CR - Procedures and Skills Flashcards
(20 cards)
What are the indications for operative management of a hemothorax?
- blood loss >/= 1,500 mL in the initial chest tube drainage
- blood loss > 200 ml/hr for 2-4 hours
- refractory hypotension or cardiopulmonary decompensation
- persistent bleeding requiring serial blood transfusions
- > /= 50% pneumothorax
Name 4 locations of internal hemorrhage that may result in significant hemodynamic compromise
Thoracic cavity
Abdominal cavity
Pelvic cavity
Thigh - femur fracture
Physical signs of tension pneumothorax may include:
- decreased breath sounds
- hypotension
- hypoxia
- hyper-resonance on percussion
- distended neck veins
- respiratory distress
- tracheal deviation
- increased resistance to ventilatory support
What qualifies a patient as a potential candidate for ED thoracotomy?
A qualified surgeon must be present on arrival and/or is immediately available
Penetrating chest trauma with witnessed signs of life and/or cardiac activity
Conditionally in blunt chest trauma if there are signs of life present
Unresponsive hypotension < 70 mmHg
Rapid exsanguination from chest tube (> 1500 ml)
CPR < 15 minutes
Evidence of cardiac tamponade
True or false: a single instance of hypotension in patients with severe head injury has been shown to double mortality
True
Clinical presentation: a patient on warfarin presents with acute subdural hematoma after a fall, potential reversal agents include:
FFP
Prothrombin complex concentrates
Vitamin K
What are potential reversal agents for novel oral anticoagulants?
Prothrombin complex concentrates
Adnexanet alfa
Idracizumab
Praxabind for dabigatran (pradaxa)
What is the preferred initial access for resuscitation
Tow short large bore peripheral IVs placed in the antecubital fossa
After placement of chest tube for a pneumothorax, continuous air leak is present and repeat chest x-ray demonstrates chest tube in proper position but a persistent pneumothorax. What injury is suspected?
Tracehobronchial injury
True or false: negative chest x-ray and negative CT chest/abdomen effectively rule out diaphragmatic injuries
False
Laparoscopy may be required to make the diagnosis, so clinicians must maintain a high index of suspicion
If urethral injury is suspected, ____ ____ must be performed prior to foley catheter placement
Retrograde urethrogram
In a pediatric trauma patient with difficult peripheral vascular access, ____ access is preferred over placing a central line
Intraosseous
What is the role of transabdominal ultrasound in trauma during pregnancy?
In addition to the FAST exam, ultrasound may be useful in assessing fetal well-being and confirm fetal dating, but is not sensitive enough to rule out abruption or uterine rupture
List the level one indications for emergency tracheal intubation for trauma patients
- airway obstruction
- hypoventilation
- perisistent hypoxemia (SaO2 </= 90%) despite supplemental oxygen
- severe cognitive impairment (GCS </= 8)
- severe hemorrhagic shock
- cardiac arrest
What is the immediate treatment of tension pneumothorax?
Needle decompression with long, large bore, 14g IV needle at the second intercostal space at the midclavicular line. Alternativley the 4th-5th intercostal space at the anterior axillary line may be used
1st line paralytic for RSI
Succinylcholine (1.5 mg/kg) fast onset and short duration
Contraindications: preexisting hyperkalemia (increases serum potassium by 0.5 mEq/L), burn/crush/denervation injuries and severe infection > 5 days, history of malignant hyperthermia, myopathy
What is the treatment for open pneumothorax?
Placement of a 3-sided occlusive dressing (creating a flap-valve that allows air to escape during expiration, but not to enter during inspiration)
Placement of a large bore chest tube away from site of injury
According to canadian c-spine rules, what constitutes a dangerous mechanism of injury?
Fall from >/= 3 feet or 5 stairs
Axial load to head e.g. diving
MVC high speed (>100 km/hr) rollover, ejection
Motorized recreational vehicles
Bicycle struck or collision
Patients with a TBI may manifest increased ICP with Cushing’s triad - hypertension, bradycardia, and altered breathing pattern.
Management considerations should include what?
Emergent CT scan
Elevate head of bed to 30 degrees
Adequate sedation and pain control
Consider osmotic diuretic (e.g. 3% NaCl or mannitol)
Transient hyperventilation (PaCO2 ~30 mmHg) if impending herniation
Early neurosurgery consult
A patient presents with ocular trauma from a high speed MVC. Physical exam is remarkable for proptosis and afferent papillary defect of the right eye, and the patient complains that he “can’t see anything” from that eye. What is the suspected diagnosis and treatment?
Diagnosis: retrobulbar hematoma
Treatment: lateral canthotomy (do not have to await CT diagnosis)
