CCP 219 - Trauma Flashcards
How is C-spine cleared?
CT or preferably MRI.
C-spine XR is not acceptable.
What does rectal exam assess?
1) Rectal tone determining lower extremity neurological impairment.
2) Puncture of rectal wall in pelvic fracture.
What does the neurological exam entail in an awake patient?
1) GCS (focus on M).
2) Cranial nerve assessment.
3) Peripheral neuro (ie. reflexes and tone).
HOB elevation to 30 degrees from supine reduces ICP by ___ mmHg instantly.
10-12 mmHg.
When is seizure prophylaxis indicated in TBI?
1) Hx of Sz.
2) Witnessed Sz after current TBI.
3) Depressed skull fracture.
4) Penetrating skull fracture.
5) Temoral lobe injury (ie. MCA rupture).
Outline the approach to status epilepticus:
1st: Benzodiazepines.
2nd: Phenytoin, Keppra, VPA.
3rd: Propofol infusion, midazolam infusion, ketamine.
4th: Magnesium, hypothermia, surgery, ECT, ketogenic diet, volatile gases.
What is the dosage of phenytoin?
20mg/kg (as a MAX 50mg/min because it can produce hypotension).
When is phenytoin contraindicated?
In TCA overdose (because of sodium channel blockade).
What is the risk of propofol infusions for the management of seizure?
Runs the risk of propofol infusion syndrome.
Risk factors for propofol infusion syndrome include:
1) > 80mg/kg/hr
2) Young age
3) Prolonged infusion (ie. > 12 hr)
Why is magnesium used in the management of eclampsia?
Because other antiepileptics are toxic to the fetus.
What does the DIMSS mnemonic for status epilepticus causes stand for?
D - Drugs I - Infection M - Metabolic S - Structual S - Seizure disorder
What is the timed approach for the management to status epilepticus?
0-15min = Benzos 15-30min = Phenytoin, VPA, Keppra. 30-45 = Propofol/midaz infusion, ketamine. 45-60 = Magnesium, hypothermia, surgery, ECT, ketogenic, volatile gas.
What is “central cord syndrome”?
The shaking/stretching back-and-forth of the spinal cord, producing discrepancy between upper and lower neurons.
What might indicate that propofol infusion syndrome is developing?
Increasing lactate without other cause of shock.
Approximately ___% of DAI CTs are normal.
50%.
Ischemic CVA without thrombolysis should have SBP managed < ___.
< 220.
Ischemic CVA with thrombolysis should have SBP managed < __.
< 180.
What is the ependyma?
The thin neuroepithelial lining of the ventricular system of the brain.
Outline the approach to impending herniation:
1) Hyperventilation guiding ETCO2 between 25-30.
2) HTS 3% 5mL/kg or Mannitol 1g/kg.
3) Increase MAP (ie. to 80-100).
4) Increase sedation.
5) Hyperoxygenate.
A patient with an upwards trending ICP (currently at 20mmHg) is being treated with osmotherapy to prevent herniation; what can be done with the dose in the absence of herniation?
Cut the dose of HTS/mannitol in half.
The second half can be given later as a “top-up” dose.
How long does osmotherapy take to exert effect?
20-30 minutes.
Should osmotherapy be given liberally, or conservatively?
Liberally.
What is an effective bridge to reduce ICP until osmotherapy begins to take effect?
Hyperventilation.
Intubation is necessary in neuromuscular disease when:
1) Hypercapnia exists (or normocapnia with hyperventilation).
2) Accessory muscle use.
3) C6 impairment.
4) VC < 20mL/kg.
What are the three highest yield data points for shock state differentiation?
1) Skin (Distributive vs ALL)
2) JVP (Hypovolemic/distributive vs cardiogenic/obstructive)
3) U/S (Cardiogenic vs obstructive)
What is “triple H” therapy?
Treatment of cerebral vasospasm associated with SAH:
Hypervolemia
Hypertension
Hemodilution
