RUPP TRAUMA Flashcards
What are the three areas of highest incidence of recall?
- Cardiovascular – (CABG)
- OB – (crash C-sections)..every second counts..
- Trauma
What are the 5 criteria for potential cervical spine injury?
1) neck pain
2). severe distracting pain
3) any neurological signs and symptoms
4) intoxication (treat as if spine injury if drunk)
5) loss of consciousness at the scene
What is the best way to intubate a patient with a cervical spine injury?
Manual inline stabilization (MILS). Can be used with glide scope.
Do you use nitrous Oxide(N2O) on any trauma?
NO!!!! It can increase pressure in closed spaces
It tends to accumulate in closed spaces. Avoid in trauma patients with a pneumothorax, pneumocephalus, or pneumoperitoneum. Best practice do not use.
What trauma patients do you specifically avoid N20 with?
pneumothorax
pneumocephalus
pneumoperitoneum
Succinylcholine can increase serum potassium levels if administered ___ hours after a burn, spinal cord or crush injury.
24 hours
burn, spinal cord or crush injury.
Transfusion info
Postop after massive transfusions patients get metabolic alkalosis
If transfusion rate exceeds 1 unit every 5 minutes you can see cardiac depression caused by hypocalcemia
In an anesthetized patient-hemolytic reactions are recognized by increased temp, tachycardia, hypotension, hemoglobinuria, and oozing at the field
What ABG imbalance do patients get after massive transfusions?
metabolic alkalosis
What rate of transfusion can you see cardiac depression caused by hypocalcemia?
rate exceeds 1 unit every 5 minutes
How are patient-hemolytic reactions recognized in the anesthetized patient?
by increased temp, tachycardia, hypotension, hemoglobinuria, and oozing at the field
Warm fluids
In Erie —hypothermic traumas
Hypothermia worsens acid/base balance
Coagulopathies – platelet sequestration and red blood cell deformities
*Risking myocardial function
What is a common cause of bleeding after massive transfusions?
Dilutional thrombocytopenia
What is the half-life of colloids and crystalloids?
Crystalloids- half life of 20 – 30 minutes
Colloids half life of 3 – 6 hours
What is less likely to cause hyperkalemic acidosis than normal saline?
Lactated Ringers
Are dextrose solutions contraindicated in trauma, because it may exacerbate ischemic brain damage?
YES! Avoid dextrose solutions
Does calcium in the LR make it less or more compatible with blood transfusions?
LESS
NEVER HANG LR WITH BLOOD.
Only with NS
LR is slightly _____ and with large volumes can aggravate cerebral edema
Hypotonic
Are colloids effective in rapidly restoring intravascular volumes?
YES
Albumin
Dextran
Hetastarch
*Dextran and hetastarch can cause coagulopathy
What type of blood can be released to the moribund trauma patient requiring immediate blood transfusion that HAS NOT been typed and crossed?
Type O negative blood
Factor ____ can decrease by __% after two days in storage.
Dilutional _______ quickly develops when a patient is massively transfused.
Factor VIII can decrease by 50% after two days in storage.
Dilutional thrombocytopenia (low platelets) quickly develops when a patient is massively transfused.
Does the hypovolemic patient need less or more anesthetics?
Need LESS anesthetics
Alveolar concentration IS UP in shock patients r/t a decrease in C.O. and increased ventilation
Smaller intravascular volume so the intravenous anesthetics are EXAGGERATED
What are the best induction agents for the trauma patient?
ketamine, etomidate
Injury to _____ or lower urinary tract can cause ________.
Injury to KIDNEYS or lower urinary tract can cause HEMATURIA.
Cervical spine injury occurs in ___% of all trauma patients
2%
