Chapter 9:Basic Trauma and Burn Support Flashcards
GCS that probably needs a protected airway
8 or less
Hemothorax indications for thoracotomy
immediate evacuation of 1500ml or more or >200 ml per hour for 2-4 hours.
what is paradoxical chest movement seen In segmental rib fractures
inward movement of segment on inspiration
how much blood can an average adult lose and stay normotensive with minimal tachycardia
1,200ml
what combo for massive transfusion
PRBC, FFP, cryoprecipitate
Citrate in PRBC’s may chelate ____, promoting coagulation defect in massive transfusion patients
Calcium
where is needle compression done for tension pneumothorax
midclavicular line second intercostal space
4 classic signs of cardiac tamponade
JVD, Hypotension, distant heart sounds, pulses paradoxus
what chamber of the heart is most commonly involved in blunt cardiac injury
RV
What radiographs are acquired in primary surgery of blunt multisystem trauma
supine CXR and pelvis, CT if head involved or altered level of conciseness, maybe get it for cervical stuff too.
What is next step if C spine has radiographic evidence of fracture on primary surgery x ray
x ray the entire spine bc 10% will have another fracture lower down.
After spine is cleared what radiographs to get
Chest PA upright or Revers Trendelinburg. Better evaluate for hemorrhage/pneumo thorax, mediastinal widening,, fractures, and correct placement of tubes
Persistent pneumothorax despite a functioning chest tube indicates____
tracheobronchial injury
If urethral injury is suspected a ____ should be done before placing a catheter
urethrogram
3 trauma situations with systemic abx coverage and what bacteria need to be covered in each situation
- Patients undergoing intercranial pressure monitoring or chest tube placement get gram + coverage when device is inserted
- Patients with penetrating abdominal trauma may be given coverage for gram - aerobic and anaerobic organisms for the first 24 hours after injury
- Open fractures get gram + coverage for 24 hours as orthopedic evaluation is arranged
2 agents that cause pupil dilation and can lead to false dx of more severe head injury
atropine and dopamine
signs of compartment syndrome
pain, pallor, pulselessness, paresthesia, cold. loss of pulse is a very late finding
what pressure is indicative of compartment syndrome and what is the tx
> 30 mmHg and tx is fasciotomy
What 4 things do damaged myocytes release in a crush injury
myoglobin, K, Phos, Ca
Crush syndrome manifestations
dysrhythmias, renal failure, metabolic acidosis, hypovolemia
tx for crush syndrome
aggressive hydration to maintain urine output above 3-4 ml/kg/h helps prevent pigment associated renal injury. can add on bicarb and manitol.
best end points for resuscitation
lactate concentration and resolution of metabolic acidosis
3 stages of inhalation injury
- Acute hypoxia
- Upper airway and pulmonary edema
- Infectious complications
Half life CO on room air and on 100% O2
4 hrs, 30 minutes
Why should succinylcholine be used with caution in burn patients
possible hyper k
What is the preferred resuscitation fluid in burn injuries
LR
In small burns max edema is seen ___ to ___ hours after injury but in larger burns it is seen ____ to ___ hours after
8-12, 12-24
Formula for fluids in burn patient
2-4 ml/kg * %TBSA
half given in first 8 hours
other half in next 16 hours.
lower end may prevent compartment syndrome.
tx when circumferential burn is compromising circulation
escharotomy
