Ortho Trauma Anesthesia Rotation

The Orthopedic Trauma Anesthesia Rotation at Stanford University Medical Center offers an experience in the care of trauma patients both in the acute and hyper-acute setting. Although the rotation will be primarily based on orthopedic trauma cases carried out during the 2-week segment, the objective of the module is to incorporate the management of trauma outside this defined period to include all trauma cases encountered throughout residency. Additionally, with an ever-aging population this rotation seeks to expose residents to key concepts in geriatric anesthesia, as many orthopedic trauma cases involve patients of advanced age with multiple co-morbidities necessitating careful consideration to anesthetic choices

Goals and Objectives

1. To provide expert anesthetic care for urgent and emergent orthopedic trauma cases across a range of physiologic complexity.

2. To rapidly evaluate trauma patients and determine readiness for surgery, with particular attention to cardiopulmonary risk assessment and optimization.

3. To understand anesthetic implications for common trauma presentations, including positioning, regional anesthesia coverage options, surgical duration, expected blood loss, and complications.

4. To manage geriatric hip fractures efficiently and sensitively, applying principles of Enhanced Recovery After Surgery (ERAS) to reduce morbidity and improve outcomes.

5. To recognize and manage the effects of acute and chronic methamphetamine use on anesthetic risk.

6. To develop proficiency in real-time, team-based coordination with surgeons, regional anesthesia, medicine, cardiology, and nursing.

7. To understand and appropriately address perioperative code status, including counseling patients and referencing the ASA’s ethical guidelines.

Patient Care (PC)

• PC1: Performs expedited but comprehensive preoperative assessments, identifying key risks including frailty, cardiopulmonary compromise, substance use, anticoagulation, and code status. Orders and interprets appropriate preoperative studies (e.g., ECG, troponin, BNP, echocardiogram) to assess surgical readiness. Initiates coordinated discussions with consultants to streamline optimization and avoid unnecessary delays.

• PC2: Develops dynamic anesthetic plans tailored to injury type, patient physiology, and urgency. For each common trauma case (e.g., hip fracture, ankle ORIF, long bone fracture), understands: optimal positioning, regional anesthesia feasibility, anticipated duration and blood loss, and potential complications. Applies institutional ERAS pathways for hip fracture patients, including early surgery prioritization, use of spinal anesthesia and regional blocks, maintenance of normothermia and euvolemia, and implementation of multimodal analgesia. Thoughtfully weighs risks and benefits of delaying vs. proceeding in the context of acute illness, stimulant use, or incomplete optimization.

• PC3: Demonstrates technical and cognitive proficiency in airway management, resuscitation, and invasive monitoring in urgent situations. Interfaces with the regional anesthesia team to ensure appropriate preoperative pain control and safe positioning.

• PC4: Anticipates intraoperative instability and executes contingency planning. Recognizes the need for escalation, consultation, or conversion and communicates proactively.

• PC7: Navigates changes in case order, optimization status, or consultant recommendations with professionalism and agility. Participates in interdisciplinary decision-making and real-time adjustments to care plans.

Medical Knowledge (MK)

• MK1: Understands trauma-specific pathophysiology and its anesthetic implications, including hemorrhagic shock, frailty, fat embolism, and delirium risk. Describes how acute and chronic methamphetamine use impacts cardiovascular and anesthetic risk. Knows the indications for fluid resuscitation and blood transfusion in orthopedic trauma patients, including how to assess volume status and perfusion, when to initiate balanced resuscitation or transfusion, risks of over-resuscitation, and coordination with the team.

• MK2: Applies perioperative risk stratification and understands the clinical components of ERAS and multimodal analgesia. Demonstrates knowledge of pharmacologic mechanisms and appropriate use of agents in multimodal pain control strategies. Refers to the ASA Statement on Ethical Guidelines for the Anesthesia Care of Patients with Do-Not-Resuscitate Orders.

Systems-Based Practice (SBP)

• SBP2: A core skill: coordinating seamlessly with surgeons, regional anesthesia, consulting services (e.g., cardiology, medicine, geriatrics), and nursing in real time. Facilitates inter-service alignment for patients requiring urgent surgery but not fully optimized. Engages perioperative teams in ERAS-based and multimodal pain management protocols for trauma patients.

• SBP3: Navigates trauma workflow and institutional logistics. Participates in institutional pathways supporting early surgery, standardized analgesia, and delirium prevention in hip fracture patients.

Practice-Based Learning and Improvement (PBLI)

• PBLI2: Reflects on the impact of multimodal analgesia and ERAS adherence on patient outcomes, recovery, and opioid use. Seeks feedback and reviews literature on trauma anesthesia, pain management, and interdisciplinary optimization.

Professionalism (P)

• P2: Elicits and documents perioperative code status, initiates appropriate counseling, and collaborates with the surgical team on how to ethically proceed. Balances patient-centered care with clinical urgency in complex trauma scenarios.

• P3: Demonstrates awareness of limitations and the importance of interprofessional respect in high-stakes cases involving patient instability, ethics, or incomplete optimization.

Interpersonal and Communication Skills (ICS)

• ICS1: Clearly explains anesthetic plans and counseling around DNR status in the perioperative context. Educates patients and families on expectations regarding pain control, block use, and recovery trajectory.

• ICS2: Excels in interdisciplinary communication, coordinating with surgical, nursing, regional, and consulting teams to ensure safe, aligned trauma care. Provides structured handoffs emphasizing medical complexities, intraoperative events, and next steps in the recovery plan.