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Clin Specialties Surgery Exam > Lecture 6: Trauma > Flashcards

Lecture 6: Trauma Flashcards

1
Q

What are the components of the primary survey?

A 
ABCDE
A - Airway 
B - Breathing 
C - Circulation
D - Disability (Neuro Exam)
E - Environment/Exposure
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2
Q

In what situation should you always leave a C-collar to maintain a patient’s airway?

A

blunt multisystem trauma (esp if altered LOC or fracture above the clavicle)

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3
Q

A trauma patient is brought to the ER, she not communicating with anyone but has a patent airway, does this means she has adequate ventilation?

A

NO

Airway patency doesnt ensure adequate ventilation

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4
Q

A patient is brought to the ER d/t blunted forced trauma injury, while examining her you note paradoxical movement of part of her chest wall. What should you do to confirm the Dx?

A

Obtain CT
- Dx: flail chest
(2 fractures per rib in at least 2 ribs)

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5
Q

When assessing circulation what are the 3 most important issues to consider?

A

BV, CO and Bleeding

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6
Q

Tracheal shift, absent breath sounds, respiratory distress, and hyper-resonance to percussion are indicators for what treatment intervention?

A

Needle Decompression

Dx: Tension Pneumothorax

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7
Q

What is the placement for Needle Decompression for Tension Pneumothorax?

A

Chest tube inserted at the 2nd ICS mid-clavicular line

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8
Q

What are the different categories for the Glasgow Coma Scale, and how many points can be earned in each category?

A 
Eye opening (4 points)
Verbal responses (5 points)
Motor responses (6 points)
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9
Q

A patient from an MVA is brought to the ER, when you calculate his GCS what determines whether you need a definite airway-cuffed, and what is an example of one?

A

GCS <8 –> needed a ET tube (definite airway cuffed)

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10
Q

What are 2 methods use to help prevent hypothermia in trauma patients?

A

Warm blankets/device

Warm IV fluids

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11
Q

What is required for immobilization of trauma patients? What must you check before & after immobilizing them?

A
  1. Semi-rigid cervical collar
  2. Head immobilization (blocks)
  3. Backboard
  4. Tape/straps

Check PMS before and after

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12
Q

In the initial management of an unconscious patient, what three interventions can be done to decrease cerebral edema?

A

Give 1 time dose of mannitol, moderate hyperventilation (to a PCO2 32-35) and give hypertonic saline

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13
Q

For a patient who is unconscious what should given for fluid resuscitation?

A

1-2 L warm bolus of NS or LR

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14
Q

What is the definition of a massive transfusion?

A

> 10 units of pRBCs within 24 hours of admission

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15
Q

A patient is brought to the ER after a massive bleed from a gunshot wound, she has lost a significant amount of blood and is not responding to standard hemostatic therapy, what should you give her?

A

Activated Factor VII

Note: indicated for rescue therapy w/life threatening bleed, not responding to std hemostatic Tx

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16
Q

What are the indications for Recombinant Factor VIIa (other than trauma)?

A

Congenital VII deficiency
Hemophilia
Warfarin related intracerebral hemorrahge

17
Q

TXA is what type of drug?

A

TXA = anti-fibrinolytic –> prevents breakdown of clots

18
Q

A patient is having a total knee replacement performed, what agent can be given to combat bleeding associated w/fibrinolysis?

A

TXA (Tranexamic acid)

Others: cardiac surg, prostatecetomy

19
Q

What the 5 conditions that TXA is used for?

A
  1. Heavy menstrual bleeding
  2. Tooth extraction in hemophiliacs
  3. Blood loss prevention/reduction in high blood loss surgeries
  4. Trauma associated hemorrhage
  5. Traumatic hyphema
20
Q

A patient who was found unconscious outside presents to the ER with a pulse of 140 and a temperature of 95.0F, what must you consider?

A

shock

Pts who are cool and tachycardic are considered to be in shock until proven otherwise

21
Q

What is the most common type of shock, and how do you initially try to manage it?

A

Hypovolemic shock

Initially give crystalloid fluids–> immediately admin 2L of NS or LR

22
Q

A patient comes in w/hypovolemic shock and you administer 2L of isotonic fluids (NS/LR) but the patient continues to remain in critical condition, what is the appropriate next step?

A

Administer 2 units of pRBCs rapidly

23
Q

Common cause of Cardiogenic shock and common MOA for cardiac injury?

A

Cardiac tamponade

MOA to thorax= rapid deceleration (wearing seatbelt)

24
Q

A patient presents to the ER with tachycardia, muffled heart sounds, and dilated engorged neck veins with hypotension resistant to fluid therapy. What is the immediate step in managing this patient?

A

Thoracotomy (to treat cardiac tamponade)

25
Q

How do you differentiate a tension pneumothorax from cardiac tamponade as a cause of a patient’s HoTN?

A

They can look similar on CT but:

tension pneumo has absent breath sounds, tracheal deviation, and hyper-resonance

26
Q

Typical MOA causing neurogenic shock?

A

Cervical or upper thoracic spinal cord injury –> HoTN

27
Q

A patient with a neck injury from a MVA presents w/HoTN without narrowed pulse pressure (BP 90/50), a pulse of 60 and no cutaneous vasoconstriction is seen on exam, what is the most likely Dx and next step?

A

Neurogenic Shock
(Presents w/HoTN w/out tachycardia and no narrowed pulse pressure)

Give crystalloids or colloids to Tx the HoTN…must be done before going to OR

28
Q

In what type of shock is onset of the infection often delayed several hours and is often caused by a penetrating abdominal injury?

What are the initial steps to managing this type of shock?

A

Distributive (septic) Shock

All w/in the first 3 hrs:

  1. Get lactate level (if >4 give crystalloids)
  2. Get blood cultures
  3. Give broad spectrum ABX
29
Q

After the primary survey of a hypotensive patient in an emergency setting, what is the order of the interventions that need to be administered?

A

Fluids -> Blood/Blood Products -> Anti-Hypotensive agents (Epinephrine, Dopamine)

30
Q

What must the Dx of shock include?

A

Evidence of inadequate organ perfusion

31
Q

What is the purpose of the peritoneal lavage in penetrating/blunt abd trauma?
What indicates a positive result?

A

To determine if there is free floating fluid in the abdominal cavity

(+) result –> blood in the initial sample

32
Q

What is the purpose of the FAST exam?

A

look for free fluid in abdomen or look for pneumothorax in lungs

looks at peritoneal, pericardial, & pleural cavities

33
Q

What two drugs are given to provide hemodynamic support in cardiogenic shock?

A

Dopamine, Epi, Dobutamine

34
Q

What drug is given for septic shock?

A

NE

Clin Specialties Surgery Exam (13 decks)

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