Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Trauma Course > REBOA > Flashcards

REBOA Flashcards

1
Q

What is a leading cause of preventable trauma deaths?

A

Non-compressible haemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What injuries are associated with rapid exsanguination and mortality rates nearing 50%?

A

Pelvic, abdominal, thoracic and junctional vascular injuries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the recommended approach to the management of exsanguinating patients in extremis?

A

A resuscitative thoracotomy and clamping the descending aorta which is associated with poor outcomes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is REBOA?

A

Resuscitative endovascular ballon occlusion of the aorta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What does the REBOA procedure involve?

A

The placement of an endovascular balloon in the aorta to gain proximal control of exsanguinating haemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What can be used as an alternative to performing a resuscitative thoracotomy in traumatic arrest or as an adjunct for temporising intra-thoracic, abdominal, pelvic or junctional haemorrhage?

A

REBOA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Where does zone 1 for REBOA extend from?

A

Origin of the left subclavian artery to the coeliac artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Where does zone 2 for REBOA extend from?

A

Coeliac artery to the mouth at caudal renal artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Where does zone 3 for REBOA extend distally from?

A

The most caudal renal artery to the aortic bifurcation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the 2 areas of the aorta that are of interest in the context of catastrophic control?

A

The Supra-coeliac aorta (immediately above the coeliac trunk and diaphragm) and the terminal aorta (below the renal and mesenteric arteries)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

In young adult males, zone 1,2 and 3 are approximately how long in length?

A

Zone 1 - 20 cm
Zone 2 - 3 cm
Zone 3 - 10cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

In young adult males what is the diameter of the thoracic aorta and distal aorta?

A

Thoracic aorta - 20mm
Distal aorta - 15mm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the average distance from puncture site to the terminal aorta and supra-coeliac aorta for REBOA?

A

To terminal aorta - 30 cm
To supra-coeliac aorta - 45 cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

As distances and diameters are variable in every patient, when inserting the REDOA catheter what is essential?

A

Measurement of surface anatomy and careful feel for the balloon abutting the aortic wall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the external landmark for the zone 1 ‘landing zone’?

A

Mid sternum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the external landmark for the zone 3 ‘landing zone’?

A

Immediately cranial to the umbilicus

17
Q

What is the indications for a patient needing REBOA?

A

Adult trauma patient (over 16 years old) with blunt or penetrating injuries and suspected exsanguinating sub diaphragmatic haemorrhage indicated by:
- mechanism compatible with causing injuries resulting in exsanguinating haemorrhage
- identifiable injuries
- appropriate timescale
- hypotension/unrecordable BP
- pale, clammy
- absence of peripheral venous filling
- air hunger
- low/falling end tidal CO2

18
Q

Is recent hypovalaemic cardiac arrest a contra indication to REBOA?

A

No, but common femoral artery cannulation is likely to be challenging

19
Q

What is the priority for all patients who have undergone REBOA?

A

To expedite the patients transfer to theatre and the patient will require rapid surgical intervention. ED should be seen as a pit stop

20
Q

What essential investigations should be done for REBOA patients?

A

Blood gas
Essential pharmacotherapy e.g. TXA
FAST scan
Chest and pelvic X-ray
Abdo X-ray to check balloon locations
An attempt a P-REBOA

21
Q

If a patients has had a REBOA where should the balloon be seen in zone 1 or zone 3?

A

Zone 1 - just above the diaphragm
Zone 3 - overlying the L2-L4 vertebrae

22
Q

To prevent the need to re-transduce the IABP lines for a patient who has had a REBOA pre-hospital what should be done in resus?

A

Patient should remain on the HEMs monitor

23
Q

What should happen to REBOA patients who remain haemodynamically unstable and any patient with hemoperitoneum on FAST scan?

A

Transfer to theatre without delay

24
Q

If a REBOA patient is responding well to blood transfusion what could be considered?

A

Attempt P-REBOA with a view to undertaking CT and subsequent angioembolisation in the IR suite

25
Q

Why would you attempt at P-REBOA?

A

In order to minimise the ischaemic and reperfusion associated with prolonged complete occlusion is reasonable stability has been achieved

26
Q

What is P-REBOA?

A

When you partially deflate the REBOA balloon

27
Q

How do you know what your ‘baseline’ occlusion pressure is if your patients has had REBOA?

A

The arterial pressure reading from the side arm of the sheath downstream of the balloon will read a low number e.g. 5-10 mmHg, not usually zero

28
Q

How do you achieve P-REBOA?

A

Remove 0.5ml of saline from the balloon and observe the response. If there is no critical deterioration the balloon should be deflated a further 0.5ml and then repeat until either the baseline pressure rises to 10 mmHg above the baseline pressure or a degree of pupsitility is seen to return to the downstream IABP trace

29
Q

What is the aim of P-REBOA?

A

To transition to partial occlusion by allowing enough flow through to raise the baseline occlusion pressure by 10mmHg

30
Q

Why during deflation of the REBOA balloon is it likely that the blood pressure will fall?

A

It is secondary to reinstitution of distal flow, reduced after load and reperfusion of tissues and progression towards a ‘partial occlusive’ state

31
Q

What is the aim of P-REBOA?

A

To strike a balance between maintaining an adequate aortic blood pressure, haemostatsis and distal organ perfusion

32
Q

If the catheter migrates when deflating the REBOA balloon, what should be considered before re-inflating if needed?

A

Consider deflating and re-inserting to the initial pre-determined depth before re-inflating

33
Q

What should happen if a patients haemodynamic a fall beyond antolerable level during P-REBOA?

A

The balloon should be re-inflated and transferred to theatre with aggressive volume resuscitation

Trauma Course (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions