Trauma

Question 1

What are the ABCDE’s of trauma care?

Answer 1

A - airway
B - breathing
C - circulation
D - Disability (neuro)
E - environment

Question 2

What should you do after primary survey completed with trauma pt?

Answer 2

complete head-to-toe and neuro exam

Question 3

Direct impact,
abrupt deceleration, continuous pressure,
shearing and rotational forces

Answer 3

blunt trauma

Question 4

important thing to consider about trauma victims?

Answer 4

assume unstable c-spine until confirmed!!

Question 5

thoracic blunt trauma consideration?

Answer 5

40% have pneumothorax that can’t be seen so avoid N2O!!

Question 6

Hypotension, sub-cu emphysema, unilateral ↓BS, ↓ chest wall motion, distended neck veins, tracheal shift

Answer 6

tension pneumo

Question 7

Rx for tension pneumo?

Answer 7

emergent needle aspiration 2nd ICS (above 3rd rib), MCL and chest tube

Question 8

precaution you should take regarding meds used with pericardial tamponade pts?

Answer 8

careful during induction - dont want to knock out compensation - use ketamine, etomidate.
no prop/versed/etc

Question 9

where is subxiphoid approach pericardiocentesis?

Answer 9

between xiphoid process and L costal margin 30-45 d angle

Question 10

lethal triad?

Answer 10

acidosis
hypothermia
coagulopathy

Question 11

damaged control surgery components

Answer 11

immediate control of bleeding
prevent lethal triad
limit crystalloid, increase products

Question 12

what is FAST and why is it used?

Answer 12

focused assessment with sonography in trauma

-rapid assessment of blood to look for internal bleeding, cost effective and sensitive

Question 13

A (ABCDE’s) major assumptions

Answer 13

no turning back, full stomach, c - spine concerns

Question 14

best way to intubate trauma pt?

Answer 14

RSI with paralytic, stabilize neck!

Question 15

B - breathing goals?

Answer 15

↓ TV, ↓ PIP (< 32 cm H20), avoid 02 toxicity

prevent barotrauma and ards

Question 16

most deaths r/t to circulation are due to

Answer 16

coagulopathies, not on admit

Question 17

stage I shock

Answer 17

blood volume normalized by shifting fluids

Question 18

CV depression d/t ischemia,

thrombosis, toxins, cellular damage

Answer 18

Stage II (progressive) hem shock

Question 19

Stage III (irreversible) hem shock

Answer 19

ATP depleted,
cellular death
[pt will die immediately or later down the road]

Question 20

Minimize bleeding by maintaining
SBP

Answer 20

85-90 mmHg

Question 21

When bleeding controlled, maintain bp

Answer 21

SBP >100 mmHg and HR <100

Question 22

Replace EBL with

Answer 22

1:1 PRBCs, 3:1 crystalloid

Question 23

using these fluids result in rapid restoration but ↑ risk of pulmonary
edema and bleeding.

Answer 23

Colloids

Question 24

fluids best for perfusion

Answer 24

Isotonic crystalloids

Question 25

Maintain BG __ for suspected TBI or | cerebral edema.

Answer 25

<150 mg/d

Question 26

Elevated PT on admission tells us pt more likely to have

Answer 26

massive hemorrhage, injury and poor perfusion | state

Question 27

causes of Trauma-Induced Coagulopathy (TIC)

Answer 27

Dilution Hypothermia & acidosis TBI Shock

Question 28

how to AVOID DILUTIONAL | COAGULOPATHY

Answer 28

Damage control resuscitation (DCR) | - DCS, rewarming, restricted crystalloids, permissive hypotension, balanced transfusion, massive transfusion protocol

Question 29

Until targeted transfusion is available, empirically transfuse:

Answer 29

PRBCs/plasma/platelets at 1:1:1 (units) infusion

Question 30

ASA recommends INR and plt count?

Answer 30

INR of ≤1.5*, PLT ct >50,000

Question 31

Hypothermia probably alters

Answer 31

plt function and decreases fibrin formation

Question 32

1°C drop causes

Answer 32

5% ↓ in clotting reactions

Question 33

2 things in trauma pt that cause significant coagulopathy

Answer 33

Acidosis (pH <7.l) + hypothermia

Question 34

pH of 7.2 does what to clotting

Answer 34

clotting function ↓ to 50% of noraml

Question 35

pH of 6.8 does what to clotting

Answer 35

↓ to 20% of normal clotting

Question 36

what does the T-T complex do?

Answer 36

activated protein C (APC) pathway

Question 37

activated protein C (APC) pathway

Answer 37

Inhibits V & VIII Promotes fibrinolysis results in systemic anticoagulation

Question 38

4 components of Assessment of blood consumption (ABC) score

Answer 38

Penetrating injury SBP <90 HR >120 Positive FAST

Question 39

ABC score ≥ 2 =

Answer 39

↑ risk of needing massive | transfusion

Question 40

TXA dose >12 years

Answer 40

1 gm bolus then 1 gm over 8 hrs

Question 41

txa dose <12 years

Answer 41

5 mg/kg bolus then 2 mg/kg/hr for 8 hrs

Question 42

timeframe TXA must be administered

Answer 42

<3 hours post-injury

Question 43

according to BROHI what should you do?

Answer 43

check and make sure TXA bolus has been given! if not, then give bolus over 10 mins

Question 44

Code red pack A MTP

Answer 44

6 U PRBCs | 4U FFP

Question 45

code red pack B MTP

Answer 45

6 U prbc 4 u FFP 10 plt 2 cryo pools

Question 46

what GCS should you intubate?

Answer 46

<8

Question 47

C HTN = ICP

Answer 47

>10; Treat ICP >25 mmHg

Question 48

clinical targets of neuro trauma pt

Answer 48

-Maintain MAP at 70-75 mmHg to maintain CPP at >50 mmHg -Moderate hyperventilation (PaCO2 of 30-35 mmHg) -Ventriculostomy (EVD) for monitoring and venting

Question 49

drugs to avoid neuro trauma?

Answer 49

N2O ketamine etomidate

Question 50

how to treat increased ICP?

Answer 50

ncremental propofol, moderate hyperventilation, mannitol (0.25–1 gm/kg), furosemide, head elevation.

Question 51

TREAT ALL TRAUMA PTS AS

Answer 51

C-SPINE INJURED | UNTIL PROVEN OTHERWISE.

Question 52

consideration when using succ with spinal chord injuries?

Answer 52

Fasciculations | can worsen SCIs

Question 53

spinal shock triad?

Answer 53

Hypotension, bradycardia, hypothermia

Question 54

anesthesia considerations for spinal chord injury pts?

Answer 54

prepare difficult intubation document pre op deficits heavy blood loss

Question 55

anesthesia med considerations for spinal chord injury?

Answer 55

avoid succ and N2O | consider ket and dexmed

Question 56

``` Massive SNS response d/t stimulus below level of spinal injury (frequently r/t bladder), most common above T5 ```

Answer 56

AUTONOMIC HYPERREFLEXIA

Question 57

AUTONOMIC HYPERREFLEXIA triad

Answer 57

Hypertension, bradycardia, dysrhythmias

Question 58

AUTONOMIC HYPERREFLEXIA can occur

Answer 58

``` during N2O/opioid GA or regional anesthesia (not seen with volatile agents) ```

Question 59

rx HTN crisis with

Answer 59

direct acting vasodilators

Question 60

Major risks: ortho

Answer 60

Hemorrhage, shock, fat emboli, PE emboli (especially with pelvic and long bones)

Question 61

Injury to areas “junctional” to the trunk (pelvis, groin, perineum, axilla, neck)

Answer 61

JT is non-compressible

Question 62

what does JUNCTIONAL | TOURNIQUET do

Answer 62

Compresses the aorta at the umbilical level

Question 63

Most intra-op trauma deaths r/t

Answer 63

hyperkalemia, hypocalcemia, | acidosis.

Question 64

later deaths from trauma r/t

Answer 64

PIICS (persistent inflammatory, immunosuppressed catabolic syndrom