Problems in general anaesthesia. Emergencies and trauma.

Emergencies resulting in death of the patient are sufficient reason for insisting on only medically qualified people giving anaesthetics. Unlike in most other specialities, complications in anaesthesia usually will not await the arrival of the expert. Trauma provides the anaesthetist with some of his most testing occasions. Most problems are related, as with emergencies, to basic derangements of respiratory and circulatory physiology However, there is a steady progression with severe trauma cases that is not a common feature of the ordinary anaesthetic disaster. Respiratory problems are either of obstructive origin or due to failure to generate respiratory muscle activity. Circulatory problems, in the vast majority of cases, consist of low cardiac output because of relatively deficient circulatory blood volume. Overload of the circulation resulting in acute pulmonary oedema is often feared but uncommonly seen. Another cause of failure of output of the heart lies in the heart itself, either because heart muscle is not contracting well enough--myocardial failure, or because of disorder of rhythm.