Am Coll Surg. 2002;194(2):142–6.

    Article  PubMed  Google Scholar 

  47. Teo LT, Punamiya S, Chai CY, Go KT, Yeo YT, Wong D, et al. Emergency angio-embolisation in the operating theatre for trauma patients using the C-Arm digital subtraction angiography. Injury. 2012;43(9):1492–6.

    Article  PubMed  Google Scholar 

  48. Perez JV, Hughes TM, Bowers K. Angiographic embolisation in pelvic fracture. Injury. 1998;29(3):187–91.

    Article  PubMed  CAS  Google Scholar 

  49. Yasumura K, Ikegami K, Kamohara T, Nohara Y. High incidence of ischemic necrosis of the gluteal muscle after transcatheter angiographic embolization for severe pelvic fracture. J Trauma. 2005;58(5):985–90.

    Article  PubMed  Google Scholar 

  50. Hare WS, Holland CJ. Paresis following internal iliac artery embolization. Radiology. 1983;146(1):47–51.

    PubMed  CAS  Google Scholar 

  51. Agolini SF, Shah K, Jaffe J, Newcomb J, Rhodes M, Reed 3rd JF. Arterial embolization is a rapid and effective technique for controlling pelvic fracture hemorrhage. J Trauma. 1997;43(3):395–9.

    Article  PubMed  CAS  Google Scholar 

  52. Wong YC, Wang LJ, Ng CJ, Tseng IC, See LC. Mortality after successful transcatheter arterial embolization in patients with unstable pelvic fractures: rate of blood transfusion as a predictive factor. J Trauma. 2000;49(1):71–5.

    Article  PubMed  CAS  Google Scholar 

  53. Shapiro M, McDonald AA, Knight D, Johannigman JA, Cuschieri J. The role of repeat angiography in the management of pelvic fractures. J Trauma. 2005;58(2):227–31.

    Article  PubMed  Google Scholar 

  54. O’Neill PA, Riina J, Sclafani S, Tornetta 3rd P. Angiographic findings in pelvic fractures. Clin Orthop Relat Res. 1996;329:60–7.

    Article  PubMed  Google Scholar 

  55. Heetveld MJ, Harris I, Schlaphoff G, Sugrue M. Guidelines for the management of haemodynamically unstable pelvic fracture patients. ANZ J Surg. 2004;74(7):520–9.

    Article  PubMed  Google Scholar 

  56. Miller PR, Moore PS, Mansell E, Meredith JW, Chang MC. External fixation or arteriogram in bleeding pelvic fracture: initial therapy guided by markers of arterial hemorrhage. J Trauma. 2003;54(3):437–43.

    Article  PubMed  Google Scholar 

  57. Verbeek D, Sugrue M, Balogh Z, Cass D, Civil I, Harris I, et al. Acute management of hemodynamically unstable pelvic trauma patients: time for a change? Multicenter review of recent practice. World J Surg. 2008;32(8):1874–82.

    Article  PubMed  Google Scholar 

  58. Grottke O, Henzler D, Rossaint R. Use of blood and blood products in trauma. Best Pract Res Clin Anaesthesiol. 2007;21(2):257–70.

    Article  PubMed  CAS  Google Scholar 

  59. Gutierrez G, Reines HD, Wulf-Gutierrez ME. Clinical review: hemorrhagic shock. Crit Care. 2004;8(5):373–81.

    Article  PubMed  Google Scholar 

  60. American College of Surgeons Committee on Trauma. ATLS advanced trauma life support for doctors, student course manual. 9th ed. Chicago: American College of Surgeons; 2012.

    Google Scholar 

  61. Snyder HS. Significance of the initial spun hematocrit in trauma patients. Am J Emerg Med. 1998;16(2):150–3.

    Article  PubMed  CAS  Google Scholar 

  62. Kass LE, Tien IY, Ushkow BS, Snyder HS. Prospective crossover study of the effect of phlebotomy and intravenous crystalloid on hematocrit. Acad Emerg Med. 1997;4(3):198–201.

    Article  PubMed  CAS  Google Scholar 

  63. Manikis P, Jankowski S, Zhang H, Kahn RJ, Vincent JL. Correlation of serial blood lactate levels to organ failure and mortality after trauma. Am J Emerg Med. 1995;13(6):619–22.

    Article  PubMed  CAS  Google Scholar 

  64. Siegel JH. Immediate versus delayed fluid resuscitation in patients with trauma. N Engl J Med. 1995;332(10):681; author reply 2–3.

    Article  PubMed  CAS  Google Scholar 

  65. Davis JW, Kaups KL. Base deficit in the elderly: a marker of severe injury and death. J Trauma. 1998;45(5):873–7.

    Article  PubMed  CAS  Google Scholar 

  66. Randolph LC, Takacs M, Davis KA. Resuscitation in the pediatric trauma population: admission base deficit remains an important prognostic indicator. J Trauma. 2002;53(5):838–42.

    Article  PubMed  Google Scholar 

  67. Spahn DR, Rossaint R. Coagulopathy and blood component transfusion in trauma. Br J Anaesth. 2005;95(2):130–9.

    Article  PubMed  CAS  Google Scholar 

  68. Martini WZ. Coagulopathy by hypothermia and acidosis: mechanisms of thrombin generation and fibrinogen availability. J Trauma. 2009;67(1):202–8; discussion 8–9.

    Article  PubMed  CAS  Google Scholar 

  69. Fries D, Martini WZ. Role of fibrinogen in trauma-induced coagulopathy. Br J Anaesth. 2010;105(2):116–21.

    Article  PubMed  CAS  Google Scholar 

  70. Engstrom M, Schott U, Romner B, Reinstrup P. Acidosis impairs the coagulation: a thromboelastographic study. J Trauma. 2006;61(3):624–8.

    Article  PubMed  Google Scholar 

  71. Farkash U, Lynn M, Scope A, Maor R, Turchin N, Sverdlik B, et al. Does prehospital fluid administration impact core body temperature and coagulation functions in combat casualties? Injury. 2002;33(2):103–10.

    Article  PubMed  Google Scholar 

  72. Gentilello LM, Jurkovich GJ, Stark MS, Hassantash SA, O’Keefe GE. Is hypothermia in the victim of major trauma protective or harmful? A randomized, prospective study. Ann Surg. 1997;226(4):439–47; discussion 47–9.

    Article  PubMed  CAS  Google Scholar 

  73. Cosgriff N, Moore EE, Sauaia A, Kenny-Moynihan M, Burch JM, Galloway B. Predicting life-threatening coagulopathy in the massively transfused trauma patient: hypothermia and acidoses revisited. J Trauma. 1997;42(5):857–61; discussion 61–2.

    Article  PubMed  CAS  Google Scholar 

  74. Wolberg AS, Meng ZH, Monroe 3rd DM, Hoffman M. A systematic evaluation of the effect of temperature on coagulation enzyme activity and platelet function. J Trauma. 2004;56(6):1221–8.

    Article  PubMed  CAS  Google Scholar 

  75. Kermode JC, Zheng Q, Milner EP. Marked temperature dependence of the platelet calcium signal induced by human von Willebrand factor. Blood. 1999;94(1):199–207.

    PubMed  CAS  Google Scholar 

  76. Schierhout G, Roberts I. Fluid resuscitation with colloid or crystalloid solutions in critically ill patients: a systematic review of randomised trials. BMJ. 1998;316(7136):961–4.

    Article  PubMed  CAS  Google Scholar 

  77. Bisonni RS, Holtgrave DR, Lawler F, Marley DS. Colloids versus crystalloids in fluid resuscitation: an analysis of randomized controlled trials. J Fam Pract. 1991;32(4):387–90.

    PubMed  CAS  Google Scholar 

  78. Human albumin administration in critically ill patients: systematic review of randomised controlled trials. Cochrane Injuries Group Albumin Reviewers. BMJ. 1998;317(7153):235–40.

    Google Scholar 

  79. Choi PT, Yip G, Quinonez LG, Cook DJ. Crystalloids vs. colloids in fluid resuscitation: a systematic review. Crit Care Med. 1999;27(1):200–10.

    Article  PubMed  CAS  Google Scholar 

  80. Roberts I, Alderson P, Bunn F, Chinnock P, Ker K, Schierhout G. Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev. 2004;(4):CD000567.

    Google Scholar 

  81. Battison C, Andrews PJ, Graham C, Petty T. Randomized, controlled trial on the effect of a 20% mannitol solution and a 7.5% saline/6% dextran solution on increased intracranial pressure after brain injury. Crit Care Med. 2005;33(1):196–202.

    Article  PubMed  CAS  Google Scholar 

  82. Simmons RL, Collins JA, Heisterkamp CA, Mills DE, Andren R, Phillips LL. Coagulation disorders in combat casualties. I. Acute changes after wounding. II. Effects of massive transfusion. 3. Post-resuscitative changes. Ann Surg. 1969;169(4):455–82.

    Article  PubMed  CAS  Google Scholar 

  83. Peyrou V, Lormeau JC, Herault JP, Gaich C, Pfliegger AM, Herbert JM. Contribution of erythrocytes to thrombin generation in whole blood. Thromb Haemost. 1999;81(3):400–6.

    PubMed  CAS  Google Scholar 

  84. Hebert PC, Wells G, Blajchman MA, Marshall J, Martin C, Pagliarello G, et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. N Engl J Med. 1999;340(6):409–17.

    Article  PubMed  CAS  Google Scholar 

  85. McIntyre L, Hebert PC, Wells G, Fergusson D, Marshall J, Yetisir E, et al. Is a restrictive transfusion strategy safe for resuscitated and critically ill trauma patients? J Trauma. 2004;57(3):563–8; discussion 8.

    Article  PubMed  Google Scholar 

  86. Malone DL, Dunne J, Tracy JK, Putnam AT, Scalea TM, Napolitano LM. Blood transfusion, independent of shock severity, is associated with worse outcome in trauma. J Trauma. 2003;54(5):898–905; discussion –7.

    Article  PubMed  Google Scholar 

  87. Claridge JA, Sawyer RG, Schulman AM, McLemore EC, Young JS. Blood transfusions correlate with infections in trauma patients in a dose-dependent manner. Am Surg. 2002;68(7):566–72.

    PubMed  Google Scholar 

  88. Sauaia A, Moore FA, Moore EE, Norris JM, Lezotte DC, Hamman RF. Multiple organ failure can be predicted as early as 12 hours after injury. J Trauma. 1998;45(2):291–301; discussion –3.

    Article  PubMed  CAS  Google Scholar 

  89. Weinberg JA, McGwin Jr G, Marques MB, Cherry 3rd SA, Reiff DA, Kerby JD, et al. Transfusions in the less severely injured: does age of transfused blood affect outcomes? J Trauma. 2008;65(4):794–8.

    Article  PubMed  Google Scholar 

  90. Bickell WH, Wall Jr MJ, Pepe PE, Martin RR, Ginger VF, Allen MK, et al. Immediate versus delayed fluid resuscitation for hypotensive patients with penetrat-ing torso injuries. N Engl J Med. 1994;331(17):1105–9.

    Article  PubMed  CAS  Google Scholar 

  91. Dutton RP, Mackenzie CF, Scalea TM. Hypotensive resuscitation during active hemorrhage: impact on in-hospital mortality. J Trauma. 2002;52(6):1141–6.

    Article  PubMed  Google Scholar 

  92. Kwan I, Bunn F, Roberts I. Timing and volume of fluid administration for patients with bleeding. Cochrane Database Syst Rev. 2003;(3):CD002245.

    Google Scholar 

  93. Poloujadoff MP, Borron SW, Amathieu R, Favret F, Camara MS, Lapostolle F, et al. Improved survival after resuscitation with norepinephrine in a murine model of uncontrolled hemorrhagic shock. Anesthesiology. 2007;107(4):591–6.

    Article  PubMed  CAS  Google Scholar 

  94. Aehlert BJ. Workbook for paramedic practice today: above and beyond. St. Louis: Mosby/JEMS; 2009.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anaesthesiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany

    Christian Zentai MD, Oliver Grottke MD, PhD & Rolf Rossaint MD

Authors
  1. Christian Zentai MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Oliver Grottke MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rolf Rossaint MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christian Zentai MD .

Editor information

Editors and Affiliations

  1. Department of Orthopaedics, Swedish Medical Center, Englewood, Colorado, USA

    Wade R. Smith

  2. Department of Orthopedics, Denver Health Medical Center, Denver, Colorado, USA

    Philip F. Stahel

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer Science+Business Media New York

About this chapter

Cite this chapter

Zentai, C., Grottke, O., Rossaint, R. (2014). Perioperative Management. In: Smith, W., Stahel, P. (eds) Management of Musculoskeletal Injuries in the Trauma Patient. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8551-3_2

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-8551-3_2

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-8550-6

  • Online ISBN: 978-1-4614-8551-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation