Surgery Trauma Lecture + Reading

Question 1

Which pts require a definitive airway?

Answer 1

GCS < 8
ALOC
Severe head injury

Question 2

Signs of tension pneumothorax?

Answer 2

Hypotension
Distended neck veins
Tracheal shift away from affected side
Hyperresonance

Question 3

What is the treatment for tension pneumothroax?

Answer 3

Needle in 2nd ICS midclavicular

Converts tension to simple

Question 4

Treatment for open pneumothorax

Answer 4

Seal would with occlusive dressing on 3 sides - flutter valve

Then put in chest tube

Question 5

How do you place a chest tube in?

Answer 5

Midaxillary line at the level of the nipple

Directed posteriorly and superiorly toward the apex of the thorax

Question 6

What venous access is necessary for a pt in shock?

Answer 6

At least 2 14-16 gauge IV lines in antecubital fossa

If this fails go IO

Question 7

After IV line is inserted, what is the first fluid that will be administered?

Answer 7

Crystalloid infusion

Adults - 2L LR or NS (if no response give 2 more L, unless you think they’re in hemorrhagic shock, then you would move to blood products)

Children - 20 mL/kg

Question 8

Besides giving PRBC what must you considering giving to pts?

Answer 8

Fresh plasma or thawed fresh frozen plasma to avoid coagulopathy in massively transfused pts

Question 9

TXA

Answer 9

Tranexamic acid
Clotting promoter
Antifibrinolytic (blocks breakdown of blood clots)
NOT qeffective if given <3h post injury

Question 10

What is the ratio of fresh frozen plasma to PRBC you should administer a pt?

Answer 10

1:5

Question 11

When is an emergency room thoracotomy appropriate?

Answer 11

For pts with penetrating thoracic trauma in cardiac arrest

Question 12

What 3 interventions can you do to decrease the ICP in an unconscious pt?

Answer 12

Mannitol
Hypertonic saline
Moderate hyperventilation

Question 13

FAST exam

Answer 13

Ultrasound

• subxiphoid pericardial window
• morison’s pouch - hepatorenal recess
• perisplenic
• Douglas pouch - suprapubic window

Question 14

What tests are you going to first order for an unconscious pt?

Answer 14

Blood EtOH
Urine toxicity
Glucose
Head CT

Question 15

Which blood do you give to a women of child bearing age?

Answer 15

Rh negative

Question 16

What is the order of fluid administration when resuscitating a trauma?

Answer 16

1) give fluids (cystalloid)
2) blood products if bleeding
3) still hypotensive: give epi

Question 17

What should you do for a pt with blunt trauma complaining of neck injury but had a negative CT?

Answer 17

Get an MRI

Question 18

What is a definitive airway?

Answer 18

Cuffed airway —ET tube

Question 19

What injuries impair ventilation in the short term?

Answer 19

Remember that a patent airway does not mean adequate ventilation

Tension pneumothorax
Flail chest with pulmonary contusion
Massive hemothorax
Open pneumothorax

Question 20

What is the ultimate treatment for pneumothorax?

Answer 20

Chest tube

Question 21

Flail chest

Answer 21

At least 2 fractured ribs with 2 fractures per rib (free segment)

Question 22

What is the predominant cause of preventable deaths?

Answer 22

Hemorrhage

Question 23

Once you have treated the tension pneumothorax, what is the next step?

Answer 23

Treated hypotension

Question 24

Where are the major areas of internal bleeding?

Answer 24

Chest
Abdomen
Retroperitoneum
Pelvis
Long bones

Question 25

What is GCS used for?

Answer 25

Predictor of head injury severity and neurological recovery

Question 26

Trauma pts are assessed once all of their clothes have been removed, once the assessment is done, what should you do?

Answer 26

Cover pt with warm blankets and warm IV fluids to prevent hypothermia

Question 27

Which 3 conditions if present show a bad prognosis for shock pts?

Answer 27

Hypothermia Coagulopathy Acidosis

Question 28

Decorticate vs decerbate

Answer 28

Decorticate GCS 3 Arms to the core of the body Decerebrate GCS 2 Upper motor neuron Arms down at the side

Question 29

Massive transfusion is defined as

Answer 29

> 10 units of PRBCs within 24 hours of admission

Question 30

An injured pt who is ___ and ___ is in shock until proven otherwise

Answer 30

Cool and tachy

Question 31

Who do you not give LR to?

Answer 31

Pts with renal problems d/t potassium

Question 32

Cardiac tamponade is most commonly seen with what type of trauma?

Answer 32

Penetrating thoracic

Question 33

Do isolated intracranial injuries cause shock?

Answer 33

No

Question 34

Pts who have sustained a spinal injury often have ______ trauma

Answer 34

Abdominal

Question 35

What should be obtained within 3 hours of septic shock admin?

Answer 35

Obtain lactate level Blood cultures (prior to ABX) ABX broad-spectrum 30mL/kg of crystalloid solution

Question 36

What is the hgb level that requires RBC transfusion?

Answer 36

Below 7g/dl Taget rage is 7-9 g/dL

Question 37

Ketamine

Answer 37

An induction agent used for RSI ``` Drawbacks: Increased secretions HTN Tachycardia Raised IOP ```

Question 38

What two types of drugs are given for RSI?

Answer 38

``` Induction agent (sedative) Nueromuscular blocking agent (paralytic) ``` ALWAYS sedate them first before giving paralytic

Question 39

What are the 3 neuromuscular blockers?

Answer 39

Suxamethonium Rocuronium Vecuronium

Question 40

What is the major difference between ketamine and etomidate?

Answer 40

Ketamine provides analgesic while etomidate does not —etomidate is typically pre-treated with fentanyl IV to aid in analgesic

Question 41

What are the benefits of etomidate over ketamine?

Answer 41

Etomidate is used for status epilepticus There is an antagonist available Both are used for hemodynamically unstable

Question 42

What are the adverse side effects to ketamine?

Answer 42

Increase secretions Raised IOP Caution with CV disease

Question 43

What are the adverse effects are etomidate?

Answer 43

Adrenal suppression | Myoclonus

Question 44

What 2 sedatives are used for hemodynamically stable patients?

Answer 44

Propofol | Midazolam

Question 45

What similarities do propofol and midazolam have in common?

Answer 45

Hemodynamically stable Provide sedation and amnesia without analgesia Adverse effects: hypotension

Question 46

Which induction agents are used for status epilepticus?

Answer 46

Etomidate Propofol Midazolam

Question 47

When is atropine used?

Answer 47

To prevent bradycardia upon induction | Commonly used in children