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Anesthesia Exam 3 > Trauma Patient Anesthesia > Flashcards

Trauma Patient Anesthesia Flashcards

(68 cards)

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1
Q

what is the initial evaluation with a trauma patient?

A
  • level of consciousness
  • airway/breathing/circulation
  • always other potential areas needing to check
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2
Q

what are special considerations to check with trauma patients?

A
  • lungs
  • brain
  • heart
  • kidneys
  • liver
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3
Q

what does prevention/treatment of shock look like before anesthesia?

A
  • oxygen!! always right answer, put face mask
  • IV/IO (large bore) catheter: correct blood volume
  • fluids: crystalloids/colloids/blood
  • inotropes and/or vasopressors
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3
Q

what does compensatory shock look like?

A
  • increased symp nervous system
  • maintain blood flow and O2 delivery
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4
Q

T/F: most patients from trauma are in shock

A

true, or about to go into shock and in compensatory state

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5
Q

how common are thoracic injuries in trauma patients?

A

very common in HBC: 39-59%

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6
Q

what are examples of thoracic injuries?

A
  • lung contusions
  • pneumothorax
  • myocardial contusions
  • diaphragmatic hernia
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7
Q

T/F: lung contusions account for 50% of traumatic thoracic injuries

A

true

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8
Q

lung contusions

A
  • 50% thoracic inj
  • may be missed initially! may take a day or 2 to show, may. not show up on radiographs until later. always assume that there is some degree of lung contusions in trauma/HBC patients
  • affects oxygenation and ventilation
  • prone to atelectasis
  • hypoxemia/hypoventilation
  • depends on severity
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9
Q

what is a lung contusion?

A

bruised lung, is an injury to the lung tissue caused by blunt force trauma to the chest. This injury results in bleeding and swelling within the lung parenchyma, impairing its ability to efficiently exchange oxygen

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10
Q

why are lung contusions bad

A
  • affects oxygenation and ventilation
  • prone to atelectasis
  • hypoxemia/hypoventilation
  • depends on severity
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11
Q

should you use IPPV for patients with lung contusions?

A
  • may require it bUT
  • lungs are more fragile! risk for barotrauma/pneumothorax
  • positive pressure created to expand lungs, if lungs traumatized could have alveolar tissue rupture
  • low peak inspiratory pressures: be very conservative and let them spontaneously ventilate, but if have to, give small breaths but increasing rate so that there isn’t as big of an expansion to protect the lung tissue
  • PEEP: positive end expiratory pressure
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12
Q

if you have to ventilate a patient that has lung contusions, how should you do it?

A

be very conservative and let them spontaneously ventilate, but if have to, give small breaths but increasing rate so that there isn’t as big of an expansion to protect the lung tissue
faster rate and not as big of expansion

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13
Q

what is PEEP

A

positive end expiratory pressure: valve to put on machine to create resistance to exhalation. lungs don’t come down hard the whole way; you keep the alveoli open a little bit to keep some air in there

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14
Q

what are the types of pneumothorax

A

open or closed
open: lesion caused perforation in chest wall, thoracic cavity is open = lungs collapse. atelectasis, hypoxemia
closed: chest wall intact: lil alveoli broke and leaking into chest wall. can create a tension pneumothorax if you spontaneously ventilate!! collapses heart and lungs bc increasing pressure in chest

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15
Q

pneumothorax

A
  • open or closed
  • very common in HBC
  • DO NOT want to create a tension pneumothorax! closed pneumothorax
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16
Q

what are causes of an open pneumothorax?

A
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17
Q

what are causes of a closed pneumothorax? why is this very scary?

A

chest wall intact: lil alveoli broke and leaking into chest wall. can create a tension pneumothorax if you spontaneously ventilate!! collapses heart and lungs bc increasing pressure in chest

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18
Q

T/F: in a patient with a closed pneumothorax, the first treatment is IPPV

A

FALSE! can create a tension pneumothorax if you spontaneously ventilate!! collapses heart and lungs bc increasing pressure in chest, affects venous return as well = leads to drop in BP!

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19
Q

what are clinical signs of a tension pneumothorax?

A
  • cardiovascular collapse!!
  • built up pressure in thorax leads to
  • decreased lung compliance
  • sudden drop in BP from decreased venous return
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20
Q

do you see an increase or decrease in BP with a patient with a tension pneumothorax?

A

decreased BP because have CV collapse, so have decreased venous return

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21
Q

what is the first thing you want to do for a patient experiencing a tension pneumothorax under anesthesia?

A

take them off the ventilator!! will only make worse, each. breath increases tension in the chest.
- need to evacuate tension from chest: catheter, syringe and extension set

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22
Q

what if you expect a pneumothorax to happen in a patient?

A
  • put chest tube in BEFORE anesthesia
  • all it is is a catheter allowing the pressure in teh chest to be released
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23
Q

diaphragmatic hernia

A

diaphragm gets lacerated and organs start to leak thru chest
- hear quiet and muffled sounds on exam
- decreased FRC
- atelectasis
- organs pushing into lungs push up against and heart
- respiratory distress
- hypoxemia

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24
myocardia contusions
- issues/angry parts in myocardium becomes arrhythmias: they are hurting (12-24 hrs) - should be on ECG!! - may be WORSE when anesthetized - if just 1 here and there, just watch - if seeing more often, need to correct if compromising circulation - if they look multifocal they are originating in different areas
25
what can you do to treat myocardial contusions and their subsequent arrhythmias?
- O2 - Fluids - analgesia - lidocaine
26
what are things that stimulate catecholamines that would irritate myocardial cells and cause arrhythmias?
- hypoxemia: endogenous catecholamines - pain - hypoventilation
27
what to use to treat VPCs
lidocaine
28
what are common anti arrhythmic drugs that should be avoided?
alpha 2 agonists, thiopental, halothane
29
a cat went missing for 2 days, comes with scrapes and non wight bearing on the RF limb. during PE you notice that heart and lungs sounds are muffled and RR is elevated. what do you suspect the cat has?
diaphragmatic hernia. could also have contusions but this is most likely with the muffled heart sounds often see this years later- cat disappeared, then 2 years alter you see the old diaphragmatic hernia
30
is hemorrhage obvious
- not always! can be hidden, liver, intra thoracic, bone fractures can create a significant hematome - fractured spleen/liver can lead to hemoabdomen
31
with acute blood loss, what happens to BP?
hypovolemia + hypotension see tachycardia: heart trying to support the low blood pressure
32
what happens to HR and BP with acute blood loss?
- tachycardia - hypotension when starting to correct to give volume, if there is significant blood loss, can create anemia if you start diluting them. if too anemic can affect oxygen delivery
33
what do you need to be careful with when restoring blood volume in a hypovolemic trauma patient?
if significant blood loss, you may end up diluting the patient if you give too much fluid can start creating anemia if given too much crystalloids!! creates anemia and hypoproteinemia - if too anemic, decreases O2 delivery bc most is transported thru Hgb - low protein: most anesthetic drugs are highly protein bound. crystalloids don't have proteins, so see more pronounced effect with same amount of drug bc less plasma proteins
34
what do you need to be careful with when administering fluids to a hypoproteinemic patient?
most anesthetic drugs are highly protein bound. crystalloids don't have proteins, so see more pronounced effect with same amount of drug bc less plasma proteins see a more pronounced effect!!f
35
with a hypoproteinemic patient, do you see a more severe effect or less severe effect when giving drugs after you've given crystalloids?
crystalloids don't have proteins, and many anesthetic drugs are highly protein bound. so if you are giving drugs to a hypoproteinemic patient, will see a more pronounced effect of that drug with the same normal amount
36
if. blood loss >20%, what do you do
need to give blood products to avoid hypoprotenemia and anemia
37
rupture of urinary tract
- ruptured bladder most common - leak of urine into abdomen - need US - azotemic - electrolyte imbalance: low Na, Cl, and high K
38
what electrolyte abnormalities occur with a ruptured bladder patient?
LOW: Na+, Cl- HIGH: K+ = most severe!! bad. raises resting membrane potential and leads to severe arrhytmias
39
why is rupture of the urinary bladder into the abdomen really bad?
- hyperkalemia = life threatening - raises resting membrane potential gets closer and closer to threshold potential, eventually matches it and goes above, causing asystole from overcomign the threshold
40
what changes on ECG do you see with hyperkalemia?
- prolonged PR - tented T wave - loss of P wave- flatten and disappear - widening QRS - V-fib/asystole
41
what do you want to do with a hyperkalemic/ruptured urinary bladder?
- anesthesia may worsen arrhythmias - catheter!! stop urine in abdomen and drain urine - continous ECG - normalize K+! with Ca2+, NaHCO3
42
what does Ca2+ do to correct hyperkalemia?
doesn't do anything to K+ it gets the threshold potential and brings it UP. recreates a normal distance between the resting membrane and the threshold and normalizes the ECG temporarily
43
what is the most common treatment for hyperkalemia?
insulin/dextrose: drives the K+ back into teh cell if pt very acidotic, could use bicarb to correct pH, but only works if in metabolic acidosis
44
what is your treatment plan for a patient with a ruptured urinary bladder who is becoming hyperkalemic?
- urinary catheter - treat with Ca2+ = time-buyer to correct - insulin/dextrose
45
head trauma
- increased intracranial pressure - mentation/pupil size - cushing's response: hypertension, bradycardia - breathing pattern worried about. brain herniating from increased intracranial pressure!!
46
cushing's response
hypertension and bradycardia and often weird resp patterns but harder to see in anesthetized patient why: as pressure increases in brain, less BF to get in there from increased resistance, so systemic blood struggles to get there. brain not perfused and panics = body creates a hypertensive response, then baroreceptors are like woah why are we hypertensive, and drops blood pressure drastically
47
how can anesthesia affect blood flow to brain?
- coughing and vomiting are bad! maropitant, make sure actually deep enough - intubation can spike ICP: use lidocaine - IA affects cerebral autoregulation - inhalants above MAC vasodilate, want to keep under 1 MAC: combo with opioids or add other things - control ventilation!! CO2 in brain is a vasodilator
48
CO2 is a vaso ______
dilator want to ventilate and maintain CO2 within normal so it doesnt lead to more vasodilation and increased ICP
49
why should you be careful when handling an anesthetized trauma patient?
may have neuro injuries that we don't know about yet that pt was hiding when stiff and in pain
50
untreated pain
- more difficult to treat the longer it goes untreated - excessive sympathetic stimulation - impairs patient evaluation: if painful, cannot do things you need - increase risk of aggression
51
if a trauma patient is not stable
should avoid anesthesia if possible bUT sometimes it is necessary - need detailed and frequent monitoring - continue aggressive support therapy: inotropes, oxygen, etc - careful drug selection and administration
52
what is the ideal protocol for trauma patients?
- CV and pulm sparing - reversible and titratable** - OXYGEN OXYGEN OXYGEN - secure airway - tailor to each patient!! brain, hemoabdomen, etc might need to be concerned about regurgitation if trauma bc pt may have just eaten
53
what is the goal of premedication
decrease amount of induction drugs, relaxation, analgesia need to change administration: may need to give opioid IV instead of IM. needs to be fast sequence
54
how do you do direct IV induction in trauma patient?
- fast airway control - quick transition to monitoring
55
what is standard anesthetic protocol for neuroleptoanalgesia?
opioid + sedative/tranquilizer!! usually benzo fentanyl + midazolam/diazepam (benzos) this is very DEEP sedation where the patient allows us to intubate. very CV sparring - biggest adverse effect = bradycardia from opioids, but that is easily fixable with an anticholinergic
56
standard anesthetic protocol for neuro trauma patients
opioid + benzodiazepine may not be enough- may need to use TINY amount of propofol, etomidate, alfaxolone, ketamine, etc. tiny amount to get to point of intubation
57
what is the biggest side effect seen with the neuroleptoanalgesia protocol?
bradycardia from the opioids but this is easily fixed with an anticholinergic
58
what is a very CV and resp sparing induction protocol
- etomidate + benzo - etomidate doesn't give much muscle relaxation so need diazepam or midazolam - most CV and resp sparing - great for cats with CV dz - cortisol suppression (short) - hemolysis (high osmolality)-need to dilute!!
59
in cats that are really severe and sick?
opioid induction works well, watch for behavior changes, but if really sick and obtunded use opioids. if fine, then etomidate
60
what are concerns with etomidate?
- cortisol suppression (short) - hemolysis (high osmolality)-need to dilute!!
61
if you have a brain trauma with TBI, what are good induction agents?
propofol and alfaxolone: decreases ICP. can maintain anesthesia with TIV
62
ketamine for TBI?
not alone, not first choice. increase ICP, caution in head trauma - good to add for pt with fentanyl/midzaolam, maintains symapthetic tone - ketamine has direct and indirect effect (increases symp tone) esp in acute trauma tone, usually have symp tone so get a positive hemodynamic response from ketamine
63
why do you want to titrate drugs to effect with trauma pts?
- not healthy patients and have low co !! - give drug = vein to brain time is longer bc CO is SLOW, takes longer for drug to hit brain - when titrating, remember it will be slower, don't want to give too much, want to be calm and slow - avoid deep planes of anesthesia!!
64
maintenance of trauma pts
- balanced anesthesia! combo fo drugs to use less of each one - analgesics - sedatives/muscle relaxants - want small amounts of IA!!! MAC reduction to decrease adverse effects from inhalantdrugs
65
what is the msot common maintennace of trauma pts?
- inhalants with balanced technique - easily and quickly titratable. turn vaporizer down or increase flow to bring concentration down - cannot do injectables: need to wait to clear and that can be tricky - minimal systemic metabolism - by itself, very CV depressive - MAC reduction is key!!
66
balanced anesthesias for trauma pateitns
- opioid CRIs - low dose ketamine - low dose lidocaine NOT FOR CATS - regional anesthesia: blocks, epidurals (good for things caudal, but can cause vasodilation so be prepared)
67
lidocaine in cats?
NO- decreases CO in cats

Anesthesia Exam 3 (7 decks)

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