Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

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

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

You may prefer our related Brainscape-certified flashcards:
Biology 101 flashcards
1
Q

What is the target ICP

A

<22 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the definition of ROSC

A

aortic BP maintained >60 for 10 consecutive minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the oxygen extraction equation

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what would a high oxygen extraction indicate

A

reduced delivery

increased usage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what would a low oxygen extraction indicate

A 
increased delivery (hyperbaric chamber)
decreased usage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is the downside of permissive hypotension in TBI

A

further reduces CPP inducing secondary ischaemic injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

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

A

> 18 seconds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What INR indicates haemorrhagic complications

A

> 1.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is a downside of ROTEM machines

A

Don’t take into account any exogenous anticoagulants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

State some complications of transfusions

A

acute haemolytic transfusion reaction (ABO incompatibility)
TRALI
sepsis
TACO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Reference ranges for platelets

A

140-400 x 10^9/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Reference ranges for Hb and haematocrit

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Normal PT and APTT

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Reference ranges for fibrinogen

A

1.5-4.5 g/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

TXA complications and contraindications

A

seizures and hypotension

pregnancy, renal failure and seizure history

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

In which DCS patients should interventional radiology be considered

A

active arterial pelvic haemorrhage

spleen, liver, kidney injury with arterial haemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

define base excess

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What 4 key processes contribute to ATC

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

define base excess

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What 3 processes/ reflexes are involved in the physiological response to blood loss

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Describe the benefits of filming within pre-hospital care

A

educate the public
increased funding
benefit of telling your story for the patients
highlight safety issues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Describe the negatives of filming within pre-hospital care

A

consent and confidentiality issues
distracts the clinicians
can give false hope if only happy stories are shown

30
Q

The storage of RBCs reduces what components of it?

A

2-3DPG
neutrophils
haematocrit

31
Q

State the 4 stages of DCS

A

0=hameorrhage control and recognition that a patient needs DCS
1=initial exploratory laparotomy
2=physiological correction in ICU
3=further definitive surgery

32
Q

The storage of RBCs reduces what components of it?

A

2-3DPG (increased affinity of Hb for O2)
neutrophils
haematocrit

33
Q

What is fibrin glue

A

fibrinogen + thrombin

produces a clot in 10 seconds

34
Q

What blood products to HEMS carry

A

blood-plas (mixed o negative and plasma)
PCC
TXA

35
Q

What are the NICE guidelines for permissive hypotension

A

aim for palpable central pulse (femoral or carotid)

36
Q

Describe the MOA of TXA

A

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
Q

What is the role of factor 13

A

fibrin stabilisation: converts soluble fibrin to insoluble fibrin by crosslinking
It is activated by thrombin

38
Q

What are the LAA RSI indications

A 
unconscious 
airway obstruction
at risk of ventilatory failure
humanitarian
to facilitate procedures ie predicted clinical course
severe agitation
39
Q

What is the role of factor 5

A

bound to activated platelets it is needed by factor 10a to convert prothrombin to thrombin

40
Q

What dose of Ketamine would you use for analgesia, sedation IV and sedation IM

A

analgesia: 0.1mg/kg
IV sedation: 0.5mg/kg (slightly more in paeds)
IM sedation: 5mg/kg

41
Q

What are the LAA RSI indications

A 
unconsciousness
airway compromise
ventilatory failure
humanitarian
to facilitate procedures 
severe agitation
42
Q

What is oxygen delivery dependant on

A

CO
Hb O2 saturation
Hb concentration

43
Q

Compare when you’d use CT, FAST and DPL for assessment of a trauma patient

A

stable? = CT

unstable and FAST no available = DPL

44
Q

complications of a thoracotomy

A 
pneumothorax
phrenic nerve damage 
vagus nerve damage
bronchopleural fistula
arrhythmias
45
Q

complications of a thoracostomy

A 
intercostal artery damage and bleeding
recurrent pneumothorax
blocked drain
diaphragm injury
re-expansion oedema
46
Q

benefits of doing a subclavian CVC over IJV

A

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
Q

complications of CVC

A

pneumothorax
brachial plexus injury
lymphatic duct damage
phrenic nerve damage

48
Q

REBOA complications

A 
femoral artery damage = retroperitoneal bleed
aortic rupture (balloon overinflation)
ischaemic distal to balloon
hypertension and worsening TBI 
thrombosis
49
Q

How is DPL carried out

A

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
Q

What does DPL assess

A

intraperitoneal haemorrhage

hollow organ damage

51
Q

Complications of DPL

A

bladder or stomach injury if not been deflated

iliac vessel damage

52
Q

compare the advantages and disadvantages of DPL, FAST and CT

A

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
Q

How do you calculate the weight of a child

A

(age + 4) x 2

54
Q

How do you calculate ET tube size for a child

A

(age/4) + 4

55
Q

How much fluid do you give to a paediatric patient as a bolus

A

20ml/kg

56
Q

What energy is used to shock a paediatric patient

A

4j/kg

57
Q

What is the dose of lorazepam and adrenaline for a child

A

lorazepam: 0.1mg/kg
adrenaline: 0.1ml/kg 1:10,000

58
Q

What is the dose of dextrose for a child

A

2ml/kg of 10% dex

59
Q

How is TCA managed

A 
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
Q

When should a death be reported to the coroner

A

occurred within 24 hours of admission
occurred whilst under anaesthesia
unnatural or suspicious
died of industrial disease

61
Q

Target MAP and CPP in TBI

A

MAP 90mmHg

CPP 70mmHg

62
Q

signs of a retroperitoneal bleed on a plain film

A

obliteration of psoas outline

63
Q

Where do the vertebral arteries travel

A

transverse foramen

64
Q

State some issues with a permissive hypotension strategy

A

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
Q

Which clotting pathway is measured by PT and which by APTT

A

PT: extrinsive
APTT: intrinsic

66
Q

What does hypothermia do to the oxygen dissociation curve

A

shifts it left meaning Hb has a higher affinity for O2

67
Q

Pathological endogenous processes occurring as a result of TBI

A

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
Q

Benefits of cryo over FFP

A

less volume so lower risk of TRALI and TACO

less need for blood type matching

69
Q

TARN stands for what

A

trauma audit and research network

70
Q

Problems caused by intubating a haemorrhage patient

A

induction agents cause further hypotension

PPV reduces diastolic filling

71
Q

Signs of a pneumothorax on eFAST

A

absence of lung sliding and B lines

presence of A lines and lung point sign

PHM BSc - Trauma Science (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions