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Co-Exisiting Disease 2 > Trauma > Flashcards

Trauma Flashcards

(73 cards)

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1
Q

Shock trauma requires what 2 things?

A

Resuscitation and interventions

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2
Q

4 goals for trauma?

A
  1. Keep pt alive
  2. Identify life threatening injury
  3. Stop ongoing bleeding
  4. Complete definitive treatment as early as possible
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3
Q

5 initial trauma management steps:

A
  1. Preparation space, equipment, PPE, staff
  2. Assumption of care from prehospital providers
  3. Primary survey (ABCDEs)
  4. Secondary survey
  5. Definitive care
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4
Q

What does ABCDE stand for?

A 
Airway 
Breathing
Circulation
Disability 
Environment
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5
Q

What intubation is considered for trauma patients?

A

RSI; increased aspiration risk due to full stomach

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6
Q 
For pneumothorax unassisted breathing: 
SpO2
Pleural flap valve
RR
BP
Venous return
A

82 (low)
One way
Tachypnea
Maintained due to compensatory mechanisms
Maintained due to increasingly negative intrathoracic pressure

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7
Q 
For pneumothorax assisted breathing: 
SpO2
Pleural flap valve
RR
BP
Venous return
A 
82 (low)
More air forced out into pleural space 
Controlled
Hypotension leading to cardiac arrest 
Decrease
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8
Q

Treating tension pneumothorax quickly and definitive:

A

Bilateral needle decompression (14ga at 2nd intercostal space at midcalvicular line)
Chest tube at 6-7 intercostal space at mid axillary line

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9
Q

4 quick assessments for circulation:

A

Palpate, skin temp/moisture, skin color, obvious signs of bleeding

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10
Q

FAST exam means:

A

Focused assessment with sonography in trauma

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11
Q

Assessment of blood consumption score (4):

A

HR >120bpm
SBP <90mmHg
Positive FAST exam
Penetrating injury

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12
Q

What does the score need to be to have a high mortality, trauma-induced coagulopathy, and require a massive transfusion?

A

2 or greater

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13
Q

Class 1 hemorrhage (3)

A

> 15% loss of circulating volume
HR/BP do not change
Resuscitation not required

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14
Q

Class 2 hemorrhage (4)

A

15-30% loss of circulating volume
HR increase
DBP increase
Replacement with IV fluids

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15
Q

Class 3 hemorrhage (4)

A

30-40% loss of circulating volume
BP decrease/HR increase
Metabolic acidosis
Transfusion necessary

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16
Q

Class 4 hemorrhage (4)

A

> 40% loss of circulating volume
Profound HTN
Trauma induced coagulopathy (TIC)
Require massive transfusion

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17
Q

Thrombin is generated primarily via what pathway?

A

Extrinsic

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18
Q

When thrombomodulin (TM) is presented by the endothelium, it complexes thrombin which is no longer available to cleave what?

A

Fibrinogen

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19
Q

Anticoagulant thrombin activates protein C inhibits what 2 cofactors?

A

5 and 8

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20
Q

tPA is released from the endothelium by injury and hypoperfusion and cleaves plasminogen to initiate what?

A

Fibrinolysis

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21
Q

Tranexamic acid needs to be given when to be effective?

A

Early — within 3 hrs of injury

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22
Q

Loading dose of TXA:

A

1g ove 10 min (by slow IV injection or an isotonic IV infusion)

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23
Q

Maintenance dose of TXA:

A

1g over 8hrs (in an isotonic IV infusion)

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24
Q

Brief neurological exam performed fo what 3 things:

A

Level of consciousness
Pupillary size/reaction
Potential spinal cord injury

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25
Persistently depressed levels of consciousness should be considered a what injury until proven otherwise?
CNS
26
Glascow coma scale grades what 3 things:
EMV Eye opening Best motor response Verbal response
27
Minimum and max Glasgow coma scale:
3 and 15
28
What is patient at risk of when considering environment?
Hypothermia
29
Hypothermia is minimized by what 3 things?
OR/ER bay near body temp Warm fluids and blood products Body warmers
30
What 2 things should be emphasized on when getting consent from conscious trauma pt?
Blood transfusion | Possible intraop awareness
31
Induction of trauma (3)
``` 100% FiO2 RSI Meds -etomidate (.3-.4) -ketmine (1-2) -sux (1-2) -RSI roc (1.2) ```
32
Ventilation for maintenance of trauma:
Low VT, lung protective strategy
33
Fluid management for maintenance of trauma
Crystalloid preferred
34
Early access to what to deposit coils or foam within the vessels to control hemorrhage?
Interventional radiology (IR)
35
Massive transfusion protocols definition (4)
20 units PRBCs in 24 hrs (1blood volume of 70kg) Loss of 50% of blood volume in 3 hrs Need of >4units PRBCs in 1 hr BLOOD LOSS >150ML/HR
36
What 8 things are needed for blood bank to provide first MTP pack?
``` CBC ABG BMP Lactate PT PTT INR Fibrinogen ```
37
Type and screen time and reaction risk?
45 min | 1%
38
Type and cross time and reaction risk?
<1 hr | 0%
39
Emergency blood administration is what type of blood?
0 neg
40
If you give more than how many units of emergency blood should you continue with type O blood?
8 units
41
Balanced administration of pRBC:FFP:PLT
1:1:1
42
What does FFP include?
All clotting factors
43
What blood products should NOT be warmed?
Platelets
44
What does cryoprecipitate contain?
Fibrinogen, factor 8, 13, and xWF
45
``` Target resuscitation goals: SBP Temp Hb pH BE Lactate Ca++ PLTs PT/PTT INR Fibrinogen ```
``` 80-100 >35 >7 >7.2 >-6 <4 >1.1 >50,000,000 <1.5 x normal <1.5 >1 ```
46
How often should you get labs rechecked when resuscitation?
60mins
47
Thromboelastography (TEG) point of care test that can assess what time?
Whole blood coagulation
48
Normal reaction time:
4-10min
49
MTP complications (5)
``` Hyperkalemia Citrate toxicity (hypocalcemia and acid base balance) Coagulopathy Hypothermia TACO ```
50
Hyperkalemia becomes problematic when infusion exceeds what?
100ml/min
51
Symptoms of hyperkalemia (2)
Arrhythmias (peak T wave) | Skeletal muscle weakness
52
How do you prevent hyperkalemia?
Use fresh blood when possible
53
Symptoms of hypocalcemia (3)
Parasthesia HTN Arrhythmias
54
Cardiac depression of hypocalcemia from citrate toxicity is unlikely unless transfusion rate exceeds what?
1 unit every 5 min
55
Which type of pts are more prone to hypocalcemia?
Hepatic dysfunction
56
Which acid base balance is more UNCOMMON?
Metabolic acidosis due to rapid metabolism of citrate by the liver
57
Metabolic alkalosis can lead to what?
Hypokalemia
58
What is the most common cause of non surgical bleeding following MTP?
Dilutional thrombocytopenia
59
How to fix dilution of clotting factors?
Add cryoprecipitate
60
What is hypothermia most likely to cause with arrhythmias?
Vfib
61
Blood products given at a rate greater than pts CO and occurs when provider has not recognized that the source of bleeding has stopped?
Transfusion associated circulatory overload (TACO)
62
Symptoms of TACO (6)
``` Dyspnea Orthopnea Peripheral edema Increased BP Pulmonary edema CV changes ```
63
Transfuse only when Hb is what and how to treat when above?
<7 | If Hb >7 treat hypotension with fluids
64
What do you prevent for cervical spine injuries?
Any flexion of neck, chin lift and head tilt
65
4 primary brain injury?
Sub dural hematoma, epidural hematoma, intraparenchy mal injuries, diffuse neuronal injury
66
4 secondary brain injury
HTN, hypoxia, hypercarbia, hypothermia
67
Equation for CPP?
MAP-ICP
68
Recommended CPP?
50-70
69
recommended ICP?
<20
70
Method to decrease cerebral BF?
Decrease arterial CO2 causing cerebral vasoconstriction and decreasing CBF
71
Method to increase CBF?
Increase arterial CO2 causes cerebral vasodilation and increases CBF
72
CBF is directly related to what levels?
CO2
73
7 things to reduce ICP?
Drain, lasix, hyperventilate, avoid HTN, elevate head (30), avoid PEEP, mannitol

Co-Exisiting Disease 2 (11 decks)

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