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Sim Lab 3 > Trauma > Flashcards

Trauma Flashcards

(106 cards)

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1
Q

What is ATLS

A

Advanced Trauma Life Support

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2
Q

ATLS Primary Assesment

ABCDE

A
  • A: Airway
  • B: Breathing
  • C: Circulation
  • D: Disability
  • E: Exposure
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3
Q

A: Airway - what are we looking for?

A
  • Airway noises
  • Position of head
  • Foreign Body
  • Fluids / Secretions
  • Edema
  • Aspirations
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4
Q

A: Airway - How do we treat it?

A
  • Suction #1
  • open
  • secure
  • O2
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5
Q

A: Airway - Securing the airway?

A

Combitube - EMS usually uses this
Intubation

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6
Q

What is a combitube?

A

Dual lumen tube. Distal portion is placed into the esophagus and a ballon is inflated. The proximal balloon is inflated in the oral cavit. The distal balloon helps reduce aspiration while ventilaiton is achieved by the proximal balloon.

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7
Q

B: Breathing - what are we looking for?

A
  • Look - Listen - Feel
  • Respiratory rate and effort
  • Breath and any sounds assocated
  • Subcu emphysema
  • symmetry of chest movements
  • tracheal deviation
  • jugular vein distention
  • cyanosis
  • TBI induced respiratory depression
  • Shock
  • Hypothermia
  • Aspiriation
  • Pulmonary Contusion (R-L shuting)
  • Smoke inhalation (bronchospams)
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8
Q

B: Breathing - how do we treat it?

A
  • Supplemental O2
  • Pneumothorax decompression
  • Inhalation therapy
  • ventilation if needed
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9
Q

C: Circulation - what are we looking for?

A
  • HR
  • BP
  • capillary refill
  • bleeding
  • skin color
  • diuresis

Shock!!!

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10
Q

C: Circulation - how do we treat

A
  • IV or IO access
  • control bleeding
  • fluids
  • drugs
  • transfusion
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11
Q

C: Circulation - assessment ↦ Chest

A
  • CT of chest
  • Chest tube output
  • CXR
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12
Q

C: Circulation - Treatment ↦ Chest

A
  • Observe
  • Surgery
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13
Q

C: Circulation - assessment ↦ Abdomen

A
  • Ultrasound FAST scan
  • Abdominal CT
  • Physcial Exam
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14
Q

C: Circulation - treatment ↦ Abdomen

A
  • Observe
  • Surgical ligation
  • angiography
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15
Q

C: Circulation - assessment ↦ retroperitoneum

A
  • Angiogram
  • CT Scan
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16
Q

C: Circulation - treatment ↦ retroperitoneum

A

Angiogram

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17
Q

C: Circulation - assessment ↦ long bones

A
  • Physical exam
  • X-ray of bones
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18
Q

C: Circulation - treatment ↦long bones

A
  • fix fx
  • ligation
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19
Q

C: Circulation - assessment ↦ outside the body

A

Physcial exam

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20
Q

C: Circulation - treatment ↦ outside the body

A

Applied pressure
ligation

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21
Q

D: Disability - what are we looking for?

A
  • AVPU / GCS
  • reactivity and symetry of pupils
  • Glucose level
  • C-Spine / stabilization
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22
Q

D: Disability - how do we treat

A
  • Glucose if hypo
  • insulin if hyper
  • antidotes
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23
Q

AVPU?

A
  • Alert = awake
  • Verbal = responds to verbal stim only
  • Pain = responds to pain stim only
  • Unresponsive
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24
Q

GCS Quick Numbers

A
  • 3-8 = severe
  • 9-12 = Moderate
  • 13-15 = Mild
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25
E: Exposure - what are we looking for?
* Head to toe exam * History * Temp * Injuries * Drug abuse? * Infection?
26
E: Exposure - how do we treat
* Identify the cause * thermo-management * NG tube * Compartment syndrome * Antibiotics
27
Levels of urgency to send to surgery
1. Airway: Cricothyroidotomy 2. Control exsanguination: Ex-Lap, Ex Thoracotomy, Pelvic Ex-Fix 3. Intracrania Mass: Epidural hematoma, subdural hematoma with midline shift 4. Sepsis / Loss of limb / Loss of eyesight / Continued hemorrhage (not massive amounts) 5. Early patient mobilization / cosmetic
28
Adam's secondary assessment: SAMPPLLE
* Signs and symptoms * Allergies * Medications * Past Medical History * Pictures (CXR, CT, U/S) * Last meal * Lab values * Events
29
FAST Scan: What is it?
**F**ocused **A**ssessment with **S**onography in **T**rauma is a rapid bedside ultrasound examination performed by surgeons, emergency physicians, and paramedics as a screening test for blood around the heart (pericardial effusion) or abdominal organs (hemoperitoneum) after trauma.
30
FAST Scan Order: 1-6
1. Pericardium 2. RUQ 3. LUQ 4. Suprapubic 5. R Anterior thoracic 6. L Anterior thoracic
31
FAST: Pericardium ↦ what are we looking for and where?
Subxiphoid Aimed U/S at heart just inferior and (to the patients) right of xiphoid cartilage. Looking for cardiac tamponade cause by effusion
32
FAST: RUQ ↦ what are we looking for and where?
Looking for blood from liver and right sided retroperitoneal bleeding
33
FAST: LUQ ↦ what are we looking for and where?
Splenic/Pancreatic and retroperitoneal bleeding in LUQ
34
FAST: Suprapublic ↦ what are we looking for and where?
looking for blood in and around the bladder in the pelvis
35
FAST: R/L Anterior Thoracic ↦ what are we looking for and where?
Looking for presence of pneumo or hemothorax
36
Indications for intubation in trauma ## Footnote CARD-IFF
* Cardiac or Respiratory arrest * Airway protection * Respiratory insufficiency * Deep sedation or high narcs * ICP too high, hyperventilation required * FiO2 100% for CO posioning * Facilitate workup for intoxicated or uncooperative patient
37
Ultrasound for NPO: Transducers
Adults: Curvilinear Pedi: Linear
38
Ultrasound for NPO: Transducer positioning
Supine Transducer long axis in subxiphoid Fan right to left to get view of antrum Repeat in Right lateral decubitus
39
Ultrasound for NPO: Stomach Layers
40
Ultrasound for NPO: Anatomy
41
Ultrasound for NPO: Empty Stomach
42
Ultrasound for NPO: Fluid in Stomach
Hypoechoic ## Footnote Stary night effect = carbinated
43
Ultrasound for NPO: Solid in Stomach
Hyperechoic and shadow
44
Ultrasound for NPO: Fluid and Solid in Stomach
Hyper and Hypoechoic
45
Ultrasound aspiration risk: No fluid in antrum in supine
Low risk
46
Ultrasound aspiration risk: Just fluid in right lateral but not supine
Low risk
47
Ultrasound aspiration risk: Fluid in both supine and right lateral
Higher risk
48
Ultrasound aspiration risk: Solid matter in either supine or right lateral
Higher risk
49
Signs of tension pneumo
* Increased airway pressure * Jugular distension * Hypotension * tachycardia
50
Emergency airway: Percutaneous Translaryngeal Ventilation | technically this is oxygenation only ## Footnote 6 steps
1. Hyperextend neck, palpate cricothyroid membrane 2. With a 14ga angiocath on a saline filled syringe. Insert the needle caudally at a 30-45° 3. Aspirate as you advance, stop once air bubbles are seen 4. Advance catheter to the hub into the trachea 5. Remove needle 6. Attach to O2 supply then start oxygenation
51
Emergency airway: Melker Percutaneous Cricothyrotomy | This is ventilation ## Footnote 4 step
1. Palpate cricothyroid membrane and advance needle at 45° in caudal direction. Aspiriate with saline filled syrine for air bubbles. 2. Advance catheter then remove needle. Thread guidewire through catheter into trachea. Remove catheter 3. Knick the skin at guidewire entry 4. Place dilator into the airway catheter and thread over guidewire. Advance until level with skin. Remove guidewire and dilator. Secure
52
One Unit of PRBC will raise Hg and Hct by how much? ## Footnote One unit = 350 mL
Hg 1 g/dL Hct 3%
53
When should we transfuse PRBC?
Hg < 6 g/dL ## Footnote When Hg 6-10 consider patient status before transfusion. Bleeding, ishemia, IV volume status, or inadequate oxygenation
54
One Unit of platelets will raise plt # by how much? ## Footnote One unit = 200-250 mL
5-10,000 μL ## Footnote ABO compatability not needed
55
One Unit of FFP will raise clotting factor by how much? ## Footnote One unit = 200-250 mL
2-3% ## Footnote ABO needed / Rh not
56
One Unit of cryoprecipitate will raise fibrinogen by how much? ## Footnote One unit = 10-20 mL
5-7 mg/dL ## Footnote ABO compatability not needed
57
Minimum IV sizes for blood admin
Adult 20 ga Pedi 24 ga
58
What is something all shocks have in common?
Hypotension and decreased CO
59
Name the 4 shocks ## Footnote DOC-H
* Distributive * Obstructive * Cardiogenic * Hypovolemic
60
Hypovolemic shock: Define
Not enought fluid in circulation
61
Obstructive Shock: Define
blood is blocked, usually by a pulmonary emolism or collapse lung
62
Cardiogenic shock: Define
Heart can not pump enough blood to meet demand. Think heart attack
63
Distributive Shock: Define
When the blood vessels lose tone and organ perfusion is reduced
64
3 Different Distributive Shocks
* Neurogenic * Anaphylactic * Septic
65
The two steps to shock: Macro and Mircocirculatory
* Macro: vascoconstriction and catecholamine surge * Micro: Ischemic cells take up interstitial fluid ⇀ cellular edema ⇀constricting capillary flow ⇀ more ischemia ⇀ free radical and lactate production
66
What does lactate do to contractability?
Decrease it
67
Hemorrhagic shock stages: detailed ## Footnote 5 total
Stage 1: mild/stable Stage 2: Moderate/stabilized (responsive to fluid test) Stage 3: Hypotensive shock (not responsive to fluid test) Stage 4: Shock with heart and brain ischemia (≥40% blood loss) Stage 5: Cardiac arrest by exsanguination
68
Hemorrhagic shock stages: Overview
Stage 1: Stable HS Stage 2: Stabilized, compensated HS Stage 3: Progressive, Unstable Stage 4: Critical HS, impending cardiac arrest Stage 5: Cardiac arrest by exsanguination ## Footnote HS = Hemorrhagic Shock
69
What 9 goals do we have for early resuscitation goals in hemorrhagic shock? ## Footnote CHAPPS-NNF
* Core temp > 35°C * Hematocrit 25-30% * Adequate anesthesia and analgesia * Platelets > 50,000 * Prevent lactate increase * SBP 80-100 mmHg * Normal PT and PTT * Normal ionized calcium * Functional pulse ox
70
What are the two lactate levels Adam gives?
Normal: < 2mmol/L Acidosis: > 5mmol/L
71
Why don't we just give fluids to help with volume in a trauma situation?
We aren't incresing RBC's and oxygen delivery Causing dilutional anemia and coagulapathy
72
Normal calcium levels (Total and Ionized)
* Total: 8.6-10.3 mg/dL * Ionized: 4.6-5.2 mg/dL
73
What does ionized mean?
free in serum and available for use by the body
74
Adams obession with the 16ga IV
Not much time is gained from the 14 ga angiocath or 6 Fr sheath introducer
75
Rapid transfuser benefits ## Footnote WAARRP-FC
* Warms Fluids * Accurate recording of volumes and pressures * Able to pump through multiple lines * Rates up to 1500 mL/min * Reservoir allows mixing of products * Portable for travel * Fail-safe to prevent air infusion * Compatable with all fluids and blood products execpt platelets
76
Rapid transfuser: Fluids and Blood products
* Crystalloid * Colloids * PRBC's * Washed Salvaged Blood * FFP
77
Prothrombin Time (PT) ## Footnote Extrinsic pathway (INR)
11.5-14.5 sec
78
Partial Prothrombin Time (PPT) ## Footnote Intrinsic pathway
24.5-35.2 secs
79
Thrombin Time ## Footnote Time to clot once thrombin added
22.1-31.2 secs
80
Activated CLotting Time (ACT) ## Footnote Test tube reagent clotting
70-180 sec
81
Platelets ## Footnote Pure count in blood
150-450K
82
P2Y12 ## Footnote Plavix inhibition test
180-376 PRU
83
What is INR?
International Normalized Ratio makes each PT test standardized
84
TBI anestetic goals
* Maintain CPP (80-100mmHg) * Treat increased ICP (20 mmHG and above) * Avoid hypoxemia * Avoid hyper and hypocapnea * Avoid hyper and hypoglycemia
85
Which steroid is contraindicated in TBI?
125mg or more of methylprednisolone
86
Toxicology: Cannabis
Acute: drowsy, possible MI or arrythmias Chronic: cough and respiratory issues, possible heart ischemia Withdrawal med: Benzos
87
Toxicology: Cocaine
Acute: vasoconstriction, hyperthermia, tachy, hypertension, arrhythmias, stroke, cardiomyopathy, seizure Chronic: Epistaxs, bowel ischemia, aspiration pneumonia, pulmonary htn Withdrawl med: propranolol | Acute: mydriasis or dilated pupils ## Footnote these folks are catecholomine depleted so we would need to use Epi not ephedrine if they go hypotensive
88
Toxicology: Heroin
Acute: slow bretahing, brady, nausea Chronic: Abcesses, endocarditis, liver and renal dz, pulmonaey edmea, pulmoary emobilisms Withdrawal Med: Methodone | Acute: miosis or constricted pupils
89
Toxicology: Ketamine
Acute: Hallucinations, increased BP, slow breathing Chronic: Stomach pain, cystitis Withdrawl meds: none
90
Toxicology: MDMA
Acute: Increased HR and BP, teeth clenching, hyperthermia, rhabdo, hyponatermia, ESLD, ESRD, CHF Chronic: Anxiety and aggression Whithdrawl meds: antidepressants
91
Toxicology: Meth
Acute: High energy, tachypnea, tachycardia, hypertension, hyperthermia Chronic: Violent, dental issues, anxiety Whidrawal: Antidepressnats ## Footnote Like cocaine, catecholamine depleted
92
Toxicology: Herbal meds
Basic jist, platelet inhibition so increased bleeding time
93
TEG: full name and breakdown
Thromboelastography Thrombo: thrombus or clot Elast: ability to change Graphy: record of
94
St Luke's Process for TEG
* Call blood bank * draw sample and put in blue top * date and time tube * send asap * Initial results in 15 mins * complete in 30-45
95
Componets of a TEG ## Footnote 5 things
* Reaction time (R time) * Kinetics time (K Time) * Alpha angle * Maximum amplitude (MA) * Lysis at 30 mins (LY30)
96
R time or Reaction Time
* Start of clot formation * Normal is **5-10 mins** * Prolonged R time indicates a deficient coagulation factors * Treatment: **FFP**
97
K time or Kinetics time
* Time from end of R time to when a clot reaches an amplitude of 20mm * Measures strength of clot * Normal is **1-3 mins** * Prolonged K time indicates fibrinogen deficiency * Treatment: **Cryoprecipitate**
98
Alpha angle
* Speed of fibrin accumulation * Normal is **53-72 degrees** * Low angle indicates fibrinogen deficiency * Treatment: **Cryoprecipitate**
99
MA or Maximum amplitude
* Measures the strength of fully formed clot * Normal value is **50-70mm** * Lower value indicates a platelet deficiency * Treatment: **Platelets or DDVAP**
100
LY30 or Lysis 30
* Measures fibrinolysis after 30 mins * Normal is **0-8%** * higher numbers indicate hyper fibrinolytic * Treatment: **TXA**
101
TEG picture examples
102
Benefits of TEG ## Footnote WRTS
* Whole blood used * Real time results * Treatment guide * Shows if patient is clotting
103
Limitations of TEG ## Footnote FUN-DV
* Familiarity with results * Uremia, vW Dz, or aspirirn not indicated * Needs frequent calibration * Doesn't test platelet adhesion * Venous coagulaiton only
104
DIC
Disseminated Intravascular Coagulation
105
TACO
Transfusion associated circulatory overload More blood is administered than the CO can account for
106
TRALI
Transfucsion related acute lung injury Similar to ARDS Usually from plt/FFP admin

Sim Lab 3 (6 decks)

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