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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
What happens to resp system if fresh water is inhaled
Depletion of surfactant, causing vq mismatch | Inhaled water absorbed by vascular system increasing shunt and hypoxia
26
What happens to other organs with inhalation of fresh water
Fresh water is rapidly absorbed into circulation, causing electrolyte imbalance. Hyponatremia can cause seizures Hyperkalemia can cause vfib
27
What happens to resp system with inhalation of salt water
Hypertonic fluid in lungs causes water to move from circulation into the lungs Damages ac membrane Causes sustained edema and shunt
28
What happens to other organs with inhalation of salt water
Rapid loss of circulating volume causes hypernatremia, hypoalbuminema, and Hemoconcentration. This can lead to vascular collapse and hypovolemic shock
29
Management of near drowning
Airway-breathing-circulation, cpr if needed Airway clearance via bronchoscopy, lavage or proning Mechanical ventilation
30
Near drowning patients almost always develop ?
Ards
31
What causes death in burns
Burn shock within first hours | Wound sepsis in those who survive burn shock
32
Survival in burn patients is associated with
Early fluid recus Prevention of post burn sepsis Aggressive surgical treatment Improved peri operative care
33
What should be first priority In burn patients
Airway management because inhalation of hot gasses and smoke can cause edema and swelling. Intubation ASAP
34
Indications for early intubation in burn patients
Gradual, progressive compromise of gas exchange | Facial burns or evidence of upper airway involvement.
35
What is a first degree burn
Superficial, only to the epidermis
36
What is a second degree burn
Burns to the dermis
37
What is third degree burn
Destruction of epidermis and dermis
38
What is fourth degree burn
Involves muscles and burns
39
When should surgical debridement be considered
Any burn second degree or greater
40
What happens to the lungs in burns with chest wall involvement
Often ards develops
41
What is the percent tbsa of a burn to the head
9
42
What is the percent tbsa of a burn to the torso
36 (18 for front, 18 for back)
43
What is the percent tbsa of a burn to the arms
9 (4.5 each)
44
What is the percent tbsa of a burn to the legs
18 (9 each)
45
What is the percent tbsa of a burn to the genitals
1
46
Carbon monoxide poising occurs in?
Fire related burns
47
When to patients with co poisoning become symptomatic
With levels above 15%
48
What co levels are lethal
50% and up
49
Which way does co shift the oxy hgb curve
Left
50
How do we treat co poisoning
Give 100% o2 | Hyperbaric chamber
51
What are early signs of co or cyanide poisoning
``` Anxiety Tachycardia, tachypnea Arrhythmia Hypertension Headache Confusion Bradycardia, seizures, decreased loc ```
52
What does cyanide poisoning do to ABG
Adequate oxygen, Metabolic acidosis with anion gap
53
How much cyanide is considered dangerous
20 ppm
54
How much cyanide is considered lethal
100 ppm
55
What happens to intravascular fluid if body surface burns exceed 25%
The fluid shifts to extra vascular space and edema occurs
56
Why is it important for burn patients to be well hydrated
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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