What is the leading cause of death in the first 4 decades?
trauma injury50% of all deaths between 5-34
what percentage of trauma related deaths are immediate?
what are the ABCDE of trauma evaluation?
A = airwayB = breathingC = circulationD = disabilityE = exposure
what is the assumed induction plan for a trauma patient?
RSI !!!C-spine precautions for every pt until cleared
In the event of a PTX what is one thing you should never give?
N2O will exacerbate it
define tension PTX
progressive build up of air in the pleural space due to lung laceration which causes a one way valve for air flow into pleural space
what is the main role of anesthesia in the OR for trauma?
management of shock!
circulatory failure leading to inadequate organ perfusion and oxygen delivery
what are the symptoms of shock?
pallordiaphoresisagitationhypotensiontachycardiadiminished urine outputnarrow pulse pressure
what are the 4 main types of shock?
hypovolemic (blood loss)cardiogenic (pump failure/dysrhythmias)obstructive (PTX/tamponade/PE)distributive (septic/neurogenic)
a glascow coma score of ___ usually requires intubation
What is an ISS?
Injury Severity Score-muti-injury scoring system-assigns a score to six regions of body
What is FAST?
Focused Assessment by Sonography in Trauma (+ result means there's blood somewhere there shouldn't be)
TBI short for ____ ______ _____ are responsible for _____% of trauma deaths
Traumatic Brain Injury50%
what is the cushing triad?
what is a normal CPP value? and how is it calculated?
80-100mmHgCPP = MAP - ICP
what induction drug can you not give 48hrs post-trauma?
what is cardiac tamponade? and how can it be diagnosed?
collection of fluid/blood in pericardial sacBeck's triad = JVD, hypotension, muffled heart tonesTEE or + FAST
What is the motto for Cardiac Tamponade treatment?
"Tight, light, fast, full"-Tight vessels-Light anesthesia-Fast HR-Full of fluids
What is the induction agent of choice for cardiac tamponade?
what are the most common abdominal trauma seen in OR?
Spleen and Liver lacerations
GSW require what type of procedure?
laparotomy...unknown bullet path
what is an important consideration for pelvic and femur fx?
hypovolemic shockhigh occurance of sepsis
what is compartment syndrome and when is immediate surgical intervention needed?
swelling within a compartment of an extremity that causes decreased perfusion and nerve damage due to pressure build up-30mmHg req. fasciotomy
What is the induction agent of choice for the unstable trauma patient?.....if they are hemodynamically unstable?
etomidateketamine (no brain injuries)
why can propofol be dangerous for a pt in shock?
drop in SVR could cause cv collapse
what are the main fluid resuscitation goals for the trauma patient?
1. maintain circulating volume2. restore oxygen carrying capacity3. correction of coagulopathy
PRBC universal donor?
what qualifies as a massive transfusion?
-one blood volume loss in 24 hrs (5-7L)-4 or more PRBC in 1 hr-50% blood volume loss in 3 hrs
What is an important consideration when administering fluids to a trauma pt?
what is a main concern/complication from transfusions?
citrate intoxication causes a serious decrease in what ion?
after admistering several units of PRBC, you can expect what of the K+ levels?
Why is temperature management so important?
<34*C severely inhibits enzymatic reactions of coagulation cascade
What is TIC? and how can it be combatted?
Trauma induced Coagulopathygive FFP (warmed)give cryogive platelets