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ANESTHESIA PRACTICE 2 > ANESTHESIA FOR TRAUMA > Flashcards

ANESTHESIA FOR TRAUMA Flashcards

1
Q

define blunt trauma

A

collision between two objects (impact without broken skin)
* momentum is conserved, but kinetic energy is not, and does work on the objects in the form of deformation or conglomeration

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2
Q

define penetrating trauma

A

object pierces skin and enters body creating a wound

  • missile decelerates transmitting kinetic energy to surrounding tissues
  • because kinetic energy = 1/2 mv^2, VELOCITY is more important than mass in determining the amount of damage done
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3
Q

what is the primary survey of trauma?

A

KEEP CALM and ABCDE

  • Airway maintenance w/ c-spine protection
  • Breathing and ventilation
  • Circulation and hemorrhage control
  • Disability/neurologic assessment
  • Exposure and environmental control
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4
Q

what are the pros and cons of propofol?

A
  • pros: provides more muscles relaxation if need to intubate without use of NMBDs
  • cons: profound cardiac depressant; severe reductions in systemic vascular resistance
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5
Q

what are the pros and cons of ketamine?

A
  • pros: maintains BP in severely hypovolemic patients; increases sympathetic outflow; can produce sedation without respiratory depression
  • cons: direct myocardial depressant; may increase ICP (contraindicated in traumatic brain injury), can produce vivid hallucinations (many trauma patients are already intoxicated)
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6
Q

what are the pros and cons of etomidate?

A
  • pros: rapid onset, short duration of action; cardiovascular stable; may be particularly useful in traumatic brain injury where eve a single episode of hypotension is associated with poorer outcomes
  • cons: does not provide good muscle relaxation by itself; inhibition of cortisol secretion (via 11-beta hydoxylase inhibition)
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7
Q

how should circulation and hemorrhage control be approached?

A
  1. 2 large bore PIVs (≥ 16g) vs. central access
  2. hypovolemic shock: STOP THE BLEEDING!
    * thoracic cavity
    * abdominal cavity
    * pelvic fracture
    * long bones
    * external bleeding
  3. tourniquets
  4. 2L of warm isotonic fluid, assess response, the BLOOD
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8
Q

how should pupils be assessed in trauma?

A
  • pinpoint or blown?

* equal or unequal?

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9
Q

in what instances can pupil assessment be unreliable?

A
  • in the presence of certain intoxicants

* in the presence of facial or orbital trauma

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10
Q

how is best eye response (E) graded on glasgow coma scale?

A 
4 = spontaneous – open with blinking at baseline
3 = opens to verbal command, speech, or shout
2 = opens to pain, not applied to face
1 = none
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11
Q

how is best verbal response (V) graded on glasgow coma scale?

A 
5 = oriented
4 = confused conversation, but able to answer questions
3 = inappropriate responses, words discernible
2 = incomprehensible speech
1 = none
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12
Q

how is best motor response (M) graded on glasgow coma scale?

A 
6 = obeys commands for movement
5 = purposeful movement to painful stimulus
4 = withdraws from pain
3 = abnormal (spastic) flexion, decorticate posture
2 = extensor (rigid) response, decerebrate posture
1 = none
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13
Q

at what glasgow coma scale score is intubation indicated?

A

“less than 8 = intubate”

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14
Q

what is the approach for exposure and environmental control?

A
  • complete removal of patient’s clothing
  • warming of the OR
  • bair huggers wherever possible
  • warming of all fluids and good products
  • temperature monitoring: esophageal or bladder

hypothermia –> coagulopathy –> acidosis –> hypothermia…

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15
Q

what are the advantages of FAST (Focused Abdominal Sonogram for Trauma)?

A
  • faster than CT (2-5min)
  • cheaper than CT
  • no ionizing radiation
  • no transport to CT scanner
  • easy to rapidly repeat if patient decompensates
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16
Q

what position should patient be in for FAST?

A

supine – allows for free fluid to accumulate in dependent areas
* full bladder ideally for pelvic view

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17
Q

what are the transducer positions for FAST?

A

pericardial, right upper quadrant, left upper quadrant, pelvis

18
Q

what is the protocol for penetrating chest wounds following Echo?

A
  • positive echo –OR
  • equivocal/ambiguous echo – pericardial window
  • negative echo – observe
19
Q

describe DPL (diagnostic peritoneal lavage)

A
  • instrumental in diagnosing unstable blunt abdominal trauma
  • small infraumbilical incision to place catheter
  • instill 1L NS and allow to drain by gravity
  • need return of 200-300ml for accurate interpretation
20
Q

how is a positive DPL interpreted ?

A
  • 100,000 red cells/µL
  • 500 white cells/µL
  • 175 units amylase/dL
  • bacteria on Gram-stained smear
  • bile
  • food particles
21
Q

how is an intermediate DPL interpreted?

A
  • pink fluid on free aspiration
  • 50,000-100,000 red cells/µL in blunt trauma
  • 100-500 white cells/µL
  • 75-175 units amylase/dL
22
Q

how is a negative DPL interpreted?

A
  • clear aspirate

*

23
Q

describe damage control surgery

A
  • arresting surgical hemorrhage (abdominal packing, interventional radiology and balloon tamponade)
  • containing GI spillage
  • temporary abdominal closure
  • definitive repair and possible closure 6-48hr after initial injury
24
Q

describe damage control resuscitation

A
  • early blood product transfusion
  • restoration of blood volume and physiologic/hematologic stability
  • stop hemorrhage, restore blood volume, correct coagulopathy, acidosis, and hypothermia
  • avoid physiologic exhaustion and metabolic failure
25
Q

who needs damage control?

A
  • patients who are more likely to die from an uncorrected state of shock than from failure to complete organ repairs
26
Q

what are the parameters of damage control?

A
  • temp -15
27
Q

what is the first package given for massive transfusion protocol?

A

6u PRBCs, 6u FFP (repeated for package 2-6)

28
Q

when are platelets administered during massive transfusion protocol?

A

package 2, 4, 6 (1u each)

29
Q

when is cryoprecipitate administered during massive transfusion protocol?

A

package 3, 5

30
Q

when is rFVIIa approved automatically approved during massive transfusion protocol?

A

automatically approved after package 3, may repeat once

31
Q

how soon after injury is hyperkalemia with succinylcholine administration a risk?

A

does not occur until at least 24hr after injury

32
Q

how soon after injury is autonomic hyperreflexia with urinary catheterization a risk?

A

does not occur until weeks to years after injury

33
Q

how does spinal injury relate to thermoregulation?

A

patients lack thermoregulation below the level of the spinal cord injury

34
Q

how many individuals does it take to intubate with manual in-line stabilization?

A

takes 3 to intubate

  • one to perform DL
  • one to hold head and prevent neck movement
  • one to hold cricoid pressure during RSI
35
Q

how does a high spinal cord lesion increase the risk of respiratory failure?

A

patients with high spinal cord lesions lack the ability to cough vigorously and clear the airway

36
Q

describe a halo cervical brace

A
  • used to maintain complete immobility for patients with an unstable spine
  • unlike a c-collar, this should never be removed
37
Q

why should potassium chloride not be give to patients after transfusion?

A

stored blood may have lysed erythrocytes therefore causing hyperkalemia when transfused

38
Q

what effect does magnesium sulfate have on blood pressure?

A

may cause hypotension when transfused d/t smooth muscle relaxation

39
Q

what effect does calcium chloride have on blood pressure?

A

CPDA-1 in stored blood binds calcium. hypocalcemia may cause hypotension

40
Q

how is methylene blue effective as an antihypotensive?

A

nitric oxide synthetase inhibitor that can be used to treat vasolplegia (refractory hypotension) after CPB

41
Q

which patients are type O-negative RBCs prioritized for in periods of shortage?

A

prioritized for women of childbearing age to prevent isoimmunization and future erythroblastosis fettles in future pregnancies

42
Q

which patients can receive O-positive blood before patient’s blood type is known?

A

males and females past childbearing age

ANESTHESIA PRACTICE 2 (5 decks)

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