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Trauma > MANAGEMENT OF CIRCULATION > Flashcards

MANAGEMENT OF CIRCULATION Flashcards

1
Q

______ is drawn directly from an on-site donor

A

Fresh Whole Blood (FWB)

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2
Q

Fresh =

A

not refrigerated or stored

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3
Q

True/false
FBW does not undergo processing into separate components

A

True

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4
Q

FWB is also known as what to the army?

A

Low Titer O Whole Blood (LTOWB)

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5
Q

What is a component of FWB that can cause patients to react adversely during the transfusion process.

A

Immunological components
(WBC’s, antibodies, cytokines, etc)

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6
Q

The blood collection kit contains _____ solution

A

CPD
(anticoagulant citrate and nutrient phosphate and dextrose)

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7
Q

What is the shelf life for collected FWB?

A

24 – 48 hours

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8
Q

True/False
All males can receive either O positive or O negative blood at any time

A

True

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9
Q

All females of childbearing age receive _________ blood ONLY
(unless life or death)

A

O NEGATIVE
O pos can induce Rh disease

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10
Q

Indications for what?
1. Life threatening injuries that require additional time before definitive care is achieved.
2. Hemorrhagic shock
3. Evidence of severe bleeding to a non-compressible or difficult to compress area with hypotensive patient
4. Delayed evacuation or prolonged evacuation.

A

transfusion

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11
Q

What class of shock?
30% of blood loss
1) 1500-2000 ml of blood loss
2) > 120 pulse rate per minute
3) Decreased blood pressure
4) 30-40 respirations per minute
5) Urine output 5-15 ml per hour
6) Level of Consciousness exhibiting confused demeanor

A

Class III

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12
Q

What class of shock?
> 40% of blood loss
1) > 2000 ml of blood loss
2) > 140 pulse rate per minute
3) Decreased blood pressure
4) > 35 respirations per minute
5) Urine output negligible
6) Level of Consciousness exhibiting lethargic demeanor
Absent radial pulse/systolic blood pressure below 80mmHg

A

Class IV

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13
Q

Radial pulse will be absent at what BP?

A

Systolic Below 80mmHg

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14
Q

Complications of Blood Transfusions:
______ is a potentially life-threatening reaction caused by acuteintra vascular hemolysis of transfused red blood cells

A

Hemolytic Reactions

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15
Q

Complications of Blood
Presenting signs of what:
1)Fever
2)Chills
3)Flank pain
4)Oozing from intravenous sites

A

Hemolytic Reactions

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16
Q

Complications of Blood
________ : any allergic reaction other than hives. This includes angioedema, wheezing, and/or hypotension

A

Anaphylaxis Reaction

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17
Q

Citrate Toxicity:
Recommendation though is to give ___ amp of Calcium Gluconate every ____ units of FWB to avoid toxicity and hypocalcemia

A

1 amp of Calcium
to
4 units of FWB

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18
Q

normal human liver can process ____ units worth of FWB without needing additional Calcium

A

13

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19
Q

_________: these are common; these reactions are characterized by fever, usually accompanied by chills, in the absence of other systemic symptoms.

A

Febrile non-Hemolytic Reaction

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20
Q

Febrile non-Hemolytic Reaction tx

A

1 gram of Tylenol PO/PR every 8 hours

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21
Q

IMMEDIATE ACTIONS (ALL PATIENTS) that develop an acute transfusion reaction should follow these steps:

A

(a) Immediately stop the transfusion
(b) Start fluid bolus with balanced crystalloid
(c) Assess the patient, including symptoms of fever, respiratory distress, chest pain, back pain, itching, angioedema
(d) Measure VS and PE guided by s/s
(e) Confirm the correct product was transfused to the intended patient and correct blood type of donor
(f) Contact your supervising physician to discuss the appropriate evaluation and initial management as soon as the tactical situation allows
(g) Pass all the information to the next echelon of care

22
Q

Administering FWB
Monitor the vital signs every ___ minutes for the first ____ minutes and observe the casualty for indications of an adverse reaction.

A

q 5 min for the first 15 min

23
Q

Set the flow rate to deliver approximately ____ml of blood over the first 15 minutes. UNLESS what?

A

10-30
(1gtt/4-6 sec = 1ml/min).

if pre-collected O LowTiter from pre-screened individuals

24
Q

Indication for what?
If a casualty is anticipated to need a significant volume of blood transfusion due to the following:
(a) Hemorrhagic Shock
(b) One or more amputations
(c) Penetrating torso trauma
(d) Evidence of severe bleeding

A

Tranexamic Acid (TXA)

25
Q

______ helps to reduce blood loss from internal hemorrhage sites that cannot be addressed by tourniquets and hemostatic dressings

A

TXA

26
Q

True/False
TXA promotes new clot formation

A

FALSE
Does not

27
Q

TXA Administration
(1) Survival benefit is greatest when TXA is given within ______ of injury.
(2) The greatest decrease in blood loss is seen when TXA is started ASAP!
(3) Administer ______ gram of tranexamic acid in 100 ml normal saline or lactated ringers as soon as possible, but not later than _____ after injury.
(4) When administering TXA is should be administered over ______.
(5) A second infusion of 1 gram TXA may be administered after _________ has been completed.

A

1) 1 hour
3) 1g, 3 hours
4) 10 minutes
5) initial fluid resuscitation

28
Q

TXA
Storage and Handling
Recommended temperature range for storage: _____ degrees F.

A

59-86

29
Q

IV therapy
______ therapy- replaces normal ongoing losses

A

Maintenance therapy

30
Q

IV therapy
_____ therapy - corrects any existing water and electrolyte deficits.

A

Replacement therapy

31
Q

IV fluids come in what four different forms:

A

(a) Colloids
(b) Crystalloids (Isotonic, Hypotonic, Hypertonic)
(c )Blood and blood products

32
Q

What type of IV fluid?
-Used to increase the blood volume following severe loss of blood (hemorrhage) or loss of plasma (severe burns).
-More suitable in hospital setting than field use.

A

Colloids (Volume Expanders)

33
Q

What type of IV fluid?
(a) Fluids that consist of water and dissolved crystals, such as salts and sugar.
(b) Used as maintenance fluids to correct body fluids and electrolyte deficit.

A

Crystalloids

34
Q

When the crystalloid contains the same amount of electrolytes as the plasma, itis referred to as ____

A

isotonic

35
Q

If a crystalloid contains more electrolytes than the body plasma, it is more concentrated and referred to as _____

A

hypertonic

36
Q

Administration of hypertonic crystalloid causes what?

A

water to shift from the extravascular spaces into the bloodstream, increasing the intravascular volume

37
Q

Uses of what IV fluid:
a) Shock
b) Resuscitation
c) Fluid challenges
d) Blood transfusions
e) Metabolic alkalosis
f) Hyponatremia
g)DKA

A

Normal Saline Solution (NSS)

38
Q

Uses of what IV fluid:
a) Dehydration
b )Burns
c) GI tract fluid loss
d) Acute blood loss
e) Hypovolemia

A

Lactated Ringers (LR)

39
Q

Uses of what IV fluid:
a) Fluid loss and dehydration
b) Hypernatremia

A

D 5 W

40
Q

D 5 W Special consideration:
a) Solution becomes hypotonic when _____ is metabolized
b) Do not use for ______
c) Use cautiously in _______ patients

A

a) dextrose
b) resuscitation
c) renal and cardiac

41
Q

Lactated Ringers (LR) Special consideration:
a) Contains Potassium, can cause _______ in renal patients
b) Patients with liver disease cannot metabolize _____
c) Lactate is converted into bicarb by liver which with larger volumes can lead to ______.

A

a) hyperkalemia
b) lactate
c) metabolic alkalosis

42
Q

Normal Saline Solution (NSS) Special consideration:
a) Use with caution in patients with ______, ______, or ______
b) Can lead to ________
c) Speeds up the lethal triad of ______, _______ and ______

A

a) heart failure, edema, or hypernatremia
b) volume overload
c) hypothermia, coagulopathy, and acidosis

43
Q

What are the most desirable fluids for replacement due to hemorrhage?

A

Platelets, Packed red blood cells, and Plasma

44
Q

OI
The procedure must be performed under sterile conditions to avoid causing ________

A

osteomyelitis (infection of the bone).

45
Q

When is IO indicated?

A

3 failed attempts at venous access or 90 secconds

46
Q

Intraosseous (IO) Contra-indications

A

(1) Ipsilateral fracture or crush injury of an extremity
(2) Previous orthopedic procedure near site
(3) Previous IOVA attempts in the same bone
(4) Infection at site
(5) Brittle bones

47
Q

The best site for IO is the

A

flat anteromedial aspect of the tibia

48
Q

IO tibia
The site for cannulation lies ___ cm below the _____ on the anteromedial surface of the tibia

A

1-3, tuberosity

49
Q

Complications of IO

A

(1) tibial fracture, especially in small framed people.
(2) Compartment Syndrome
(3) Osteomyelitis
(4) Skin Necrosis

50
Q

The intraosseous route should be replaced as soon as what?

A

a normal vein can becannulated and certainly within a few hours

Trauma (17 decks)

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