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Special Pops II > Exam 4 Trauma > Flashcards

Exam 4 Trauma Flashcards

1
Q

*what are the three components of the lethal triad in a bleeding patient?

A

COAGULOPATHY (d/t loss of clotting factors)
Lactic ACIDOSIS (d/t loss of blood volume)
Decreased myocardial performance (empty tank)

at increased risk of HYPOTHERMIA

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2
Q

*Hemorrhagic shock: Blood loss of 1 L classified as…

A

Class II

(Class II: 750-1500)

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3
Q

Hemorrhagic shock: Blood loss of 1700 mL classified as…

A

Class III

(Class III: 1500-2000)

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4
Q

Hemorrhagic shock: Blood loss of 800 mL classified as…

A

Class II

(Class II: 750-1500)

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5
Q

*Hemorrhagic shock: Blood loss of 3 L classified as…

A

Class IV

(Class IV: >2000)

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6
Q

Hemorrhagic shock: Blood loss of 400 mL classified as…

A

Class I

(Class I: up to 750)

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7
Q

*IMIST Abbreviation

A

*NOT primary survey, but useful handover tool

I: Identification (of patient)
M: Mechanism (medical complaint)
S: Signs (VS/GCS)
T: Treatment (Trends and response to tx)

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8
Q

Components of the Primary Survey*

A

ABCDE

A: Airway (and cervical spine control)
B: Breathing (and oxygenation)
C: Circulation (and hemorrhage control)
D: Disability
E: Exposure

In addition: GCS Status and NAKED to perform full-body exam

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9
Q

What is performed in a secondary exam?

A

Systematic overview

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10
Q

*List 7 patient conditions that may require endotracheal intubation:

A
  1. MAXILLOFACIAL TRAUMA
  2. Major hemodynamic instability
  3. Low SaO2
  4. Burns
  5. HEAD INJURY
  6. Intoxicated/behavioral/safety issues
  7. Transport (radiology/OR/ICU/external)
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11
Q

When making decisions on managing a patient’s airway consider the following THREE items:

A
  1. Airway burns
  2. Oral trauma
  3. Direct airway injury
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12
Q

*What is the objective of manual in-line stabilization?

A

to minimize movement of the cervical spine during laryngoscopy

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13
Q

List 3 life-threatening breathing abnormalities:

A

Tension PTX
FLAIL CHEST
Open PTX

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14
Q

*FLAIL CHEST

A

Cx: chest injury and rib fractures at more than 2 sites of at least 3 adjacent ribs or rib fractures with associated costochondral or sternal fracture

S/S: PARADOXIC MOVEMENT OF THE CHEST AT THE SITE OF RIB FRACTURE (“paradoxical right-sided breathing”)

Characteristics: During inspiration, chest wall moves inward, during expiration, moves outwards

Tx: PPV

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15
Q

Management of flail chest and underlying contusion

A

may develop ARDS
treat pain with epidural LA and opioids

supplemental O2, pain relief, if mechanical ventilation is required add PEEP, avoid N2O

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16
Q

Management of hemothorax

A

Thoracotomy and chest tube
supplemental O2, pain relief, if mechanical ventilation is required add PEEP, avoid N2O

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17
Q

*List 4 life-threatening conditions of hemodynamic shock/differential diagnoses of shock in the trauma patient:

A
  1. Massive hemorrhage
  2. TENSION PNEUMOTHORAX
  3. TAMPONADE
  4. Severe cardiac contusion
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18
Q

*Necessary SEVEN anesthesia induction agents in trauma and their rationales:

A
  1. KETAMINE: sympathomimetic
  2. Etomidate: cardiovascular stability
  3. Opioids: cardiovascular stability but may cause bradycardia
  4. SUCCINYLCHOLINE: RSI
  5. Non-depolarizers: paralysis
  6. Benzodiazepines: amnesia
  7. SCOPOLAMINE: amnesia
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19
Q

Do not give NaHCO3 (Sodium bicarb) unless…

A

pH is < 7.20 because dissociates to bicarbonate ion and CO2 which may worsen acidosis

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20
Q

Phase 1 of Major Traumatic Resuscitation:

A

Life-threatening uncontrolled hemorrhage
Priority: stop the bleeding

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21
Q

Phase 2 of Major Traumatic Resuscitation:

A

Ongoing hemorrhage – not immediately life-threatening, partial surgical control
Priority: tailored resuscitation

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22
Q

*What is used to guide/tailor fluid requirements during Phase 2 of Major Traumatic Resuscitation?

A

SERIAL LACTATE/BASE EXCESS

HR + BP ARE NOT INDICATIVE OF FLUID RESUSCITATION

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23
Q

What is used to guide coagulation and blood products during Phase 2 of Major Traumatic Resuscitation?

A

TEG/ROTEM to guide coagulation products
ABG to guide RBC transfusion

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24
Q

*Phase 3 of Major Traumatic Resuscitation:

A

HEMORRHAGE CONTROLLED
Priority: Restore physiology; step-wise deepening of anesthesia

Low-dose vasoactive infusions can be considered to counteract anesthesia-induced vasodilation

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25
Q

When performing MTP, what is a critical piece of equipment?

A

Rapid infuser + warmer

delivers large amounts of warmed blood products very quickly and safely

26
Q

*administration of PRBC + FFP (TWO):

A

use a fluid warmer
use a rapid infuser system

27
Q

*administration of platelets (speed + temp):

A

administer slowly (30-60 min)
administer at room temperature

28
Q

1st cooler of MTP

A

4 units PRBC
4 units FFP

29
Q

2nd cooler of MTP

A

4 units PRBC
4 units FFP
6 units platelets

30
Q

*Trauma patient coming in from ER

A

FOLLOW MTP

31
Q

Cornerstones of Damage Control Resuscitation (DCR):

A
  • Early use of blood products
  • Limited crystalloids and colloids
  • Early hemostasis
32
Q

*Lab values for DCR:

A

PT < 14
PLT > 50
HCT > 25

33
Q

Hct values between what range are targeted in controlling hemorrhage?

A

18-25%

34
Q

TEG Phase 1:

A

Preclot

deficiencies require: Prothrombin complex concentrate and FFP

35
Q

TEG Phase 2:

A

Formation

deficiencies require: cryoprecipitate/fibrinogen concentrate/platelet concentrate

36
Q

TEG Phase 3:

A

Stability

treated with: antifibrinolytic product

37
Q

TEG: R Time

A

time until initial fibrin formation

38
Q

*PROLONGED R TIME on TEG, what do you administer?

A

FFP

39
Q

*DEFICIENT R TIME on TEG, what is it and how do you treat?

A

Hypercoagulable state (either due to DIC or thrombosis). Administer anticoagulant for thrombosis or can ADMINISTER FFP FOR DIC (or platelets, cryo)

40
Q

What does MA represent on TEG?

A

strength of the fibrin clot and platelet bonding

41
Q

*LOW MA ON TEG, what is it and what do you administer?

A

means a decrease in platelet number or function

ADMINISTER PLATELETS OR DDAVP

42
Q

*Manifestations of high thoracic (T4 and above) and cervical spinal cord injury and rationale

A

Significant bradyarrhythmia and AV Block

Mechanism: owing to disruption of sympathetic cardiac accelerator fibers, unopposed parasympathetic response

43
Q

Management of T4+ and cervical SCI

A

administration of isotonic fluid, vasopressors, and inotropes

MAP should be kept 85-90 mm Hg to maintain adequate spinal cord perfusion

44
Q

What can occur with direct laryngoscopy and intubation of patients with cervical or high thoracic injuries?

A

Exaggerated bradycardic response and hypotension

45
Q

*SCI: Succinylcholine

A

May be used within first 24 H of injury
Avoid after 48 H of injury because of the risk of severe hyperkalemia

46
Q

Nine s/s of PTX

A
  1. Dyspnea
  2. Cyanosis
  3. Hypoxia
  4. Agitation
  5. Diaphoresis
  6. Tracheal deviation to contralateral side
  7. Distended neck veins
  8. Mediastinal shift
  9. Tachypnea
47
Q

*PTX treatment (needle decompression)

A

Needle decompression: placement of large-bore needle (14 G) through the SECOND INTERCOSTAL SPACE MIDCLAVICULAR LINE

48
Q

Definitive PTX treatment

A

Chest tube placed at 4th and 5th ICS anterior to midaxillary line

49
Q

Nitrous in PTX?

A

No, expands pneumo

50
Q

*Cardiac tamponade: Beck’s Triad

A

HYPOTENSION
NECK VEIN DISTENTION (JVD)
DISTANT/MUFFLED HEART TONES

51
Q

*Cardiac Tamponade anesthetic considerations (4) and what NOT to do

A
  1. Etomidate or Ketamine
  2. INOTROPES*
  3. INCREASE PRELOAD*
  4. Fluid resuscitation

NOT vasopressors!!!

52
Q

Cardiac tamponade video: what is of utmost importance and what should be avoided?

A

Preserving CO most important
Avoid propofol, cardiac depressants, and PPV if possible

53
Q

*List some KEY POINTS in pediatric trauma (4):

A
  1. LATE PHYSIOLOGIC DECOMPENSATION*
  2. potentially difficult IV access, consider IO
  3. Look out for NONACCIDENTAL INJURY*
  4. any blood loss is significant
54
Q

Blood volume estimate of a preterm neonate:

A

95 mL/kg

55
Q

Blood volume estimate of a full-term neonate:

A

85 mL/kg

56
Q

*Blood volume estimate of an INFANT:

A

80 mL/kg

i.e. 22-lb 10-month old EBV would be…..

22 lb = 10 kg
10 kg x 80 mL/kg = 800 mL*

57
Q

Blood volume estimate of an adult male:

A

75 mL/kg

58
Q

Blood volume estimate of an adult female:

A

65 mL/kg

59
Q

*What are the key points for trauma in pregancy?

A
  1. Normal signs of blood loss are late (look to urine output or fetal distress)
  2. FETAL DISTRESS IS FIRST SIGN OF MATERNAL COMPROMISE*
  3. Don’t forget left tilt uterine displacement to reduce aortocaval compression
  4. Reduced FRC - rapid desaturation
60
Q

*Describe how anatomy increases the risk injury in a pregnant patient in their 3rd trimester:

A

BLADDER IS AT INCREASED RISK OF INJURY (not protected by uterus and fetus)

PLATELETS* (?)

61
Q

To prevent longer-term impact on future pregnancies, an Rh-negative mother should be given

A

Anti-D immunoglobulin (can temporarily increase platelets?)

62
Q
A

Special Pops II (8 decks)

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