Trauma Rupp Flashcards by J C

three areas of highest recall?

Cardiovascular,
OB,
Trauma

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5 criteria for potential cervical spine injury

neck pain
severe distracting pain
any neurological signs and symptoms
intoxication
loss of consciousness at the scene

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what is the best way to intubate a patient with a cervical spine injury?

Manual inline stabilization (MILS), Can be used with glide scope

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What gas do you want to avoid in trauma patients?

N2O

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What can N2O do in trauma patients?

Accumulate in closed spaces. Avoid in trauma patients with a pneumothorax, pneumocephalus, or pnuemoperitoneum.

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What can succs do if administered 24 hours after a burn, spinal cord or crush injury?

increase potassium

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what injuries can succs increase potassium level?

burn, spinal cord, or crush injury

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what ph imbalance can postops have after massive transfusion?

metabolic alkalosis

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what can happen if transfusion rate exceeds 1 unit every 5 minutes?

You can see cardiac depression caused by hypocalcemia

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in an anesthetized patient-hemolytic reactions are recognized by

increased temp,
tachycardia,
hypotension,
hemoglobinuria,
and oozing at the field

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hypothermia in trauma can cause

worsen acid/base balance,
coagulopathies-plt sequestration and red blood cell deformities,
risking myocardial function

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common cause of bleeding after massive transfusions is

dilutional thrombocytopenia

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half life of crystalloids

20-30 minutes

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half life of colloids

3-6 hours

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Which is less likely to cause hyperkalemic acidosis? LR or NS?

lactated ringers

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why is LR less compatible with blood transfusions?

calcium in the LR

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Why are dextrose solutions contraindicated in trauma?

r/t it may exacerbate ischemic brain damage

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LR is slightly ______ and with large volumes can _____ cerebral edema

hypotonic,

aggravate

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What type of solutions are effective in restoring intravascular volumes?

colloids

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Different types of colloids?

albumin,
dextran,
hetastarch,
dextran and hetastarch can cause coagulopathy

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What blood type can be released immediately to the moribund patient without type and cross?

Type O negative

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Factor ___ can decrease by ___% after two days in storage. ______ thrombocytopenia quickly develops when a patient is massively transfused.

VIII,
50%,
Diluational

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With anesthetics, alveolar concentration is up in shock patients r/t

a decrease in CO and increased ventilation,

smaller intravascular volume so the intravenous anesthetics are exaggerated

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Hypovolemic trauma patient induction patients

ketamine,

etomidate

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what can cause hematuria?

injury to kidneys or lower urinary tract

what percentage of all trauma patients does cervical injury occur?

Shock=

circulatory failure leading to inadequate vital organ perfusion and oxygen delivery

Trauma patients think

ABC's--- theses patients are always at risk for aspirations

Consider what in any trauma patient with an altered consciousness

a brain injury

Signs of brain injury include

restlessness, convulsions, cranial nerve dysfunction (non reactive pupils)

Scale used to assess brain injury?

Glasgow Coma Scale

Cushing's triad symptoms

hypertension, bradycard, respiratory disturbances (triad are late signs and preceded by brain herniation)

What type of meds induce pupillary dilation? important to know with brain injuries

anticholinergics meds (robinol, spiriva, atrovent)

Avoid what meds in. brain injury to preserve exam?

sedatives or analgesics

Cardiac tamponade-Beck's Triad

neck vein distension, hypotension, muffled heart tones

distended neck veins may signal pericardial tamponade and _____ can kill

diprivan

pulsus paradoxus=

>10mmHg decline on BP during spontaneous ventilation

What should you watch for if a pericardialcentesis is done

watch for electrocardiographic changes when needle goes to far into myocardial tissue

What can happen when they open the abdomen with ex lap in abdominal trauma?

HYPOTENSION-> need large IV and blood... fluid resuscitation

Abdomen trauma usually involves...

``` vascular, hepatic, splenic, renal, pelvis, (Remember hyperkalemia with massive transfusions) ```

A femur fracture can mean how many units of blood loss?

pelvic fractures can lead to _____ shock and ____ embolism risks with fractures

hypovolemic, | fat

fat embolism labs

elevation of serum lipase, fat in urine, thrombocytopenia

extremity reattachement if spinal or regional....

increases blood flow, | watch hypotension with decreases blood flow

extremity reattachment if general....

keep warm, | avoid shivering on emergence to help perfusion

facial fractures name degree

Lefort fractures 1-3

how is intracranial hypertension controlled?

by fluid restrictions, diuretics (mannitol), hypocapnia (paCO2 26-30mmHg)

what can treat htn and tachycardia during intubation?

lidocaine and or fentanyl

what three things can control intracranial hypertension?

fluid restrictions, diuretics (mannitol), hypocapnia (paCO2 26-30mmHg)

what anesthetic agent can increase intracranial pressure and want to avoid in ICP?

Ketamine

_____ hypothermia can assist saving brain tissue in a head injury

Mild

Cervical spine injury affecting the phrenic nerve

c3-c5

cardiac accelerators spinal cord

T1-T4

symptoms of spinal shock with high cord injury

``` loss of sympathetic tone, hypotension, warm to the touch, bradycardia, areflexia, GI atony ```

Autonomic hyperreflexia is NOT associated in first ___ hours and ________ OK at this point

48, | succinylcholine

what is autonomic hyperreflexia?

a reaction of the autonomic (involuntary) nervous system to overstimulation.

Symptoms of autonomic hyperreflexia?

high blood pressure, change in heart rate, skin color changes (paleness, redness, blue-grey skin color), and excessive sweating.

Pneumothorax can be _____ or _____

simple or tension

a simple pneumothorax is

air in the parietal and visceral pleura. Lung collapse causes vent/perf mismatch and hypoxia

Treatment of simple pneumo

chest tube 4th or 5th intercostal space

tension pneumo is

air in pleural space trapped and increases with inspiration and not escape with expiration-see the tracheal shift

what can turn a simple pneumo into a tension?

positive pressure (bagging or ventilator)

treatment of tension pneumo

14 gauge needle at second intercostal space at midclavicular line then a chest tube like for a simple pneumo

Endotracheal tube for hemothorax and why

double lumen tube to isolate bleeding lung from healthy lung

Acute Respiratory Distress Syndrome causes

``` Delayed lung response to trauma. sepsis, thoracic injury, aspiration, head injury, fat emboli, massive transfusion, Mortality 50% ```

How can ARDS manifest in OR and what to do

alarms on anesthesia machines, need a better ventilator with higher gas flows r/t their poor lung compliance. Need high airway pressures.

Trauma Rupp Flashcards

(66 cards)