Exam 2 Trauma

Question 1

Describe Class I hypovolemic shock?

Answer 1

15% loss; normal VS

Question 2

Describe Class II hypovolemic shock?

Answer 2

15 – 30% loss; tachycardia, normal SBP

Question 3

Describe Class III hypovolemic shock?

Answer 3

30 – 40% loss; significant drop in BP & mentation; HR > 120 & delayed cap refill

Question 4

Describe Class IV hypovolemic shock?

Answer 4

> 40% loss;
hypotensive w/ narrowed pulse pressure;
UO absent;
significant altered mentation

Question 4

Where is the goal SBP in patients with head injuries?

Answer 4

~ 110 mmHg

Question 5

What are the two big things we worry about with abdominal trauma patients?

Answer 5

Over-resuscitation with IVF → hemodilution &
abdominal compartment syndrome

Question 6

What happens in the microcirculatory response in trauma/shock?

Answer 6

The ischemic cells uptake interstitial fluid, become edematous & further depleting intravascular space.

Question 7

What is the CNS response to shock?

Answer 7

Decreased glucose uptake &
decreased cortical activity & reflexes

Question 8

What are the kidney/adrenal responses to shock?

Answer 8

Early: maintains GFR.
Late: inability to concentrate urine= ATN

Question 9

What is the heart’s response to shock?

Answer 9

Dysfunction/ischemia d/t negative inotropes (lactate) &
tachycardia

Question 10

What is a trauma dose for TXA?

Answer 10

2 gram IVP

Question 11

When is the best time to give TXA to a trauma victim & when should it not be given anymore?

Answer 11

Within 1hr of trauma.
>3hrs there is an increased chance of bleeding

Question 12

What is the TXA dose for pediatric traumas?

Answer 12

15mg/kg bolus & then 2mg/kg/hr x 8hrs

Question 13

What kind of trauma is TXA best suited for?

Answer 13

Best for traumas with non-compressible injuries

Question 14

Which clotting factors require calcium?

Answer 14

Factor II, VII, & X

Question 15

How does calcium play a role in clotting?

Answer 15

It helps stabilize fibrinogen & platelets in the development of thrombus

Question 16

What 2 things decrease citrate metabolism?

Answer 16

Hypothermia & liver injury

Question 17

Which calcium variant is preferred in the presence of abnormal liver function & why?

Answer 17

Calcium chloride because decreased citrate metabolism by the liver results in slower release of ionized calcium

Question 18

How much calcium is contained in 10mL of 10% calcium chloride, what about gluconate?

Answer 18

chloride: 270mg
gluconate: 90mg

Question 19

2 units PRBC drop the iCa2+ to what?

Answer 19

<1.0mmol/L

Question 20

5 units PRBC drop the iCa2+ to what?

Answer 20

<0.8mmol/L

Question 21

What worsens coagulopathy?

Answer 21

Acidosis & hypothermia → decreased fibrinogen & platelets

Question 22

When is calcium chloride given when transfusing whole blood?

Answer 22

Trick question, it is not needed.

Question 23

What are the contraindications for a REBOA catheter?

Answer 23

Pericardial tamponade,
aortic dissection,
widened mediastinum

Question 24

Which site is preferred when inserting a REBOA?

Answer 24

The left femoral

Question 25

A REBOA should no be inflated for longer than?

Answer 25

30 minutes

Question 26

What GCS indicates a moderate TBI?

Answer 26

9 – 12

Question 27

A tear in what usually causes an epidural hematoma?

Answer 27

Tear in the middle meningeal artery

Question 28

What are the S/S of an epidural hematoma?

Answer 28

A lucid interval is the classic sign. mydriasis, bradycardia, HTN

Question 29

What are the S/S of subdural hematoma?

Answer 29

HA, progressive drowsiness, visual disturbances, gait disturbances

Question 30

What is the current ventilation for TBIs?

Answer 30

PaCO2 of 30 – 35mmHg if elevated ICP

Question 31

What are the upsides & downsides of regional anesthesia for orthopedic traumas?

Answer 31

- Ups: Allows continued assessment of mental status, increased vascular flow, decreased incidences of DVT. - Downsides: difficult to assess nerve function, may wear off before surgery ends

Question 32

What does a pulmonary embolism present as?

Answer 32

Hypoxia, tachycardia, petechia on upper chest, increased PAP with decreased CO

Question 33

What are the 5 P’s of compartment syndrome?

Answer 33

Pallor Paralysis Paresthesia Pain Pulsenesness

Question 34

What is the most common site for acute compartment syndrome?

Answer 34

Tibia

Question 35

What are some conditions resulting in the need for a thoracotomy?

Answer 35

Mediastinal injury, chest tube output >1,500mL in first hour, tracheal or bronchial injury w/ massive air leak, unstable hemodynamics w/ obvious chest trauma

Question 36

Where is the most common aortic injury in MVA’s?

Answer 36

The ligamentum arteriosum just distal to the takeoff of the left subclavian

Question 37

What type on ventilation may be required in a person with a flail chest?

Answer 37

Positive pressure ventilation

Question 38

What is beneficial in reducing pulmonary complications with rib fractures?

Answer 38

Peripheral nerve blocks

Question 39

How is blunt cardiac trauma managed?

Answer 39

Control of fluids; coronary vasodilators; treat dysrhythmias; possible ASA/heparin

Question 40

What does Becks triad consist of?

Answer 40

Hypotension muffled heart tones distended neck veins

Question 41

What meds are given for a preterm laboring woman involved in a trauma?

Answer 41

Beta agonists & magnesium