Trauma Flashcards
(78 cards)
1
Q
What is the leading cause of death for patients ages ____ to _____
A
Trauma
ages 1 - 45
US
2
Q
Leading cause of death worldwide between ages 15 and 44?
A
Still trauma
3
Q
Name the three components of an initial evaluation
A
- Rapid Overview
- Primary Survey - ABCDE
- Secondary Survey
4
Q
Primary Survey
A
- Airway Patency (obstruction?)
- Breathing
- Circulation (skin temp, color, 2 large bore IVs)
- Disability (GCS)
- Exposure
5
Q
Airway Patency Assessment
A
Are they talking?
Agitated? = Hypoxia
Gargling? = Tracheobronchial injury
6
Q
Flail Chest
A
3 or more fractured ribs associated w/costrochondral separation
resp insufficiency and hypoxemia over several hours w/deterioration of CXR and ABG
pain management > mechanical ventilation
CPAP or BiPAP may be helpful
7
Q
Tension Pneumothorax
A
due to air leaking from the lung, or chest wall into the pleural space
pneumothorax presents in 40% of blunt thoracic injuries
this is why nitrous oxide is c/i in thoracic trauma
8
Q
Massive hemothorax
A
> 1500 mL
9
Q
pneumothorax s/s (6)
A
hypotension hypoxia tachycardia diminished breath sounds SQ emphysema distended neck veins
10
Q
GCS Scale - Eye Opening
A
4 points = spontaneous
3 = to verbal
2 = to pain
1 = not at all
11
Q
GCS Scale - Verbal
A
5 = normal conversation 4 = responds, but doesn't make sense 3 = responds, incomprehensible 2 = no words, moans 1 = no response
12
Q
GCS Scale - Pain
A
6 = follows commands 5 = localizes pain 4 = withdraws from pain 3 = decorticate 2 = decerebrate 1 = does nothing
13
Q
GCS < 8
A
intubate
14
Q
GCS > 13
A
mild brain injury
15
Q
GCS 9 - 12
A
moderate brain injury
16
Q
Secondary Survey
A
Begins after critical life saving actions have begun i/e/ (intubation, chest tubes, fluids)
Focus includes: history, LAMP
DM? Low blood glucose?
17
Q
Airway Evaluation
A
Assume patient absolutely requires an airway and cannot be re-awakened electively
18
Q
Jaw broken
A
can you mask ventilate? maybe just NRB and intubate from that
19
Q
Direct airway injury
A
maybe no edema now.. but there will be later
20
Q
Airway obstruction considerations (8)
A
- cervical deformity
- cervical hematoma
- foreign bodies
- dyspnea, hoarseness, stridor, dysphonia
- SQ emphysema + crepitation (tracheal tear?)
- Hemoptysis (no fiberoptic w/active bleeding)
- Tracheal deviation - tension pneumo + death
- JVD - cardiac tamponade
21
Q
Cardiac tamponade s/s
A
narrowed pulse pressure
muffled heart sounds
hypoperfusion
22
Q
Some considerations for airway management (3)
A
Full stomach
Oral ett > nasal ett b/c airway pressures
C-Spine stability
23
Q
Major contraindications for a nasal intubation
A
basilar skull fracture
24
Q
s/s basilar skull fracture
A
battle sign
CSF leakage
raccoon eyes
25
Indication for ETT intubation (7)
1. cardiac/resp arrest
2. Deteriorating respiratory condition (contusion/pneumo/burns)
3. Need for deep sedation
4. GCS < 8
5. CO poisoning - need that 100% FiO2
6. Uncooperative/intoxicated pt
7. Transient hyperventilation for a head injury
26
Tracheotomy
takes longer to perform
| need neck extension (c/i c-spine injury)
27
Cricothyroidotomy contraindications (2)
c/i in those < 12 y.o.
| laryngeal damage - c/i
28
How long can a cricothyroidotomy last?
72 hours
29
Cricothyrotomy supplies
1. Scalpel - 2.5cm vertical incision, keep < 1.3 cm deep
2. Dilator
3. Tracheal Hook - Keep dilator in until tracheal hook placed
4. 10 cc syringe + trach cuff
5. Trach tube (< 7 ) or ETT 6.0
30
Instances you do a cric (5)
macey
1. massive trauma to the face
2. angioneurotic edema
3. supraglottic obstruction
4. croup/epiglottitis
5. inhalational injury
31
Gold standard for C-Spine injury
fiberoptic intubation - awake (pt gotta be cooperative tho)
32
LMA
contraindicated for a definitive airway
33
etomidate
0.2 - 0.3 mg/kg (if severly compromised, you will still see a drop in BP)
34
ketamine
2 - 4 mg/kg (c/i in head injury)
4 - 10 mg/kg IM
* direct cardiac depressant; usually masked by catechols*
* great choice for tamponade pt*
35
Sux
1 - 1.5 mg/kg IV
30 second onset; fasiculate
5 - 12 m duration
c/i w/globe injury or head injury
pre-treat w/rocuronium 5 mg
36
Roc
1.2 mg/kg IV
30 - 60 s onset; 60 - 90 m duration
may need gentle mask ventilation (MRSI)
37
Scopalamine
0.4 mg/mL
Dose = 5 - 10 mcg/kg
c/i in pregnancy
38
How to clear a c-spine pt
Complete xray C1 - C7
| pt not obtunded or under influence
39
manual in-line stabilization
(MILS)
| hold mastoid process
40
Name the 3 factors that influence a penetrating injury
1. type of instrument
2. velocity
3. characteristics of the tissue through which it passes through
41
laryngotracheal damage s/s (7)
```
hoarseness
muffled voice
dyspnea
stridor
dysphagia
cervical pain/tenderness
flattened thyroid cartilage
```
42
why do you intubate w/c4 or c5 lesion
diaphragm
43
why do you intubate w/c6 or c7 lesions
pt cannot cough or clear secretions with those
44
pulmonary contusion
bruising of alveoli allowing protein rich fluid to escape and increase alveolar capillary membrane distance
leading to ARDS
keep pplat < 32
45
hemothorax
make sure you havee adequate fluids on board prior to ct placement
s/s: hypotension, hypoxemia, tachycardia, increased CVP
46
anesthesia considerations for a hemothorax
one lung ventilation
| use regular ett first
47
name the 3 types of a pneumothorax
simple
communicating
tension
48
when do you treat a pneumo
> 20% of the lung collapsed
needle decompression at 2nd/3rd rib - mid clavicle
14 or 16 gauge
49
initial response to shock
mediated by neuroendocrine system
hypotension - catecholamine + vc
-heart kidney brain preserved
50
name all the hormones released during shock
```
renin/AT
vasopressin
ADH
GH
glucagon
cortisol
epi/NE
```
51
Lungs + Shock
the destination of inflammatory byproducts that accumulate in capillary beds leading to ARDS
52
Trigger for MOSF
likely the gut b/c hypoperfusion
53
coagulopathies explained (4)
hypotension, tissue injury
inflammatory response
endothelial activation of protein C
hyperfibrinolysis d/t APC
54
what does APC do
blocks factor 5/8 to limit clot propagation in normals.
55
why do trauma pt have coagulopathies (4)
1. dilution
2. hypothermia/acidosis
3. TBI
4. hemorrhagic shock
56
PRBC Hct?
55%
57
Plt (50 ml) =
5.5 x 10^10
58
Plasma =
80% coags
59
What is base deficit?
reflects the severity of shock, oxygen debt, changes in oxygen delivery, fluid resuscitation adequacy ?
60
Base deficit of 2 - 5 =
mild shock
61
base deficit of 6 - 14
modereate shock
62
what is severe shock
base deficit > 14
63
blood lactate level
leess specific than base deficit, but still important
elevated levels correlate w/hypoperfusion
normal 0.5 - 1.5 and half life is 3 hours
64
plasma lactate > 5 =
significant lactic acidosis
65
how do you assess systemic perfusion?
1. vs - not indicate occult hypoperfusion
2. UO - can be inaccurate d/t diuretics, renal injury, intoxication
3. acid-base balance - confounded by resp. status
4. lactate clearance - timing
5. CO - need PA cath
6. SVO2 - accurate marker, hard to get
7. SVV
66
how long can an IO stay?
2 - 3 days
67
Goals for EARLY resuscitation (24 - 48h)
1. SBP 80 - 100
2. HCT 25 - 30
3. PTT (25 - 35) and PT (11 - 13) WNL
4. PLT > 50
5. Normal Ionized Calcium 4.6 - 5.2
6. Core temp > 35
7. prevent worsening lactate, acidosis
8. keep them without pain and under anesthesia
68
Risks of aggressive volume replacement during early resuscitation
```
increased BP
decreased viscosity
decreased hct
decreased clotting factor conceentration
need more tx
lytes out of wack
direct immune suppression
premature reperfusion
```
69
Goals for LATE resuscitation
SBP > 100 and HR < 100
2. maintain hct at individualized level
3. normalize coags/lytes/body temp
4. good urine output
5. reverse systemic acidosis
6. good CO
7. seerial lactate. if it does not decrease, something else. is going on
70
What is the end point for resuscitation
Lactate < 2mmol
Base Deficit < 3
Gastric intramucosal pH > 7.33
71
No type and cross - what do you give ?
RH negative, esp if woman is of childbearing eyars
72
FFP:PRBC
2 u FFP to every 4 u PRBC
73
what can you mix w.blood
NS
| plasmalyte
74
how fast can you give fluids
1500 mL/m
crystalloid, colloid, PRBCs, plasma
all mix together in reservoir
38 - 40 degrees Celsius
75
what is the lethal triad
coagulopathy
acidosis
hypothermia
76
what does hypothermia do ? (6)
1. acid base d/o
2. coagulopathy (inhibits thrombin and fibrinogen, impairs platelet, abnormal calcium and K hemostasis)
3. myocardial dysfunction
4. oxy-hgb to left
5. decreases metabolism of lactate, citrate, and some anesthetic drugs
6. causes vasoconstriction - BP appears higher
77
29 degrees c PT and PTT
increase by 50%
78
29 degrees C platelets
decrease 40%
