Ex 3 - AC for trauma patients Flashcards
What are the first things you evaluate in a trauma patient?
- Level of consciousness
2. ABC –> airway, breathing, circulation
Shock treatment
Prevent or treat shock before anesthesia!
O2, IV/IO catheter, Fluids, Inotropes and/or vasopressors
What is a common injury in HBC cases?
Thoracic injury!
Lung Contusions (bruising)
Easy to miss initially –> don’t always show on rads
Can lead to:
- atelectasis
- hypoxemia/hypoventilation
- depending on severity
During anesthesia, PPV may be needed
Pneumothorax
Can be open or closed
Can lead to:
- atelectasis
- hypoxemia
PPV and pneumothorax
PPV –> may cause a tension pneumothorax (does not allow lungs to expand) –> acts as a one-way valve
- inc pressure in thorax –> affects CV/pulmonary fxn –> leads to CV collapse
- emergency thoracocentesis or chest tube placement may be indicated
Signs of tension pneumothorax under anesthesia
- Dec lung compliance
- Sudden decrease in BP (due to dec venous return)
- CV collapse
Myocardial contusions
- Arrhythmia’s can occur 12-24 hours after the traumatic event
- VPCs
- anesthesia may worsen
- treat if the arrhythmia is compromising circulation (O2, volume correction, analgesia, lidocaine, etc)
*Pre-op ECG should be done
Which drugs are arrythmogenic and thus should be avoided in myocardial contusion cases?
a2-agonists, thiopental (propofol), halothane
Diaphragmatic hernia
- Dec FRC (desaturation of Hgb)
- Atelectasis
- Hypoxemia
Hemorrhage
May not be obvious –> bleeding into body cavities or hematomas
What can cause a hemoabdomen?
Fractured spleen/liver
What are the results of acute blood loss?
Hypovolemia and hypotension
- As you correct the hypovolemia/hypotension w/ crystalloids, this may lower the PCV/TP –> revealing a more serious deficit than you initially thought
Results of anemia/hypoproteinemia
Dec O2 delivery
Reduced drug binding
Rupture of urinary tract
(Rupture of bladder is the most common)
Urine leakage into abdomen
Azotemia
Electrolyte imbalance
What is of most concern regarding electrolyte imbalances following ruptured bladder?
Hyperkalemia! (raises resting membrane potential)
Try to normalize prior to anesthesia
What does hyperkalemia cause? (ECG)
Bradycardia
Prolonged PR Tented T waves Loss of P waves Wide QRS Vfib or systole
How can you treat hyperkalemia?
Insulin/dextrose, Ca++, Na/HCO3
cardio protection & drive K back into cells; HCO3 helps to correct acidosis which exacerbates hyperkalemia
What do we worry about with head trauma?
Increased ICP!
Assess the patient’s mentation and pupil size
What is the Cushing’s response?
physiological nervous system response to increased intracranial pressure (ICP) that results in Cushing’s triad of increased blood pressure, irregular breathing, and bradycardia
How can anesthesia alter blood flow to the brain?
Intubation can spike ICP
*use lidocaine to prevent coughing/gagging
What drugs increase ICP and should be avoided in head trauma cases?
Ketamine & a2agonist
What should always be a top priority in the trauma patient?
Treating PAIN!
Everything is better when pain is treated
What lab data is important for anesthesia?
Hgb levels –> O2 carrying capacity (transfuse with blood products if low)
Acid-base status
Electrolytes (K, Ca++)
Oxygenation/ventilation parameters
What if the patient is unstable?
AVOID anesthesia if possible; if not possible, monitor closely and continuously
Anesthetic Protocol (5)
- CV and pulmonary sparing
- Reversible & titratable
- O2, O2, O2!
- Secure airway
- Its tailored to each patient!
What is neuroleptanalgesia?
An intense analgesic and amnesic state produced by the combo of narcotic analgesics and neuroleptic drugs
Neuroleptic drugs = antipsychotic drugs, major tranquilizers
What drug combos can be used to achieve neuroleptoanalgesia?
- Opioid + sedative/tranquilizer
2. Fentanyl + midazolam/diazepam
What induction drugs are the most CV and respiratory sparing?
Etomidate + midazolam/diazepam
*good in cats
What induction drugs can be used to decrease ICP?
Propofol, alfaxalone
Results in hypotension, apnea, decreased ICP
What induction drugs would increase ICP?
Ketamine!
*Caution in head trauma
Why is titration so important in trauma patients?
These are not healthy patients! We need the ability to titrate to effect rather than give too large of a dose to quickly
What is balanced anesthesia?
Using a combination of different drug classes to decrease the overall amounts/negative effects.
This results in better CV stability in our patients
Analgesics + Sedatives/muscle relaxants + small amounts of IA
*IA reduces MAC – be careful!
What are the pros and cons of IA?
Pros:
- easily/quickly titratable
- minimal systemic metabolism
Cons:
- dose-dependent cardiopulmonary depression (CO, vasodilation, hypovent)
- MAC reduction is key!
