Test #2 Trauma in the OR-Josh Flashcards Preview

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Flashcards in Test #2 Trauma in the OR-Josh Deck (114):
1

Trauma is a severe blunt or penetrating injury primarily caused by what?

  • Automobile Crashes
  • Gunshots
  • Knife wounds
  • Falls
  • Battery
  • Burns

2

B/t the ages of ____ to ____ trauma kills more people than any other diesease

birth to 30 y.o.

3

Trauma Scoring:

What are the 3 categories the scoring system is based off?

  • BP
  • GCS
  • RR

4

Trauma Scoring:

what is the points range?

  • 4
  • 3
  • 2
  • 1
  • 0

5

Trauma Scoring:

Give the correct Values for BP

  • 4
  • 3
  • 2
  • 1

 

  • >90
  • 76-89
  • 50-75
  • 1-49
  • 0

(0-50-25-15-10)

6

Trauma Scoring:

Give values for GCS

  • 4
  • 3
  • 2
  • 1
  • 0

  • 13-15
  • 9-12
  • 6-8
  • 4-5
  • 3

7

Trauma Scoring:

Givw the values for RR

  • 4
  • 3
  • 2
  • 1
  • 0

  • 10-29
  • >29
  • 6-9
  • 1-5
  • 0

8

Trauma Scoring:

what are the chances of survival based on thre following trauma scores

  • 8
  • 6
  • 4
  • 2
  • 1
  • 0

  • 98
  • 92
  • 60
  • 17
  • 7
  • 3

9

put trauma table here

10

put other trauma table here

11

War and the advancement of trauma resuscitation:

when were blood transfusions developed

WWI

12

War and the advancement of trauma resuscitation:

what was created in WWII (2 things)

 

  • Antibiotic use
  • reduce transport time to 4 hours

13

War and the advancement of trauma resuscitation:

what was created in the Korean war (2 things)

  • Air ambulances
  • early vascular repair

14

War and the advancement of trauma resuscitation:

what was the advancement made in the vietnam war? (2 things)

  • helicopter use (reduced time of injury to surgery to 1 hour)
  • More regulated guidlines for resuscitation tech

15

War and the advancement of trauma resuscitation:

what was the advancement made in fluid resuscitation in the vietnam war

  • Aimed at avoiding renal failure and other consequences of hypotension
  • However the asanguinous resuscitational fluids further diluted remaining plateletes and coag factors

16

True or False

The majority of deaths on the modern battlefield are non-survivable?

true

17

The improved methods of __ or _____-_____, noncompressible hemostasis combined w/ rapid evacuation to surgery may increase survival

IV

Intra-cavitary

18

What was 4 of the Major findings from the 2003 research on fluid rescusitation in Modern combat causualty care:

  • Stop bleeding w/ tourniquets and better dressings
  • Most casualties do not require resuscitation (use hextand)
  • Titrate to radial pulse and mental status
  • Use no more than 1000mLs of colloid

19

what are 3 PREVENTABLE causes of combat death

  • Hemorrhage from extrmity wounds
  • tension Pneumothorax
  • Airway obstruction (facial trauma)

20

what is a CAT

not a thing that is all nibbly bibbly and meows in a damn tree

  • It's a combat Application Tourniquet

21

What are some examples of hemostatis agents (5)

  • hemCon bandage
  • HemCon Chitoflex tape
  • QuikClot Powder
  • QuickClot ACS
  • Celox

22

what are the 3 Blood prodects to give for trauma

FFP

Platelets

Cryo

23

what does Cryo have that others dont?

  • Factor VIII and I
  • vWf and Fibrinogen

24

what are 2 machines that can assist you in getting blood into pt fast

Belmont

Rapid infuser

25

what is the trauma Triad of death

Hyperthermia

Acidosis

Coagulopathy

26

why does Hypothermia happen:

what are teh 4 ways we lose heat

  • Evaporation
  • Radiation
  • Convection
  • Conduction

27

Hypothermia:

Hypothermia causes increased what? (3 complications)

  • Mortality
  • Bloodloss
  • Blood transfusion

28

Hypothermia:

what 2 physiological clotting complications can occur

  • Platelet dysfunction
  • Coagulopathy (biggest complication)

29

Hypothermia:

<___ degress c on admission="100%" mortality>

  • <32 degrees C

30

Hypothermia-Cardiac effects

what occur at 33-36 C

  • Increased HR, BP, CO

31

Hypothermia-Cardiac effects

what happens at 32-33 C

opposite effect

  • DECREASED HR, BP, CO

32

Hypothermia-Cardiac effects

< 31 C

  • Inc atrial and Ventricular irritability

33

Hypothermia-Cardiac effects

< 30 C

Bradycardia profound and Vfib is likely

34

Hypothermia-Cardiac effects

19-20 C

Asystole usually occurs

35

Hypothermia-Renal function:

renal fx is dependent of what?

Cardiac Output

36

Hypothermia-Renal function:

At 33-35 C ______ pressure increases secondary to systemic vasoconstriction

Afferent

37

Hypothermia-Renal function:

@ temps < 33 C, GFR _____. and impairment of distal tubular reabsorption can cause ______.

  • Decreases
  • Polyuria

38

Hypothermia-Renal function:

in almost ALL states of HYPOthermia you will get ___uria

Polyuria

39

Hypothermia-Hematological effects:

what happens to HCT?

 

Increases

40

Hypothermia-Hematological effects:

whay does HCT increase

  • results from fluid shift to interstitial space and loss of fluid due to decreased distal tubular reabsorption

41

Hypothermia-Hematological effects:

what happens to bleeding times?

Increased

42

Hypothermia-Hematological effects:

what are bleeding times increased?

  • Platelets are sequestered in the spleen and liver resulting in increased bleeding times

43

Hypothermia Prevention:

what is a HPMK

Hypothermia prevention and Management Kit

Comes w/

  • Reflective cap
  • Self heating blanket
  • heat reflecting shell

44

Acidosis and Outcomes:

pH < 7.2 postop in the ICU what % lived

0%

45

Acidosis and Outcomes:

pH of > 7.33 postop in the ICU what % lived

88%

46

Acidosis:

what are the actual causes? (5)

  • Shock/ O2 delivery
  • Coagulopathy
  • Hypotension/Catecholamine receptor "uncoupling"
  • Arrhythmias
  • Decreased CO

47

Acidosis:

what actually perfuses the tissue SPO2 or PaO2

  • PaO2
  • O2 dissolves across cell and oxygenates the cell

48

Acidosis:

what is a better shift on the Oxyhemoglobin curve? right or left

 

  • Right (slight)
  • B/c the right shift increases PaO2 thus increases O2 perfusion to the tissues

49

Coagulopathy of Trauma:

majority of trauma pts (90%) are what? pro-thrombic or coagulopathic

 

Prothrombic

50

Coagulopathy of Trauma:

what does being Pro-Thrombic cause?

  • DVT
  • PE

51

Coagulopathy of Trauma:

what is the major need of trauma pt since they are usually pro-thrombic?

Need anticoagulation

52

Coagulopathy of Trauma:

Pro-thrombic pts are a real problem in what type of trauma pt's?

Hemorrhagic

53

Coagulopathy of Trauma:

Since most pts are prothrombic and are prone to clots they are usually given what?

heparin

54

Coagulopathy of Trauma:

only a minority (10%) of trauma pts are what? Pro-thrombic or Coagulapathic

Coagulopathic

55

Coagulopathy of Trauma:

what is the problem associated with Coagulopathic pt

Bleeding and Death

56

Coagulopathy of Trauma:

what do the Coagulopathic pt need

DCR

57

Hemostasis:

How does platelet adhesion occur?

  • Damage to endothelial surface > subendothelial collagen exposure
  • production/ release of vWF from endothelial cells
  • vWF anchors platelets to subendothelial collagen vascular wall

58

Hemostasis:

what is the most common inherited coagulation defect

Von Wilebrands Disease

59

what is the tx for Von Willebrands Dz

DDAVP

60

how does DDAVP work

releases vWF from endothelial cells

61

Platelet activation:

Prothrombin > _________ (___) whoch activatees platelets

Thrombin (IIa)

62

Platelet activation:

 thrombin (IIa) is responsiable for shape change and release of what 2 mediators

  • TX2
  • ADP

63

Platelet activation:

TX2 and ADP promote _____ aggregation

 

 

Platelet

64

Platelet activation:

TX2 and ADP "uncover" the fibrinogen receptor what?

GPIIb/IIIa

65

Platelet activation:

the "uncovering" of fibrinogen receptor GPIIb/IIIa. what does that receptor do?

 

  • Allows Fibrinogen (I) to bind to the receptor and further aggregate platelets

66

Platelet activation:

After platelets aggregate, ______ are woven into platelets and crosslinked

Fibrin

67

Platelet activation:

After platelets aggregate, fibrin are woven into platelets and crosslinked. The cross linage requires _____

Fibrin Stabilizing factor (XIII)

68

Damage Control:

Teh medic titrates fluids given to casulty based upon what 2 peramiters?

 

  • Pulse
  • Mental status

69

Damage Control:

the goal is to avoid excessive fluid administration which can inhibit what?

Clotting

70

Damage Control:

what is the trilogy of damage control

  • Abbreviated operation
  • Resuscitation in ICU
  • Return for the operatinf room for definitive operation

71

Damage Control:

what is the abbreviated laparotomy

  • Stop bleeding
  • Stop contamination
  • Leave abdomen open

72

Standard Resuscitation:

you want to Dx and treat what 2 things?

  • hypothermia
  • Acidosis

73

Standard Resuscitation:

What should you give following LR administration

PRBCs

74

Standard Resuscitation: LR

is it designated for trauma resucitation?

nope

75

Standard Resuscitation: LR

can it make you acidodic or alkolotic

Acidodic

76

Standard Resuscitation: LR

does it have clotting factors

you better say no

77

Standard Resuscitation: LR

how much is left from a liter 60 min after infusion

200 mL's

78

Standard Resuscitation: LR

LR is proinflammatory. T/F

True

79

Standard Resuscitation:

the ruscitation trigger was after CV collapse. which is a SBP of what

<90

80

Standard Resuscitation: LR

the endpoint of resuscitation is often what?

Normal BP

81

Standard Resuscitation: LR

Crystalloid will get BP up but will not deliver O2 to tissue, thus ______ are better choices. If there is no CO- give crystalloids to increase forward flow

Colloids

82

Standard Resuscitation: LR

what is the resuscitation protocol or what is the standard massive transfusion protocol

  • 6 PRBCs
  • 6 FFP 1:1 ratio
  • 6 unit platelets
  • 10 units cryo
  • Factor VIIa
  • Whole blood
  • Minimize Crystaloid******

83

what is the formula for O2 delivery

Do2= CI x (1.34 x Hb x SaO2) x 10

84

What is teh formula for O2 uptake

VO2= CI x 1.34 x Hb x (SaO2 - SvO2) x 10

85

what is the oxygen extraction ratio formula

oxygen uptake / Oxygen delivery

86

what are some indications to initiate the MT protocol?

  • SBP < 90
  • Temp <96
  • Hgb < 11
  • INR > 1.5
  • Base deficit > 6
  • More than 1 proximal amputation
  • Truncal injury w/ significant shock or coagulopathy

87

Transfuse RBC:FFP:PLT in what ratio

8:8:1

88

what should the MT be in the ER ASAP

  • Emergency release of O-
  • Thawed Plasma
  • Easly rFVIIa (90 mcg/kg) and (cry 10U)
  • Continue w/ 6 U RBC and FFP
  • 1 unit platelete

89

when do u stop the Massive Transfusion protocol

  • When bleeding stops
  • Adequate CO
  • Mixed venous sat 70%
  • Resolving Lactate or base deficit

90

what do you always minimize in trauma

Crystalloids

91

what is thawed plasma

FFP

92

Thawed plasma is FFP that is lept up to ___ Days at 4 C

5

93

FFP (Thawed Plasma) not only addresses the metabolic abnormality of shock, but initiates the reversal of the early _____ of trauma

Coagulopathy

94

Once an ABO blood tyoe is available the use of group O uncrossmatched red cells is converted to what?

the pt's biological tyoe

95

rFVIIa:

why is it used

correct acidosis

96

rFVIIa:

There is a decreased efficacy when pH is what

pH < 7.2

97

rFVIIa:

for it to work you need adequate what?

  • Fibrinogen
  • Platelets

98

rFVIIa:

what is the dose

  • 90-120 mcg.kg

99

rFVIIa:

how often can you adminiter it

Q2 hours

100

rFVIIa:

what are the relative indications

  • Severe Bleeding
  • at rick for MT
    • Temp < 96
    • SBP <90
    • Hb <11
  • Intracranial hemorrhage with AMS
  • Double amputee
  • Chest tube output > 1000 ml's or 200mL's/hr
  • Major truncal injury w/ positive FAST

101

Burns:

the chance of survival drops after what %

30%

102

Burns:

Direct inhalational thermal injury results in what

  • pulm edema

103

Burns:

the deactivation of surfactant leads to what?

Atelectasis

104

Burns:

CO shifts the Oxy heme curve to the???

LEFT

105

Burns:

______ changes cause massive fluid shifts

  • Permeability

106

Burns:

Contraction of Intravascular volume is highest during the 1st ____ hours

24

107

Burns:

Fluid replacement normal

 

  • 2-4 mL/kg / %body burned

108

Burns:

the parkland formula

  • Volume over 24 hours = kg x 4 x %BSA
  • 1/2 in first 8 hours
  • 25% next 8 hours
  • 25% final * hours

109

Burns:

blood pressure and HR are usually what (elevated or Decreased)

Elevated

110

Burns:
Tissue destruction releases extra _____ into Circulation complicating resuscitation

K+

111

Burns:

in later phases, renal wasting and gastric losses lead to what

Hypokalemia

112

Burns:

electrical burns are associated w/ ______ which often leads to Acute renal failure

  • Myoglobinuria

113

Burns:

what NMB is contraindicated in burn pt's and why?

Suxs

Hyperkalemia

114

Burns:

NDMR doses have to be ______ d/t protein binding and more extrajunctional acetylcholine receptors

increased