Trauma

Question 1

Indications for surgery?

Answer 1

Severe pancreatitis
Cholangitis
Ruptured aneurysm
Major trauma/burns

Question 2

What is a trauma “rainbow panel”?

Answer 2

CBC
Coags
CMP
Cardiac enzymes
Type and Screen

Question 3

What does a pulmonary artery catheter measure?

Answer 3

Swan-Ganz catheter:
PAP
CO
PCWP
SVR

Question 4

What is shock due to?

Answer 4

Drop in blood pressure

Question 5

What characterizes traumatic shock?

Answer 5

Hypovolemia with direct shock tissue damage and bone fractures

Question 6

What will CVP/PAWP, CO and SVR be in hypovolemic shock?

Answer 6

CVP/PAWP: low
CO: low
SVR: High

Question 7

Treatment for hypovolemic shock?

Answer 7

2-3 L crystalloid IV over 10-30 mins

Blood products if pt. doesn’t respond

Question 8

What type of output most accurately reflects volume status?

Answer 8

Urine output
Class I shock: over 30 mL/hr
II: 20-30
III: 5-15
IV: none

Question 9

What will CVP/PCWP, CO and SVR be in traumatic shock?

Answer 9

CVP/PCWP: low
CO: high or low
SVR: high or low

Question 10

Treatment for traumatic shock?

Answer 10

Volume and pressors?

Question 11

What will CVP/PCWP, CO, and SVR be in cardiogenic shock?

Answer 11

CVP/PCWP: high
CO: low
SVR: high

Question 12

What can cause compressive cardiogenic shock?

Answer 12

Tamponade

Overventilation

Question 13

Treatment for tension pneumothorax?

Answer 13

Emergency needle decompression and tube thoracostomy

Don’t have time for imaging

Question 14

What is Beck’s Triad?

Answer 14

Diagnoses cardiac tamponade

• Low arterial BP
• Distended neck veins
• Distant muffled heart sounds

Question 15

Treatment for a cardiac tamponade?

Answer 15

Pericardiocentesis

Question 16

What is hyper dynamic or high output septic shock?

Answer 16

PCWP/CVP: low
CO: high
SVR: low
Vasodilation

Question 17

What is cold or low output septic shock?

Answer 17

Cold, mottled extremities
CO: low
SVR: high

Question 18

Treatment for septic shock?

Answer 18

Broad spectrum ABX
Volume
Inotropes/vasoconstrictors
Operate: drain and debride

Question 19

What will PCWP/CVP, CO and SVR be in neurogenic shock?

Answer 19

All low
Patient will have warm and well-perfused extremities
Tachycardia and hypotension

Question 20

Treatment for neurogenic shock?

Answer 20

Volume

Vasopressors

Question 21

How does hypo adrenal shock present?

Answer 21

Refractory shock in surgery patients

Question 22

What type of shock could present with hyperthermia?

Answer 22

Hypoadrenal shock

Question 23

Treatment for hypo adrenal shock?

Answer 23

Volume
Pressors
Hydrocortisone

Question 24

What are some examples of vasopressors?

Answer 24

Epinephrine/Norepinephrine
Dopamine
Phenylephrine
Vasopressin

Question 25

Which vasopressor can cause ishcemia of mesenteric arteries? Myocardial depression?

Answer 25

A) Phenylephrine | B) Vasopressin

Question 26

What is SIRS?

Answer 26

Systemic inflammatory response syndrome: Fever or hypothermia Tachycardia and Tachypnea High WBC or could be low

Question 27

Causes of SIRS?

Answer 27

Sepsis Trauma Inflammation Ischemia

Question 28

What is MODS?

Answer 28

Multi Organ Dysfunction Syndrome: 2 or more of vital organ systems Risk factors: shock, SIRS, massive transfusion

Question 29

Treatment for MODS?

Answer 29

Supportive | Aimed at underlying illness

Question 30

Pathologic hallmark of ARDS?

Answer 30

Diffuse alveolar damage (DAD) | -Results in non-cardiogenic pulmonary edema

Question 31

What will pulmonary wedge pressure be like in ARDS?

Answer 31

Low to normal

Question 32

What will PaO2/FIO2 be like in ARDS?

Answer 32

<300 is acute lung injury (ALI)

Question 33

Treatment for ARDS?

Answer 33

Treat underlying condition | Ventilation: low tidal volume and high PEEP

Question 34

Indications for mechanical ventilation?

Answer 34

RR>36, labored breathing, tachycardia, accessory muscles Heavy sedation ABG: PaO2 less than 60 with supplemental O2 >50% PaCO2>45: ventilation failure

Question 35

What do tidal volume and RR affect on ABG?

Answer 35

pCO2

Question 36

What do FIO2 and PEEP affect on ABG?

Answer 36

Oxygen

Question 37

How is renal failure diagnosed?

Answer 37

Rising creatinine

Question 38

How is insulin affected in hospitalized patients?

Answer 38

Pts. often develop insulin resistance

Question 39

What diagnostic test can diagnose location renal failure?

Answer 39

FENa: Fractional excretion of Sodium Normal: 2-3%: renal

Question 40

Treatment for pre-renal renal failure?

Answer 40

Fluids if hypovolemic | Don't give fluids if pt. has cardiogenic shock; give Lasix