How do trauma surgeons deal with the fact that the patients they operate on probably haven’t fasted the night before given that trauma patients don’t know in advance they’ll be having surgery?

Question

I know that with elective surgeries, patients have to fast the night before to prevent vomiting when they go under anesthetic, but I was wondering how this concern is navigated in trauma or emergency surgeries in which patients definitely didn’t fast the night before? Do they just try to deal with the vomit or is there a special procedure to prevent vomiting from occurring?

In: 1727

Answer 1

Trauma anesthesiologist here. When we induce anesthesia for your surgery you lose your airway reflexes. When this happens due to the drugs we have given you, you also lose smooth muscle tone. If you have food or fluid in your stomach, this can reflux into your trachea and into your lungs causing you to aspirate. We take this risk of intubating you with a full stomach (putting a breathing tube into your lungs that can also keep gastric contents out of your lungs) because the alternative is loss of life or limb. This can be due to you having suffered a gunshot wound to your stomach damaging major organs and causing you to bleed to death, or major trauma from a car accident leading to organ injury. This is typically done with a rapid sequence induction which is where someone holds pressure on your trachea in an attempt to compress your esophagus while we intubate in order to decrease the risk of aspirating gastric contents.