Chapter 9:Basic Trauma and Burn Support

Question 1

GCS that probably needs a protected airway

Answer 1

8 or less

Question 2

Hemothorax indications for thoracotomy

Answer 2

immediate evacuation of 1500ml or more or >200 ml per hour for 2-4 hours.

Question 3

what is paradoxical chest movement seen In segmental rib fractures

Answer 3

inward movement of segment on inspiration

Question 4

how much blood can an average adult lose and stay normotensive with minimal tachycardia

Answer 4

1,200ml

Question 5

what combo for massive transfusion

Answer 5

PRBC, FFP, cryoprecipitate

Question 6

Citrate in PRBC’s may chelate ____, promoting coagulation defect in massive transfusion patients

Answer 6

Calcium

Question 7

where is needle compression done for tension pneumothorax

Answer 7

midclavicular line second intercostal space

Question 8

4 classic signs of cardiac tamponade

Answer 8

JVD, Hypotension, distant heart sounds, pulses paradoxus

Question 9

what chamber of the heart is most commonly involved in blunt cardiac injury

Answer 9

RV

Question 10

What radiographs are acquired in primary surgery of blunt multisystem trauma

Answer 10

supine CXR and pelvis, CT if head involved or altered level of conciseness, maybe get it for cervical stuff too.

Question 11

What is next step if C spine has radiographic evidence of fracture on primary surgery x ray

Answer 11

x ray the entire spine bc 10% will have another fracture lower down.

Question 12

After spine is cleared what radiographs to get

Answer 12

Chest PA upright or Revers Trendelinburg. Better evaluate for hemorrhage/pneumo thorax, mediastinal widening,, fractures, and correct placement of tubes

Question 13

Persistent pneumothorax despite a functioning chest tube indicates____

Answer 13

tracheobronchial injury

Question 14

If urethral injury is suspected a ____ should be done before placing a catheter

Answer 14

urethrogram

Question 15

3 trauma situations with systemic abx coverage and what bacteria need to be covered in each situation

Answer 15

1. Patients undergoing intercranial pressure monitoring or chest tube placement get gram + coverage when device is inserted
2. Patients with penetrating abdominal trauma may be given coverage for gram - aerobic and anaerobic organisms for the first 24 hours after injury
3. Open fractures get gram + coverage for 24 hours as orthopedic evaluation is arranged

Question 16

2 agents that cause pupil dilation and can lead to false dx of more severe head injury

Answer 16

atropine and dopamine

Question 17

signs of compartment syndrome

Answer 17

pain, pallor, pulselessness, paresthesia, cold. loss of pulse is a very late finding

Question 18

what pressure is indicative of compartment syndrome and what is the tx

Answer 18

> 30 mmHg and tx is fasciotomy

Question 19

What 4 things do damaged myocytes release in a crush injury

Answer 19

myoglobin, K, Phos, Ca

Question 20

Crush syndrome manifestations

Answer 20

dysrhythmias, renal failure, metabolic acidosis, hypovolemia

Question 21

tx for crush syndrome

Answer 21

aggressive hydration to maintain urine output above 3-4 ml/kg/h helps prevent pigment associated renal injury. can add on bicarb and manitol.

Question 22

best end points for resuscitation

Answer 22

lactate concentration and resolution of metabolic acidosis

Question 23

3 stages of inhalation injury

Answer 23

1. Acute hypoxia
2. Upper airway and pulmonary edema
3. Infectious complications

Question 24

Half life CO on room air and on 100% O2

Answer 24

4 hrs, 30 minutes

Question 25

Why should succinylcholine be used with caution in burn patients

Answer 25

possible hyper k

Question 26

What is the preferred resuscitation fluid in burn injuries

Answer 26

LR

Question 27

In small burns max edema is seen ___ to ___ hours after injury but in larger burns it is seen ____ to ___ hours after

Answer 27

8-12, 12-24

Question 28

Formula for fluids in burn patient

Answer 28

2-4 ml/kg * %TBSA
half given in first 8 hours
other half in next 16 hours.
lower end may prevent compartment syndrome.

Question 29

tx when circumferential burn is compromising circulation

Answer 29

escharotomy