4. Trauma Flashcards
(188 cards)
1
Q
which trauma has incr risk of vascular tearing
A
deceleration
1
Q
3 types of trauma
A
penetrating
blunt
deceleration
2
Q
primary goal of anesthesia during trauma
A
airway managment
3
Q
trauma bay equipment (9)
A
anesthesia cart
code cart
FULL airway cart
resuscitation equipment
Vascular access
POC labd
echocardiography
warming devices
rapid transfusers
4
Q
RED triage
A
immediate attention
cannot survive w/o immediat treatment but have chance of survival
5
Q
YELLOW triage
A
observation
serious injuries need immediat attention
better chance of recovery
6
Q
GREEN triage
A
non-life threatening injuries
7
Q
BLACK triage
A
decease or mortally wounded
8
Q
WHITE triage
A
no injury
9
Q
most trauma pts die of
A
tissue hypoxia
10
Q
all trauma pts are considered
A
full stomach
11
Q
indications to intubate
A
- inadequate airway proetction
- loss of conscioussness
- high spinal injury
- aspiration
- loss of airway
- severe maxillofacial deformity
- neck hematoma
- CO poisonig
- hperventilation needed for ICP
- laryngeal/tracheal injury
- stridor
- poor ventilation
- GCS < 8
12
Q
trauma induction doses
A
greatly reduced due to incr susceptibility for HD effects
13
Q
can you oxy pt with ambu bag
A
yes but you must squeeze the bag for blow by
14
Q
cervical spine considerations
A
- jaw thrust only
- in-line stabilization during intubation
- video scope 1st attempt
15
Q
which pts have unstable c-spine
A
ALL trauma pts are assumed to have unstable c-spine unless proven by radiography
16
Q
which induction agents cause hypotension or cardiac arrest in trauma pts
A
ALL
propofol
etomidate
ketamine
17
Q
best choice induction agent trauma
A
ketamine
18
Q
etomidate SE
A
inhibits catecholamines
19
Q
ketamine SE
A
direct myocardial depression
20
Q
sux CI
A
burns
ESRD
recent denervation
incr ICP
(hyperkalemia)
21
Q
what can sux cause
A
incr ICP
histamie release
22
Q
tension pneumothorax diagnosis
A
sudden CV collapse after PPV
- tachycardia
- hypotension
- incr PIP
- hypercarbia
- hypoxia
23
Q
what is the indication for tension pneumo decompression?
A
pt becomes unstable
24
CI for decompression?
none - be cautious of breathing and anatomical changes
25
tension pneumo stable consideration
avoid PPV
supp O2
anxiolytic
26
skin prep options
iodine
betadine
chlorhexidine
27
MCL
2nd intercostal space
28
AAL
5th intercostal space
29
needle size for decompression
14 ga
30
needle stick location for decompression
superior to inferior ribs
31
chest tube atrium water seal function
allows for escaping air without entraning new air
32
water moves up atrium tube
when pt takes breath
33
what kills most trauma pts
shock
34
shock symtoms
hypotension
tachycardia
prolong cap refill
diminished UOP
narrow pulse pressure
35
chest bleeding diagnosis
radiography
thoracostomy tube output
CT
36
chest bleed treatment
observation
surgery
37
abdominal bleed diagnosis
physical exam
FAST scan
CT
peritoneal leakage
38
abdominal bleed treatment
surgical ligation
angiography
observeration
39
retroperitoneum bleed diagnosis
CT
angiography
40
retroperitoneum treatment
angiography
41
long bone bleeding diagnosis
exam
plain radiography
42
long bone bleed treatment
fracture fixation
surgical ligation
43
exterior bleed diagnosis
physical exam
44
exterior bleed treatment
digital pressure
surgical ligation
45
capillary bleeding
slow
bright red
46
venous bleeding
slow
dark red
47
arterial bleeding
spurting
pulasating
bright red
48
class 1 hemorrhage
< 15% loss of circ volume
no change HR/BP
resuscitation not required
49
class 2 hemorrhage
15-30% loss of circ volume
HR incr
DBP incr
IV fluid replacement
50
class 3 hemorrhage
30-40% loss of circ volume
HR incr
BP decr
metabolic acidosis
transfusion necessary
51
class 4 hemorrhage
> 40% loss of circ volume
profound hypotension
trauma induced coagulopathy
massive transfusion
52
shock
abnormality of the circ system that causes inadequate organ perfusion and tissue oxygenation
53
common theme with shock
hypotension
decr CO
54
most common type of shock
septic
55
which types of shock have incr SVR
hypovolemia
cardiogenic
56
which types of shock have decr SVR
anaphylactic
septic
57
which type of shock has pink, warm, flushed skin
septic
57
which type of shock has warm dry skin
neurogenic
58
septic shock treatment
crystalloid
59
resuscitation
restoration of normal circulating blood volume
normal vascular tone
normal tissue perfusion
60
macrocirculatory response
vasoconstriction
catecholamine surge
61
microcirculatory response
cellular edema
== **free radical/lactate**
== decr BF
62
macrocirc response agents
renin
angiotensin
vasopressin
ADH
growth hormone
glucagon
cortisol
epi
norepi
63
microcirc response agents
prostacyclin
thromboxane
prostaglandins
leukotrines
endothelin
interleukins
64
lactate/free radical cause
negatrive inotropic effects
65
kidneys/adrenal shock response
produce catecholamines
66
heart shock reponse
responds to global effects
67
lung shock response
filters proinflammatory markers
precipitates ARDS
68
gut shock response
produces inflammatory mediators
bacteria
bowel dysfunction
69
liver shock response
reperfusion-like manifestation
70
which organ is most susceptible to hypoperfusion
gut
71
shock stage 1
mild/stable
skin
tachycardia
72
shock stage 2
mod/stable
responsive to fluid test
73
shock stage 3
hypotensive shock is responsive for 20-30 mins
or
hypotensive shock not responsive to 500 mL fluid test
74
shock stage 4
heart/brain ischemia
total blood volume loss > 40%
75
shock stage 5
cardiac arrest due to exsangiunation
76
shock early resuscitation goals: SBP
80-100 mmHg
77
shock early resuscitation goals: Hct
Hct 25-30%
78
shock early resuscitation goals: PT/PTT
normal PT/PTT
79
shock early resuscitation goals: Plts
Plt > 50,000
80
shock early resuscitation goals: core temp
> 35C
81
shock early resuscitation goals: pulse ox
functioning
82
shock early resuscitation goals: lactate
prevent changes in lactate
83
shock early resuscitation goals: anesthesia/analgesia
ensure adequate anesthesia/analgesia
84
shock late resuscitation goals: SBP
> 100mmHg
85
shock late resuscitation goals: Hct
Hct above transfusion goal
86
shock late resuscitation goals: coag status
normalized
87
shock late resuscitation goals: electrolyte status
normalized
88
shock late resuscitation goals: core temp
normalized
89
shock late resuscitation goals: urine output
normalized
90
shock late resuscitation goals: CO
maximized CO
91
shock late resuscitation goals: systemic acidosis
reversed systemic acidosis
92
shock late resuscitation goals: lactate
normalized lactate level
93
what is anestheisa responsible for during shock management?
early resuscitation goals
94
normal lactate
< 2 mmol/L
95
acidosis lactate
> 5 mmol/L
96
what can volume expansion with only fluids cause
dilutional anemia
coagulopathy
97
normal PT
11-13.5 sec
98
normal PTT
25-35 sec
99
normal ionized Ca2+
4.6-5.2 mg/dL
100
total Ca2+ level
8.6-10.3 mg/dL
101
liver CO
25%
102
gut CO
10-15%
103
kidney CO
25%
104
brain CO
12%
105
risk of femoral lines
abdominal injury concern
106
risk of IJ lines
cervical spine
pneumo risk
107
risk of subvlacian lines
pneumo
108
rapid transfuser rate
1500mL/min
109
which blood product cannot be used with rapid transfusers?
Platelets
110
which blood products can be used with rapid transfusers?
crystalloids
colloids
PRBCs
washed blood
FFP
111
rapid transfusers advantages
1. FAST
2. mix products in reservoir
3. warm fluids
4. pump simultaneous
5. fail-safe air detection
6. accurate vol/pressure recording
7. portable
112
PRBCs effect
incr Hg 1g/dL
or
incr Hct 3%
113
FFP effect
2-3% incr in clotting factors
114
Plts effect
incr 5000-10,000/microL
115
cryo effect
incr fibrinogen 5-7 mg/dL
116
PT normal
11.5-14.5 s
117
PT pathway
extrinsic
118
standardized PT test
INR
119
PTT normal
24.5-35.2s
120
PTT pathway
intrinsic
121
thrombin time normal
22.1-31.2 s
122
thrombin time measure
time to clot once exogenous thrombin is added
123
fibrinogen normal
175-433 mg/dL
124
fibrinogen measure
pure count
125
activated clotting time normal
70-180 s
126
activated clotting time measures
test tube reagent clotting
127
plt normal
150k-450k
128
plt measures
pure count
129
P2Y12 normal
180-376 PRU
130
P2Y12 measures
plavix inhibition test
131
FAST scan locations
pericardium
RUQ
LUQ
suprepubic area
right anterior thoracic
left anterior thoracic
132
pericardium FAST scan probe/location
phased array
inferior to xiphoid process
transverse
133
what is used as acoustic window for pericardium FAST scan
liver
134
RUQ FAST scan prob/location
curve-linear
posterior to MAL
between ribs 8-11
135
RUQ FAST scan visualized
liver tip
right paracolic gutter
morrison's puch
136
LUQ FAST scan probe/location
curve-linear
posterior to MAL
between ribs 6-9
137
LUQ FAST scan visulaizes
left kidney
spleen
left paracolic gutter
138
suprapubic FAST scan probe/location
curve-linear
cephalad to pubic sympasis
sweep left/ride
angle probe cephalad/caudal
139
which FAST scan is most dependedn lcoation in intraperitoneal cavity
suprapubic area
140
anterior thoracic FAST scan probe/location
linear probe
MCL 2nd-4th intercostal
longitudinal orientation
141
lowest score for GCS
3
142
*A*VPU
fully awake
143
A*V*PU
responds to verbal stim only
144
AV*P*U
responds to pain stim only
145
AVP*U*
unresponsive
146
mild GCS / TBI
13-15
147
mod GCS / TBI
9-12
148
severe GCS / TBI
3-8
149
mild TBI
minimal deterioration
post concussive effects
150
mod TBI
long term morbidity
151
sev TBI
significant risk of mortality
152
which trauma accounts for 50% of all trauma deaths
CNS
153
mortality rate of meningeal vessel bleed
15-20%
154
TBI _____ ICP
incr ICP
155
TBI _____ CPP
decr CPP
156
TBI hypotension
SBP < 90 mmHg
157
TBI hypoxemia
PaO2 < 60 mmHg
158
most common cause of TBI
falls
159
anesthetic goals for TBI
mx CPP
decr ICP
avoid hypoxemia
avoid hyper/hypocarbia
avoid hyper/hypoglycemia
160
TBI airway
always ETT
161
TBI PaO2
> 60 mmHg
162
when do you need a central line in TBI pts
if you need to give hypertonic saline
163
TBI SBP
>90mmHg
164
what fluids can you give TBI pts
warmed, non -glucose crystalloids
hypertonic saline
mannitol
165
what fluid should you not give TBI
no albumin
no dextrose
166
TBI pts have incr risk of
anemia
167
effect of HCT on CBF
high Hct will decr CBF
168
Glu range TBI
80-180 mg/dL
169
what drug is CI in pts with mod/severe TBI
high dose methyprednisolone
170
cannabis withdrawal meds
benzos
171
cocaine withdrawal meds
propranolol
172
heroine withdrawal meds
methadone
173
MDMA withdrawal meds
antidepressants
174
meth widrawal meds
antidepressants
175
echinacea
immunosuppresion
176
ginki biloba
inhibits plt activating factor
177
garlic
inhibits plt aggregation
incr fibrinolysis
178
ginseng
lower blood glu
incr PT/PTT
inhibits plt aggregation
179
saw palmetto
cox inhibitor
180
ephedra
indirect sympathomimetic effect
181
valerian
sedation
182
kava
sedation
anxiolysis
183
st john's wort
inhibits neurotransmitter reuptake
184
leeding cause of death in trauma pts
sepsis
185
how to prevent sepsis
start abx asap
186
hypothermia SE
incr bleeding
incr HD instability
arrhythmias
