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Initial Management of the Trauma Patient in Maxillofacial Surgery

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Perioperative Assessment of the Maxillofacial Surgery Patient

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Abstract

Oral maxillofacial surgeons must be integral members of the trauma team. With the unique skill sets of this specialty, OMFS is a certain critical participant in the initial evaluation and management of patients with multiple injuries, particularly with critical issues such as a difficult airway due to injuries involving the head and neck, massive hemorrhage from these areas, and threatened vision loss. Although definitive repair of injuries within the area of OMFS generally does not occur until several days past the resuscitation of the critically injured, early participation of the oral and maxillofacial surgeon in optimal care of trauma victims promotes a more thorough understanding of the complex pathophysiology that may adversely affect perioperative preparation for these cases. Moreover, familiarity with recent advances in resuscitation of shock following trauma prepares the surgeon for catastrophic bleeding that may occasionally complicate OMFS. Fundamental knowledge of cardiovascular physiology, a detailed understanding of the coagulation system, and appreciation for the intricate pathways and delicate balance of homeostasis provide an arguably necessary scientific foundation for safe and effective surgical practice of any specialty.

“Shock is a rude unhinging of the machinery of life.”

—Samuel Gross. 1871

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Notes

  1. 1.

    National Association of Emergency Medical Technicians

  2. 2.

    Blood volume for males is 75 mL/kg, for females 65 mL/kg.

  3. 3.

    Expression of clinical data in canonical forms tends to substantially expand the informational content of the raw data, and consequently data in this form are utilized whenever possible during assessment and management of a multiple trauma patient. For example, any one PaO2 value expressed in relation to the fractional amount of oxygen in the gas the patient is inspiring when the PaO2 is drawn, referred to as the P/F ratio, may now indicate one of several different clinical conditions. Thus, a P/F ratio = 100 for a ventilated, critically injured patient with a PaO2 of 100 mmHg on a FiO2 of 1.0 implies severe respiratory failure. This is, of course, a substantially different scenario compared to a healthy individual breathing room air who also has a PaO2 of 100 mmHg (P/F = 100/0.2 = 500).

  4. 4.

    During subsequent phases of management, determination of ScvO2 may be used to uncover risk for reintubation in patients who successfully have met all other criteria for extubation.

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Acknowledgments

The authors gratefully acknowledge many helpful discussions with Jill Castor, R.N., T.C.R.N., and Tracy Spitzer, M.S.N., R.N., C.C.R.N., T.C.R.N., during preparation of this manuscript.

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Authors and Affiliations

  1. Department of Surgery, Section of Acute Care Surgery, Indiana University Health—Methodist Hospital, Indianapolis, IN, USA

    Timothy H. Pohlman M.D., F.A.C.S.

  2. Department of Emergency Medicine, Indiana University Health—Ball Memorial Hospital, Muncie, IN, USA

    William Gossett M.S.H.C.M., B.S.N., R.N., N.R.P. & Jan R. Kornilow MD, FACEP, FAAEM, BCEMSP

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  1. Timothy H. Pohlman M.D., F.A.C.S.
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  2. William Gossett M.S.H.C.M., B.S.N., R.N., N.R.P.
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  3. Jan R. Kornilow MD, FACEP, FAAEM, BCEMSP
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Correspondence to Timothy H. Pohlman M.D., F.A.C.S. .

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  1. University of Connecticut, Farmington, Connecticut, USA

    Elie M. Ferneini

  2. Indianapolis, Indiana, USA

    Jeffrey D. Bennett

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Pohlman, T.H., Gossett, W., Kornilow, J.R. (2018). Initial Management of the Trauma Patient in Maxillofacial Surgery. In: Ferneini, E., Bennett, J. (eds) Perioperative Assessment of the Maxillofacial Surgery Patient. Springer, Cham. https://doi.org/10.1007/978-3-319-58868-1_4

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