Multi-system orthopedic trauma and the acute care anesthesiologist: Are we “clear”?

Have you ever wondered why some surgeons seem to be so concerned whether their patient is “cleared” for surgery?  It almost seems like they expect anesthesiologists to roll dice to decide whether their procedure is cancelled or not.  In the setting of multi-system trauma, this is a perfect opportunity for you to step up as a member of the perioperative team to help guide management in orthopedic fractures.  Dr. Justin E Richards has taken the time to provide thoughtful guidelines to determine if it is in your patient’s best interests to have definitive fixation.

Dr. Richards hails from R Adams Cowley Shock Trauma Center’s Division of Trauma Anesthesiology.  His career in medicine started when he went to Temple University for his doctorate in medicine.  He then went on to Vanderbilt University for residency and completed his training at the University of Maryland when he finished his fellowship in Critical Care Medicine.  His research foci are mainly in the traumatically injured surrounding critical care and orthopedics.  To view his editorial, click here


  1. commenter img tasedit3 years ago

    ​Very well written and thought provoking. I had the pleasure of working under John Border for a short while (sat in the back of the OR and smoked his cigarettes) – one of the old-style trauma surgeons who – akin to much of European trauma surgery – performed traumatic osteofixation along with all other surgical trauma care. Early mobilization, in his book, was the most critical element of post-operative management.

    The question of TBI is much more difficult than any other aspect of trauma surgery, mostly because of inflammatory – more than ICP – considerations. The time frame for CNS susceptibility to systemic inflammatory exacerbation of injury is indeed very individual and quite poorly defined. There doubtlessly are serum markers, but in contrast to lactate extremely expensive and not well documented. Very interested to read input from the group on this subject.

    Different question (cookbook type – almost literally): Does anybody in the group have experience with direct (as in warm saline solution) warming of the hypothermic, fibrillating heart in trauma prior to epicardial defibrillation? What would the minimum contact time be?



Leave a Comment