trauma Flashcards by ericka karas

assessment PP: trauma leading cause of death for what age range?

0-30 yrs old

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assessment PP: Approx. 75% of hospital mortality from
trauma occurs within how many hours after admission – most commonly from CNS, thoracic, abdominal, retroperitoneal, or vascular injuries.

48 hrs

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assessment PP: which 2 types of injury are the most common causes of early mortality?

CNS injury and hemorrhage

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assessment PP: most common MOI is what? second? third? which is asso with the highest percentage of death?

MVA 38%;
fall 30%;
GSW 6.6%;
GSW 16%

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assessment PP: what are the 2 phases of assessment?

primary and secondary

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assessment PP: what are you trying to ascertain in primary assessment? what is the priority assessment?

immediate life-threatening injuries;

ABCDEs

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assessment PP: what does ABCDE stand for?

airway, breathing, circulation, disability (MS, GCS), expose

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assessment PP: what are you assessing for with airway? breathing?

is it patent;

adequate ventilations, RR, effort, chest wall mvmt, BS;

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assessment PP: what are you assessing for with circulation?

pulse RRR, cap refill, BP, bleeding, ECG

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assessment PP, circulation: if you can feel a radial pulse, the sbp is at least what? femoral? carotid? less than what sbp is poor cerebral flow?

radial >80;
femoral >70;
carotid >60;

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assessment PP, disability: what does AVPU stand for?

alert, responds to verbal stim, responds to painful stim, unresponsive

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assessment PP, disability: always intubate with a GCS of what?

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assessment PP: what is the goal of resuscitation?

restore tissue oxygenation

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assessment PP: anesthesia’s primary concern during assessment of the trauma pt is what (3)?

preserve CNS function, maintain adequate resp gas exchange, and achieve circulatory homeostasis

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assessment PP, CNS resuscitation: how do we preserve CNS function?

ensure adequate flow of well-oxygenated arterial blood to the brain and by preventing secondary spinal cord damage due to the mvmt of an unstable spinal fx

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assessment PP, resp gas/exchange: do all trauma pts get supp O2?

yes

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assessment PP, resp gas/exchange: if resp function inadequate, do what?

intubate

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assessment PP, resp gas/exchange: assume what precaution with all trauma pts (2)?

full stomach and cervical spine injury

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assessment PP, resp gas/exchange: give MR if unable to ventilate?

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assessment PP, resp gas/exchange: how are c-spine injuries cleared?

neuro exam AND radiological exam

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assessment PP, resp gas/exchange: what is mandatory during intubation?

c-spine stabilization; can take front collar off

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assessment PP, resp gas/exchange: when can blind NTT be attempted?

if pt breathing spontaneously

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assessment PP, resp gas/exchange: avoid NTT and NGTs in what scenario? why? what lefort fxs would you avoid NTT/NGT?

basilar skull fxs;
tube may enter the cranial vault thru the cribiform plate;
LeFort II/III fxs

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assessment PP, resp gas/exchange: when sld an awake intubation be avoided? why?

pt with vascular neck trauma;

gagging and coughing can accelerate bleeding and incr ICP

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assessment PP, resp gas/exchange: why avoid blind NTT and OETT with pts with blood in airway and/or maxillo-facial injuries?

bc tissue, bone fragments or teeth may be pushed into the trachea

assessment PP, resp gas/exchange: if intubation is impossible, what is the next option for securing airway?

needle or incisional cricothyroidotomy or tracheotomy, LMA

assessment PP, resp gas/exchange: when is cricothyroidotomy not recommended? why not?

laryngeal fx; | bc in some pts the inominate artery crosses over the trachea

assessment PP, resp gas/exchange: cricothyroidotomy is reserved from which pts?

with severe facial or upper airway obstruction

assessment PP, resp gas/exchange: cricothyroidotomy what equipment is needed (3)? how secure?

scalpel, dilator or curved hemostat, and #7 ETT or trach tube; sew

assessment PP, resp gas/exchange: with a mandible repair, the surgeon may want what type of ETT?

nasal rae

assessment PP, circ hemostasis: when sld fluids be initiated?

in the field

assessment PP, circ hemostasis: # PIVs

assessment PP, circ hemostasis: blood loss replaced with how much blood product? crystalloid?

1: 1; 3: 1

assessment PP, circ hemostasis: administer up to how many liters of hetastarch? why limit?

1L; | >1L risk for coagulopathy

assessment PP, circ hemostasis: what is the lethal triad you need to avoid?

acidosis, hypothemria, and coagulopathy

assessment PP, circ hemostasis: if ST (>120bpm) persists after infusion of 2L crystalloid, what suspect?

bleeding and then consider blood transfusion

assessment PP, circ hemostasis: what is an early sign of significant blood loss or pericardial tamponade?

diminished pulse pressure

assessment PP, circ hemostasis: if no type specific blood available, what is next best?

Oneg PRBCs

assessment PP, circ hemostasis: what is the most common cause of coagulopathy in trauma pt?

dilutional thrombocytopenia

assessment PP, circ hemostasis: what blood products have no hemostatic function? what else must you give?

PRBCs-only replacing hgb; | plt, FFP and/or cryo

assessment PP, circ hemostasis: what coagulation factor can administer to improve hemostatic function? what is the caveat for it to work?

Factor VII; 70-90mcg/kg; need good plt count

assessment PP, circ hemostasis young people: d/t tremendous hemodynamic reserve, HOTN may not develop until what % of blood volume is lost? ST may not occur until what % of blood volume lost?

30-40%; | 20-25%

assessment PP, secondary survey: complete head to toe exam with further neuro assessment once what is achieved?

stabilization

assessment PP: in which survey (primary or secondary) would you do CT, c-spine, XRs, U/S, angiography,rectal exam?

secondary

assessment PP, secondary survey: what does SAMPLE stand for?

signs/sxs, allergies, medications, PMH, last oral intake, events and environment r/t injury

burns PP: what are the 3 physiological functions of the skin?

protection from environment, thermoregulation, guards against microbial invasion

burns PP: what are the 3 layers of the skin?

epidermis, dermis, sq

burns PP: what are the 4 classifications of burns?

chemical, thermal, electrical, and inhalation

burns PP: also known as partial-thickness a. first b. second c. third d. fourth

burns PP: muscle, fascia, bone a. first b. second c. third d. fourth

burns PP: grafting necessary a. first b. second c. third d. fourth

burns PP: dry, tissue paper skin a. first b. second c. third d. fourth

burns PP: complete excision required a. first b. second c. third d. fourth

burns PP: sunburn a. first b. second c. third d. fourth

burns PP: 2 types: superficial dermal and deep dermal a. first b. second c. third d. fourth

burns PP: all epidermis and dermis a. first b. second c. third d. fourth

burns PP: heals spontaneously a. first b. second c. third d. fourth

burns PP: limited function a. first b. second c. third d. fourth

burns PP: epidermis destroyed a. first b. second c. third d. fourth

burns PP: full-thickness a. first b. second c. third d. fourth

burns PP: blisters a. first b. second c. third d. fourth

burns PP: second degree, moist, shiny surface a. superficial dermal b. deep dermal

burns PP: second degree, mottled with white, waxy, dry surface a. superficial dermal b. deep dermal

burns PP: second degree, red or pale ivory color a. superficial dermal b. deep dermal

burns PP: second degree, epidermis and deep dermis damage a. superficial dermal b. deep dermal

burns PP: second degree, blisters may or may not appear a. superficial dermal b. deep dermal

burns PP: second degree, significant scarring a. superficial dermal b. deep dermal

burns PP: second degree, immediate blistering a. superficial dermal b. deep dermal

burns PP, electrical: T/F tissue damage greatly exceeds apparent damage.

true, estimating TBSA% is often difficult

burns PP, electrical: s/sxs of renal insult (3)?

myoglobinuria, hemoglobinuria, and renal failure

burns PP, electrical: UOP goal? give what meds to promote diuresis? what may be given to alkalinize the urine?

1-1.5cc/kg/hr; mannitol, lasix; bicarb

burns PP, electrical: what other 2 systems may have issues d/t the electrical charge?

neuro and CV

burns PP, electrical: dysrhythmias may last how long?

months

burns PP, electrical: what is the typical pattern on the skin after a lightening strike?

ferning

burns PP: what is an escharotomy?

incision thru eschar

burns PP: what complications can turn a 2nd deg burn into a 3rd?

infxn and cellulitis

burns PP, considered a "major burn": a. second deg involving >? % TBSA in adults b. second deg involving >? % TBSA at age extremes c. any this type of burn d. burn complicated by what?

a. >10% b. >20% c. electrical d. smoke inhalation

burns PP, mortality: if pt age + %TBSA is > what = mortality >80%

115

burns PP: what are the 3 most common causes of demise?

sepsis, burn shock, and MI (ages >45)

burns PP: how long before revascularization in full thickness burns? partial thickness?

3-4wks; | 24-48hrs

burns PP: why is there a reduction of circulating volume?

translocation of fluid from intravascular space to interstitial space

burns PP: when does the major portion of increased cap permeability occur? how long does it persist? what is the cause?

first 12 hrs; 2-3wks; liberation of vasoactive substances from the area of injury as a direct result of heat

burns PP, cap perm: allows colloidal substances with a MW >what to escape into ECF? if burn is what %, it is present throughout the body?

>150000; | 30%

burns PP: this 3rd spacing results in what 2 things regarding hgb?

hemoconcentration and red cell destruction

burns PP: hemolysis occurs w/in how many hrs of burn?

24hrs

burns PP, hemolysis: RBCs are destroyed but hct increases why?

due to a rapid loss of plasma volume

burns PP hemolysis: large increases in hct reflect what?

poor fluid resuscitation

burns PP hemolysis: burn pts have a markely reduced red cell survival time, about what % of normal?

30%

burns PP plasma proteins: how long do plasma proteins continue to be lost after initial injury? how does this matter to CRNA?

up to 36hrs; | may theoretically alter the responses to highly protein-bound drugs resulting in increased free drug levels

burns PP microbial invasion: intially which type of organisms proliferate? day 5?

``` gram pos (e.g. staph); gram neg especially pseudomonas ```

burns PP microbial invasion: which complication can incr TBSA% size of burns?

cellulitis

burns PP microbial invasion: what time period does sepsis occur?

anytime

burns PP, CV: CO up or down?

down

burns PP, CV: CO drop occurs when? why does it decr?

immediately after the burn; | d/t loss of vasc and endothelial integrity and plasma proteins

burns PP, CV: how soon does burn shock happen?

24-36hrs after the burn

burns PP, CV: in large burns CO falls to as much as what % of baseline withing 30min of injury?

50%

burns PP, CV: what are the 3 cardiac related reasons as to why the CO decr?

release of myocardial depressant factor, incr blood viscosity, release of vasoactive substances

burns PP, CV: how long before CO returns to baseline?

within 36hrs post-burn

burns PP, pulm: how soon do early pulm complications occur after injury? delayed with complication example? late with complication example?

0-24hrs-carbon monoxide poisoning 2-5 days-ARDS; days to weeks-pneumonia, atelectasis, and PE

burns PP, pulm: incr or decr a. FRC b. lung and chest wall compliance c. alveolar/arterial gradient d. MV and why does it change?

a. decr b. decr c. incr d. incr d/t incr O2 requirements and VQ mistmatch

burns PP, pulm: can compromise occur without inhalation injury? what is the major factor contributing to pulm complications?

yes; | release of mediators

burns PP, pulm: decr COP + impaired vascular/cap permeability + large IVF = what?

pulm edema

burns PP, inhalation injury: when does it occur?

when hot gases, toxic substances, and reactive smoke particles reach the tracheobronchial tree

burns PP, inhalation injury: s/sxs

wheezing, bronchospasm, corrosion, and airway edema

burns PP, inhalation injury: what labs/diagnostic tools? which tool determines the extent of the parenchymal damage?

ABG, carboxyhemoglobin concentration, xenon scan, FOB; | none, just diagnose inhalation injury

burns PP, inhalation injury: damage to the lung is almost entirely due to what? is steam inhaled frequently? why or why not?

chemical-byproducts of combustion are inhaled and induce a chemical pneumonitis; rarely bc rarely reaches the carina with high temps

burns PP, inhalation injury: name the 4 pulm responses to inhalation injury.

surfactant production impaired, incr cap perm, resp ciliary action halted, and gas exchange impairment

burns PP, inhalation injury: what is the specific tx?

none, supportive care (e.g. O2, vent with PEEP)

burns PP, inhalation injury: typically gets worse over how many days from time of injury?

first 3 days

burns PP, carbon monoxide poisoning: what is the affinity of CO to hgb compared to O2?

200x stronger

burns PP, carbon monoxide poisoning: what does abg reveal? sao2? pulse ox accurate?

PaO2 is normal but low O2 content; low SaO2; no

burns PP, carbon monoxide poisoning: what directional shift on oxyhgb curve?

left

burns PP, carbon monoxide poisoning: why doesn't the pt become tachypneac?

bc carotid bodies are sensitive to arterial PaO2 and not aterial O2 content.

burns PP, carbon monoxide poisoning: tx? tx with decr LOC? tx for high CO levels or symptomology?

100% O2 NRB; intubate; hyperbaric

burns PP, carbon monoxide poisoning: what is the 1/2 life of COhgb on RA? why are preggos more at risk?

3-4hrs; | bc fetal hgb has even higher affinity for CO and takes longer to get rid of it

burns PP, metabolic changes: when does hypermetabolic state occur after the injury/

first few hrs

burns PP, metabolic changes: why does hypermetabolic state occur?

prob d/t incr adrenergic activity, incr catecholamine secretion, endogenous resetting of energy prdxn, and heat loss

burns PP, metabolic changes: results of hypermetabolic state?

incr blood flow to organs/tissues

burns PP, hypermetabolic state s/sxs: a. protein b. BGL c. body temp d. HR e. RR f. O2 consumption

a. protein-incr catabolism and nitrogen waste b. BGL - hyperglycemia c. body temp - hyperthermia d. HR -incr e. RR- incr f. O2 consumption - incr

burns PP, hypermetabolic state: tx (3)

incr O2, ventilation, and nutrition

burns PP, renal: what system is activated immediately d/t decr RBF and GFR?

RAAS

burns PP, renal: what hormone is released? results in retention of what (2) and loss of what (3)?

ADH; Na and water; loss of Ca, K, and Mg

burns PP, renal: UOP goal initially for adults? kids

.5cc/kg/hr; | 1 cc/kg/hr

burns PP, renal: what causes myoblobinemia? tx (2)?

electrical burns can cause extensive areas of devitalized muscle; fluids, diuretics

burns PP, immune system: how are these effected? a. neutrophil chemotaxis b. phagocytosis c. macrophage activity d. T-suppressor cells e. leukocyte function f. immunoglobulin levels

a. neutrophil chemotaxis - decr b. phagocytosis - decr c. macrophage activity - impaired d. T-suppressor cells - incr e. leukocyte function - poor f. immunoglobulin levels - low

burns PP, immune system: tx

abx

burns PP, GI: what complication? what artery is under perfused? tx?

ileus; splanchnic (leading cause of sepsis); prophylactic NG, antacids, H2 blockers

burns PP: why does anemia occur with big burns?

erythrocytes are damaged or destroyed by heat and are removed by the spleen in the firs 72hrs

burns PP: what is the parkland formula?

4cc/kg/%TBSA; | 1/2 given over 8hrs, 1/4 given next 8hrs, last 1/4 given next 8hrs

burns PP: given colloids in first 24hrs?

not recommeded

burns PP initial fluid resus: what are the 3 factors known to incr the vol of fluid required to resuscitate?

delay in initiation of fluid resus, inhalation injury, and high BAC

burns PP airway mgmt: what size tube?

1 size smaller

burns PP airway mgmt: which nerve blocks helpful/

transtracheal or laryngeal

burns PP: what is the leading cause of death? what will reduce the rate of infxn?

infxn and sepsis; | early excision and grafing

burns PP indxn: preferred sedation?

opioids

burns PP surgery: when is the first surgical excision usually done?

24-48 hrs post-burn after fluid resus

burns PP surgery: what do surgeons use to control bleeding after harvesting grafts that we need to be concerned with? what do they use to make it easier to obtain the grafts?

epi soaked sponges; | phenylephrine to raise skin with pitkin injector

burns PP MRs: burns cause denervation of the muscle membrane and in response, what happens to the muscle membrane receptors? what is the change in response of muscle to depolarizing and NDMR during the first 24hrs after injury?

proliferation of extrajunctional receptors; | no change

burns PP MRs: at what point should sux not be used? why not? what others issues does sux create?

after 24hrs since injury d/t extrajunctional receptors for 1yr; incr K release with burns exceeding 10% TBSA

burns PP MRs: which type of burn and injury are immediately susceptible to elevated K?

electrical burns and crush injuries

burns PP MRs: there will be resistance to NDMRs in pts with burns >what% TBSA? begins when? peaks when? bc of this, how manage NDMRs?

>30%; 1wk after injury and peaks 5-6wks; may need higher dosing or more frequent redosing

burns PP altered drug responses: drugs administered by any route other than IV are faster or slower or same absorption? after how many hrs is the plasma albumin concentration decr?

slower; | 48hrs - protein bound meds will have prolonged effect

burns PP altered drug responses: what is the effect of drugs metabolized by the liver by oxidative metabolism (phase I)? conjugation (phase II)?

prolonged; | no change

burns PP altered drug responses: opioid requirements incr or decr?

incr

burns PP altered drug responses: indxn drugs and inhalation agents are likely to cuase HOTN secondary to what?

hypovolemia

intraop mgmt PP: technique to induce?

RSI

intraop mgmt PP: inxn med dosing guidelines?

dose to effect

intraop mgmt PP: MAC?

.3-.5

intraop mgmt PP: hemorrhage and hypovolemia lead to a lower/higher than normal blood concentration of IV agents? decr/incr sensitivity of brain to anesthetics?

higher; | incr

intraop mgmt PP: careful giving opioids to pt in shock bc plasma concentrations of fent and remifent are decr/incr? why?

incr bc of less vol of distribution

intraop mgmt PP: decr vol of distrib increases blood level of prop by what %?

20%

intraop mgmt PP: ketamine okay? which injury is it contraindicated?

yes, but not with TBIs (incr ICP)

intraop mgmt PP: opioids have a lot or little direct effect on CV or baroreflex depressant effect? how do they cause HOTN?

little; | by inhibiting central sympathetic activity

intraop mgmt PP: trauma pts are at high risk of what?

recall

intraop mgmt PP: scopolamine dose with volatile agent

.6mgIV

intraop mgmt PP: nitrous okay?

intraop mgmt PP: which gas is the best?

no difference altho des can cause ST

intraop mgmt PP: what MIVF use? glucose containing fluids okay? why or why not?

LR; | no, BGL will be high d/t release of catecholamines

intraop mgmt PP: tx hyperglycemia?

no, bc once problems are corrected, BGL will equilibrate and it is not a priority

intraop mgmt PP: side effect of hyperglycemia that will further aggravate hypovolemia?

osmotic diuresis

intraop mgmt PP: what is the most common complication?

hypothermia

intraop mgmt PP: complications of hypothermia a. metabolism b. 1/2 life of drugs c. platelets d. oxygen dissociation curve e. myocardial function

a. metabolism - decr b. 1/2 life of drugs - incr c. platelets - sequestration d. oxygen dissociation curve - shift left e. myocardial function - decr

intraop mgmt PP hypothermia: how long would it take to incr 1deg with active warming?

1hr

intraop mgmt PP acid base imbalance: what is the most desirable tx to correct metabolic acidosis?

restore adequate perfusion by correcting underlying hypoxemia, hypovolemia, or decr CO

intraop mgmt PP acid base imbalance: what do you give if HOTN and acidosis persist in spite of control of bleeding and fluid resus? what are the disadvantages of this med (3)?

Na bicarb; | left shift of carboxyhgb, hyperosmolar state, and alkalosis

intraop mgmt PP coag: most common cause of coagulopathy?

dilutional thrombocytopenia

intraop mgmt PP coag: admin platelets when value below what? treat factor V and VIII deficiencies with what?

intraop mgmt PP meds: propofol a. effects on CMRO2 b. effects on ICP c. what is MOA that causes HOTN

a. decr b. decr c. d/t Ca influx in periphery and Ca efflux in heart

intraop mgmt PP meds: etomidate a. dose b. effects on CMRO2

a. .2-.3mg/kg | b. decr

intraop mgmt PP meds: lidocaine a. dose b. effect on ICP?

a. 1.5mg/kg | b. decr with min hemodynamic effects

intraop mgmt PP meds: sux a. effects on ICP b. dose of pretreat NDMR for fasiculations

a. incr | b. roc 10-20mg

intraop mgmt PP meds: most commonly used osmotic therapy? dose? monitor which lab?

mannitol; .25-1mg/kg; serum osmolarity (sld not exceed 320mOsm)

intraop mgmt PP meds: lasix | a. dose

a. 1mg/kg

intraop mgmt PP meds: what med is primarily given in the setting of intracranial HTN refractory to mannitol.

hypertonic saline

intraop mgmt PP meds: hypertonic saline dose?

20-40ml/hr

intraop mgmt PP meds: inhalation agents effects on a. CMRO2 b. CBF

a. decr | b. incr

intraop mgmt PP meds: which gas has the least vasodilatory effects?

iso

intraop mgmt PP meds: administering opioids to a spontan breathing TBI pt may produce hypoventilation resulting in what?

incr CBF and ICP

intraop mgmt PP meds: avoid which vasodilators to treat HTN? why? which med is preferred?

nitroprusside, NTG, hydralazine bc they dilate cerebral vessels increasing CBF and ICP; nicardipine

spinal, abd, ortho PP: leading cause of spinal cord death?

aspiration pneumonia

spinal, abd, ortho PP: what are the 6 conditions that highly correlate with SCI?

paralysis, pain, position, paresthesias, ptosis, and priapism

spinal, abd, ortho PP: possible to reverse initial CNS damage?

spinal, abd, ortho PP: most common avoidable complication contributing to further CNS damage are (4)?

ischemia d/t hypoxemia, HOTN, tissue swelling, and delay in tx

spinal, abd, ortho PP: spinal traction can usually be accomplished by what type of anesthesia

local

spinal, abd, ortho PP: what cervical vertebrae is visualized with a swimmers view?

spinal, abd, ortho PP: T/F presence of spontan mvmt and response to painful stim are helpful and their absence is due to a spinal cord injury.

False, could be due to a head injury

spinal, abd, ortho PP: the major cause of death in pts with acute SCI is due to what?

respiratory failure secondary to paralysis of the resp muscles

``` spinal, abd, ortho PP: allow full diaphragmatic control, however, accessory muscles of resp are affected depending on the level of SCI a. pentaplegia b resp quadriplegia c. cervical lesions below C4 d. cervical lesions at or below C6 e. ondine's curse ```

``` spinal, abd, ortho PP: describes a state of SCI at the junction of the brain stem and spinal cord. voluntary diaphragmatic contrxn is not possible bc phrenic nerve paralysis. a. pentaplegia b resp quadriplegia c. cervical lesions below C4 d. cervical lesions at or below C6 e. ondine's curse ```

``` spinal, abd, ortho PP: also called idiopathis or primary alveolar hypoventilation syndrome a. pentaplegia b resp quadriplegia c. cervical lesions below C4 d. cervical lesions at or below C6 e. ondine's curse ```

``` spinal, abd, ortho PP: spontaneous ventilation occur only with voluntary effort and ceases during periods of inattention to breathing or sleep a. pentaplegia b resp quadriplegia c. cervical lesions below C4 d. cervical lesions at or below C6 e. ondine's curse ```

``` spinal, abd, ortho PP: accessory muscles of resp are no longer under voluntary control a. pentaplegia b resp quadriplegia c. cervical lesions below C4 d. cervical lesions at or below C6 e. ondine's curse ```

``` spinal, abd, ortho PP: permit partial functioning of the phrenic nerve, ressulting in at least some degree of voluntary control of resp. Vital capacities are 20-25% of normal. a. pentaplegia b resp quadriplegia c. cervical lesions below C4 d. cervical lesions at or below C6 e. ondine's curse ```

``` spinal, abd, ortho PP: results from cervical lesions at approx C2-3 sparing the cranial uupper most cervical nerves. paralysis of the phrenic nerves and the nerves that innervate the accesory muscles of resp a. pentaplegia b resp quadriplegia c. cervical lesions below C4 d. cervical lesions at or below C6 e. ondine's curse ```

b (and a?)

spinal, abd, ortho PP, hemodynamic changes with acute SCI: may persist for how many weeks after the injury?

1-3 weeks

spinal, abd, ortho PP, hemodynamic changes with acute SCI: profound HOTN may result from loss of what?

vascular tone and consequent decr preload

``` spinal, abd, ortho PP, hemodynamic changes with acute SCI: which cardiac dysrhythmias can be observed? a. ST b. p wave changes c. decr PR intervals d ectopic beats e. CHB ```

a. ST, no SB b. p wave changes-yes c. decr PR intervals-no, incr d ectopic beats-yes e. CHB-yes

spinal, abd, ortho PP, hemodynamic changes with acute SCI: why does SB occur?

from lack of sympathetic input to the heart

spinal, abd, ortho PP, hemodynamic changes with acute SCI: from which spinal area does the heart receive sympathetic input?

cardioaccelerator fibers T1-T4

spinal, abd, ortho PP: T/F if poss, avoid intubation until XR and neuro exams have been completed.

true

spinal, abd, ortho PP, intubation techniques: awake blind nasal intubation after what has been done?

good topical anes

spinal, abd, ortho PP, intubation techniques: name 3

awake NTT or OETT, GS, or FOB

spinal, abd, ortho PP, intubation: sux is prob safe within how many days of injury? however, avoid sux with what type of patient? use which MR for RSI?

4-7 days; paraplegic; roc

spinal, abd, ortho PP, intubation: in the pt with facial injuries, intubation s/b done how? why?

direct vision to avoid pushing bone gragment, tissue or teeth into the trachea

spinal, abd, ortho PP, intubation: during what situation would risk of spinal cord damage become secondary?

in extreme emergencies

spinal, abd, ortho PP, intubation: regardless of method of intubation, one person s/b responsible for what during intubation?

holding head in neutral position

spinal, abd, ortho PP, CV status: physiologic transection of the cord results in what? this usually resolves within how many hrs?

HOTN; | 48hrs

spinal, abd, ortho PP, CV status: maintaining a map of what range is important to preserve BF to injured cord?

80-90mmHg

spinal, abd, ortho PP, CV status: treat HOTN with? and SB with?

fluids; | atropine

spinal, abd, ortho PP, ventilation: lesions located at where and above will abolish phrenic nerve function?

C4 and above

spinal, abd, ortho PP, ventilation: pts with C3-4 lesions can be weaned from vent support but they may be more prone to what which makes them susceptible to suppressant drugs.

sleep apnea

spinal, abd, ortho PP, ventilation: lesions above where abolish all abd and intercostal muscle function?

spinal, abd, ortho PP, ventilation: vital capacity will be decreased to what % of normal? what 3 other things will be decr?

35-50%; | RV, FEV1, IR

spinal, abd, ortho PP, ventilation: if the pt isn't intubated preop, ventilation s/b evaluated with what 2 diagnostics?

spirometry and ABG

spinal, abd, ortho PP, neuro pulm edema: seen immed after SCI is secondary to what?

CNS insult

spinal, abd, ortho PP, neuro pulm edema: what are the 2 outcomes of NPE?

pulm alveolar exudate and fluid accumulation

spinal, abd, ortho PP, temp regulation: the pt with a SCI is poikilothermic (ambient temp) where?

in the area below the lesions

spinal, abd, ortho PP, temp regulation: why are SCI pts prone to hypothermia?

can't sweat in the area below the lesion

spinal, abd, ortho PP, GI: how prevent vomiting and aspiration due to gastric distention?

NGT or OGT

spinal, abd, ortho PP: where is the major site for post traumatic bleeding?

abd trauma

abd trauma: death most commonly results from what?

uncontrolled hemorrhage

abd trauma: what are the 2 typess of blunt trauma forces

compression and deceleration

abd trauma: solid organs are most commonly injured by what type of trauma

blunt

abd trauma: causeds shearing and stretching of elements located btwn fixed and mobile structures a. compression b. deceleration

abd trauma: this trauma causes the abd cavity to push up against a fixed object such as a safety belt resulting in a rapid incr in intraluminal pressure a. compression b. deceleration

abd trauma: there is an increased probability of intra abd injury when there are signs of what injury pattern?

seat belt

abd trauma: ecchymosis and abrasions on the neck and upper chest have been asso with what type of injuries?

cervical vascular injuries

abd trauma: what are the 3 factors that determine how bad a penetrating trauma will be?

size of the object, location, force transmitted to organs

abd trauma: what are the 4 compartments the abd is divided into?

thoracic, peritoneal (true abd), retroperitoneal, pelvic spaces

abd trauma: where does the intrathoracic abd lay? what organs/structures are located there?

beneath the rib cage; | diaphragm, liver, spleen, stomach

abd trauma: during exhalation, the diaphragm often ascends to what thoracic vertabra?

3rd

abd trauma: where is the hollow viscera almost completely contained?

true abd, also contains omentum, gravid uterus, and dome of bladder when full

abd trauma: what are the 6 structuress in the retroperitoneum area?

great vessels, kidneys, ureters, panc, 2nd and 3rd portions of duodenum, some segments of the colon

abd trauma: what type of fracture often results in significcant retroperitoneal hemorrhage?

pelvic fx

which organ is most commonly penetrated injured solid organ? second most blunt trauma injury?

liver for both

liver trauma: what are 5 clinical findings suggesstive of liver injury?

right lower rib fxs, elevated right hemidiaphragm, right pleural effusion, ptx, RUQ tenderness

what is the most commonly injured organ following blunt trauma? frequently injured following penetrating trauma to the left thorax or abd?

spleen; | speen

spleen trauma: what is the most common initial finding?

HOTN from hemorrhage

spleen trauma: suspect a spleen injury with what type of fx?

left lower rib fx

this injury is usually due to an anteroposterior compression mechanism that crushes this organ against the vertebral column? what are the 2 s/sxs? what 2 labs are elevated?

panc; burning epigastric and back pain; amylase, lipase

what is the most common MOI for kidneys?

during deceleration injuries

kidney trauma: suspect a kidney injury with what 3 s/sxs?

hematuria, lower rib fxs, flank pain

stomach trauma: what is the most common cause of stomach trauma?

penetrating injury

stomach trauma: suspect a stomach injury with what 4 s/sxs?

blood in mouth, rapid onset of epigastric pain, peritonitis caused gastric contents leakage, XR shows free air

small bowel trauma: what is the most common cause of SB trauma?

penetrating injury

small bowel trauma: how does it present?

vague generalized pain

small bowel trauma: how does duodenal pain present?

referred pain to the back

colon trauma: what is the most common cause of colon trauma?

GSW

colon trauma: what are the s/sxs due to?

bowel content leakage rather than blood loss

what is the leading cause of nonobstetric death?

trauma

OB trauma: most common COD to fetus? what is happening internally causing the death?

blunt and penetrating abd trauma; | complete or incomplete placental separation

OB trauma: after how many wks does data suggest delivery of fetus may improve maternal survival?

after 24wks

OB trauma: delivery of fetus by c sxn s/b started within how many minutes of CPR initiation? by what minute should the baby be delivered?

within 4min; | the 5th min

anes for trauma: why may abd incision cause HOTN?

by release of the tamponaded abd bleeding

anes for trauma: what are the 2 early signs of VAE?

HOTN, changes in ETCO2

GA goals for abd trauma, hemodynamics: first line for HOTN? second? why would we want to limit fluids to need?

fluids; pressors; minimize bowel edema

GA goals for abd trauma: N2O?

avoid

GA goals for abd trauma, coagulapathy: monitor what 3 labs?

hct, i-Ca, coags

GA goals for trauma: CPP goal?

>70mmHg

ortho trauma: usually life threatening? how much EBL possible for femur fx?

no, but can be asso with significant blood loss; | 1L for femur

ortho trauma, pelvic injury: with this injury you can predict what type of asso injuries (5)?

vascular, nerve, bladder rupture, vaginal and/or bowel damage.

trauma anes considerations: what anesthetic technique s/b used? what is one indxn consideration that is specific to trauma?

RSI; | c-spine stabilization

trauma anes considerations: what type of table is used for hip, femur, or pelvic fxs? what are the 2 benefits to this table?

fx table; | constant trxn, easy C-arm access

trauma anes considerations, fx table: how secure the arms? need to be careful to pad what? when the unaffected limb is elevated, what risk is there?

crossed and secured across chest or one arm opposite on arm brd while other arm secured across chest; peritoneal post as it can have severe pressure on pelvis; risk of hypoperfusion

trauma anes considerations, fat emboli: when does a fat emboli usually occur?

within 72hrs of trauma

trauma anes considerations, fat emboli: 3 s/sxs? what labs do you see changes in (4)? in late signs, how do the lungs present?

change in MS, petechiae, and fat in urine or sputum; incr serum trigs, lipase, anemia, and thrombocytopenia; stiff lungs with decr vital capacity

trauma anes considerations, fat emboli: what are the 6 things you can do to tx?

supportive, incr fio2, intubation, peep, steroids, heparin

closed redxn fxs: when are they emergent?

when it involves joint dislocations

TBI PP: may be focal or diffuse a. primary injury b. secondary injury

TBI PP: can occur anytime after event a. primary injury b. secondary injury

TBI PP: irreversible damage a. primary injury b. secondary injury

TBI PP: includes skull fxs, vasc injuries subdural epidural or subarachnoid hemorrhage, contusions, DAI a. primary injury b. secondary injury

TBI PP: potentially preventable causes include systemic HOTN, hypoxemia, hypercapnia, hyperthermia a. primary injury b. secondary injury

TBI PP: MOI include inflammation, reperfusion, superoxide prdxn, excitotoxic AA release with necrosis and apoptosis a. primary injury b. secondary injury

TBI PP: occurs at scene a. primary injury b. secondary injury

TBI PP: contributing factors to secondary brain injury a. ICP b. CO2 c. O2 d. BP e. obstruction where f. BGL g. Na h. osmolarity

a. incr b. incr or decr c. decr d. decr e. vasospasm/venous obstrxn f. incr g. decr h. hypoosmolarity

TBI PP: decrease in delivery in what as a result of HOTN and hypoxia has the the greatest negative effect?

TBI PP: when there is change in MS what 2 possible contributors must be considered first at the cause?

hypoxia or shock

TBI PP: dilated and sluggish pupil response indicates what a compression of what nerve? compressed by what?

compression of the oculomotor nerve; | by the medial portion of the temporal lobe

TBI PP: maximally dilated and blown pupils indicate what injury?

uncal herniation

TBI PP, CT scans: what postitive findings will you have to indicate a TBI (6)?

midline shift, ventricle and cistern distortion, effacement of the sulci in the uninjured hemisphere, hematoma, fxs, intracranial air

TBI PP: is a scalp lac a priority?

not if bleeding is controlled

TBI PP: what causes a concussion? always have a LOC?

violent shock or jarring; | not always

TBI PP: what are the 3 types of skull fxs? open fxs require early sx to decr risk of what? which type of fx requires more force to cause this trauma?

open, depressed, or basilar; meningitis; basilar skull fx

TBI PP, open fx: requires debridement within how many hrs?

24hrs

TBI PP, depressed skull fx: what procedure performed to remove depressed area of skull?

craniectomy

TBI PP: what defines a basilar skull fx?

linear fxs that occur in the floor of the cranial vault

TBI PP, basilar skull fx: name the 4 s/sxs.

blood in sinuses, CSF leak from nose or ears, periorbital ecchymosis, retroauricular ecchymosis

TBI PP: what is the most common focal intracranial lesion?

subdural hematoma

TBI PP: which lesion has the highest mortality rate?

subdural hematoma

TBI PP: where is the subdura located btwn?

brain and dura

TBI PP: what usually causes a subdural hematoma?

tearing of bridging veins connecting the cerebral cortex and dural sinuses

TBI PP, subdural hematoma: the outcome is worse if the midline shift exceeds what?

the thickness of the hematoma

TBI PP, subdural hematoma: what is the sx intervention? what 2 things can we do?

immediate sx decompression; | give mannitol and temporarily hyperventilate

TBI PP, epidural hematoma: where is it located btwn?

dura and skull

TBI PP, epidural hematoma: this hematoma is due to what artery bleeding?

meningeal artery

TBI PP, epidural hematoma: name 5 s/sxs

HA, V, seizure, HTN, SOB

TBI PP, epidural hematoma: LOC?

often have brief LOC followed by period of lucidity

TBI PP, epidural hematoma: tx if small and there is no pressure on the brain? tx if severe HA, deterioration of brain funxn, or EDH >1cm?

observation; | decompression, evacuation

TBI PP, cerebral hematoma: where is the location of the hematoma?

parenchyma

TBI PP, cerebral hematoma: will you see it on the CT scan immediately?

may be delayed for up to 24-48hrs; | not necessarily

TBI PP, cerebral hematoma: what is the primary sx with onset?

MS deterioration

TBI PP, cerebral hematoma: sx intervention?

hematoma evac with/w/o decompression craniectomy

TBI PP, DAI: caused by?

sudden deceleration (e.g. MVA, shaken baby syndrome)

TBI PP, DAI: injury occurs where in brain?

at the gray-white matter junction

TBI PP, DAI: best dx technique?

MRI

TBI PP, DAI: sequella?

DAI causes downstream deafferentation (interruption or destruction of the afferent connections of nerve cells) and disconnection in the brainstem leading to coma

TBI PP, DAI: how does it effect the function of the brainstem?

brainstem function remains intact

TBI PP, DAI: when does pt have LOC?

immediately with no period of lucidity

TBI PP: what are the 3 contents inside skull?

brain, CSF, blood

TBI PP: with inury, what causes the changes in ICP?

due to changes in one or more of the skull's fixed volumes (brain, CSF, blood)

TBI PP: how calculate CPP?

MAP - ICP

TBI PP: what is normal ICP

10-15mmHg

TBI PP: ICP monitoring is recommended in all pts with a GCS

TBI PP: what are the 4 sxs of incr ICP?

HA, vomiting, papilledema, and change in MS

TBI PP: which type of posturing is seen with incr ICP?

decerebrate posturing

TBI PP: what are the 3 s/sxs of cushing's syndrome? at what ICP level will cushing's reflex occur?

HTN, SB, irregular RR; | when ICP approaches systemic arterial pressure

TBI PP: name 2 methods for reducing ICP via CSF.

mannitol, external drain

TBI PP: name 4 methods for reducing ICP via brain.

mannitol, lasix, decompressive crani, rsxn/evac of mass/contusion.

TBI PP: name 6 methods for reducing ICP via blood

mannitol, propofol/barbs/MR, hyperventilate, hypothermia, HOB elevated, control seizures

TBI PP: brain received what % of CO?

15%

TBI PP: is CBF autoregulated?

yes

TBI PP: in normal pts, the MAP can vary btwn what range and the CBF will accommodate/remain constant?

50-150mmHg

TBI PP: how does CBF autoregulate/accommodate for change in MAP 50-150?

adjusting cerebral vascular resistance

TBI PP, CBF: what chronic co-morbidity shifts autoregulation to higher pressures?

HTN

TBI PP: name 3 ways CBF autoreg can be abolished?

trauma, hypoxia, some anesthetics

TBI PP: when BP exceeds the autoreg range it can cause disruption of what?

BBB leading to cerebral edema

TBI PP: what arterial gas is a powerful vasodilator?

partial pressure of CO2

TBI PP, CO2: doubling PaCO2 will increase CBF by how much?

it will double and vice versa

TBI PP, anesthesia: if pt already intubated in ED, do what?

verify placement with CO2 detector

TBI PP, anesthesia: what are 4 indicators for intubation?

decr LOC, incr risk of aspiration, hypoxia, hypercarbia

TBI PP, anesthesia: what are the 2 risk factors that would give you a suspicion of c-spine injury?

MVA and GSC

TBI PP, anesthesia: intubate with what type of device is preferred (e.g. ett, lma, ntt)

ETT

TBI PP, anesthesia: drugs to facilitate intubation and dosages a. pentothal b. etomidate c. lidocaine d. which MRs? e. avoid which gas?

a. pentothal 3-6mg/kg b. etomidate .2-.3mg/kg c. lidocaine 1.5mg/kg d. which MRs? sux or roc e. avoid which gas? N2O

TBI PP, anesthesia: maintain CPP btwn what range?

60-70mmHg

TBI PP, anesthesia: name preferred med for HOTN. HTN.

phenyl; | nicardipine

TBI PP, anesthesia: what is map goal?

70-80mmHg

TBI PP, GCS scores: a. mild head injury = ? b. moderate = ? c. severe = ?

a. mild head injury = 13-15 b. moderate = 9-12 c. severe = 3-8

TBI PP, GCS scores: when should GCS score be assessed?

once pt has been resuscitated and is normotensive

TBI PP, anesthesia: what is an effective way for us to quickly and temporarily decr ICP?

hyperventilate

TBI PP, anesthesia: why is excessive or prolonged hyperventilation harmful? what is the current standard?

may cause cerebral ischemia by decreasing CBF; | maintain pt normacapnia except when hypocapnia is nec to control acute increases in ICP

TBI PP, anesthesia: bc the brain is rich in tissue thromboplastin, a severe TBI with contusion can lead to what?

DIC

TBI PP, anesthesia: FFP is indicated when INR is > what? admin plt when plt are

1.4; | 100k or pt is on ASA

TBI PP, anesthesia: will systematic hypothermia helps or hinders coagulopathy?

aggrevates it

TBI PP, anesthesia: what are the preferred fluids for resuscitation? what is the preferred colloid?

hypertonic or isotonic crystalloids; | blood

TBI PP, anesthesia during neuro sx: what should be done until dura is opened?

hyperventilation

TBI PP, anesthesia: why avoid N2O?

increases CMRO2, CBF, and ICP

thoracic PP: emergency thoracotomy is required in what % of pts with thoracic trauma?

15%

thoracic PP: a thoracotomy is indicated if how much cc blood loss with CT insertion? how much cc/hr blood loss via CT post insertion?

total blood loss from CT >1000-1500cc at time of insertion or >300cc/hr post insertion

thoracic PP: what is the first dx test that should be done in a severely injured pt?

CXR

thoracic PP: what dx test is helpful in determining need to vent support?

ABG

thoracic PP: what test is indicated when there is a suspicion of damage to great vessels in the chest?

arch study

thoracic PP: what position for CXR is preferable and why?

upright CXR bc mediastinum appears wider on a supine XR

thoracic PP: if see asymmetrical chest wall, do what?

intubate, could be a hemo or pneumothorax

thoracic PP: what injury does this describe: CP, dyspnea, ST, HOTN, contralateral trachial deviation, ipsilateral lung hyperresonance with absence of BS?

pneumothorax

thoracic PP: a pneumothorax is confirmed with what test?

thoracic PP: T/F a pt with PTX s/b intubated prior to CT placement.

false, don't wait to place CTs

thoracic PP, ptx: a. N2O? b. PEEP? why or why not to these?

a. no N2O b. no PEEP any disruption of pleural space can become a tension ptx

thoracic PP: what problem has these sxs: decr BS and compliance, HOTN, wheezing, trach dev, and JVD? tx if equipment and staff available? tx if not?

tension ptx; place CT; needle decompression

thoracic PP: what problem has these sxs: shock, resp distress, decr BS, dullness to percussion, mediastinal shift? what are 2 possible causes? what is the priority?

hemothorax; large pulm lac or great vessel/intercostal vessel injury; fluid resuscitation

thoracic PP: hemothorax has a rapid accumulation of how much cc of blood in the pleural space?

>1500cc

thoracic PP, hemothorax: what is the preferred blood product to replace loss?

autotransfusion from CT output

thoracic PP: ideally, what s/b done first: DLT placement or thoracotomy? why?

endobronchial tube placed first to prevent mvmt of blood from damaged lung to the unaffected lung via airways

thoracic PP: hemothorax can be adequately treated most times by what?

tube thoracotomy and fluid resuscitation

thoracic PP, hemothorax: an urgent thoracotomy is required if CT output is >what for >3 consecutive hrs?

>250cc/hr

thoracic PP: what injury do these sxs describe: chest wall pain on inspiration, splinting, and occasionally crepitus?

rib fx

thoracic PP, rib fxs: first line tx for pain?

oral/IV/epidural/IC or paravertebral blocks

thoracic PP, rib fxs: the splinting, decr RR, atelectasis, decr FRC can lead to what lung issues (3)

decr lung compliance, V/Q mismatch, hypoexmia

thoracic PP: why does atelectasis occur during indxn?

pt on 100% O2 and it washes out the nitrogen in the lungs

thoracic PP, rib fxs: intubation and mechanical ventilation is indicated if VC is

thoracic PP: what injury has these sxs: paradoxical chest wall motion, shallow RR, hypoxia, hypercarbia secondary to rib sxs/sternal fxs?

flail chest

thoracic PP: tx for flail chest?

sx stabilization of flail segments

thoracic PP: how would we manage these pts?

intubation, mechanical ventilation with PEEP

thoracic PP: what injury do these sxs describe: HOTN, JVD, muffled hrt tones, dyspnea, angina, and/or dysrhythmias?

cardiac tamponade

thoracic PP: dx test for cardiac tamponade?

TTE or TEE but time consuming

thoracic PP, cardiac tamponade: 2 txs?

pericardiocentesis, thoracotomy

thoracic PP: evidence of these clinical presentations is indicative of what injury: high speed deceleration MVA, ejxn from vehicle, UE HTN, pulse pressure differences btwn UEs, precordial/paravertebral systolic murmur, cardiac contusion, unexplained HOTN?

rupture of thoracic aorta

thoracic PP, thoracic aorta rupture: most pts die when?

at the scene

thoracic PP, thoracic aorta rupture: most common site of disruption?

descending thoracic aorta just distal to the left SC artery

thoracic PP, thoracic aorta rupture: repair of tears to ascending aorta usually require what intraop?

CPB

thoracic PP, thoracic aorta rupture: what med give to manage upper body HTN d/t cross clamp during CPB?

vasodilator such as nitroprusside

thoracic PP, thoracic aorta rupture: bc the aortic clamp is often placed proximal to the left SC artery, the arterial line must be placed in which UE?

right

thoracic PP: these sxs describe which injury: TIA, bruit, cervical-supraclavicular hematoma, trach deviation?

thoracic outlet injury

thoracic PP, thoracic outlet injury: injuries here result in compression of nerves or BVs in the area btwn where?

btwn the base of the neck and armpit including the front of the shoulders and chest

thoracic PP, thoracic outlet injury: anesthetist primary concern?

airway mgmt

thoracic PP, thoracic outlet injury: what is the preferred intubation technique?

awake NTT

thoracic PP, thoracic outlet injury: why avoid awake oral ETT? why should a tracheotomy be avoided?

pt is more likely to gag causing an incr in the size of the hematoma; fascia that surrounds the trachea also surrounds the carotid and innominate arteries which may be the source of the bleding

thoracic PP: what injury do these sxs describe: continued air leak following CT placement, resp distress, mediastinal or SQ emphysema, and/or "dropped" lung on CXR?

tracheobronchial tree inury

thoracic PP: when a major airway tear is suspected, it s/b dx how?

bronched with LA

thoracic PP, tracheobronchial tree injury: why shouldn't pts with these injuries be paralyzed during intubation?

bc pos pressure ventilation may be impossible

thoracic PP, tracheobronchial tree injury: if a CT is in place and there is a bronchopleural fistula, where will most of the inspired vol be exit? if there is no CT, pos pressure ventilation can lead to what?

via CT; | tension ptx

thoracic PP: what injury has the following sxs: ST-T segment changes (T wave inversion), dysrhythmias, angina not relived with NTG?

myocardial contusion

thoracic PP, myocardial contusion: goal of anesthesia?

minimize myocardial O2 demand

thoracic PP: what injury has these sxs: incr RR, hemoptysis, decr compliance arterial/inspired oxygen ratio

lung contusion

thoracic PP, lung contusion: tx (3)

fluid restriction, suctioning, supp O2

thoracic PP, lung contusion: intubation with mechanical vent with PEEP is indicated if the arterial/inspired O2 ratio falls below what?

thoracic PP, lung contusion: it may not be noticed upon admission since it takes how long before it would be seen on CXR?

1-2hrs

thoracic PP: alveolar-venous fistulas leading to systemic air embo can result from what type of injury?

penetrating injury

thoracic PP, penetrating injury: what issue s/b considered in a pt who has a penetrating chest injury and abn neuro findings in absence of a head injury?

air emboli

thoracic PP, penetrating injury: name 3 interventions?

needle decompression, heimlick valves, or emergency thoracotomy

thoracic PP: what injury has these sxs: air pulled into the thorax thru a hole in the chest wall?

sucking chest wound

thoracic PP, sucking chest wound: what causes air to trap leading to a tension ptx?

loss of neg pressure

thoracic PP, sucking chest wound: 2 txs?

moist sterile airtight drsg, CT

thoracic PP: what injury has these sxs: substernal discomfort, dysphagia, SQ or mediastinal emphysema, ptx?

esophageal damage

thoracic PP: what injury has these sxs: resp distress, bowel sounds in the chest area, obscured or elevated hemidiaphragm?

diaphragm injury

thoracic PP, diaphragm injury: tx?

trauma Flashcards

(406 cards)