66. Trauma

Question 1

GCS

Answer 1

1-4 eyes
1-5 verbal 4 confused
1-6 motor 4 withdraws from pain

Question 2

Referral to trauma center

Answer 2

SPB < 90
GCS < 13
RR < 10, > 29
Fall 20 feet 6m
Pregnant > 20w
Children, age > 55
Burns, penetrating, pelvic fracture, skull, chest
Death in te same vehicule
Bleeding / coagulation d.

Question 3

Early resuscitation goals

Answer 3

SBP > 80-100
Htc > 25/30
PT norm
Ptl > 50
t > 35 degrees

Question 4

Compartment syndrome characterisics

Answer 4

20 - 30 mmHg below diastolic
4-6 hours leads to total ischemia

Question 5

Treatment for crush syndrome

Answer 5

Crystalloids

Question 6

Phases in major traumatic resuscitation

Answer 6

1. Stop bleeding (Life threatens)
2. Tailored resuscitation (partially controlled)
3. Restored physiology (Hemorrhage controlled)

Question 7

In isolated TBI

Answer 7

Avoid hyperventilation (PCO2 > 35)
CCP 60-70
BP > 100 (in elderly, more than 70 and btw 15-49)
Na 140-145
Hct 30-33%

Question 8

Burns and scoline

Answer 8

Increase scoline risk after 48-72h

Question 9

When to do thoracoscopy

Answer 9

If there is more than 1.5 l in chest tube

Question 10

Pediatric characteristics of TBI

Answer 10

80%
Decrease O2 decrease HR
Decrease 1 degree decrease 10% clotting activity