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PHM BSc - Trauma Science > Bits and Bobs (mainly stolen from anki) (thanks Joe) > Flashcards

Bits and Bobs (mainly stolen from anki) (thanks Joe) Flashcards

1
Q

What is the target ICP

A

<22 mmHg

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2
Q

In bleeding, what endogenous processes have a procoagulant effect

A

endothelium activation which leads to

a) platelet activation and adhesion
b) subendothelial tissue is exposed which has procoagulant effects
c) clotting factor production and release

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3
Q

In bleeding, what endogenous processes have a anticoagulant effect

A

a) aPc activation: reduced factor 5 and 8 + increased plasmin
b) platelet dysfunction
c) glycocalyx barrier is shed
d) increased fibrinolysis due to release of tPA, PAP and proteolytic enzymes eg plasmin

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4
Q

What is the definition of ROSC

A

aortic BP maintained >60 for 10 consecutive minutes

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5
Q

Describe primary, secondary, tertiary and quarternary blast injuries

A

primary: blast wave itself causing hollow organ damage
secondary: debris injuries
tertiary: injuries from being thrown from the blast
quarternary: injuries as a result of the explosion such as burns

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6
Q

What is the oxygen extraction equation

A

oxygen extraction = oxygen removed from blood by metabolising tissue/oxygen delivery

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7
Q

as oxygen delivery reduces what happens to oxygen extraction and why

A

it increases to compensate for the reduced delivery in an attempt to maintain the amount available for tissues to use

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8
Q

what would a high oxygen extraction indicate

A

reduced delivery

increased usage

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9
Q

what would a low oxygen extraction indicate

A 
increased delivery (hyperbaric chamber)
decreased usage
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10
Q

what is the downside of permissive hypotension in TBI

A

further reduces CPP inducing secondary ischaemic injury

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11
Q

Why do we use permissive hypotension

A

lower hydrostatic pressure so less likely to disturb any clots that have formed
reduced acidosis, hypothermia and haemodilution

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12
Q

What prothrombin time indicates ATC and what should be given to correct it

A

> 18 seconds

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13
Q

What INR indicates haemorrhagic complications

A

> 1.5

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14
Q

Why do we want to avoid pain in bleeding patients

A

pain further increases sympathetic activation which in turn leads to:
glycocalyx barrier disruption
vasoconstriction so worsening tissue hypoxia

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15
Q

What is a downside of ROTEM machines

A

Don’t take into account any exogenous anticoagulants

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16
Q

State some complications of transfusions

A

acute haemolytic transfusion reaction (ABO incompatibility)
TRALI
sepsis
TACO

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17
Q

Reference ranges for platelets

A

140-400 x 10^9/L

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18
Q

Reference ranges for Hb and haematocrit

A

Hb: 115-180 g/L
haematocrit: 0.4-0.54

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19
Q

Normal PT and APTT

A

PT: 10-14 seconds
APTT: 24-37 seconds

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20
Q

Reference ranges for fibrinogen

A

1.5-4.5 g/L

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21
Q

What is the advantage of being acidotic in bleeding and what are the disadvantages

A

reduced affinity of Hb for O2 so offloads
however…
increased work of breathing to compensate
reduced catecholamine receptor responsiveness
reduced clotting factor activation
increased fibrinolysis

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22
Q

TXA complications and contraindications

A

seizures and hypotension

pregnancy, renal failure and seizure history

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23
Q

In which DCS patients should interventional radiology be considered

A

active arterial pelvic haemorrhage

spleen, liver, kidney injury with arterial haemorrhage

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24
Q

define base excess

A

The amount of acid needed to return 1L of fluid to a normal pH

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25
What 4 key processes contribute to ATC
glycocalyx barrier shedding: autoheparinization and fibrinolysis platelet dysfunction: activated on mass but then become exhausted and don't respond to further stimulation depleted fibrinogen: used up aPC: resulting in anticoagulation and fibrinolysis
26
define base excess
The amount of acid needed to return 1L of blood to a normal pH
27
What 3 processes/ reflexes are involved in the physiological response to blood loss
arterial baroreceptors: reduce vagal tone and increase sympathetics cardiac vagal c fibres: induce bradycardia and vasodilate in an attempt to reduce myocardial O2 demand arterial chemoreceptors: tachypnoea and vasoconstriction
28
Describe the benefits of filming within pre-hospital care
educate the public increased funding benefit of telling your story for the patients highlight safety issues
29
Describe the negatives of filming within pre-hospital care
consent and confidentiality issues distracts the clinicians can give false hope if only happy stories are shown
30
The storage of RBCs reduces what components of it?
2-3DPG neutrophils haematocrit
31
State the 4 stages of DCS
0=hameorrhage control and recognition that a patient needs DCS 1=initial exploratory laparotomy 2=physiological correction in ICU 3=further definitive surgery
32
The storage of RBCs reduces what components of it?
2-3DPG (increased affinity of Hb for O2) neutrophils haematocrit
33
What is fibrin glue
fibrinogen + thrombin | produces a clot in 10 seconds
34
What blood products to HEMS carry
blood-plas (mixed o negative and plasma) PCC TXA
35
What are the NICE guidelines for permissive hypotension
aim for palpable central pulse (femoral or carotid)
36
Describe the MOA of TXA
binds to lysine receptors on plasminogen and prevents the conversion to plasmin therefore reducing the amount of plasmin available to break down the fibrin clot
37
What is the role of factor 13
fibrin stabilisation: converts soluble fibrin to insoluble fibrin by crosslinking It is activated by thrombin
38
What are the LAA RSI indications
``` unconscious airway obstruction at risk of ventilatory failure humanitarian to facilitate procedures ie predicted clinical course severe agitation ```
39
What is the role of factor 5
bound to activated platelets it is needed by factor 10a to convert prothrombin to thrombin
40
What dose of Ketamine would you use for analgesia, sedation IV and sedation IM
analgesia: 0.1mg/kg IV sedation: 0.5mg/kg (slightly more in paeds) IM sedation: 5mg/kg
41
What are the LAA RSI indications
``` unconsciousness airway compromise ventilatory failure humanitarian to facilitate procedures severe agitation ```
42
What is oxygen delivery dependant on
CO Hb O2 saturation Hb concentration
43
Compare when you'd use CT, FAST and DPL for assessment of a trauma patient
stable? = CT | unstable and FAST no available = DPL
44
complications of a thoracotomy
``` pneumothorax phrenic nerve damage vagus nerve damage bronchopleural fistula arrhythmias ```
45
complications of a thoracostomy
``` intercostal artery damage and bleeding recurrent pneumothorax blocked drain diaphragm injury re-expansion oedema ```
46
benefits of doing a subclavian CVC over IJV
can do it with a cervical collar in place can do it during chest compressions more likely to be successful in bleeding as held open by surrounding structures
47
complications of CVC
pneumothorax brachial plexus injury lymphatic duct damage phrenic nerve damage
48
REBOA complications
``` femoral artery damage = retroperitoneal bleed aortic rupture (balloon overinflation) ischaemic distal to balloon hypertension and worsening TBI thrombosis ```
49
How is DPL carried out
can be open or closed 1) incision is made between pubic symphysis and umbilicus 2) aspirate 3) if no blood then flush with 1L of fluid 4) drain and send for analysis
50
What does DPL assess
intraperitoneal haemorrhage | hollow organ damage
51
Complications of DPL
bladder or stomach injury if not been deflated | iliac vessel damage
52
compare the advantages and disadvantages of DPL, FAST and CT
DPL and FAST >CT : be done if patient is unstable, no radiation damage, cheaper FAST > DPL: reproducible, non-invasive, no interference with any subsequent CT scans CT> FAST and DPL: assess solid organ damage, assess retroperitoneum
53
How do you calculate the weight of a child
(age + 4) x 2
54
How do you calculate ET tube size for a child
(age/4) + 4
55
How much fluid do you give to a paediatric patient as a bolus
20ml/kg
56
What energy is used to shock a paediatric patient
4j/kg
57
What is the dose of lorazepam and adrenaline for a child
lorazepam: 0.1mg/kg adrenaline: 0.1ml/kg 1:10,000
58
What is the dose of dextrose for a child
2ml/kg of 10% dex
59
How is TCA managed
``` simultaneously: manage catastrophic haemorrhage gain control of the airway and ventilate bilateral chest decompression Then assess if thoracotomy is appropriate for relief of cardiac tamponade and proximal haemorrhage control via aortic compression activate MTP ```
60
When should a death be reported to the coroner
occurred within 24 hours of admission occurred whilst under anaesthesia unnatural or suspicious died of industrial disease
61
Target MAP and CPP in TBI
MAP 90mmHg | CPP 70mmHg
62
signs of a retroperitoneal bleed on a plain film
obliteration of psoas outline
63
Where do the vertebral arteries travel
transverse foramen
64
State some issues with a permissive hypotension strategy
differing definitions used by different people Can worsen TBI Doesn't work if the hypotension is caused by a bleeding mimic Individuals require differing blood pressures (eg a hypertensive 100kg man would need different to a 90y/o 50kg female) based largely on animal studies
65
Which clotting pathway is measured by PT and which by APTT
PT: extrinsive APTT: intrinsic
66
What does hypothermia do to the oxygen dissociation curve
shifts it left meaning Hb has a higher affinity for O2
67
Pathological endogenous processes occurring as a result of TBI
catecholamine surge leading to: a) glycocalyx shedding leading to coagulopathy b) coronary vasospasm and myocardial ischaemia c) neurogenic pulmonary oedema BBB breakdown leading to inflammatory factor release into systemic circulation consumptive coagulopathy due to platelet activation factor and brain tissue factor release
68
Benefits of cryo over FFP
less volume so lower risk of TRALI and TACO | less need for blood type matching
69
TARN stands for what
trauma audit and research network
70
Problems caused by intubating a haemorrhage patient
induction agents cause further hypotension | PPV reduces diastolic filling
71
Signs of a pneumothorax on eFAST
absence of lung sliding and B lines | presence of A lines and lung point sign

PHM BSc - Trauma Science (15 decks)

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