The review aims to educate the readership in recent advances in trauma practice, culminating in a novel empiric massive transfusion algorithm seamlessly guiding the clinician through the initial resuscitation stage resulting in reduced mortality, morbidity, coagulopathy and decreased overall blood product usage.

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In the UK, major trauma has a peak incidence between 16 and 20 years of age and is the leading cause of death under 40 years. It is increasingly recognized in the elderly, with patients over 65 yr accounting for a third of the caseload and half of the deaths in severely injured patients.Most out-of-hospital trauma deaths are related to airway and bleeding, 1 both areas of expertise for anaesthetists. Anaesthetists are also key providers of care in head injury, the leading cause of death within hospital. It is surprising that there are so few consultant anaesthetic posts with specific responsibility for major trauma care. Anaesthetists still have to travel abroad to gain concentrated experience in this field, undertaking recognized trauma fellowships or working within the armed forces in areas of conflict.Effective trauma networks provide a seamless transition from the pre-hospital to the rehabilitation phase, using validated indicators to track performance. 1 Robust evidence from Victoria State, Australia, indicates that integrated, centralized care increases survival and reduces the overall burden to society. The improvements have been attributed to better pre-hospital care and the use of damage control resuscitation (DCR). 2 The UK's poor performance has been highlighted repeatedly in the last 20 years by organizations such as the Royal College of Surgeons of England, 3 4 the National Confidential Enquiry on Patient Outcomes and Death (NCEPOD), and the National Audit Office. 5 Consultant involvement in major trauma cases has often been delayed or absent. Major trauma mortality in the UK has lagged behind that in the USA. With the formal institution of major trauma networks in England in 2012, there is an opportunity to catch up and excel.

This chapter discusses a collection of practical topics of relevance to the anaesthetist. Topics covered include herbal medicines, blood exposure incidents, target-controlled infusions, death on the table, dealing with a complaint, anaphylaxis follow-up, latex allergy, long-term venous access, enhanced recovery and cardiac output monitoring, depth of anaesthesia monitoring, neuromuscular blockade and reversal, evidence-based anaesthesia, and the Cochrane Collaboration. There is a section on military anaesthesia which includes damage control resuscitation, medical emergency response team, the Triservice Anaesthesia Apparatus, and military uses of total intravenous anaesthesia.