Trauma Flashcards
(50 cards)
1
Q
leading causes of trauma mortality
A
- head trauma - 40%
- hemorrhagic shock
2
Q
2-4% of blunt traumas have
A
concurrent C-Spine injuries
3
Q
70% of blunt airway injuries
A
also have C-Spine injuries
4
Q
flail chest diagnosed with
A
- two or more sites of at least three adjacent rib fractures
- rib fractures associated with costochondral separation or sternal fracture
5
Q
open pneumothorax is a concern for
A
vascular air entrainment
6
Q
definitive tx of trauma shock
A
operative control of bleeding
7
Q
expect major bleeding with
A
- falls from greater than 6 feet
- high energy deceleration injury
- high velocity GSW
8
Q
C/I to cricothyroidotomy
A
- children under 12 - permanent laryngeal damage may occur
- suspsected laryngeal trauma - uncorrectable airway trauma may occur
9
Q
Blunt Airway Injury Symptoms
A
- hoarseness
- muffled voice
- dyspnea
- stridor
- dysphagia
- odynophagia
- cervical pain
- tenderness
- ecchymosis
- subQ emphysema
10
Q
Airway management of blunt/penetrating airway trauma
A
- CT if feasible
- FOB or surgical airway
- Laryngeal damage precludes cricothyroidotomy - trach distal to penetrating wound
11
Q
Interventions for tension pneumothorax
A
- needle decomprssion 2nd ICS at mid clavicular line - inferior border of 2ICS
- CT, mid-axillary line, 5th ICS
12
Q
flail chest diagnosis
A
- 2 or more sites of at least 3 adjacent rib fractures
- rib fractures are either sternal fracture or costochondral separation
13
Q
flail chest interventions
A
- will deteriorate over 3-6 hours
- ARDS is very likley if lung contusion >20%
- better to focus on analgesia and maintain adequate excursion and oxygenation
- may need epidural or thoracic paravertebral block
- evaluate for co-existing trauma (hemothorax, pneumothorax)
- Automatic intubation - NOT reccomended, O2 supplementation + Non invasive PPV
14
Q
sx of tension pneumo
A
- cyanosis
- tachypnea
- hypotension
- neck vein distention
- tracheal deviation
- diminished breath sounds on affected sides
15
Q
blunt thoracic trauma that arrives pulseless has survival rate of
A
<1%
16
Q
Tachycardia may be absent in hypotensive trauma patients
A
- up to 30%
- because of Bezold-jarisch reflex
- increased vagal tone
- chronic cocaine use
17
Q
injury without compensation of tachyardia
A
increases mortality
18
Q
most consistent pediatric VS change for early volume loss
A
narrow pulse pressure
19
Q
pediatric pts only decompensate after
A
35-40% of blood volume loss
20
Q
Base Defecit
A
- -2 to -5: mild shock
- -6 to -9: moderate shock
- over -10: severe shock
21
Q
lactate, free radicals, and other humoral factors released by ischemic cells
A
all act as negative inotropes
22
Q
cardiac dysfunction in shock
A
is a late and often terminal sign.
Cardiac is preserved from ishcemia r/t neuroendocrine response to hemorrhagic shock.
23
Q
Gut response to hemorrhagic shock
A
One of the earliest organs affected by hypoperfusion; may be the prime trigger of MSOF.
24
Q
skeletal muscle response to shock
A
- release lactic acid adn ree radicals, tolerate ischemia better than other organs
25
no cross-match and severe hemorrhage:
1. O+ positive PRBCs (except women of childbearing age)
2. AB- FFP
26
normal lactate
* normal lactate = 0.5 to 1.5 mmol/L
* levels over 5 mmol/L = significant lactic acidosis
27
permissive hypotension not possible with
1. TBI
2. SCI
3. elderly with chronic hypertension
28
administration of large volumes of LR/NS
administration of large volumes of lacatate/NS
* LR: increases lactate
* NS: increases base defecit
29
large volumes of crystalloid infusion found to be an independent cause of
1. ARDS
2. abdominal compartment syndrome
30
components of the coagulopathy of the trauma patient
1. **ATC: acute trauma coagulopathy**
* develops shortly after trauma and is caused by hyperfibrinolysis and severe tissue injury that releases tissue factors, which in turn activates the coagulation pathways
* - this type of coagulopathy appears to be independent of hypothermia/diluation of factors
2. **RAC: resuscitation associated coagulopathy**
* caused by hypothermia, fluids, and possibly other resusctation related factors
31
Primary objective of the early management of brain trauma
prevent or alleviate the secondary injury process that may follow any complication that d ecreases the oxygen supply to the brain, inlcuding:
1. systemic hypotension
2. hypoxemia
3. anemia
4. raised ICP
5. acidosis
6. possibly hyperglycemia \>200 mg/dL
32
Patients with GSC \<8 have a 40% likelihood
of an intracranial hematoma
33
most important therapeutic maneuvers in brain injury patients:
avoid hypotension, hypoxemia, anemia, raised ICP, acidosis, glucose
normalize:
1. BP - MAP \>80 mmHg
2. PaO2 \>95%
3. ICP \<20 to 25 mmHg
4. CPP at 50-70 mmHg (MAP - ICP)
34
preferred fluid for head trauma
NS \> LR
* LR is slightly hypotonic
35
mannitol/hypertonic NS
* mannitol - 0.25 - 0.5 g/kg over 30-60 minutes
* hypertonic: 15%NS, 0.42ml/kg
36
most damaging insult to brain:
hypotension/hypoxia
37
brown-sequard syndrome
* ipsilateral motor and contralateral sensory defecit below the injury
38
tx for pericardial tamponade
1. must maintain preload
2. must maintain contractility
3. prefer to evacuate under local anesthesia
39
s/sx of abdominal compartment syndrome
1. tense, severely distended abdomen
2. increased peak airway pressure
3. CO2 retention
4. oligura
5. intra abdominal pressure \>20-25 mmHg signals decrased perfusion and may require surgical decompresion
40
25% of pelvic fractures
* lead to major hemmorhage (major cause of mortality)
* exsanguination occurs in 1% of all injuries
* most cases, bleeding results from venous disruptions by fragments of bone
* approx 18-20% of pts havebleeding that does not stop (needs embolization)
41
R value =
* reaction time, initial fibrin formation
* rough approximateion of PT/aPTT/intrinsic clotting
problem here = coagulation factors, give FFP
42
K time
K time
* time taken to minimal sufficinet clot strenth
* depends on fibrinogen
* tx with Cryo (fibrinogen)
43
alpha angle
* slope between R and K
* fibrin build up and cross linking takes place
* depends mostly on fibrinogen level
* if problem: cryo
44
MA
maximum amplitude
* represents the utlimate strength of the fibrin clot, overall stability of the clot. Depends on fibrinogen and plt function
* if problem; plts and/or DDAVP
45
Protein C inhibits
* clotting factors V and VIII
* contributes to coagulopathy
* decreases the inhibition of TPA
46
FDP \>40mg/mL
Is suggestive of DIC
47
cryoprecepitate contians
1. factor 8
2. fibrinogen (1)
3. VWB
4. fibronectin
5. Factor 13
used primarily to replace fibrinogen
48
effects of hypothermia
* acidosis, hypotension, coagulopathy
* **cardiac depression and ischemia**
* arrthymias
* peripheral vasoconstriction
* impaired tissue oxygenation delivery
* **elevated oxygen consumption during rewarming**
* **blunted responses to cathecholamines**
* **increased blood viscosisty**
* elevated acidosis, electrolyte imbalances,
* **reduced drug clearance**
* infection
49
occult hypoperfusion syndrome
common in post operative trauma patients, particularly young ones.
Syndrome is characterized by a normal BP maintained by systemic vasoconstriction; decreased intravascular volume and CO and organ ischemia
50
kleihauer-Betke test
has fetal blood entered mom's circulation?
If yes and Mom is Rh- carrying an Rh+ fetus, then give Rhogam.
