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There should be clear guidelines on how to manage patients on anticoagulant therapy presenting with trauma or for elective orthopaedic surgery. Specific reversal agents may be required, such as prothrombin complex concentrate in the trauma setting in patients on warfarin. Direct oral anticoagulants (DOACs), patients on dual antiplatelet therapy (DAPT) and second generation drug eluting stents (DES) all require careful...
There should be a policy for the prevention of thromboembolic events postoperatively. This should include planning for anticoagulant prophylaxis in patients who are vulnerable to further bleeding.
NICE Guidance 157 provides clear guidelines for centres providing primary joint replacements we should be adhered to.75 Additionally, enhanced recovery programmes should be promoted for the benefits of early mobilisation and reduced mortality associated with their use.
Post induction hypotension associated with poor outcomes in patients with a high ISS. Standard operating procedures should be in place to minimise hypotension post induction.93
Consultant anaesthetists and intensivists should be involved in the planning of local trauma services. Those with defined responsibility for major trauma management should be engaged in the layout and logistics of the resuscitation room.
In MTCs, multidisciplinary mortality and morbidity meetings should take place and follow the guidance of the World Health Organization (WHO).94
Decision support systems for crisis scenarios should be available, for example the advanced life support algorithm, difficult airway guidelines and major haemorrhage protocols.17,18
Governance meetings should take place across the entire trauma network at defined intervals. Besides individual case discussion, feedback information from the Trauma Audit and Research Network (TARN)1 should be disseminated, and mechanisms set in place to correct any problems identified.
Commitment to early screening of trauma patients at risk of severe pain and opioid related adverse events by the acute pain service along with interdisciplinary protocol implementation of multimodal analgesia will lead to improved patient outcomes.95
Research in anaesthesia for trauma and orthopaedic surgery should be encouraged. Staff undertaking research should have received training on ethical and organisational issues. They should complete a good clinical practice course with regular updates.
