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Fa: Sim 3 > 4. Trauma > Flashcards

4. Trauma Flashcards

1
Q

which trauma has incr risk of vascular tearing

A

deceleration

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1
Q

3 types of trauma

A

penetrating
blunt
deceleration

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2
Q

primary goal of anesthesia during trauma

A

airway managment

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3
Q

trauma bay equipment (9)

A

anesthesia cart
code cart
FULL airway cart
resuscitation equipment
Vascular access
POC labd
echocardiography
warming devices
rapid transfusers

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4
Q

RED triage

A

immediate attention
cannot survive w/o immediat treatment but have chance of survival

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5
Q

YELLOW triage

A

observation
serious injuries need immediat attention
better chance of recovery

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6
Q

GREEN triage

A

non-life threatening injuries

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7
Q

BLACK triage

A

decease or mortally wounded

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8
Q

WHITE triage

A

no injury

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9
Q

most trauma pts die of

A

tissue hypoxia

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10
Q

all trauma pts are considered

A

full stomach

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11
Q

indications to intubate

A
  1. inadequate airway proetction
  2. loss of conscioussness
  3. high spinal injury
  4. aspiration
  5. loss of airway
  6. severe maxillofacial deformity
  7. neck hematoma
  8. CO poisonig
  9. hperventilation needed for ICP
  10. laryngeal/tracheal injury
  11. stridor
  12. poor ventilation
  13. GCS < 8
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12
Q

trauma induction doses

A

greatly reduced due to incr susceptibility for HD effects

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13
Q

can you oxy pt with ambu bag

A

yes but you must squeeze the bag for blow by

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14
Q

cervical spine considerations

A
  1. jaw thrust only
  2. in-line stabilization during intubation
  3. video scope 1st attempt
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15
Q

which pts have unstable c-spine

A

ALL trauma pts are assumed to have unstable c-spine unless proven by radiography

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16
Q

which induction agents cause hypotension or cardiac arrest in trauma pts

A

ALL
propofol
etomidate
ketamine

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17
Q

best choice induction agent trauma

A

ketamine

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18
Q

etomidate SE

A

inhibits catecholamines

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19
Q

ketamine SE

A

direct myocardial depression

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20
Q

sux CI

A

burns
ESRD
recent denervation
incr ICP
(hyperkalemia)

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21
Q

what can sux cause

A

incr ICP
histamie release

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22
Q

tension pneumothorax diagnosis

A

sudden CV collapse after PPV
- tachycardia
- hypotension
- incr PIP
- hypercarbia
- hypoxia

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23
Q

what is the indication for tension pneumo decompression?

A

pt becomes unstable

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24
Q

CI for decompression?

A

none - be cautious of breathing and anatomical changes

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25
Q

tension pneumo stable consideration

A

avoid PPV
supp O2
anxiolytic

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26
Q

skin prep options

A

iodine
betadine
chlorhexidine

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27
Q

MCL

A

2nd intercostal space

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28
Q

AAL

A

5th intercostal space

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29
Q

needle size for decompression

A

14 ga

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30
Q

needle stick location for decompression

A

superior to inferior ribs

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31
Q

chest tube atrium water seal function

A

allows for escaping air without entraning new air

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32
Q

water moves up atrium tube

A

when pt takes breath

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33
Q

what kills most trauma pts

A

shock

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34
Q

shock symtoms

A

hypotension
tachycardia
prolong cap refill
diminished UOP
narrow pulse pressure

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35
Q

chest bleeding diagnosis

A

radiography
thoracostomy tube output
CT

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36
Q

chest bleed treatment

A

observation
surgery

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37
Q

abdominal bleed diagnosis

A

physical exam
FAST scan
CT
peritoneal leakage

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38
Q

abdominal bleed treatment

A

surgical ligation
angiography
observeration

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39
Q

retroperitoneum bleed diagnosis

A

CT
angiography

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40
Q

retroperitoneum treatment

A

angiography

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41
Q

long bone bleeding diagnosis

A

exam
plain radiography

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42
Q

long bone bleed treatment

A

fracture fixation
surgical ligation

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43
Q

exterior bleed diagnosis

A

physical exam

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44
Q

exterior bleed treatment

A

digital pressure
surgical ligation

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45
Q

capillary bleeding

A

slow
bright red

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46
Q

venous bleeding

A

slow
dark red

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47
Q

arterial bleeding

A

spurting
pulasating
bright red

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48
Q

class 1 hemorrhage

A

< 15% loss of circ volume
no change HR/BP
resuscitation not required

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49
Q

class 2 hemorrhage

A

15-30% loss of circ volume
HR incr
DBP incr
IV fluid replacement

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50
Q

class 3 hemorrhage

A

30-40% loss of circ volume
HR incr
BP decr
metabolic acidosis
transfusion necessary

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51
Q

class 4 hemorrhage

A

> 40% loss of circ volume
profound hypotension
trauma induced coagulopathy
massive transfusion

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52
Q

shock

A

abnormality of the circ system that causes inadequate organ perfusion and tissue oxygenation

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53
Q

common theme with shock

A

hypotension
decr CO

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54
Q

most common type of shock

A

septic

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55
Q

which types of shock have incr SVR

A

hypovolemia
cardiogenic

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56
Q

which types of shock have decr SVR

A

anaphylactic
septic

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57
Q

which type of shock has pink, warm, flushed skin

A

septic

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57
Q

which type of shock has warm dry skin

A

neurogenic

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58
Q

septic shock treatment

A

crystalloid

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59
Q

resuscitation

A

restoration of normal circulating blood volume
normal vascular tone
normal tissue perfusion

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60
Q

macrocirculatory response

A

vasoconstriction
catecholamine surge

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61
Q

microcirculatory response

A

cellular edema
== free radical/lactate
== decr BF

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62
Q

macrocirc response agents

A

renin
angiotensin
vasopressin
ADH
growth hormone
glucagon
cortisol
epi
norepi

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63
Q

microcirc response agents

A

prostacyclin
thromboxane
prostaglandins
leukotrines
endothelin
interleukins

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64
Q

lactate/free radical cause

A

negatrive inotropic effects

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65
Q

kidneys/adrenal shock response

A

produce catecholamines

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66
Q

heart shock reponse

A

responds to global effects

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67
Q

lung shock response

A

filters proinflammatory markers
precipitates ARDS

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68
Q

gut shock response

A

produces inflammatory mediators
bacteria
bowel dysfunction

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69
Q

liver shock response

A

reperfusion-like manifestation

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70
Q

which organ is most susceptible to hypoperfusion

A

gut

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71
Q

shock stage 1

A

mild/stable
skin
tachycardia

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72
Q

shock stage 2

A

mod/stable
responsive to fluid test

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73
Q

shock stage 3

A

hypotensive shock is responsive for 20-30 mins
or
hypotensive shock not responsive to 500 mL fluid test

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74
Q

shock stage 4

A

heart/brain ischemia
total blood volume loss > 40%

75
Q

shock stage 5

A

cardiac arrest due to exsangiunation

76
Q

shock early resuscitation goals: SBP

A

80-100 mmHg

77
Q

shock early resuscitation goals: Hct

A

Hct 25-30%

78
Q

shock early resuscitation goals: PT/PTT

A

normal PT/PTT

79
Q

shock early resuscitation goals: Plts

A

Plt > 50,000

80
Q

shock early resuscitation goals: core temp

A

> 35C

81
Q

shock early resuscitation goals: pulse ox

A

functioning

82
Q

shock early resuscitation goals: lactate

A

prevent changes in lactate

83
Q

shock early resuscitation goals: anesthesia/analgesia

A

ensure adequate anesthesia/analgesia

84
Q

shock late resuscitation goals: SBP

A

> 100mmHg

85
Q

shock late resuscitation goals: Hct

A

Hct above transfusion goal

86
Q

shock late resuscitation goals: coag status

A

normalized

87
Q

shock late resuscitation goals: electrolyte status

A

normalized

88
Q

shock late resuscitation goals: core temp

A

normalized

89
Q

shock late resuscitation goals: urine output

A

normalized

90
Q

shock late resuscitation goals: CO

A

maximized CO

91
Q

shock late resuscitation goals: systemic acidosis

A

reversed systemic acidosis

92
Q

shock late resuscitation goals: lactate

A

normalized lactate level

93
Q

what is anestheisa responsible for during shock management?

A

early resuscitation goals

94
Q

normal lactate

A

< 2 mmol/L

95
Q

acidosis lactate

A

> 5 mmol/L

96
Q

what can volume expansion with only fluids cause

A

dilutional anemia
coagulopathy

97
Q

normal PT

A

11-13.5 sec

98
Q

normal PTT

A

25-35 sec

99
Q

normal ionized Ca2+

A

4.6-5.2 mg/dL

100
Q

total Ca2+ level

A

8.6-10.3 mg/dL

101
Q

liver CO

A

25%

102
Q

gut CO

A

10-15%

103
Q

kidney CO

A

25%

104
Q

brain CO

A

12%

105
Q

risk of femoral lines

A

abdominal injury concern

106
Q

risk of IJ lines

A

cervical spine
pneumo risk

107
Q

risk of subvlacian lines

A

pneumo

108
Q

rapid transfuser rate

A

1500mL/min

109
Q

which blood product cannot be used with rapid transfusers?

A

Platelets

110
Q

which blood products can be used with rapid transfusers?

A

crystalloids
colloids
PRBCs
washed blood
FFP

111
Q

rapid transfusers advantages

A
  1. FAST
  2. mix products in reservoir
  3. warm fluids
  4. pump simultaneous
  5. fail-safe air detection
  6. accurate vol/pressure recording
  7. portable
112
Q

PRBCs effect

A

incr Hg 1g/dL
or
incr Hct 3%

113
Q

FFP effect

A

2-3% incr in clotting factors

114
Q

Plts effect

A

incr 5000-10,000/microL

115
Q

cryo effect

A

incr fibrinogen 5-7 mg/dL

116
Q

PT normal

A

11.5-14.5 s

117
Q

PT pathway

A

extrinsic

118
Q

standardized PT test

A

INR

119
Q

PTT normal

A

24.5-35.2s

120
Q

PTT pathway

A

intrinsic

121
Q

thrombin time normal

A

22.1-31.2 s

122
Q

thrombin time measure

A

time to clot once exogenous thrombin is added

123
Q

fibrinogen normal

A

175-433 mg/dL

124
Q

fibrinogen measure

A

pure count

125
Q

activated clotting time normal

A

70-180 s

126
Q

activated clotting time measures

A

test tube reagent clotting

127
Q

plt normal

A

150k-450k

128
Q

plt measures

A

pure count

129
Q

P2Y12 normal

A

180-376 PRU

130
Q

P2Y12 measures

A

plavix inhibition test

131
Q

FAST scan locations

A

pericardium
RUQ
LUQ
suprepubic area
right anterior thoracic
left anterior thoracic

132
Q

pericardium FAST scan probe/location

A

phased array
inferior to xiphoid process
transverse

133
Q

what is used as acoustic window for pericardium FAST scan

A

liver

134
Q

RUQ FAST scan prob/location

A

curve-linear
posterior to MAL
between ribs 8-11

135
Q

RUQ FAST scan visualized

A

liver tip
right paracolic gutter
morrison’s puch

136
Q

LUQ FAST scan probe/location

A

curve-linear
posterior to MAL
between ribs 6-9

137
Q

LUQ FAST scan visulaizes

A

left kidney
spleen
left paracolic gutter

138
Q

suprapubic FAST scan probe/location

A

curve-linear
cephalad to pubic sympasis
sweep left/ride
angle probe cephalad/caudal

139
Q

which FAST scan is most dependedn lcoation in intraperitoneal cavity

A

suprapubic area

140
Q

anterior thoracic FAST scan probe/location

A

linear probe
MCL 2nd-4th intercostal
longitudinal orientation

141
Q

lowest score for GCS

A

3

142
Q

AVPU

A

fully awake

143
Q

AVPU

A

responds to verbal stim only

144
Q

AVPU

A

responds to pain stim only

145
Q

AVPU

A

unresponsive

146
Q

mild GCS / TBI

A

13-15

147
Q

mod GCS / TBI

A

9-12

148
Q

severe GCS / TBI

A

3-8

149
Q

mild TBI

A

minimal deterioration
post concussive effects

150
Q

mod TBI

A

long term morbidity

151
Q

sev TBI

A

significant risk of mortality

152
Q

which trauma accounts for 50% of all trauma deaths

A

CNS

153
Q

mortality rate of meningeal vessel bleed

A

15-20%

154
Q

TBI _____ ICP

A

incr ICP

155
Q

TBI _____ CPP

A

decr CPP

156
Q

TBI hypotension

A

SBP < 90 mmHg

157
Q

TBI hypoxemia

A

PaO2 < 60 mmHg

158
Q

most common cause of TBI

A

falls

159
Q

anesthetic goals for TBI

A

mx CPP
decr ICP
avoid hypoxemia
avoid hyper/hypocarbia
avoid hyper/hypoglycemia

160
Q

TBI airway

A

always ETT

161
Q

TBI PaO2

A

> 60 mmHg

162
Q

when do you need a central line in TBI pts

A

if you need to give hypertonic saline

163
Q

TBI SBP

A

> 90mmHg

164
Q

what fluids can you give TBI pts

A

warmed, non -glucose crystalloids
hypertonic saline
mannitol

165
Q

what fluid should you not give TBI

A

no albumin
no dextrose

166
Q

TBI pts have incr risk of

A

anemia

167
Q

effect of HCT on CBF

A

high Hct will decr CBF

168
Q

Glu range TBI

A

80-180 mg/dL

169
Q

what drug is CI in pts with mod/severe TBI

A

high dose methyprednisolone

170
Q

cannabis withdrawal meds

A

benzos

171
Q

cocaine withdrawal meds

A

propranolol

172
Q

heroine withdrawal meds

A

methadone

173
Q

MDMA withdrawal meds

A

antidepressants

174
Q

meth widrawal meds

A

antidepressants

175
Q

echinacea

A

immunosuppresion

176
Q

ginki biloba

A

inhibits plt activating factor

177
Q

garlic

A

inhibits plt aggregation
incr fibrinolysis

178
Q

ginseng

A

lower blood glu
incr PT/PTT
inhibits plt aggregation

179
Q

saw palmetto

A

cox inhibitor

180
Q

ephedra

A

indirect sympathomimetic effect

181
Q

valerian

A

sedation

182
Q

kava

A

sedation
anxiolysis

183
Q

st john’s wort

A

inhibits neurotransmitter reuptake

184
Q

leeding cause of death in trauma pts

A

sepsis

185
Q

how to prevent sepsis

A

start abx asap

186
Q

hypothermia SE

A

incr bleeding
incr HD instability
arrhythmias

Fa: Sim 3 (15 decks)

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