Ch. 3 Trauma Flashcards
What is the correct ratio for MTP?
1:1:1 pRBCs to platelets to FFP
Giving TXA within __ hours of injury has been proven to reduce mortality
3
What are the 5 signs of life for resuscitative purposes?
- palpable pulse
- spontaneous movement
- spontaneous resuscitative efforts
- cardiac activity on ECG
- pupillary light response
What is the survival rate for ED thoracotomy following blunt trauma with cardiac arrest?
<2%
What are the 3 indications for ED thoracotomy in blunt trauma?
- prehospital/hospital signs of life with loss for LESS than 10 minutes
- Unresponsive hypotension (BP <70 mmHg) despite resuscitation with echo evidence of cardiac tamponade
- Rapid exsanguination from a chest tube (>1500 cc output upon insertion)
What are 3 contraindications to ED thoracotomy for blunt trauma?
- prehospital CPR >10 minutes without response
- asystole as presenting rhythm and no echo evidence for cardiac tamponade
- significant head trauma
What are 3 indications for ED thoracotomy in PENETRATING trauma?
- prehospital/hospital signs of life
- echo evidence of cardiac activity with cardiac tamponade
- unresponsive hypotension (BP<70mmHg) despite resuscitation with penetrating chest wound
What are 3 contraindications for ED thoracotomy for penetrating trauma?
- Prehospital CPR >15 minutes without response
- Asystole as presenting rhythm and no echo evidence for cardiac tamponade
- Significant head trauma
What is ideal Cerebral Perfusion Pressure (CPP)?
> 60mmHg
What is ideal MAP in head injuries?
> 80mmHg
What is ideal ICP in head injuries?
<15 mmHg
What are the 2 brainstem tests?
- Oculocephalic response
- Oculovestibular response
What is oculocephalic response?
Conjugate deviation of eyes in direction opposite to passive head rotation (once C-spine cleared) - indicates intact brainstem function in a comatose patient
What is oculovestibular response?
Instillation of 30-mL cold saline into the ear;
horizontal nystagmus with FAST component AWAY from tested ear indicates intact brainstem function.
What is uncal herniation syndrome?
Compression of ipsilateral CN III →
IPSILATERAL pupillary dilation and decreased reactivity
“Down and out” position of eye with only lateral rectus (CN VI) and superior oblique (CN IV) functioning
Eventual compression of ipsilateral peduncle → contralateral hemiparesis
What is mannitol dosing for decreasing ICP in adults?
0.25-1g/kg IV Mannitol bolus
How is ICP decreased in pediatric patients?
Hypertonic saline 3% 0.1-1mL/kg/h (infants and children) - produces osmotic diuresis
What is dispo for anticoagulated patient with head injury and negative head CT?
Admit for obs given increased risk for delayed bleed
What types of fractures are NG tubes contraidicated?
Cribriform plate fractures
What are the 3 main concerns for blunt neck trauma?
intimal tear
pseudoaneurysm
carotid or vertebral artery dissection
Zones of the neck: What are the landmarks for Zone I?
Clavicles to cricoid cartilage
Zones of the neck: What structures are involved in Zone I?
trachea, esophagus, vertebral and carotid arteries
Great vessels, lung apices, thoracic duct, spinal cord
Zones of the neck: What are the landmarks for Zone II?
Cricoid cartilage to angle of mandible
Zones of the neck: What structures are involved in Zone II?
trachea, esophagus, vertebral and carotid arteries
larynx, jugular veins