Test #2 Trauma overview-Josh

Question 1

b/t the ages of ___ to ____ trauma kills more people than any other disease or illness

Answer 1

birth to 30

Question 2

Trauma Systems:

what are the 4 main systems that treat traumas?

Answer 2

• prevention
• First responders
• Acite care- Trauma Centers
• Post- trauma care/ rehabilitation

Question 3

Trauma Systems: Prevention

What are 3 main ways prevention is provided?

Answer 3

Education

Laws

Highway safety

Question 4

Trauma Systems: First responders

What are 3 ways first responders aid in trauma prevention/decrease mortality w/ traumas

Answer 4

Shorter response times

Well educated rescuers

Life flights

Question 5

Trauma Systems: Trauma Centers

what are the differnet levels

Answer 5

I and II

Question 6

Trauma Systems: Trauma Centers

whichh level is a comprehensive regional resource that is a tertiary care facility central to the trauma system. And is capable of providing total care for every aspect of injury from From PREVENTION to RECOVERY

Answer 6

Level I

Question 7

Trauma Systems: Trauma Centers

what are the elements of a Level I

Answer 7

• 24hr inhouse general surgeon and Prompt availablility of specilties (ortho, neuro, anesthesia, ER, radiology, peds, critical care, etc)
• Referal resource for communnities in nearby regions
• Leadership in prevention, public education
• PROVIDES CE OF THE TRAUMA TEAM MEMBERS
• comprehensive quality assessment program
• teaching and research in trauma
• Programs for substance abuse
• Meets minimum req for annual volum eof severely injured pts

Question 8

Trauma Systems: Trauma Centers

a Level ____ is able to initiate definative care for all injured pts

Answer 8

II

Question 9

Trauma Systems: Trauma Centers

whata are the elements of a level II

Answer 9

• 24 hour immediate coverage by general surgeons as well as specialties
• Tertiary care needs such as cardiac sx, hemodyalysis and microvascular may be refered to a level I
• provides trauma prevention and CE programs for staff
• Incorporateds comprehensive Quality assessment program

Question 10

Emergent Vs Urgent

Awake and stable

Answer 10

Emergent

Question 11

Emergent Vs Urgent

unconscious or unstable

Answer 11

Urgent

Question 12

what makes trauma anesthesia so different?

Answer 12

• Many unknowns
• Multiple injuries and mechanisms of injuries
• Pt’s health status unk
• No pt hx
• Decreased prep and evluation time

Question 13

Trauma anesthesia:

the amount of pt info you gather preop is largely dependent on what?

Answer 13

the stability of the pt

Question 14

Trauma anesthesia:

what are the main questions you must obtain from the trauma center?

Answer 14

• Access
• Blood products given/ avail
• Abx given
• Allergies
• Pt’s ventilation/circulation/ mental status

Question 15

Trauma anesthesia:

questions you want to ask the pt or pt’s family

Answer 15

• Allergies
• medications
• Anesthesia hx
• Significant medical hx
• NPO status

Question 16

Trauma anesthesia: Airway

what are 7 main conditions that require early intubation

Answer 16

• Apnenic
• Poor ventilation
• Decreased/ Changing mentation
• Devleoping airway obstruction (stidor/snoring)
• Airway burns (soot in nares, singed hair)
• Shock
• combativness

Question 17

Trauma anesthesia: Breathing

what are some ventilation management factors?

Answer 17

• Location of incision
• Hemnodynamic compromise
• Presence of lung injury

Question 18

Trauma anesthesia: Breathing

what is a big choice you must answer prior to tube placement

Answer 18

DLT or NO DLT

Question 19

Trauma anesthesia: Breathing

if EtCO2 is low, don’t forget to differentially diagnose the cause. what are some of the causes

Answer 19

• Shock
• Low CO
• PE
• VAE

Question 20

Trauma anesthesia: Circulation

what are your fluid choices for hemodynamic stability?

Answer 20

• Crystalloid
• Colloid
• Blood

Question 21

Trauma anesthesia: Circulation

what are the 3 main accesses you need to get

Answer 21

Large IVs

Central Lines

A-line

Question 22

Trauma anesthesia: Management

what are 3 different ways to administer anesthesia

Answer 22

GETA

Regional

MAC

Question 23

Trauma anesthesia: Management

w/ induction agents whats more important? the agent or the dose?

Answer 23

Dose

Question 24

Trauma anesthesia: Management

what are some good induction drugs?

Answer 24

• Etomadate
• Ketamine
• STP
• Propofol

Question 25

Trauma anesthesia: Management what are 4 main complications you can run into

Answer 25

Bleeding Hypoxia Acidosis Hypothermia

Question 26

Trauma anesthesia: Management what are 2 big post-op concerns?

Answer 26

Do we extubate? ABCs

Question 27

Trauma anesthesia: Management what are 6 treatments for hypotension

Answer 27

* Allow time * crystalloid/colloid * PRBC's * FFP * Platelets * Pressors

Question 28

Trauma anesthesia: Management PRBC's are concentrated to a Hct of about \_\_\_% and a volume of \_\_\_mLs

Answer 28

75% 200mLs

Question 29

Trauma anesthesia: Management storig PRBC's (just above freezing) up to \_\_\_days decreases the 2,3-DPG and ruins the platelets and neutrophils

Answer 29

42 days

Question 30

Trauma anesthesia: Management \_\_\_\_ are the fastes way to increase the O2 delivering capacity of the blood

Answer 30

PRBCs

Question 31

Trauma anesthesia: Management 1 unit of whole blood or PRBCS will rais ethe HCT by \_\_\_% and the Hgb by \_\_gm/dl

Answer 31

3% 1gm/dl

Question 32

Trauma anesthesia: Fluid Management what is used in bleeding pts w/ multiple coagulation factor deficiencies 2nd to liver dz, DIC, and the dilutional coagulopathy from Massive transfusion

Answer 32

FFP

Question 33

Trauma anesthesia: Fluid Management \_\_\_-\_\_ packs of FFP should be given for each blood volume lost, and given over 90-120 min to achive a min of 30% plasma factor concentration

Answer 33

4-8

Question 34

Trauma anesthesia: Fluid Management 1 unit of platelets in adults will raise the plt count in an adult by \_\_\_-\_\_\_

Answer 34

5-8,000

Question 35

Trauma anesthesia: Hypotension Management what are some commonly used pressors

Answer 35

* Phenylephrine * Ephedrine * Epinephrine * Dopamine * Levophed

Question 36

Trauma anesthesia: Hypotension Management what are some others drugs used for hypotension management

Answer 36

NaHCO3 CaCl2 hydrocortisone

Question 37

Trauma anesthesia: HYPERtension Management how is ot primarily treateted

Answer 37

Increasing Anesthesia

Question 38

Trauma anesthesia: HYPERtension Management if antihypertensives are used, it is advisable to use what type?

Answer 38

shortacting

Question 39

Trauma anesthesia: HYPERtension Management what are 2 examples of antihypertensives used

Answer 39

esmolol Nitro

Question 40

Trauma anesthesia: Acidosis shift OHC to the \_\_\_

Answer 40

right

Question 41

Trauma anesthesia: Acidosis w/ acidosis you get what 4 physiological effects

Answer 41

Myocardial depression Decreased SVR Hyperkalemia Alterations in drug potency

Question 42

Trauma anesthesia: Acidosis what is treatment

Answer 42

NaHCO3 Avoiding Acidic crystalloids Correcting anemia Tham Hyperventilation

Question 43

Trauma anesthesia: Bicarb generally not indicated if pH \> ?

Answer 43

7.25

Question 44

Trauma anesthesia: Bicarb not indicated in what type of acidosis

Answer 44

respiratory

Question 45

Trauma anesthesia: Bicarb large amounts should not be used w/o ?

Answer 45

controlled ventilation

Question 46

Trauma anesthesia: Fluids what was developed for the treatment of hemophilia A and Von Willebrand dz

Answer 46

Cryoprecipitate

Question 47

Trauma anesthesia: Fluids Cryo contains an abundant amount of \_\_\_\_\_\_\_, \_\_\_\_\_\_\_, and \_\_\_\_\_\_\_\_

Answer 47

* Fibrinogen * Von Willebrand-factor (VIII) * Fibrin stabilizing factor (XIII)

Question 48

Trauma anesthesia: Fluids is cell saver whole blood?

Answer 48

Nope

Question 49

thats it for this one

Answer 49

fuck yes