CT Trauma Critical Care Flashcards
what percent of patients with ruptured heart s/p trauma survive
Between 30-40% of all patients with ruptured hearts will arrive at the hospital alive and will be able to undergo diagnostic evaluation. Some autopsy series reports, however, are more pessimistic.
What is the most commonly injured chamber of the heart in survival blunt trauma injury ?
The most commonly injured chamber in survivable blunt cardiac trauma is the right atrium. Repaired atrial injuries have better outcomes than ventricular injuries in blunt trauma cases.
Bronchial rupture - how to handle
- Dont: -
- Maneuvers such as direct laryngoscopy and flexible bronchoscopymay not yield adequate information about the patient’s airway. -
- Standard orotracheal intubation can be dangerous if there has been substantial separation of the trachea from the larynx. -
DO: -
- safest tracheostomy under local anesthesia. -
- Subsequent bronchoscopy is mandatory to determine whether or not the patient has a tracheobronchial injury. -
- Intubation over a flexible bronchoscope is sometimes possible but it does not provide as rapid and safe an approach to securing the airway as a tracheostomy.
Antibody in HIT
heparin/platelet factor 4 complex
Percentage of patients with HIT that develop HITT (HIT with Thrombosis)
Approximately 50% of patients with HIT develop signs of thrombosis (HITT).
Risk of thrombosis in patient’s with HIT?
The risk of thrombosis remains quite high (20-50%) in patients with HIT who merely have cessation of heparin as their therapeutic intervention.
FDA Approved agents for the treatment of HIT
Direct thrombin inhibitors (3)
- lepirudin: longest half-life (40-120 minutes)
- bivalirudin: (Angiomax) shortest T1/2
- argatroban
Direct thrombin inhibitor with the longest half life
- lepirudin, longest half-life (40-120 minutes)
where are direct thrombin inhibitiors excreted
kidneys
When is Angiomax best used? What kind of precautions should be taken ?
- bivalirudin (Angiomax):
direct thrombin inhibitor that is readily reversible and its half-life is the shortest of these three drugs. -
when can it ideally be used? - It may be the drug of choice in patients where bleeding is a serious risk, - Other Cautions? - especially if renal function is impaired. Its dose, however, must be adjusted for renal insufficiency - ,
Inhibitors of thrombin in plasma
- In plasma, Thrombin is inhibited by: - antithrombin - heparin cofactor II
- What is “heparin resistance.”?
- What is “heparin resistance.”? - syndrome of acquired antithrombin deficiency associated with CPB
Mechanism of acquired heparin resistance?
-decreased antithrombin levels during and after CPB rise in the thrombin-antithrombin complex (TAT) levels. - DECREASED ANTITHROMBIN LEVELS - taken up by used AT reserve - More importantly, activation of hemostasis during CPB in heparin-resistant patients is attributed to stimulation of the tissue factor pathway.
How to treat AT deficiency when going on bypass
- Anticoagulation during CPB with unfractionated heparin (UFH) should be supplemented with either: antithrombin concentrates , a short-acting direct thrombin inhibitor (e.g. bivalirudin), a short-acting platelet glycoprotein IIb/IIIa antagonist.
Aortic isthmus
Rapid deceleration and the application of shearing forces mean that thoracic aortic injuries typically arise from the isthmus
the area distal to the left subclavian artery and proximal to the third intercostal artery
anacrotic notch
The anacrotic notch seen on the arterial pulse wave occurs secondary to the presystolic rise in pressure during the first phase of ventricular systole (i.e., isovolumetric contraction). It always occurs before the opening of the aortic valve.
when does an IABP fire
In a properly timed waveform, as shown, the inflation point lies at or slightly above the dicrotic notch.
CVP tracing of tricuspid regurgitaion
CVP Tracing of tricuspid regurgitaion
Normal CVP waveform
Normal CVP waveforem
what does the a wave mean?
Presystolic a wave: produced by venous distention consequent to right atrial contraction.
Large a waves: indicate that the right atrium is contacting against increased resistance (tricuspid stenosis, pulmonary stenosis, pulmonary hypertension).
The a wave is absent in patients with atrial fibrillation and junctional rhythm.
CVP wave form tracing
c wave: produced by bulging of the tricuspid valve into the right atrium during ventricular systole.
cvp waveform tracing
x-descent - what is it ?
what happenes in constrictive pericarditis and severe TR?
x descent: is due to a combination of atrial relaxation and downward displacement of the tricuspid valve.
constrictive pericarditis, there is accentuation of the x descent while it is reversed with severe tricuspid regurgitation: reversed
CVP wave form
- V wave
- what happens in TR
v wave: which results from increasing blood in the right atrium during ventricular systole, is prominent with tricuspid regurgitation.
Timing of TRALI
occurs during or within six hours after a transfusion
