Intensive Care Flashcards
Causes of depressed consciousness in trauma
Brain injury
Hypoxaemia
Shock
Alcohol
Ingested drugs
Precipitating neurological or cardiac events.
Priorities of management in major truama
Support life
Locate and control bleeding
Prevent brainstem compression
Diagnose and treat all other injuries and complications
Cross matching in trauma
6 units PRCs
Rationale for opiate administration in trauma
Titrated IV as IM or subcutaneous routes give unpredictable absorption in shock,
Blood loss into femoral fracture?
1L
Most constant reliable sign of shock
Cold, pale peripheries- shock until proven otherwise
Possible sites of blood loss
External loss
Major fractures
PLeural cavity
Peritoneal cavity
Retroperitoneum
Distended neck veins, shcoked
?tPTx
?Concurrent MI
Myocardial contusion
Tamponade
Issues with FAST
Operator dependent
High false negative
Fals-positive rate small but important
Unable tom diagnose ruptured bowel
Not good for pelvic bleeding
Use of FAST
Positive FAST, shock-> laparotomy
Why are albumin solutions contraindicated in trauma
SAFE study, comparing albumin and NS for fluid resuscitation conducted in ICU patients showed higher mortality in patients given albumin, particularly those with TBI
Causes of post-resuscitaiton diuresis
Adequate resuscitation
Ethanol
Mannitol
Dopamin
DI
Non-oligric renal failure.
Polyuria may mask early recognition of renal failure
When is non-oliguric renal failure seen post-trauma?
2-4/7 post ictus
Caused by the shock and delayed or inadequate resuscitation.
Often heralded by polyuria, which may be misinterpreted as a sign of adequate resuscitation
What is the leading cause of death in those <45y/o
Traumatic head injury
Mechanisms of primary brain injury
Mediator release, alteration in BBB permeability, neuronal damage, microbascular changes
Haemorrhage, haematoma, contusion
Sympathetic surge
