In the final installment of the Trauma and Burn Anesthesia Series, we explore the unique physiology and management of burn patients, a population that differs significantly from blunt or penetrating trauma. This episode covers the classification and severity of burns, the pathophysiology of burn shock, and essential principles like calculating burn extent using the rule of nines, applying the Parkland formula for fluid resuscitation, and monitoring for fluid creep. We also examine systemic complications affecting the cardiovascular, pulmonary, and metabolic systems, challenges of smoke inhalation injury and carbon monoxide poisoning, and the altered pharmacology that impacts anesthesia care. Finally, we discuss perioperative considerations such as blood loss, temperature control, and multimodal pain management, emphasizing why burn patients require such specialized care and preparation from anesthesia providers.

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In part 9 of the Trauma Anesthesia Series, we dive into the critical topic of mass casualty events—what defines them, how hospitals respond when resources are overwhelmed, and the principles of patient triage that determine who gets treated first. Using real-world examples, we explore common triage algorithms, the color-coded tagging system, and the difficult but necessary decisions providers must make to save the greatest number of lives. The episode also addresses the emotional toll of these crises, highlighting second victim syndrome and the importance of resilience, mental health support, and teamwork for healthcare providers navigating these high-stakes situations.

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Welcome to part 8 of the Trauma & Burn Anesthesia Series. In this episode, we take a broad look at special populations in trauma anesthesia—pregnant, pediatric, and geriatric patients. Each of these groups presents unique physiologic challenges, risk factors, and perioperative considerations that require anesthesia providers to adapt their trauma management strategies. From managing airway swelling and aspiration risk in pregnant patients, to balancing fluid resuscitation and minimizing radiation exposure in children, to mitigating postoperative delirium and cognitive dysfunction in older adults, this episode offers a high-level overview of principles you can apply in clinical practice. Because each of these populations deserves a deeper dive, we’ve included links in the show notes to key articles and guidelines so you can explore further on your own. In future episodes, we’ll dedicate entire discussions to each special population for a more detailed breakdown. Join us as we highlight essential principles and considerations for trauma anesthesia providers caring for these vulnerable groups.

ADDITIONAL RESOURCES:

Pregnant Patients:

1. Guidelines for the Management of Pregnant Trauma Patients (Jain, 2015)
2. Trauma in the Obstetric Patient: A Bedside Tool (ACEP)

Pediatrics:

1. Initial assessment and management of pediatric trauma patients (McFadyen, 2012)

Geriatrics:

1. Perioperative Management of the Geriatric Trauma Patient (Muldowney, 2025)
2. Trauma in the elderly patient (Atinga, 2018)

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This episode of the Trauma and Burn Anesthesia Series explores the acute management of spinal cord injury, from mechanisms like motor vehicle accidents and falls to the growing impact on older adults. Key topics include early recognition, imaging strategies, spinal precautions, maintaining supranormal mean arterial pressure for cord perfusion, and the use of methylprednisolone to reduce inflammation. We break down injury types—including Brown-Séquard, anterior, posterior, and central cord syndromes—along with crucial anesthesia pearls for airway management and safe patient transfer. The episode also highlights complications like neurogenic shock and autonomic dysreflexia, detailing when succinylcholine can be used safely and practical steps for treating hypertensive crises in chronic cord injuries.

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In this episode of the Trauma and Burn Anesthesia Series, we examine traumatic brain injury, the leading cause of trauma-related death in the U.S., affecting over a million people annually and leaving millions with long-term disability. We discuss the importance of the Glasgow Coma Scale, the types of primary injuries such as subdural, epidural, and intraparenchymal hematomas as well as diffuse axonal injury, and how these lead to increased intracranial pressure, herniation, and neurological decline. We explore secondary brain injury from hypotension, hypoxemia, hypercapnia, and hyperthermia, emphasizing the need to maintain adequate perfusion and oxygenation while balancing damage control resuscitation. Key management strategies include hyperosmolar therapy, ICP monitoring, CSF drainage, hyperventilation, mannitol use, steroids, seizure and infection prophylaxis, and cautious fluid therapy. We also cover practical intraoperative considerations, avoiding excessive anesthetics, carefully managing CSF drains, and adjusting ventilation, while highlighting the added complexity when TBI patients also present with massive hemorrhage.

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In this episode of the Trauma and Burn Anesthesia Series, we take a deep dive into one of the most critical moments in trauma care: the induction and maintenance of anesthesia in hemodynamically unstable patients. We break down the principles behind choosing the right agents, why dose reductions and careful titration are essential, and how rapid sequence induction sets the standard in trauma. You’ll hear about the role of etomidate and ketamine, why propofol is dangerous in unstable patients, and when vasopressors may actually be appropriate to support induction. We also cover strategies for managing volatile anesthetics, why nitrous oxide should be avoided, and how to prevent intraoperative recall in patients at extremely high risk. From heating strategies to avoid coagulopathy, to lung-protective ventilation in the face of pulmonary injury, and even emergency interventions like thoracotomy and REBOA, this episode takes you through the challenges and nuanced decision-making of trauma anesthesia. If you’ve ever wondered how to balance unconsciousness, perfusion, and safety in critically injured patients, this is the episode for you.

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In part 4 of the Trauma and Burn Anesthesia series, we turn to the critical steps of securing the airway, establishing reliable vascular access, and safely transitioning the patient from the trauma bay to the operating room. This episode highlights the challenges of airway management in unstable and severely injured patients, including techniques for rapid sequence induction, surgical airways, and strategies to minimize the risks of hypoxemia and aspiration. Intravenous and arterial line placement are discussed in the context of urgent access for fluid resuscitation, vasoactive support, blood sampling, and continuous hemodynamic monitoring. The episode also examines the logistical and physiologic considerations of patient transfer, emphasizing teamwork, communication, and vigilance to maintain stability during this vulnerable phase of trauma care.

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In part 3 of the Trauma and Burn Anesthesia series, we focus on blood product administration and fluid resuscitation, exploring how transfusions are tailored to support oxygen delivery, coagulation, and hemodynamic stability in critically injured patients. The episode examines the indications and composition of packed red blood cells, platelets, plasma, and cryoprecipitate, as well as the role of crystalloids and colloids in resuscitation. Key complications of transfusion—including transfusion related acute lung injury (TRALI) and transfusion associated circulatory overload (TACO)—are highlighted with emphasis on recognition, prevention, and management. Listeners are also guided through the principles of massive transfusion protocols (MTPs), including balanced product ratios, calcium supplementation, and rapid delivery systems that optimize outcomes in life-threatening hemorrhage.

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In part 2 of the Trauma and Burn Anesthesia series, we discuss hemorrhage management in trauma, covering the causes and treatment of trauma-induced coagulopathies and the significance of essential lab values such as thromboelastography (TEG), blood gases and PT/INR/PTT. The discussion integrates key concepts from trauma anesthesia, including the lethal triad and diamond of death, underscoring how hypothermia, acidosis, coagulopathy, and hypocalcemia interact to worsen outcomes. Listeners are introduced to advanced diagnostics like TEG for real-time assessment of coagulation, and learn best practices for addressing hyperfibrinolysis with antifibrinolytics such as tranexamic acid to optimize resuscitative care and reduce mortality.

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In this first installment of the Trauma and Burn Anesthesia series, we dive into the critical foundations of caring for severely injured patients in the perioperative setting. Designed for nurse anesthesiologists and nurse anesthesia residents, this episode reviews the guiding principles of Advanced Trauma Life Support (ATLS) and explores how these frameworks shape anesthetic decision-making. We also walk through the concepts of damage control surgery and damage control resuscitation, emphasizing their role in stabilizing critically ill trauma patients, optimizing outcomes, and prioritizing life over limb. Listeners will gain a deeper understanding of how resuscitation strategy, surgical timing, and anesthetic management intersect when every second matters. Whether you’re new to trauma anesthesia or refining your expertise, this episode sets the stage for a high-yield exploration of trauma and burn care.

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