Trauma

Question 1

Common trauma surgeries

Answer 1

Gunshot wounds, knife wounds, Penetrating injuries to the lower leg with vascular injuries

Question 2

ABC’s of prioritizing trauma

Answer 2

Airway, Breathing, Circulation

Question 3

What two comorbidities are easy to fluid overload?

Answer 3

CAD and CHF

Question 4

Information about trauma patients do you need in a two minute period?

Answer 4

Allergies, medications, past surgical and medical history, NPO status (assume full stomach), and events leading up tot he injury

Question 5

Dosing Propofol/Etomidate during trauma

Answer 5

Use 1/10-1/2 of a normal dose

Question 6

Succinylcholine vs. Rocuronium in trauma cases

Answer 6

Sux is used in 95% of cases

Question 7

Intubating trauma patients

Answer 7

Glidescope

Risk of aspiration and neck injury are secondary to establishing a patent airway

Question 8

Symptoms of a tension pneumothorax

Answer 8

High airway pressures, low volume, hypoxia, and cardiovascular collapse

Question 9

Indications of circulation problems

Answer 9

No pulse or tachycardia
Blanched coloring
Hypertensive

Question 10

Solutions to circulation problems

Answer 10

Large bore IV access (14, 16, ports, central lines)
Arterial line (IV access higher priority)
Fluid management
Blood Products
Drugs (Tranexamic acid w/in 3 hours of the event)
Rapid infusion

Question 11

Problems caused by patient hypothermia

Answer 11

Coagulopothy

Effect on how drugs work

Question 12

*How to deal with patient hypothermia

Answer 12

*Fluid warmer, *Bair hugger, heat lamps, room temp, head cover, and low flows

Question 13

Trauma management goals

Answer 13

Fluid resuscitation, oxygen delivery, coagulopathy

Question 14

Crystalloid vs. blood products

Answer 14

crystalloid can cause dilution cagulopathy and hypotension

Question 15

Blood product delivery to restore oxygen carrying capacity

Answer 15

1:1:1

PRCB, fresh frozen, and plasma

Question 16

Massive Transfusion Protocol: Idea

Answer 16

Preemptively assume that the patient is going through coagulopathy and needs to fight base deficit

Question 17

Massive Transfusion Protocol: Product Typing

Answer 17

No cross-match!
PRCB: O- for child-bearing age women and O+ for men and post-menopausal women
Plasma: AB

Question 18

Massive Transfusion Protocol: Ratio

Answer 18

Usually 1:1

2:1 if Hg is dropping rapidly

Question 19

*Massive Transfusion Protocol: Switching to Type-Specific Blood Products

Answer 19

M&M: After 8 units switch to type-specific
Article: After 1 unit you should stick with un-crossed
Grady: By the time you take another blood sample it will probably come back as type O, so stick to un-crossed in the OR

Question 20

Massive Transfusion Protocol: Complications

Answer 20

Transfusion related acute lung injury (TRALI), hemolytic transfusion reactions, hypocalcemia, hyperkalemia, acidosis, hypomagnesemia, hypothermia, fluid overload, put patients into DIC, and citrate toxicity

Question 21

Highest Incidence complication of MTP

Answer 21

Transfusion Related Acute Lung Injury (TRALI)

Question 22

Cause of hypocalcemia during blood transfusion

Answer 22

Citrate bings to free calcium

Question 23

Cause of hyperkalemia during blood transfusion

Answer 23

There is an increase in potassium levels in stored blood equal to about 1 mmol per day

Question 24

Cause of hypothermia during blood transfusion

Answer 24

Non-warmed transfusion blood decreases core temperature by about 0.25 deg C

Question 25

Massive Transfusion Protocol: Effect of Oxygen Dissociation Curve

Answer 25

Shifts towards lower dissociation

Question 26

Decreased ATP levels during MTP leads to

Answer 26

decreased circulation to capillary beds and delivery impedance

Question 27

Up to what percentage of infused RBCs are non-functioning?

Answer 27

25%

Question 28

*Hemorrhage Class I

Answer 28

No hemodynamic changes Less that 15% blood loss Stable BP and HR

Question 29

*Hemorrhage Class II

Answer 29

Increased diastolic BP 15%-30% blood loss Managed with crystalloids

Question 30

*Hemorrhage Class III

Answer 30

Decreased BP 30%-40% blood loss Metabolic acidosis Blood transfusions required

Question 31

*Hemorrhage Class IV

Answer 31

Greater than 40% blood loss Damage control surgery needed MTP Acute traumatic coagulopathy

Question 32

Damage Control Surgery

Answer 32

Abbreviated procedure intended to stop bleeding and abdominal contamination Patients often left open

Question 33

Damage Control Resuscitation

Answer 33

Blood product therapy, blood therapy and MTP to presume coagulopathy

Question 34

Acute Trauma Coagulopathy: Causes

Answer 34

Believed to occur at onset of injury, acidosis, and hypoxia

Question 35

*Acute Trauma Coagulopathy: Best Indicator

Answer 35

Base deficit of greater than 6

Question 36

Glasglow Coma Scale (GCS)

Answer 36

Eye Response, Motor Response and Verbal Response levels given assigned points 15 point max

Question 37

Injury Severity Score (ISS)

Answer 37

Has some predictability on trauma coagulopathy

Question 38

Early vs. Late Resuscitation

Answer 38

Early: While there is active bleeding, in the OR Late: Bleeding is under control, in the ICU

Question 39

What percentage of normal clotting factor is needed to maintain homeostasis

Answer 39

20%

Question 40

What blood product aids coagulopathy

Answer 40

Fresh Frozen Plasma

Question 41

*First problem you see when giving blood transfusions

Answer 41

Hypofibrinogenemia

Question 42

Blood product used to treat Hypofibrinogenemia

Answer 42

cryoprecipitate

Question 43

After how many units of PRCB transfusion do patients experience Hypofibrinogenemia and require cryoprecipitate?

Answer 43

10

Question 44

Thrombocytopenia: Target levels

Answer 44

100,000 in major trauma and 50,000 in minor trauma

Question 45

Thrombocytopenia: Start replacing after...

Answer 45

1.5-2 blood volumes

Question 46

Which organs can replace platelets?

Answer 46

Spleen, lungs and bone marrow

Question 47

T/F Acute liver damage can cause electrolyte imbalance

Answer 47

True

Question 48

T/F Liver cirrhosis can cause an increase in clotting factors

Answer 48

False! Decrease in clotting factors!