Exam 2 Trauma Flashcards
Describe Class I hypovolemic shock?
15% loss; normal VS
Describe Class II hypovolemic shock?
15 – 30% loss; tachycardia, normal SBP
Describe Class III hypovolemic shock?
30 – 40% loss; significant drop in BP & mentation; HR > 120 & delayed cap refill
Describe Class IV hypovolemic shock?
> 40% loss;
hypotensive w/ narrowed pulse pressure;
UO absent;
significant altered mentation
Where is the goal SBP in patients with head injuries?
~ 110 mmHg
What are the two big things we worry about with abdominal trauma patients?
Over-resuscitation with IVF → hemodilution &
abdominal compartment syndrome
What happens in the microcirculatory response in trauma/shock?
The ischemic cells uptake interstitial fluid, become edematous & further depleting intravascular space.
What is the CNS response to shock?
Decreased glucose uptake &
decreased cortical activity & reflexes
What are the kidney/adrenal responses to shock?
Early: maintains GFR.
Late: inability to concentrate urine= ATN
What is the heart’s response to shock?
Dysfunction/ischemia d/t negative inotropes (lactate) &
tachycardia
What is a trauma dose for TXA?
2 gram IVP
When is the best time to give TXA to a trauma victim & when should it not be given anymore?
Within 1hr of trauma.
>3hrs there is an increased chance of bleeding
What is the TXA dose for pediatric traumas?
15mg/kg bolus & then 2mg/kg/hr x 8hrs
What kind of trauma is TXA best suited for?
Best for traumas with non-compressible injuries
Which clotting factors require calcium?
Factor II, VII, & X
How does calcium play a role in clotting?
It helps stabilize fibrinogen & platelets in the development of thrombus
What 2 things decrease citrate metabolism?
Hypothermia & liver injury
Which calcium variant is preferred in the presence of abnormal liver function & why?
Calcium chloride because decreased citrate metabolism by the liver results in slower release of ionized calcium
How much calcium is contained in 10mL of 10% calcium chloride, what about gluconate?
chloride: 270mg
gluconate: 90mg
2 units PRBC drop the iCa2+ to what?
<1.0mmol/L
5 units PRBC drop the iCa2+ to what?
<0.8mmol/L
What worsens coagulopathy?
Acidosis & hypothermia → decreased fibrinogen & platelets
When is calcium chloride given when transfusing whole blood?
Trick question, it is not needed.
What are the contraindications for a REBOA catheter?
Pericardial tamponade,
aortic dissection,
widened mediastinum
Which site is preferred when inserting a REBOA?
The left femoral
A REBOA should no be inflated for longer than?
30 minutes
What GCS indicates a moderate TBI?
9 – 12
A tear in what usually causes an epidural hematoma?
Tear in the middle meningeal artery
What are the S/S of an epidural hematoma?
A lucid interval is the classic sign.
mydriasis,
bradycardia,
HTN
What are the S/S of subdural hematoma?
HA,
progressive drowsiness,
visual disturbances,
gait disturbances
What is the current ventilation for TBIs?
PaCO2 of 30 – 35mmHg if elevated ICP
What are the upsides & downsides of regional anesthesia for orthopedic traumas?
- Ups: Allows continued assessment of mental status, increased vascular flow, decreased incidences of DVT.
- Downsides: difficult to assess nerve function, may wear off before surgery ends
What does a pulmonary embolism present as?
Hypoxia,
tachycardia,
petechia on upper chest,
increased PAP with decreased CO
What are the 5 P’s of compartment syndrome?
Pallor
Paralysis
Paresthesia
Pain
Pulsenesness
What is the most common site for acute compartment syndrome?
Tibia
What are some conditions resulting in the need for a thoracotomy?
Mediastinal injury,
chest tube output >1,500mL in first hour,
tracheal or bronchial injury w/ massive air leak,
unstable hemodynamics w/ obvious chest trauma
Where is the most common aortic injury in MVA’s?
The ligamentum arteriosum just distal to the takeoff of the left subclavian
What type on ventilation may be required in a person with a flail chest?
Positive pressure ventilation
What is beneficial in reducing pulmonary complications with rib fractures?
Peripheral nerve blocks
How is blunt cardiac trauma managed?
Control of fluids;
coronary vasodilators;
treat dysrhythmias;
possible ASA/heparin
What does Becks triad consist of?
Hypotension
muffled heart tones
distended neck veins
What meds are given for a preterm laboring woman involved in a trauma?
Beta agonists &
magnesium
