Examqo › Examqo library › Anesthesiology › Special populations

Anaesthesia for trauma and burns

In a trauma patient, assume a full stomach and a cervical spine injury, induce carefully with small doses, and keep blood pressure deliberately low until bleeding is controlled (except in head injury); in burns, calculate fluid by burn area, intubate early if there is inhalation injury, and beware of succinylcholine after the first day.

לקריאה בעברית

Why it matters in the exam

The exam asks about intubation with manual in-line stabilisation of the neck, choosing an induction drug in a shocked patient, permissive hypotension and the target in head injury, balanced resuscitation in a 1:1:1 ratio and tranexamic acid, the lethal triad, the Parkland formula and urine monitoring, signs of inhalation injury, carbon monoxide and cyanide poisoning from smoke, and succinylcholine and non-depolarising muscle relaxants in burns.

In a trauma patient a rapid sequence intubation is done with manual in-line stabilisation of the neck (opening the front of the collar), preferably with a videolaryngoscope. Drug doses are reduced greatly, because a shocked patient lives on the sympathetic system; ketamine or etomidate preserve blood pressure better. Until bleeding is stopped, a systolic pressure of 80–90 is kept (permissive hypotension), but in head injury a systolic pressure of at least 100–110 is needed to maintain brain perfusion. Blood, plasma and platelets are given in a ratio close to 1:1:1, clear fluids are limited, and tranexamic acid is given within 3 hours: 1 g over 10 minutes and then 1 g over 8 hours. The lethal triad is cold, acidosis and coagulopathy, so the patient is warmed, calcium is corrected and rapid bleeding control is sought.

In extensive burns (about 20% of body surface or more in an adult), fluid is calculated by Parkland: 4 mL times weight times burn percentage over 24 hours, with half given during the 8 hours after the burn occurred; the target is a urine output of 0.5 mL/kg per hour, because excess fluid causes oedema and compartment syndrome. A facial burn, hoarseness, stridor, soot in the mouth or a burn in a closed space suggest inhalation injury, and airway oedema worsens over the next hours — so intubation is done early. In carbon monoxide poisoning the pulse oximeter saturation looks normal, and co-oximetry is needed; 100% oxygen is given, which shortens the half-life from about 4–5 hours to about an hour. Severe lactic acidosis after inhaling smoke from plastics suggests cyanide, and the treatment is hydroxocobalamin 5 g. Succinylcholine is safe in the first 24 hours, but after that it may cause dangerous high potassium until the burn heals; in contrast there is resistance to non-depolarising muscle relaxants and a high need for analgesics.

Key points

• Trauma: full stomach, neck stabilisation, small doses.
• Systolic pressure 80–90 until bleeding is stopped, except in head injury.
• 1:1:1 and tranexamic acid within 3 hours.
• Parkland: 4 mL times weight times percentage, half in 8 hours.
• Carbon monoxide: 100% oxygen; succinylcholine only in the first 24 hours.

Summary table

In the full version for subscribers

• A simple algorithm
• Memory aid
• Exam traps
• 5 review cards
• Enough for IMLE

The full version is open to subscribers of: Anesthesiology, General surgery.

Subscriber? Read the full topic Plans and prices 25 free questions

Sources

• ATLS Advanced Trauma Life Support, 10th edition (2018) — Airway, shock and head trauma
• European guideline on management of major bleeding and coagulopathy following trauma, 6th edition (2023) — Resuscitation targets and tranexamic acid
• Miller's Anesthesia, 9th edition (2020) — Anesthesia for trauma; Anesthesia for burn injuries

Sources are given for further reading; the text is written afresh and not copied from them.

Reviewed by the Examqo AI Professor · 2026-11-02. The text may contain errors; when in doubt, check the source.