4. Trauma Flashcards
which trauma has incr risk of vascular tearing
deceleration
3 types of trauma
penetrating
blunt
deceleration
primary goal of anesthesia during trauma
airway managment
trauma bay equipment (9)
anesthesia cart
code cart
FULL airway cart
resuscitation equipment
Vascular access
POC labd
echocardiography
warming devices
rapid transfusers
RED triage
immediate attention
cannot survive w/o immediat treatment but have chance of survival
YELLOW triage
observation
serious injuries need immediat attention
better chance of recovery
GREEN triage
non-life threatening injuries
BLACK triage
decease or mortally wounded
WHITE triage
no injury
most trauma pts die of
tissue hypoxia
all trauma pts are considered
full stomach
indications to intubate
- inadequate airway proetction
- loss of conscioussness
- high spinal injury
- aspiration
- loss of airway
- severe maxillofacial deformity
- neck hematoma
- CO poisonig
- hperventilation needed for ICP
- laryngeal/tracheal injury
- stridor
- poor ventilation
- GCS < 8
trauma induction doses
greatly reduced due to incr susceptibility for HD effects
can you oxy pt with ambu bag
yes but you must squeeze the bag for blow by
cervical spine considerations
- jaw thrust only
- in-line stabilization during intubation
- video scope 1st attempt
which pts have unstable c-spine
ALL trauma pts are assumed to have unstable c-spine unless proven by radiography
which induction agents cause hypotension or cardiac arrest in trauma pts
ALL
propofol
etomidate
ketamine
best choice induction agent trauma
ketamine
etomidate SE
inhibits catecholamines
ketamine SE
direct myocardial depression
sux CI
burns
ESRD
recent denervation
incr ICP
(hyperkalemia)
what can sux cause
incr ICP
histamie release
tension pneumothorax diagnosis
sudden CV collapse after PPV
- tachycardia
- hypotension
- incr PIP
- hypercarbia
- hypoxia
what is the indication for tension pneumo decompression?
pt becomes unstable
CI for decompression?
none - be cautious of breathing and anatomical changes
tension pneumo stable consideration
avoid PPV
supp O2
anxiolytic
skin prep options
iodine
betadine
chlorhexidine
MCL
2nd intercostal space
AAL
5th intercostal space
needle size for decompression
14 ga
needle stick location for decompression
superior to inferior ribs
chest tube atrium water seal function
allows for escaping air without entraning new air
water moves up atrium tube
when pt takes breath
what kills most trauma pts
shock
shock symtoms
hypotension
tachycardia
prolong cap refill
diminished UOP
narrow pulse pressure
chest bleeding diagnosis
radiography
thoracostomy tube output
CT
chest bleed treatment
observation
surgery
abdominal bleed diagnosis
physical exam
FAST scan
CT
peritoneal leakage
abdominal bleed treatment
surgical ligation
angiography
observeration
retroperitoneum bleed diagnosis
CT
angiography
retroperitoneum treatment
angiography
long bone bleeding diagnosis
exam
plain radiography
long bone bleed treatment
fracture fixation
surgical ligation
exterior bleed diagnosis
physical exam
exterior bleed treatment
digital pressure
surgical ligation
capillary bleeding
slow
bright red
venous bleeding
slow
dark red
arterial bleeding
spurting
pulasating
bright red
class 1 hemorrhage
< 15% loss of circ volume
no change HR/BP
resuscitation not required
class 2 hemorrhage
15-30% loss of circ volume
HR incr
DBP incr
IV fluid replacement
class 3 hemorrhage
30-40% loss of circ volume
HR incr
BP decr
metabolic acidosis
transfusion necessary
class 4 hemorrhage
> 40% loss of circ volume
profound hypotension
trauma induced coagulopathy
massive transfusion
shock
abnormality of the circ system that causes inadequate organ perfusion and tissue oxygenation
common theme with shock
hypotension
decr CO
most common type of shock
septic
which types of shock have incr SVR
hypovolemia
cardiogenic
which types of shock have decr SVR
anaphylactic
septic
which type of shock has pink, warm, flushed skin
septic
which type of shock has warm dry skin
neurogenic
septic shock treatment
crystalloid
resuscitation
restoration of normal circulating blood volume
normal vascular tone
normal tissue perfusion
macrocirculatory response
vasoconstriction
catecholamine surge
microcirculatory response
cellular edema
== free radical/lactate
== decr BF
macrocirc response agents
renin
angiotensin
vasopressin
ADH
growth hormone
glucagon
cortisol
epi
norepi
microcirc response agents
prostacyclin
thromboxane
prostaglandins
leukotrines
endothelin
interleukins
lactate/free radical cause
negatrive inotropic effects
kidneys/adrenal shock response
produce catecholamines
heart shock reponse
responds to global effects
lung shock response
filters proinflammatory markers
precipitates ARDS
gut shock response
produces inflammatory mediators
bacteria
bowel dysfunction
liver shock response
reperfusion-like manifestation
which organ is most susceptible to hypoperfusion
gut
shock stage 1
mild/stable
skin
tachycardia
shock stage 2
mod/stable
responsive to fluid test
shock stage 3
hypotensive shock is responsive for 20-30 mins
or
hypotensive shock not responsive to 500 mL fluid test