Trauma Anesthesia

Question 1

What kind of acidosis does massive resuscitation with normal saline cause?

Answer 1

non-gap hyperchloremic metabolic acidosis

*chloride load results in bicarbonate spilling by the kidney to maintain electroneutrality*

Question 2

How does the hypothalamus respond to hypovolemia in trauma?

Answer 2

increased release of vasopressin

increased release of ACTH, increasing cortisol and glucagon levels

Question 3

At what temperature is hypothermia thought to cause of substantial funcitonal coagulopathy?

Answer 3

33 ^oC

Question 4

What is Beck’s triad?

Answer 4

Found in < 10% of patients with cardiac tamponade:

1) muffled heart sounds
2) distended neck veins
3) hypotension

Question 5

What is Kussmaul’s sign?

Answer 5

distention of neck veins on inspiration

*sometimes seen in cardiac tamponade*

Question 6

What are the hemodynamic goals with cardiac tamponade?

Answer 6

fast (HR), full (preload), and tight (afterload)

Question 7

What are the induction options for tamponade?

Answer 7

1) pericardiocentesis with local anesthesia
2) mask induction for maintenance of spontaneous ventilation
3) ketamine induction and intubation without muscle relaxant
4) ketamine induciton with muscle relaxant and minimal positive-pressure ventilation to limit intrathoracic pressures

Question 8

Where should needle thoracostomy be performed for tension pneumothorax?

Answer 8

just superior to the 3rd rib in the midclavicular line

Question 9

How is a stable vertebral artery disection (rarely seen with minor trauma) commonly treated?

Answer 9

anticoagulation

Question 10

What are the common scenarios for abdominal compartment syndrome?

Answer 10

blunt abdominal trauma

pancreatitis

sepsis

bowel obstruction

reperfusion injury

Question 11

How can intra-abdominal pressures be accurately estimated?

Answer 11

bladder pressure

Question 12

What are the concerns for intubation in burn victims?

Answer 12

Upper airway edema and obstruction are common so the threshold for intubation is low.

Awake fiberoptic intubation preferable given likelihood of difficult ventilation and intubation

Question 13

How does carbon monoxide poisoning affect oxygen binding and delivery?

Answer 13

Carboxyhemoglobin has a higher affinity for O₂ so the oxygen-hemoglobin disociation curve is shifted left and O₂ delivery is impaired.

Question 14

How is pulse oximetry affected by carbon monoxide poisoning?

Answer 14

Carboxyhemoglobin can be mistaken for oxyhemoglobin on pulse oximetry, overestimating SaO₂

*cherry red blood and SaO₂ 92% is classic boards scenario*

Question 15

What is the treatment for carbon monoxide poisoning?

Answer 15

100% supplemental O₂ via non-rebreather

Question 16

What is the Parkland formula for fluid resuscitation of burn victims?

Answer 16

4 mL x (kg body weight) x (% of body surface burned)

1/2 to be given over the first 8 hours

1/2 to be given over the next 16 hours

Question 17

When is succinylcholine contraindicated after a burn injury?

Answer 17

24 h and up to a year after