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TERM 3 STUDY > Complex Trauma > Flashcards

Complex Trauma Flashcards

1
Q

What is the “mainstay” of decision making

A

Risk mitigation–to the patient, public, and other crews

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2
Q

What is the goal of CRM?

A

evaluate potential risks, communicate findings, work collaboratively with others, and limit potential adverse events

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3
Q

What is the Risk assessment equation?

A

R=f (pXc)

Risk=function of (probability X consequence)

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4
Q

What is a common Trauma assessment tool?

A

MARCH
M-massive bleed
A-Airway
R-Respirations
C-Circulation
H-Head/Hypothermia

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5
Q

Describe Muliorgan Dysfunction Syndrome?

A

Organ dysfunction in the acutely ill patient resulting in the need for immediate intervention to achieve/Maintain homeostasis.

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6
Q

What is the shock index?,

A

Shock index is gathered by dividing HR by SBP, a shock state is a value greater than 1.

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7
Q

What are some easy steps to optimize delivery of oxygen (DO2) to the shock patient?

A
  • HF O2
  • MAP of 65, TBI MAP 80
  • Control what you can
  • Avoid fluctuations in hemodynamics
  • Minimize MVO2 with sedation
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8
Q

Name 4 complications of a myocardial contusion

A
  1. Septal wall rupture
  2. Myocardial infarction
  3. Arrhythmia
  4. Poor contractility (Tamponade)
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9
Q

what are the key points to neuroprotective trauma care pre-hospitally?

A

Avoid acidosis hypothermia and coagulopathy.

Goals:

  • MAP 80 (SBP 110)
  • Avoid Hypoxia (Spo2 94%)
  • Normothermia
  • ETCO2 35
  • Head of bed 30 Deg
  • Ventilate appropriately
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10
Q

How does the RV differ from the LV in terms of:

  • Afterload
  • Wall Thickness
  • Volume
  • Dependence on septal contraction
A
  • Afterload: approximately 1/4 that of the LV
  • Thickness: approximately 1/3 that of the LV
  • Intraventricular volume: 10-15% greater than LV (lower ejection fraction)
  • Dependence on septum: More dependant! 40% of RV output due to Septal contraction
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11
Q

Describe coronary blood supply to the RV and inferior LV

A
  • RV is supplied by the RCA
  • iLV is supplied by RCA in ~80% of people (right dominant), the remaining 20% are more or less equally split between LCX (left dominant) or combined LCX + RCA (co-dominant) supply
  • Figures are highly variable between sources
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12
Q

The RV is highly sensitive to changes in __________(preload/afterload/both)

A

BOTH!

While RV is highly preload dependant, it is also very intolerant of increased afterload

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13
Q

What are ECG features of inferior infarct which suggest RV involvement?

A
  • ST elevation in V1
    • ST depression in V2 along with V1 STE makes the findings highly specific for RV infarct
  • ST depression in V2 with isoelectric ST in V1
  • STE in III > STE in II
  • Atrial dysrhythmia further suggest RV involvement
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14
Q

Describe the purpose and placement of the V4R lead when acquiring an ECG

A
  • used to strengthen the case for RV infarction, typically in context of inferior infarct
  • V4 is moved from the 5th ICS, at the mid-clavicular line on the left side of the chest to the same position on the right
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15
Q

Describe sensitivity, specificity, and diangostic value of STE in V4R in detection of RV infarct

A
  • 88% sensitive
  • 78% specific
  • 83% diagnostic accuracy
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16
Q

Describe features of this ECG which suggest RV infarct

A
  • Presence of inferior STEMI (80-85% of population has right-dominant circulation)
  • STE in III>II
  • STE in V1
17
Q

Describe the role of PEEP in alveolar recruitment

A
  • PEEP does NOT recruit alveoli!
  • It mainatains alveolar recruitment
    • recruitment is only possible through sustained increase in Pip or Pplat
    • Once alveoli are recruited, PEEP holds them open
18
Q

Describe the management of APE or ARDS in presence of suspected RV infarct

A
  • limit tidal volumes to <8mL/Kg (RV is HIGHLY afterload dependant, don’t want to increase workload)
  • Decrease MVO2
  • Increase DO2
    • HFO2
    • Fluid resuscitation as required
    • Pt positioning
    • PEEP
19
Q

According to traditional CRM models, risk is a function of _________

A

probability and consequence

20
Q

Describe the START method for MCI triage

A
  • All ambulatory patients = GREEN
  • Non-ambulatory and WITHOUT signs of instability = YELLOW
  • Non-ambulatory and WITH signs of instability = RED
    • Airway maneuvres required for spontaneous breathing
    • Resp Rate > 30
    • Absent radial pulse or cap refill >2s
    • Unable to follow commands
  • Non-ambulatory, with apnea following airway maneuvers = BLACK
21
Q

What are the criteria for “black-tagging” someone under START triage procedures

A
  • Patient must be apneic following attempts to manually open the airway
  • Other obvious signs of death/futility
22
Q

Under START protocols, whgich patients are the highest priority for immediate Tx/transport?

A

RED-tagged

  • airway maneuvers required
  • RR>30
  • Absent radial pulse or cap refill >2s
  • Unable to follow commands
23
Q

What are the JumpSTART criteria and how do they differ from START criteria?

A
  • Trauma triage guidelines for pediatric patients in MCI
  • Very similar to START, except:
    • A carotid pulse check is included with apnea after opening the airway
    • If pulses are present, give 5 rescue breaths and check if apnea remains (if apneic, black tag, otherwise RED)
    • Signs of respiratory instability are RR<15 or >45 (instead of >30 for adults)
    • Instead of following commands, children must be A,V, or appropriate P (i.e. withdrawing instead of posturing) to be considered “YELLOW” (delayed)
24
Q

What is a HOTTT drill, and what are it’s components?

A

HOTTT is used to identify and adress reversible causes of cardiac arrest in trauma

  • Hemorrhage: Stop all bleeding
  • Oxygenate: ETI as required
  • Tension: needle thoracentesis
  • Tourniquet: specifically refers to AAJT, but good reminder to re-check Tqs
  • Transfuse: get in the blood!
25
Q

Describe treatment for release of a crush injury

A
  • Calcium chloride and sodium bicarbonate
  • IV N/S loading prior to release of crush
  • Tourniquets on and ready
    *

TERM 3 STUDY (11 decks)

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