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Trauma > Circulation > Flashcards

Circulation Flashcards

1
Q

Blood that is drawn directly from an on-site donor and does not undergo processing into separate components (RBCs, plasma, and platelets)

A

Fresh Whole Blood (FWB)

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2
Q

Oxygen carrying capability of the blood

A

Red blood cells

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3
Q

Cell fragments that are integral to clot formation

A

Platelets

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4
Q

Contain ALL of your clotting factors/coagulation factors needed in the process to form fibrin strands which cement the platelet plug for clotting

A

Plasma

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5
Q

Fresh whole blood contains:

A

RBCs

Platelets

Plasma

Immunological components (WBCs, antibodies, cytokines)

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6
Q

This is used to prevent the blood from clotting and prevent the cells from lysing during the time from collection to delivery.

A

CPD solution (anticoagulant Citrate and nutrient Phosphate and Dextrose)

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7
Q

Fresh whole blood has a shelf life of:

A

24-48 hours

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8
Q

Contain markers on surface that characterize the cell type

Also known as antigens-proteins and sugars that the body use to identify the blood cells that belong to the body

A

RBCs

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9
Q

Classification determined by presence or absence of antigens

A

ABO

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10
Q

Meaning it has a Rh factor

A

Rh positive

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11
Q

Meaning without Rh factor

A

Rh negative

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12
Q

This blood type has neither A & B markers

A

Type O

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13
Q

This blood type doesn’t have A or B markers, and it doesn’t have Rh factor.

A

O negative

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14
Q

This blood type doesn’t have A or B markers but does have Rh factor.

One of the two most common blood types

A

O positive

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15
Q

This blood type has A marker with no Rh factor

A

A negative

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16
Q

This blood type has A marker and Rh factor, but not B marker. One of the two most common blood types.

A

A positive

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17
Q

This blood type has B marker only and no Rh factor

A

B negative

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18
Q

This blood type has B marker only

A

B negative

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19
Q

This blood type has B marker and Rh factor, but not A marker.

A

B positive

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20
Q

All males can receive what type of blood at any time?

A

O positive and O negative

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21
Q

All females of childbearing age receive what type of blood

A

O negative

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22
Q

The only oxygen-carrying cell circulating and are needed to halt and repay oxygen debt.

A

RBCs

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23
Q

30-40% blood loss

1) 1500-2000 ml of blood loss
2) > 120 pulse rate per minute
3) Decreased blood pressure
4) 30-40 respirations per minute
5) Urine output 5-15 ml per hour
6) Level of Consciousness exhibiting confused demeanor

A

Class III Hemorrhagic shock

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24
Q

> 40% of blood loss

1) > 2000 ml of blood loss
2) > 140 pulse rate per minute
3) Decreased blood pressure
4) > 35 respirations per minute
5) Urine output negligible
6) Level of Consciousness exhibiting lethargic demeanor
* Absent radial pulse/systolic blood pressure below 80mmHg*

A

Class IV Hemorrhagic shock

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25
Q

Potentially life-threatening reaction caused by acute intravascular hemolysis of transfused red blood cells

A

Hemolytic reaction

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26
Q

Severe hemolytic reactions can occur with as little as how much blood?

A

10-30 mL

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27
Q

Presenting signs following a blood transfusion :

1) Fever
2) Chills
3) Flank pain
4) Oozing from intravenous sites

A

Hemolytic reactions

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28
Q

Treatment for hemolytic reactions

A

Aggressive hydration and diuresis

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29
Q

Recommendation is to give 1 amp of ________ every 4 units of FWB to avoid toxicity and hypocalcemia

A

Calcium Gluconate

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30
Q

These are common following a blood transfusions; these reactions are characterized by fever, usually accompanied by chills, in the absence of other systemic symptoms.

A

Febrile non-Hemolytic Reactions

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31
Q

Most common cause of febrile non-hemolytic transfusion reactions due to:

A

Release of cytokines from WBCs

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32
Q

Treatment for Febrile non-Hemolytic Reactions

A

1 gram of Tylenol PO/PR every 8 hours

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33
Q

Any allergic reaction other than _______ constitutes an anaphylactic transfusion reaction

A

Hives

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34
Q

Treatment for anaphylaxis reaction

A

IM Epinephrine, antihistamines, vasopressors

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35
Q

Are associated with hives but no other allergic findings

A

Urticarial Reaction

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36
Q

Immediate actions for hemolytic reactions

A

Immediately stop

Maintain IV/IO line with fluid bolus

Assess for symptoms

Measure vital signs and perform a physical examination

Confirm the correct product was transfused

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37
Q

Contact your local ______________ to coordinate screening your unit for cross type and match

A

Armed Services Blood Program (ASBP)

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38
Q

Fill out the back of the TCCC card or an ________ prior to transfusion and record vital signs every 10-15 minutes during transfusion

A

SF 518

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39
Q

In a patient with allergies or history of a previous allergic transfusion reaction give:

A

25-50mg diphenhydramine IM/PO/IV prophylactically before transfusion

40
Q

In a patient with a history of febrile reaction give:

A

1g acetaminophen PO/PR/IV prophylactically before transfusion

41
Q

Record baseline vitals and continue to record them through and following the transfusion at minimum every 15 minutes. For the first 15 minutes of the transfusion record them every:

A

5 minutes

42
Q

Set the flow rate to deliver approximately _____ of blood over the first 15 minutes .

A

10-30 mL (1gtt/4-6 sec = 1ml/min)

43
Q

After the first 15 minutes and there is no adverse reaction evident set the main roller clamp to deliver approximately

A

200ml/min (1 Unit (U) in 2-2.5 minutes)

44
Q

If a casualty is anticipated to need a significant volume of blood transfusion due to the following:

(a) Hemorrhagic Shock
(b) One or more amputations
(c) Penetrating torso trauma
(d) Evidence of severe bleeding

Administer what medication?

A

Tranexamic Acid (TXA)

45
Q

Helps to reduce blood loss from internal hemorrhage sites that cannot be addressed by tourniquets and hemostatic dressings

Prevents the clots from breaking down by keeping fibrin strands around longer to maintain the clot and thus helps to prevent internal bleeding and ultimately prevent death from hemorrhage

A

TXA

46
Q

The two major studies have shown a survival benefit from TXA

A

CRASH-2: 20,000 plus patients in civilian trauma centers

MATTERS (Military Application of Tranexamic Acid in Traumatic Emergency and Resuscitative Surgery) in which 896 casualties treated at a military hospital in Afghanistan.

47
Q

Survival benefit is greatest when TXA is given within ____ of injury

A

1 hour

48
Q

Administer ______ of tranexamic acid in 100 ml normal saline or lactated ringers as soon as possible, but not later than 3 hours after injury

A

1 gram

49
Q

Forms a reversible complex that displaces plasminogen from fibrin resulting in inhibition of fibrinolysis

A

TXA

50
Q

TXA

Recommended temperature range for storage:

A

59-86 degrees F

51
Q

IV Fluids

Replaces normal ongoing losses

A

Maintenance therapy

52
Q

IV fluids

Corrects any existing water and electrolyte deficits

A

Replacement therapy

53
Q

Correlation with what is a better indication for adequate perfusion?

A

Urine output

Cognitive function

54
Q

IV fluids come in what forms?

A

Colloids

Crystalloids

Blood and blood products

55
Q

Used to increase the blood volume following severe loss of blood (hemorrhage) or loss of plasma (severe burns)

A

Colloids (Volume Expanders)

56
Q

IV fluids

Plasma protein fractions, salt poor albumin, dextran, and hetastarch

Do not diffuse out of the vascular space as quickly as crystalloids

A

Colloids

57
Q

Fluids that consist of water and dissolved crystals, such as salts and sugar

Used as maintenance fluids to correct body fluids and electrolyte deficit

Contain electrolytes (e.g., sodium, potassium, calcium, chloride) but 
lack the large proteins and molecules found in colloid
A

Crystalloids

58
Q

Mainstay IV therapy in prehospital settings

A

Crystalloids

59
Q

Crystalloids are classified according to their:

A

Tonicity

60
Q

Describes the concentration of electrolytes (solutes) dissolved in the water, as compared with that of body plasma (fluid surrounding the cells)

A

Tonicity

61
Q

Crystalloid contains the same amount of electrolytes as the plasma

A

Isotonic

62
Q

Most common isotonic solutions

A

LR

NS

D5W

63
Q

A crystalloid contains more electrolytes than the body plasma, it is more concentrated and referred to as:

A

Hypertonic

64
Q

Administration of ______ crystalloid causes water to shift from the extravascular spaces into the bloodstream, increasing the intravascular volume

A

Hypertonic

65
Q

IV fluids used in:

  • Shock
  • Resuscitation
  • Fluid challenges
  • Blood transfusions
  • Metabolic alkalosis
  • Hyponatremia
  • DKA
A

NS

66
Q

IV fluids

  • Use with caution in patients with heart failure, edema, or hypernatremia
  • Can lead to volume overload
  • Speeds up the lethal triad of hypothermia, coagulopathy, and acidosis
A

NS

67
Q

IV fluids used in:

  • Dehydration
  • Burns
  • GI tract fluid loss
  • Acute blood loss
  • Hypovolemia
A

LR

68
Q

IV fluids

-Contains Potassium, can cause hyperkalemia in renal patients
-Patients with liver disease cannot metabolize lactate
-Lactate is converted into bicarb by liver which with larger volumes can
lead to metabolic alkalosis

A

LR

69
Q

IV fluids used in:

  • Fluid loss and dehydration
  • Hypernatremia
A

D5W

70
Q

IV fluids

  • Solution becomes hypotonic when dextrose is metabolized
  • Do not use for resuscitation
  • Use cautiously in renal and cardiac patients
A

D5W

71
Q

The primary fluid of choice for hypovolemia due to blood loss per TCCC, and DOD Joint trauma surgeon’s protocols.

A

Fresh Whole Blood

72
Q

The universal compatibility of ___ blood makes it the ideal choice for administration in emergent situations

A

O blood

73
Q

This is the most common intravenous access method in both hospital and field settings

A

Peripheral IV catheter

74
Q

Form of intravenous access that can be used for a prolonged period of time

A

Peripherally inserted central catheter (PICC)

75
Q

An infusion tube located in or near the heart, which is at the center of the circulatory system. For example, a Triple Lumen catheter with its tip in the right atrium.

A

Central Line

76
Q

Process of injecting directly into the marrow of a bone to provide a non-collapsible entry point into the systemic venous system

A

Intraosseous

77
Q

It is recommended that the use of intraosseous infusion be limited to a _______ until intravenous access is achieved

A

Few hours

78
Q

Placement of an IO needle is indicated during traumatic situations when:

A

Venous access fail (3 or more attempts)

> 90 seconds

Cases where IV is likely to fail and speed is essential

79
Q

Needle gauge for IO

A

16-20

80
Q

Best site for IO insertion

A

Flat anteromedial aspect of the tibia.

81
Q

IO

Palpate the tibial tuberosity. The site for cannulation lies ___ cm below this tuberosity on the anteromedial surface of the tibia

A

1-3 cm

82
Q

Complications of IO

A

Fracture

Compartment syndrome

Osteomyelitis

Skin necrosis

83
Q

Analgesia in a trauma setting should be typically completed in accordance with:

A

TCCC three options of pain management

84
Q

TCCC Option 1 of pain management

Mild to moderate pain and casualty IS able to fight

A

TCCC Combat Wound Medication Pack (CWMP)

  • Tylenol 625 mg
  • Meloxicam 15 mg
85
Q

TCCC Option 2 pain management

Moderate to severe pain, casualty is not in shock or respiratory distress

A

Oral Transmucosal Fentanyl Citrate (OTFC)

-800 ug

86
Q

TCCC Option 3 of pain control

Moderate to severe pain

Casualty is in shock or respiratory distress or at risk of developing both

A

Ketamine 50 mg with Versed

Morphine 5 mg (15mg MAX)

Naloxone (Narcan) 0.4-2.0 mg Q 2-3 minutes

Ondansetron 4 mg

87
Q

What should be given to all open combat wounds?

A

Antibiotics

88
Q

TCCC recommendations for antibiotics

A

Moxifloxacin

Ertapenem

89
Q

Antibiotic given if the patient is able to tolerate PO medications

A

Moxifloxacin

90
Q

Antibiotic given to patients experiencing shock or unconscious

A

Ertapenem

91
Q

AMAL antibiotics

A

Levofloxacin

Cefazolin

Ceftriaxone

92
Q

Form for blood transfusions

A

SF 518

93
Q

TXA is most beneficial if given within:

A

1 hour

94
Q

TXA is pushed over __ minutes

A

10 minutes

95
Q

IO

If the procedure is not sterile it can cause:

A

Osteomyelitis

96
Q

In an alert patient what should you use with the IO

A

Lidocaine

Trauma (12 decks)

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