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Egans 11th > Chapter 30-Trauma, obesity, Drowning, Burns > Flashcards

Chapter 30-Trauma, obesity, Drowning, Burns Flashcards

1
Q

What is a penetrating trauma

A

High force applied to small surface of body

Ex gunshot

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2
Q

What is a blunt trauma

A

High force over large body surface

Ex motor vehicle accident

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3
Q

How does tension pneumothorax effect hemodynamics

A

More air enters pleural space with every breath causing collapse of vascular structures including the vena cava.

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4
Q

What therapy can be considered for patients with multiple fractured ribs leading to fatigue

A

Cpap

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5
Q

When should bronchial injury be suspected

A

When large amounts of air exit chest tube in a synch pattern with Ppv

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6
Q

Displaced rib fractures can cause

A

Pneumothorax or hemothorax

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7
Q

During inspiration, flail chest moves

A

Inward

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8
Q

During expiration, flail chest moves

A

Outward

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9
Q

Blunt trauma can cause

A

Pneumothorax
Hemothroax
Pulmonary contusions
Atelectasis

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10
Q

4 treatments to focus on for patients with chest trauma

A

Mobilization to help move secretions
Humidification of airways
Pain control
Incentive spirometry and niv

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11
Q

What BMI is considered obese

A

Greater than 30

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12
Q

What bmi is severe obesity

A

Greater than 40

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13
Q

What bmi is morbid obesity

A

Greater than 45

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14
Q

What bmi is super obesity

A

Greater than 50

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15
Q

What are physiologic concerns with obesity

A 
Heart disease
Thrombosis, PE
OSA
Oha
Reduced lung volumes
Expiratory flow resistance
Air trapping, auto peep
Diabetes
Htn
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16
Q

How does obesity cause heart disease

A

Adipose tissue is perfumed by 3mls blood for each 100g of tissue
This causes an increased blood volume, increasing preload,cardiac output and cardiac work

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17
Q

What happens to lung volumes as bmi increases

A

Lung volumes decrease

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18
Q

How is obesity managed

A 
Oxygen therapy for hypoxemia
Bronchodilators for asthma
Cpap for osa 
Niv for oha and hypercsrbic resp failure 
Mv if unresponsive to niv
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19
Q

What should be suspected with sudden onset oh hypoxemia

A

Pulmonary embolism

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20
Q

What factors contribute to the success of niv

A

Patient awake and able to cooperate
Able to clear secretions
Hemodynamic stability

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21
Q

What is the preferred mode of ventilation for obesity

A

Pressure support with high peep

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22
Q

What is wet drowning

A

When patients aspirate water during drowning

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23
Q

What is dry drowning

A

When laryngospasm with glottis closure prevents aspiration of water

24
Q

What is cold shock cardiac respiratory reflex

A

With sudden immersion in water colder than 25 degrees, breathing pattern changes to gasping then hyperventilation at tlc.

Vasoconstriction occurs increasing SVR , preload and afterload. Cardiovascular collapse may occur

25
Q

What happens to resp system if fresh water is inhaled

A

Depletion of surfactant, causing vq mismatch

Inhaled water absorbed by vascular system increasing shunt and hypoxia

26
Q

What happens to other organs with inhalation of fresh water

A

Fresh water is rapidly absorbed into circulation, causing electrolyte imbalance.
Hyponatremia can cause seizures
Hyperkalemia can cause vfib

27
Q

What happens to resp system with inhalation of salt water

A

Hypertonic fluid in lungs causes water to move from circulation into the lungs
Damages ac membrane
Causes sustained edema and shunt

28
Q

What happens to other organs with inhalation of salt water

A

Rapid loss of circulating volume causes hypernatremia, hypoalbuminema, and Hemoconcentration.
This can lead to vascular collapse and hypovolemic shock

29
Q

Management of near drowning

A

Airway-breathing-circulation, cpr if needed
Airway clearance via bronchoscopy, lavage or proning
Mechanical ventilation

30
Q

Near drowning patients almost always develop ?

A

Ards

31
Q

What causes death in burns

A

Burn shock within first hours

Wound sepsis in those who survive burn shock

32
Q

Survival in burn patients is associated with

A

Early fluid recus
Prevention of post burn sepsis
Aggressive surgical treatment
Improved peri operative care

33
Q

What should be first priority In burn patients

A

Airway management because inhalation of hot gasses and smoke can cause edema and swelling.
Intubation ASAP

34
Q

Indications for early intubation in burn patients

A

Gradual, progressive compromise of gas exchange

Facial burns or evidence of upper airway involvement.

35
Q

What is a first degree burn

A

Superficial, only to the epidermis

36
Q

What is a second degree burn

A

Burns to the dermis

37
Q

What is third degree burn

A

Destruction of epidermis and dermis

38
Q

What is fourth degree burn

A

Involves muscles and burns

39
Q

When should surgical debridement be considered

A

Any burn second degree or greater

40
Q

What happens to the lungs in burns with chest wall involvement

A

Often ards develops

41
Q

What is the percent tbsa of a burn to the head

A

9

42
Q

What is the percent tbsa of a burn to the torso

A

36 (18 for front, 18 for back)

43
Q

What is the percent tbsa of a burn to the arms

A

9 (4.5 each)

44
Q

What is the percent tbsa of a burn to the legs

A

18 (9 each)

45
Q

What is the percent tbsa of a burn to the genitals

A

1

46
Q

Carbon monoxide poising occurs in?

A

Fire related burns

47
Q

When to patients with co poisoning become symptomatic

A

With levels above 15%

48
Q

What co levels are lethal

A

50% and up

49
Q

Which way does co shift the oxy hgb curve

A

Left

50
Q

How do we treat co poisoning

A

Give 100% o2

Hyperbaric chamber

51
Q

What are early signs of co or cyanide poisoning

A 
Anxiety
Tachycardia, tachypnea 
Arrhythmia
Hypertension
Headache 
Confusion
Bradycardia, seizures, decreased loc
52
Q

What does cyanide poisoning do to ABG

A

Adequate oxygen, Metabolic acidosis with anion gap

53
Q

How much cyanide is considered dangerous

A

20 ppm

54
Q

How much cyanide is considered lethal

A

100 ppm

55
Q

What happens to intravascular fluid if body surface burns exceed 25%

A

The fluid shifts to extra vascular space and edema occurs

56
Q

Why is it important for burn patients to be well hydrated

A

Fluid shifts can cause impaired perfusion resulting in ischemia, metabolic acidosis and mixed venous desats as a result of hypovolemic and distributive shock

Egans 11th (13 decks)

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