BJA REVIEW Flashcards
FAT EMBOLISM SYNDROME
Presents 24-72hrs
From long bone fractures, but also pancreatitis, liposuction, osteomyelitis, fatty liver,
Rarely presents intraop
CLASSIC TRIAD = hypoxaemia, neurological dysfunction and petechiae rash
Sequelae Resp --> ARDS CNS --> seziures, focal neuro deficits. CVS --> tachycardia, arrthymia, RHF, ischaemia Haem --> anaemia , thrombocytopaenia.
DIAGNOSTIC CRITERIA GERD MAJOR Axillary/Subconjuntival haemmorhage Hypoxia with bilateral xray changes cerebral signs not caused by another aetiology MINOR Tachycardia, Pyrexia, Fat in urine, sudden decrease haematocrit
PATHOGENESIS
MECHANICAL vs BIOCHEMICAL THEORY vs COAGULATION THEORY
Management
early fixation
ventialtion –> no described but ARDS
aim to reduce secondary injury, consider seizure prophylaxis
CVS support
DRUGS - trials hard - heparin and steriods - No major consensus
Neck Trauma
Blunt or Penetrating
ZONES OF NECK INJURY
1 clavicle to cricoid
2 cricoid to angle mandible
3 angle mandible to base of skull
EMST
early surgeon involvement
Airway - threatened or obstructed? control haemmorhage, cspine immobilised RED FLAGS STRIDOR - respiratory distress Dysponea - eccymoses of neck dyspnoea - surgical empysema dysphagia - tracheal deviation odynophagia - haemoptysis/ neck haematoma `
Airway principles different
-no cricoid , PPV could make it worse
If not deteriorating -> FNE + CT
Stable / mucosal - humidified O2 PPI, rest, HDU , review every 24
ETT - false passge, trauma, displace fracture/haematoma
Cspine - try but may need to abandon
OPTIONS
AwAKE FIbreoptic - if cooperative BUT often impractical - risk of trauma, ETT needs to be snug, topicalisation and coughing and loss of airway.
AWAKE tracheostomy is gold standard
HFNO - caution may dislodge clots and worsen surgical emphysema
NOT cooperative RSI two person technique with fibreoptic bronch past lesion. Video vs Direct blood etc Just use YOUR TECHNIQUE ETT CUFF PAST LESION If desaturation minimise PPV
Watch for life threat thoracic injury
haemmorhgae
