Trauma II

Question 1

Significant abnormalities on the neurological exam are an indication for ______

Answer 1

immediate cranial CT

Question 2

Eye Opening

Answer 2

• Spontaneous
• To Speech
• To Pain
• None

Question 3

Speech

Answer 3

• Oriented to name
• Responds, but confused
• Inappropriate speech
• Incomprehensible
• None

Question 4

Motor

Answer 4

• Follows commands
• Localizes pain
• Withdrawals from pain
• Decorticate
• Decerebrate
• Nothing

Question 5

What can cause secondary brain damage after a TBI (4)

Answer 5

bleeding
edema
ICP
hypoxia + shock

Question 6

GCS 13 - 15

Answer 6

mild TBI

watch for 24h (unless elderly, hold longer)

Question 7

GCS 9 - 12

Answer 7

early CT
intracranial lesions that require surgical evacuation
high potential for deterioration (+/- ett)

Question 8

GCS < 8

Answer 8

mortality rate 3x higher

direct care at perfusion of injured brain

Question 9

Severe TBI considerations (8)

Answer 9

CPP 60 - 70 mm Hg
Hct 30%
PaCO2 = 35 mmHg
Ventriculostomy +/-
HOB at 30 degrees
Judicious use of analgesics/sedation
Mannitol @ 0.25 - 1 g/kg
Hypertonic saline

Question 10

Hyperventilate

Answer 10

to 30 if herniation is imminent and not responsive to:

sedative, CSF drainage, NMB, osmotics, barbiturate coma

Question 11

TBI + Airway

Answer 11

Intubate

Normoventilation

Question 12

TBI + CV (5)

Answer 12

avoid ICP > 20
avoid systolic hypotension
A-Line 
Low concentrations of sevo/iso/des
Avoid nitrous

Question 13

Where do most SCI occur

Answer 13

C4 - C7

Question 14

What does the SCI outcome depend on

Answer 14

severity of injury
prevention of exacerbation
avoiding hypoxia and hypotension

Question 15

Autonomic hyperreflexia

Answer 15

develops in 85% of SCI w/complete injury above T5

Question 16

Main goal w/SCI

Answer 16

increase oxygen and MAP (>85) for at least one week to prevent worsening of injury!!

Question 17

Neurogenic shock

Answer 17

hypotension + bradycardia
massive vasodilation
loss of cardiac accelerator neurons

give fluid bolus, if no increase in BP it’s neurogenic shock!

Question 18

Incomplete vs complete lesion

Answer 18

emergent (incomplete)

complete - more ominous, less of an emergency

Question 19

SCI + airway

Answer 19

• intubate
• chin lift + MIS + video
• sux if < 24 h

Question 20

Three types of ortho trauma

Answer 20

1. isolated closed
2. open fx of major long bones + joints
3. multiple fx of long bones, spinal columns

Question 21

Fixed vs open fx

Answer 21

fixed = OR in 24 h (PNA, ARDS, fat emboli)
open = OR in 12h (infection)

Question 22

Dislocated hip

Answer 22

emergent d/t avascular necrosis (GA d/t full stomach)

Question 23

Fractured pelvis

Answer 23

BLOOOOODY
+/- angiography if they can’t stop blood
+/- laparotomy to pack abdomen
T+C for 4 U

Question 24

Crush injuries

Answer 24

muscle damage = myoglobinuria
want it clear in 8 hours
fluids, mannitol, bicarb (prevents clogs)

Question 25

compartment syndrome

Answer 25

common in tibial and FA fracture

Question 26

Ortho Trauma + Anesthesia

Answer 26

GA Lower requirements if pt has hypovolemia Controlled hypotension use spontaneous ventilations at end of case to guide narcotic use

Question 27

thoracotomy (3 reasons) & anesthesia implications

Answer 27

if drainage > 1500 mL if first few hours if tracheal/bronchial injury or massive air leak HD instability **RSI w/normal ETT. Then, double lumen tube

Question 28

Traumatic aortic injury

Answer 28

dx made via CXR, angiography, CT, TEE surgery = necessary d/t rupture risk partial bypass versus endovascular repair SBP < 100

Question 29

Rib fracture

Answer 29

flail chest w/paradoxical respiration

Question 30

beck's triad

Answer 30

cardiac tamponade | hotn, muffled, JVD

Question 31

contusion (cardiac)

Answer 31

can't distinguish from MI arrhythmias, hotn, need CV support dx: TTE or TEE

Question 32

RF for ARDS

Answer 32

``` old pre-existing conditions direct chest wall injury aspiration prolonged vent TBI severe SCI w/quadriplegia massive tx shock occult hypoperfusion wound/body cavity infectrion ```