Trauma Flashcards by Magda S

What is lethal triad?

Acidosis
Hypothermia
Coagulopathy

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Trauma stats, pt population

3rd leading cause of death in US age 1-44
WHO projects 40% increase in deaths caused by injury
Trauma pt spend more time in the hospital than heart & cancer pt

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What are the most important therapeutic maneuvers in head injured patients

Normalization of ICP,
cerebral perfusion
Oxygen delivery

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Most common cause of traumatic death

Head injury and hemorrhagic shock

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What is blunt cardiac injury

Same as myocardial contusion
Encompasses varying degrees of myocardial damage, coronary artery injury, rupture of the cardiac free wall, the septum, or valve.

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In trauma pt persistent hypotension is result of…

Bleeding, tension PTX, neurogenic shock, cardiac injury such as pericardial tamponade or myocardial contusion

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What is the most threatening consequence of head injury

Brain ischemia

cerebral vasoconstriction & hyperventilation can further aggrevate ischemia

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Trimodal distribution

Initial peak death within sec or min
- brain stem, upper spinal cord, heart & aorta
Within first 2 hrs of injury “golden hour”
- SDH, SEH, hemoPTX, ruptured spleen, liver lac, fx femur, sig blood
Death occurs days or weeks after
- sepsis & multi organ failure, ARDS, ICU pt

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Injuries types & occurrence

-Severe 5%, but 50% death
-Urgent 10-15%, can become life threatening or result in sig disability
-Nonurgent 80% of all injuries

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A for airway

Mallapati
C-collar
Full stomach, peristalsis stops when trauma present
Airway trauma
If complicated airway surgeon should be in a room for induction

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What does MILS stand for

Manual in line stabilization
Most effective
Assistant hands on both side, holds down the occiput, prevents head rotation

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B breathing & Blood

Ventilation: cyanosis, flail chest, SQ emphysema, tracheal shift
PTX, HTX

Do u have a type and cross?

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C circulation

Signs of poor circulation

Decreased urine output
Decreased EtCO2–20, crapy B/P
Hg on ABG

FLUIDS: crystalloids, colloids, blood products: O-, unmatched blood

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What is shock

Circulatory inadequacy due to poor perfusion & inadequate delivery of oxygen & nutrients to tissue

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Stage I of shock

Compensatory by negative feedback mechanism
CO & BP are maintained
Baroreceptor & CNS ischemic response
Vasoconstriction
Release of ADH & angiotensin
Mobilization of fluids from alternative space

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Stage 2 of shock

Progressive shock
Fail of CV system, caused by: ischemia, vasomotor failure, thrombosis, capillary permeability, release of endotoxins

Lactic acid

Stage 3 of shock

Irreversible shock
Adenosine triphosphate (ATP) reserves are depleted
Death results if no intervention

Pt with wide open levo/epi going to ICU

Hypovolemic shock

Loss of blood, intravascular volume
S/S: tachy, narrow pulse pressure, cold, clammy skin from vasoconstriction

Rx: crystalloids x2L, unstable BP, give blood

Cardiogenic shock

Pump failure, acute valvular dysfunction, dysrythmias

Rx: fluids, vasodilators, inotropes

Obstructive shock

Tension PTX
Pulmonary embolism
Obstructive valve disease

Rx: release of air with 14 gauge catheter, chest tube

Distributive shock

Septic, anaphylactic, neurogenic shock

Spinal cord injury, IV dye in CT
Rx: fluid, inotropes, and vasopressors

Causes of Blunt trauma

Direct impact
Deceleration coup-contra coup injuries 
Continuous pressure
Shearing and rotary forces
All associated with high levels of energy

Beck’s triad

Neck vein distention,
hypotension
Muffled heart sounds

Pulsus paradoxus

> 10 mmHg decline in SBP with inspiration

Tension PTX | S/S & Rx

Pleural cavity in punctured & pressure increases causing a shift of mediastinal structures & collapsed lung S/S: hypotension, SQ emphysema, affected BS, distended neck veins, tracheal shift Rx. Needle decompression, chest tube

Pericardial tamponade | Definition, s/s

Restricts filling of cardiac chambers which results in | decreased: CO, BP, & SV

Cardiac tamponade

May require elevated pressures to keep CO Ketamine & etomidate are good choice Propofol not good

What are some spinal & renal protective measures?

Sodium bicarb | Mannitol

Thoracic aortic dissection

``` DLT needed Fem/rad Aline L heart bypass Massive fluid management Spinal and renal protective measures ```

Anasthesia for Abdominal trauma

Management of hemorrhage, hypothermia, sepsis, ventilation Major hemorrhage associated with injuries to liver, spleen, kidneys Multiple visits to OR

Orthopedic trauma major problem

Fat embolism syndrome | Shock, thromboembolic hypoxia resp failure

Spinal shock s/s

Hypotension Tachycardia Hypothermia

When is hyperreflexia seen?

Seen with lesions above T5 | Massive sympathetic discharge from stimulation below level of injury

Mild hemorrhage

``` Decreased peripheral perfusion Normal arterial ph <20% blood loss C/o feeling cold Postural hypotension Cool pale moist skin Collapsed neck veins ```

Moderate hemorrhage

20-40% blood loss Thirst, oliguria, Anuria Metabolic acidosis Decreased central perfusion of liver, gut, kidneys

Severe hemorrhage

``` >40% blood volume loss Decreased perfusion of brain & heart Severe metabolic acidosis + respiratory acidosis Agitation, confusion, obtunded Supine hypotension & tachycardia Rapid and deep respirations ```

Massive transfusion protocol

``` 4-2-1 Thrombocytopenia Hypocalcemia - cardiac depression Hypothermia Metabolic acidosis Hyperkalemia ```

S/S of transfusion related acute lung injury | TRALI

Noncardiogenic pul edema S/S appear 1-2 hrs after transfusion & peak w/in 6 hrs Hypoxia, fever, dyspnea, & fluid in ETT

Effects of hypothermia

``` Cardiac arrhythmias Increased PVR L shift of oxyHgb Reversible coagulopathy Decreased drug metabolism Poor wound healing Increased infection ```