Trauma

Question 1

for penetrating trauma, energy is transferred to the body when? (ATOI)

Answer 1

at time of impact

Question 2

for perforating trauma, energy is deposited where? (ITT)

Answer 2

in the tissue

Question 3

what cervical spine number is the most commonly injured?

Answer 3

C7

Question 4

what are the 6 P’s of SCI?

Answer 4

pain, paralysis, paresthesia, position, ptosis, priapism

Question 5

high SCI can result in knocking out the sympathetic mediated fibers resulting in no opposition of vagal innervation when the injury is greater than what thoracic number?

Answer 5

T6

Question 6

Succs is okay in the first how many hours after SCI?

Answer 6

48 hours

Question 7

what are the 5 S/S of spinal shock below the level of the lesion? (B, A, GA, H, H)

Answer 7

bradycardia, atony, GI atony, hypotension, hypothermia

Question 8

what is the “drug of choice” for spinal shock?

Answer 8

dopamine

Question 9

short term high dose therapy of what improves neurological outcomes in SCI?

Answer 9

steroids

Question 10

what is the methylprednisolone dose for first hour after SCI? (mg/kg/hr)

Answer 10

30 mg/kg/hr

Question 11

what is the methylprednisolone dose for last 23 hours after SCI? (mg/kg/hr)

Answer 11

5.4 mg/kg/hr

Question 12

where is the trigger located that causes autonomic hyper-reflexia?

Answer 12

below the level of injury

Question 13

what are the 3 treatment options for autonomic hyper-reflexia? (RS, DA, AV)

Answer 13

remove stimulus, deepen anesthetic, administer vasodilator (nicardipine, nitroglycerine, nitroprusside)

Question 14

autonomic hyper-reflexia: vasoconstriction above or below SCI?

Answer 14

below

Question 15

autonomic hyper-reflexia: vasodilation above or below SCI?

Answer 15

above

Question 16

what is the cardinal sign of autonomic hyper-reflexia?

Answer 16

paroxysmal HTN with severe bradycardia

Question 17

autonomic hyper-reflexia happens in pts with a chronic spinal injury above what thoracic level?

Answer 17

T5-6

Question 18

what is the preferred means to maintain a patent airway in a trauma pt? (JTWIS)

Answer 18

jaw thrust with inline stabilization

Question 19

do you avoid N2O in trauma pts?

Answer 19

yes

Question 20

what should FiO2 always be at?

Answer 20

100%

Question 21

what 2 scans are the “gold standard” for SCI?

Answer 21

CT or MRI

Question 22

what are the 2 views for preliminary C-spin fx?

Answer 22

lateral and swimmer’s view

Question 23

what is the ketamine trauma dose? (mg/kg)

Answer 23

0.5-1 mg/kg

Question 24

what is the etomidate trauma dose? (mg/kg)

Answer 24

0.1-0.2 mg/kg

Question 25

what is the thiopental dose? (mg/kg)

Answer 25

0.5-2 mg/kg

Question 26

what induction agent causes hypotension?

Answer 26

thiopental

Question 27

what induction agent causes enhanced C/V stability and decreases CMRO2, CBF and ICP?

Answer 27

etomidate

Question 28

what induction agent increases CMRO2, CBF, and ICP?

Answer 28

ketamine

Question 29

what 2 muscle relaxants cause histamine release?

Answer 29

atracurium, mivacurium

Question 30

what are 7 signs of a pneumothorax? (H, SQE, IP, IBS, HR, TS, DNV)

Answer 30

1. hypotension 2. SQ emphysema 3. increase PIP 4. ipsilateral breath sounds 5. hyper-resonance 6. tracheal shift (late sign) 7. distended neck veins

Question 31

what is a temporary fix for a pneumothorax?

Answer 31

14 gauge IV 3-6 cm long into 2nd ICS midclavicular line

Question 32

what are the 3 signs of Beck's triad?

Answer 32

neck vein distention, hypotension, muffled heart tones (also widened mediastinum)

Question 33

for a flail chest is there inspiratory or expiratory retraction?

Answer 33

inspiratory

Question 34

is a hemothorax dull or hyperresonant?

Answer 34

dull

Question 35

Blood volume deficit for these: 1. unilateral hemothorax 2. hemoperitoneum with abd distention (range) 3. pelvic fx (range) 4. femur fx (range) 5. tibia fx (range)

Answer 35

1. 3000 mL 2. 2000-2500 mL 3. 1500-2000 mL 4. 800-1200 mL 5. 350-650 mL

Question 36

Hemorrhage classifications (% of TBV and mL) 1. Class 1 2. Class 2 (range for both) 3. Class 3 (range for both) 4. Class 4 (range for both)

Answer 36

1. 15%, 750 mL 2. 20-25%, 1000-1250 mL 3. 30-35%, 1500-1800 mL 4. 40-45%, 2000-2500 mL

Question 37

HR and RR > what for these hemorrhage classes: 1. class 2 2. class 3 3. class 4

Answer 37

1. HR > 100, RR > 20 2. HR > 120, RR > 30 3. HR > 140, RR > 35

Question 38

SBP for these hemorrhage classe: 1. class 2 (> what?) 2. class 3 (< what?) 3. class 4 (< what?)

Answer 38

1. 100 2. 90 3. 60

Question 39

Whose law says flow is directly proportional to the 4th power of the radius and inversely related to length?

Answer 39

Poiseuelle's law

Question 40

what is the replacement ratio of crystalloid to blood loss?

Answer 40

3:1

Question 41

what is the IV solution for head trauma?

Answer 41

NS

Question 42

what is the IV solution for trauma resuscitation?

Answer 42

LR

Question 43

what is the replacement ratio of colloid to blood loss?

Answer 43

1:1

Question 44

what are the 4 S/S of TRALI? (RD, H, H, LGF)

Answer 44

resp distress, hypoxemia, hypotension, low grade fever

Question 45

the ratio of 1:1:1 for blood product transfusion is for what products?

Answer 45

PRBC:plts:FFP

Question 46

what 2 ion concentrations increase after a massive blood transfusion?

Answer 46

K+ and H+