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673 Advanced Anesthesia Principles > Week 1 Trauma, Shock, and Burn > Flashcards

Week 1 Trauma, Shock, and Burn Flashcards

(45 cards)

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1
Q

Base deficit: Mild shock

A

-2- -5 mmol/L

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2
Q

Base deficit: Mod shock

A

-6- -14 mmol/L

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3
Q

Base deficit: severe shock

A

> -14 mmol/L

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4
Q

Blood lactate: Normal

A

0.5-1.5 mmol/L

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5
Q

Blood lactate: Severe Acidosis

A

> 5.0 mmol/L

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6
Q

What is cirrhosis associated with in the trauma pt, and why?

A

Highest death rate
* Impaired clotting

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7
Q

What drugs/doses might be used for induction sedative of anesthesia in a Trauma pt?

A
  • Ketamine: 1mg/kg
  • Propofol: 0.5-1mg/kg
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8
Q

What is critical to avoid a disatrous induction in an hemorrhaging pt?

A

Ongoing volume resuscitation

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9
Q

What is the ratio of constituent blood therapy in a trauma pt? (plasma, platelets, RBCs)

A

1:1:1 (or 1:1:2)

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10
Q

What consists of the lethal diamond of Trauma?

A
  • Hypothermia
  • Coagulopathy
  • Acidosis
  • Hypocalcemia
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11
Q

How much blood loss is associated w/ Class I shock?

A

< 750 mL (< 15%)

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12
Q

How much blood loss is associated w/ Class II shock?

A

750-1500 mL (15-30%)

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13
Q

How much blood loss is associated w/ Class III shock?

A

1500-2000 mL (30-40%)

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14
Q

How much blood loss is associated w/ Class IV shock?

A

> 2000 mL (>40%)

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15
Q

What should be avoided in early resuscitation of a Trauma pt? Why?

A

Large crystalloid administration
* Dilutional coagulopathy

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16
Q

What time frame does succinylcholine cause an increased risk of lethal arrhythmias in burn patients?

A

48 hrs to 2 years post burn

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17
Q

Your burn pt comes in and is exhibiting stridor, dyspnea, singed facial hair, and facial burns, what are you concerned of -> and gonna do?

A

Thermal airway injury
* RSI or emergent cricothyrotomy

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18
Q

List the (from most to least preferred) resuscitation fluids

A
  1. FWB
  2. RBCs & platelets in 1:1:1 ratio
  3. RBCs & plasma in 1:1 ration
  4. RBCs or Plasma alone
  5. Crystalloids
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19
Q

What are some injuries that occur with blunt trauma?

What % of blunt traumas?

Study These Flashcards
A
  • Spinal cord injury (2-4%)
  • Cardiac Contusion (10-40%)
  • Pulmonary Contusion (30%)
20
Q

What is the base deficit for mild, moderate, & severe shock?

Study These Flashcards
A
  • Mild: 2-5 mmol/L
  • Moderate: 6-14 mmol/L
  • Severe: > 14 mmol/L
21
Q

What do different levels of blood lactate indicate?

Study These Flashcards
A
  • Normal: 0.5 - 1.5 mmol/L
  • Severe acidosis: > 5.0 mmol/L
22
Q

What neuroendorine mediators maintain hematologic homeostasis?

8

Study These Flashcards
A
  • NE
  • Epinephrine
  • Vasopression (ADH)
  • Renin
  • Angiotensin
  • GH
  • Cortisol
  • Glucagon
23
Q

How do you treat Carbon Monoxide poisoning and for how long?

Study These Flashcards
A
  • 100% O2 or Hyperbaric O2 therapy
  • When COHgb is < 5% for 6 hrs
24
Q

What is the Wallace rule of nines?

5

Study These Flashcards
A
  • Head/Neck: 9%
  • Trunk: 18% ea. Anterior/Posterior
  • Arm: 9% ea.
  • Leg 18% ea.
  • Genitals: 1%….. each?
25
What is the rule of 10's for burn resuscitation?
LR mL/hr = TBSA% x 10 (+) 100mL/hr/10kg bodyweight > 80 kg Titrate 10-25% to markers of perfusion | TBSA rounded to nearest 10
26
Tx for inhaled cyanide poisoning?
Hydroxocobalamin (Vit B12)
27
Using the rule of 9's & 10's, a 100kg pt w/ burns to the face/head & anterior torso requires what kind/how much fluid resuscitation?
* 10 x 30 = 300mL/hr + 200mL/hr = 500 mL/hr
28
What is the American burn association's formula for fluid resuscitation for Adults/Children?
* Adults: 2-4 mL of LR * wt in kg * %TBSA * Children: 3-4mL of LR * wt in kg * %TBSA 1/2 in first 8 hrs, 1/2 over remaining 16 hrs
29
Criteria for adequate fluid resuscitation in a burn pt? | 5
* Normalized BP * UOP: 1-2 mL/kg/hr * Lactate: < 2 mmol/L * Base deficit: < 5 mmol/L * Gastric intramucosal pH: >7.32
30
COHgb 0-10% will have what kind of symptoms?
None, Normal | I mean not normal but no s/s
31
COHgb 10-20% will have what kind of symptoms?
HA & confusion
32
COHgb 20-40% will have what kind of symptoms? | 4
Disorientation Fatigue Nausea Visual changes
33
COHgb 40-60% will have what kind of symptoms? | 5
Hallucinations Combative Convulsion Coma Shock
34
COHgb 60-70% will have what kind of symptoms? | 3
Weak respirations/pulse Convulsion Coma
35
What, and at what affinity > O2 does CO bind to Hgb?
Carboxyhemoglobin 200x affinity
36
How can you prevent secondary injury in a TBI | 4
Prevent/Avoid: * HoTN (SBP < 90mmHg) * Hypoxemia (PaO2 < 60 mmHg) * Hypercapnia (PaCO2 > 50mmHg) * Hyperthermia (>38°C)
37
What are some first tier therapies in the tx of ↑ ICP? | 3
* Ventricular drainage * Osmotic diuretic therapy * Normocarbia (30-35 mmHg)
38
What is a normal ICP & CPP?
* ICP: 0-15 mmHg * CPP 60-80mmHg
39
How do you calculate CPP?
MAP - ICP
40
When are fluid losses the greatest in burn patients?
First 12 hours
41
What must be done to anesthetic doses in the severely hypovolemic trauma pts
Reduction of doses -> no anesthetic at all in the severely hypovolemic
42
S/sx of Tension Pneumothorax? | 6
* **Distended neck veins** * Decrease Pulmonary compliance * Decrease absent unilateral breath sounds * Tracheal deviation * Hypoxemia * Hemodynamic collapse
43
What are some 2nd tier therapies for TBI? | 5
* High Dose barbiturate therapy * Keppra/phenytoin for seizure prophylaxis * Decompressive craniectomy * HTN therapy * Hyperventilation
44
Tell me a couple things about Autonomic dysreflexia
* SCI T5 or above * Caused by a stimulus to bowel/bladder * Leads to Bradycardia & HTN
45
Treatment(s) for Autonomic dysreflexia?
* Remove stimulus (urinary catheter/bowel disimpaction) * Upright positioning (orthostatic) * Pharmacological (Nitrates, CCB, hydralazine, labetalol)

673 Advanced Anesthesia Principles (4 decks)

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