Chapters 1-3 Flashcards
GCS
8
flail chest is accompanied by what?
pulmonary contusion
HYPOTN is caused by ____ until proven otherwise
hypovolemia
what should crystalloid be heated to?
29 celcius
5 signs of urethral injury
blood at urethral meatus perineal ecchymosis blood in sctorum high riding prostate pelvic fracture
2 limitations for a FAST exam
obesity
intraluminal bowel gas
AMPLE history
allergies meds PMH/ pregancy alst meal event/ environment
minimum UOP for adults
0.5 mL/kg/hour
minimum UOP for kids
1.0 ml?kg/Hour
when will a bougie deviate R or L
at 40 cm
RSI dose for etomidate
0-3 mg/kg (usually 20 mg)
RSI for succinchycholine
1-2 mg/kg (usually 100 mg)
how will ketamine affect BP
increase
how does etomidate affect BP
it doesn’t
how will propofol and thiopental affect BP
they will drop it
RSI dose of succinylcholine lasts for how long
about 5 minutes
why do you not give sux for burn patients, crush injuries, hyperkalemia, chronic NM disease
risk for hyperkalemia
size needle for needle cric in adults? kids?
adults 12-14 gauge kids 16-18 gauge
surgical cric is not recommended under what age?
12
things to try before a surgical airway
chin lift, jaw thrust , OPANPA, LMA
what airway maneuver can you not do while maintaining c-spine precuations
jaw thrust
OPA size
corner of patient’s mouth to external auditory canal
LMA size for kid? women? man?
3,4,5
ET size for infant
size of nostril or little finger
3 for infants 3.5 for neonates
ET tube size for emergency cricothyroidotomy
5 or 6
how to calculate ET tube size for toddlers and kids
age/4 + 4= internal diameter
how much percentage of blood is located in the venous circulation
70
should vasopressors be used for hemorrhagic shock?
No, they will worsen it, only use volume replacement
SBP will drop once ___% is lost
30%
tachycardia for infants/ toddlers
> 160 (infants)
140 for preschool
120 prepubescent
100 adults
the blood loss of an obese person is based on what?
their ideal weight
class I hemorrhage
up to 15%
500 mL= ~10%
how do you treat class I hemorrhage?
you don’t usually. blood volume restored within 24 hours
blood volume loss with class II hemorrhage
15-30 % (750-1500 mL in a 70 kg adult)
Tx for class II hemorrhage
crystalloid
what CNS changes will you see with Class II hemorrhage
anxiety, fright, hostility
blood loss with Class III hemorrhage
30-40% (2000 mL)
loss of >___ % of blood leads to LOC
50%
blood loss with class IV hemorrhage
> 40%
what class hemorrhage is associated with a drop in SBP
Class III and >
Up to how much blood is lost with a femur fx
1500 mL
unexplained HPOTN/ dysrhythmias are often caused by what in children
gastric distention
blood on the floor x four more (what are the 4)
chest
pelvis
retroperitoneum
thigh
rapid responders to fluid resuscitation typically have what type hemorrhage
class I or II
transient responders are associated with what class of hemorrhage
II or III
do most patients receiving blood transfusions need calcium replacement
no
where do you make the incision for a saphenous vein cutdown and low long should the incision be?
1 cm anterior and 1 cm superior to the medial malleolus
make a 2.5cm transverse incision though skin and SQ
how to tell difference b/w hemothorax and pneumo
pneumo will be hyperresonant with percussion hemo will be dull
mass hemothorax
1500 mL or 1/3 or more of patient’s total blood loss
continuous blood loss of 200 mL/ hour for 2-4 hours
common chest tube size
38 French
where is a chest tube inserted
4th or 5th intercostal space just anterior to mid axillary line
who can get an ED thoracotomy
PEA with penetrating thoracic injuries (not with blunt!)
why should any hemothorax be drained
it can lead to lung entrapment or empyema
a pneumothorax with persistent large air leak after tube thoracostomy suggest a ____ injury
tracheobronchial
fracture of ribs 10-12 could cause an injury to what
lower ribs 10-12
4 places for FAST exam
mediastinum
hepatorenal fossa
splenorenal fossa
pouch od Douglas
only absolute c/i for DPL
pre exiisting condition requiring laparotomy
relative DPL contraindications
morbid obesity, acirrhosis, coagulopathy, previous abdominal surgery (adhesions)
2 reasons to use a supraumbilical approach for DPL
pelvic fractures and advanced pregnancy
DPL that indicates need for laparotomy (initial, not lab)
free blood (>10 mL) or GI contents
if DPL is not positive initially what do you do
Add 1,000 mL of warm isotonic crystalloid (or 10 mL/ kg) for kid
lab findings from DPL fluid that indicate need for laparotomy
> 100,000 red cells, 500 whit ecells or bacteria (on gram stain)
inidications for peritoneal laparotomy with penetrating wounds
unstable, GSW
what type of pelvic fractures are more common?
closed book
2 things to decompress before DPL
bladder adn stomach
adequate fluid return when getting DPL fluid back
30%
normal ICP in resting state
10 mm Hg
why might you hyperventilate people w/ brain injuries
high levels of CO@ cause cerebral vasculature to dilate
a midline shift great than what indicates need for neurosurgery
5 mm
mannitol dose
0.25-1.0g/kg via rapid bolus
when should a cast cutter be used to remove a trauma victim’s helmet
patient experience pain or paresthesias during inital attempt to remove helment of evidence of c-spien injury
most common type of C1 fracture
Jefferson (burst fracture)
any patient with more than __% of body burned should receive fluid resus.
20%
difference between partial and full thickness burns
full thickness burns go through dermis and into/beyond subQ
parkland formula (burns)
4(wegiht in kg)percentage BSA burned= volume in 24 hours (1st 1/2 in 8 hours 2nd over 16)
partial or full thickness burns of __% warrant transfer to a burn center (age
10%
partial or full thickness burns of a patient over 10 necessitate transfer to a burn center
20%
Tx for frostbite
soat water in 40 degree C water for 20-30 minutes.
how to estimate a child’s total circulating volume
80 mL/kg
