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Patho 2 > Shock/Trauma Anesthesia > Flashcards

Shock/Trauma Anesthesia Flashcards

(59 cards)

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1
Q

What is (LD)50

A

lethal dose

the burn size lethal to 50% of the population

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2
Q

Why do third degree burns require grafting, but not second?

A

In third degree, the basement membrane of the epithelium AND the dermis appendages are destroyed

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3
Q

According to the ABA, what qualifies as a major burn?

A
  1. 2D with > 10% TBSA
  2. 3D with more than 10% TBSA
  3. Any electrical burn
  4. burn complicated by smoke inhalation
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4
Q

What is the ABA mortality estimate tool?

A

Patient Age + %TBSA

If > 150, mortality is 80%

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5
Q

How does smoke inhalation impact mortality of a burn injury?

A

doubles it

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6
Q

What are the four types of burns

A

Chemical

Electrical

Thermal

Inhalation

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7
Q

What is the most damaging type of burn?

A

Electrical

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8
Q

Why are patients with electrical burns at high risk for renal failure?

A

Myoglobinemia

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9
Q

What is the most common burn in kids < 4?

Kids > 5?

A

Scald

Flame

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10
Q

What are the three types of inhalation injury?

A
  1. upper airway
  2. lower airway injuries caused by chemical and particulate constituents of smoke
  3. metabolic asphyxiation from CO or Hydrogen Cyanide
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11
Q

What are the three phases of burn treatment?

A
  1. resuscitative
  2. debridement and grafting
  3. reconstructive
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12
Q

What usually causes inhalation damage below the cords: heat or particles?

A

Particles

Heat really only damages the upper airways because it gets dissipated

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13
Q

In a pediatric burn patient, what size tube should be used?

A

One size smaller than is recommended for that child’s height and weight

Cuffed if < 8 yrs old

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14
Q

When is it unsafe to do an RSI with Succ for a burn victim?

Why?

A

Generally if they’re greater than 24 hours out

The body up-regulates acetylcholine receptors, increasing the amount of potassium released

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15
Q

What kind of nebs can aid in burn healing?

A

Heparin and N-Acetylcysteine

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16
Q

What percent of fire deaths are due to CO?

A

50-60%

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17
Q

What is the half life of CO in a patient that’s been put on 100% O2?

A

30 min to 2.5 hours

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18
Q

How does hydroxycobolamin aid in CO?

A

Converts CO to CO2

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19
Q

Why does cyanide poisoning cause hypoxia?

A

blocks intracellular use of oxygen:

binds to the terminal cytochrome in the ETC

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20
Q

How does hydroxycobalamin neutralize Hydrogen cyanide?

A

binds with cyanide, forming cyanocobalamin, which can be easily excreted by the kidneys

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21
Q

When are fluid losses highest after a burn?

When do they start to stabilize?

A

12 hours

24 hours

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22
Q

Pretty much all burn resuscitation formulas are based on two things:

A

weight

%TBSA

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23
Q

Why are colloid solutions not recommended in the first 24 hours?

A

Capillary permeability is too high. Those proteins will seep right out and take the fluid with it

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24
Q

What is the prime resuscitation fluid for burn patients?

25
Intrabdominal hypertension is defined as:
> 12 mmHG
26
Abdominal compartment syndrome is defined as:
IABP \> 20 mmHg with evidence of new organ dysfunction (usually oliguria)
27
What are some treatments for Abdominal Compartment Syndrome?
Paralytics Increased sedation escharotomies diuretics Decompressive laparotomy
28
What are the primary mediators of the profound hypermetabolic state associated with burns?
Catecholamines and corticosteroids
29
What are the three big causes of anemia in burn patients?
1. Hemolysis of blood cells that get thrombosed in burned tissue 2. Bone marrow suppression 3. Surgical debridements
30
How do burn patients respond to non-depolarizing paralytics?
Resistant to NDMRs Higher and more frequent dosing is often needed (more acetylcholine receptors that are less sensitive)
31
Which anesthetic should be avoided in patients with thoracic trauma?
Nitrous d/t the risk of an occult pneumothorax
32
If you suspect a massive hemothorax, when do you want to put in chest tubes?
Only after you've achieved adequate fluid resuscitation or at least have good access and are well on your way
33
Why is etomidate not an ideal drug for a trauma induction?
Adrenal suppression
34
How much propofol should be used during a trauma induction?
Ideally 10-50% of the normal dose
35
What is the most common traumatic lung injury?
Pulmonary Contusion
36
What are pulmonary contusions?
Damage to the alveoli, but not gross disruption of pulmonary structure
37
What respiratory dysfunction does a pulmonary contusion cause?
contusion (basically a bruise) causes exudate that settles into the alveolar membrane Increase the distance between air and capillaries, impairing gas exchange
38
Why does hypothermia cause coagulopathies?
Inhibits initiation of thrombin generation inhibits fibrinogen synthesis essentially: slowly makes a fragile clot that is unable to stop bleeding
39
Acidosis generally doesn't impact coagulation, except when:
It is paired with hypothermia
40
Early management of TBI includes:
rapid administration of plasma | (rFVIIa is also effective)
41
Why is it that bleeding leads to coagulopathy?
Thrombomodulin-Thrombin complexes form Lead to activated Protein C and clotting factor inactivation
42
\_\_\_\_\_carbia increases ICP
Hyper
43
In a patient with increased ICP, the goal is to keep CPP at:
> \<60 mmHg and \< 70 mmHg
44
Which anesthetic is not a good choice for patients with increased ICP?
Ketamine Raises ICP
45
What is the most common site of cervical injury?
C7
46
If a patient arrives hypoxic and needs to be intubated, what should be done?
Face mask ventilation with cricoid pressure until intubation (rather than a traditional RSI)
47
Why should succinylcholine be avoid in patients with spinal injury?
Fasciculations may worsen the spinal cord instability Also potassium
48
In spinal shock, describe: BP HR Skin
Low Low Warm/Pink
49
Innervation of the primary muscles of respiration emerge at:
C3-C5
50
The intercostal mm are innervated by nerves originating at:
T2-T11
51
Where is the vertebral artery most susceptible to injury?
At its entry point into the C-6 foramen
52
The inductions most commonly used in trauma are:
etomidate, ketamine, propofol
53
Autonomic dysreflexia is found in patients who suffer an SCI above:
T6
54
Autonomic dysreflexia is characterized by:
severe hypertension seizures pulmonary edema MI AKI Intracranial hemorrhage
55
What causes autonomic dysreflexia?
sudden activation of sympathetic response as a result of noxious stimuli (colorectal or bladder distention)
56
Most traumatic injuries are caused by two things:
Falls MVCs
57
What are the chances that a patient with one fractured femur will get a fat embolus? Two fractured femurs?
3% 33%
58
When are fat emboli typically seen?
24-72 hours after the initial injury
59
What is a landmark the anesthetist can use to determine if volume resuscitation is complete?
If the patient can tolerate a bolus of fentanyl without it tanking their BP, their hypovolemic state has probably been corrected

Patho 2 (24 decks)

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