Flashcards in Pestana- 1. Trauma Deck (183)
How is an airway most commonly inserted?
How do you visualize the airway during an orotracheal intubation?
If a patient has a c-spine injury and you cannot keep the head stable for orotracheal intubation, what is your other option?
Nasotracheal intubation over a fiber optic bronchoscope
What is a sign of major traumatic disruption of the tracheobronchial tree?
subcutaneous emphysema in the neck
What is required when securing an airway in a patient with subcutaneous emphysema in the neck?
What is required if intubation cannot be done in the usual manner and time is limited?
At what age do you start feeling comfortable with doing a cricothyroidotomy?
12 (due to potential need for future laryngeal reconstruction)
List the clinical signs of shock.
-Low BP (
What are the typical causes of shock in trauma?
In what type of shock is CVP (central venous pressure) low?
hypovolemic shock (bleeding)
How may you differentiate tension pneumothorax with pericardial tamponade?
Pericardial tamponade has NO respiratory distress where tension pneumothorax has severe respiratory distress
What are some other hints that your patient has tension pneumothorax?
-Unilateral absence of breath sounds
-Unilateral hyperresonance to percussion
-Mediastinum is shifted to opposite side
What is the routine volume replacement in the treatment of hemorrhagic shock?
-2L of Ringer lactate (without sugar)
-Blood (Packed RBCs)
When do you know to stop volume replacement in hemorrhagic shock?
-Urine output reaches 0.5-2 mL/kg/h
-CVP does NOT exceed 15mmHg
What is the preferred route of fluid resuscitation in the trauma setting?
2 peripheral IV lines, 16-gauge
What are the alternatives to the 2 peripheral IV lines in fluid resuscitation in the trauma setting?
-Percutaneous femoral vein catheter
-Saphenous vein cut-downs
What might you use to fluid resuscitate a child
Intraosseus cannulation of the proximal tibia
If the diagnosis of pericardial tamponade is not clear from clinical exam, what do you use to diagnose?
How do you treat pericardial tamponade?
How do you manage tension pneumothorax?
Immediate big needle/IV catheter into affected pleural space
After inserting big needle or IV catheter into affected pleural space in a tension pneumothorax, what is the next step?
chest tube connected to underwater seal (inserted high in the anterior chest wall)
What is the CVP in cardiogenic shock?
high (see big, distended veins)
How do you treat cardiogenic shock?
circulatory support (DO NOT GIVE FLUIDS AND BLOOD)
In what 3 situations do you see vasomotor shock?
-High spinal cord transections
-High spinal anesthesia
What is the CVP in vasomotor shock?
What is the main therapy for vasomotor shock?
What do you do with a closed (no overlying wound) linear skull fracture?
leave it alone
What do you do with an open linear skull fracture?
When do you go to the OR with a linear skull fracture?
if it is comminuted or depressed