Mod XII - M&M 39 - Miller 81: Trauma Management in Anesthesiology

Question 1

_{Trauma & Burn Management in Anesthesiology}

Which aspect of the Nurse Anesthesiology Resident (NAR)’ background will play an important role for managing patients with trauma and burn injuries?

Answer 1

The critical-care background of the Nurse Anesthesiology Resident (NAR) will play an important role for managing patients with trauma and burn injuries

Question 2

_{Trauma & Burn Management in Anesthesiology}

Trauma and burn patients require thorough assessment and immediate interventions due to

Answer 2

Pathophysiologic changes arising from traumatic injury

Question 3

_{Trauma & Burn Management in Anesthesiology}

The bodies response to trauma and shock has been described as a

Answer 3

Complex series of neural and hormonal reflexes that are induced by injury

Question 4

_{Trauma & Burn Management in Anesthesiology​}

Why shoould a great deal of effort be utilized to stabilize Trauma and burn patients in the operating room suite?

Answer 4

Trauma and burn patients are some of the most challenging patients to take care of in the operating room suite

Question 5

_{Trauma & Burn Management in Anesthesiology​}

The Nurse Anesthesiology Resident (NAR) must be aware that cell injury can occur from

Answer 5

Alteration of normal homeostasis

Question 6

_{Trauma & Burn Management in Anesthesiology​}

There needs to be emphasis on providing adequate ventilation, oxygenation, and perfusion to these patients. Why?

Answer 6

Trauma patients suffer from shock and hypoxic states.

Question 7

_{Trauma & Burn Management in Anesthesiology​}

Proper fluid resuscitation and blood administration is vital for survival in these patients. Why?

Answer 7

Trauma results in hemorrhagic blood loss or sequestration of extracellular fluid in the injured tissues

Loss of circulating volume triggers a response by low-pressure baroreceptors in the carotid arteries and aorta

Question 8

_{Understanding the Trauma Patient}

Trauma is classified at which type of medical situation?

Answer 8

Medical emergency

The trauma patient is considered a medical emergency and these patients may present totally obtunded. The NAR may not have any background information when caring for these patients

Question 9

_{Understanding the Trauma Patient}

Rapid sequence induction should always be utilized in this population. Why?

Answer 9

Full-stomach

All trauma patients are treated as a full-stomach and are high risk for aspiration.

Question 10

_{Understanding the Trauma Patient}

Compromised attempts to place an ETT - why?

Answer 10

Head injuries - cervical spine fractures - c-spine stabilization

These patients can also suffer from head injuries etc., which can compromise any attempts to place an ETT. Also, these patients may present with cervical spine fractures and require c-spine stabilization which could also impede ETT placement.

Question 11

_{Understanding the Trauma Patient}

How would the NAR go about intubating a patient with multiple facial fractures or the patient that has a completely deviated anatomy structure from injury?

Answer 11

Establishing an airway is essential for these patients

The NAR should consider utilizing a GlideScope or fiberoptic measures (if needed) to establish an airway

Question 12

_{Understanding the Trauma Patient}

Most patients come to the OR suite intubated. Whose responsibility is it to verify placement? How is this done?

Answer 12

Is the responsibility of the CRNA to verify placement by c_hecking breath sounds_ etc.

Question 13

_{Understanding the Trauma Patient}

In the case that a patient cannot be intubated by the primary anesthesia team, the surgery team should be on standby for

Answer 13

Tracheostomy

_{Understanding the Trauma Patient}

Are there certain drugs to avoid in the trauma patient?

Question 14

_{Understanding the Trauma Patient}

Are there certain drugs to avoid in the trauma patient?

Answer 14

…

Question 15

_{Understanding the Trauma Patient}

Due to the emergency nature of these patients, many things are often overlooked which leads to

Answer 15

Life-threatening outcomes

Question 16

_{Understanding the Trauma Patient}

Due to the emergency nature of these patients, many things are often overlooked which leads to life-threatening outcomes. Some of the common overlooked diagnosis include

Answer 16

Pneumothorax

Cardiac tamponade

Cardiac contusion

Cervical spine injury

Open/closed head injury

Major blood vessel injury

Question 17

_{Understanding the Trauma Patient}

Resuscitation efforts should be prompt! Which time frome after traumatic injury often determines if a patient will survive?

Answer 17

The first 60 minutes after traumatic injury

Question 18

_{Understanding the Trauma Patient}

Resuscitation efforts should be prompt! The first 60 minutes after traumatic injury often determines if a patient will survive. This is known as:

Answer 18

The “golden hour”

Question 19

_{Understanding the Trauma Patient}

The chances of survival during the The “golden hour” are decreased in patients in

Answer 19

Hemorrhagic shock

Question 20

_{Understanding the Trauma Patient}

To provide some genuine advice I would advise all NARs to do what prior to intubating these patients?

Answer 20

Stabilize the cervical spine

Question 21

_{Understanding the Trauma Patient}

if no c-collar is in place

Answer 21

Stabilize and document

Have another provider to hold the neck

Have another provider to hold the neck if no c-collar is in place

Document this thoroughly in the chart to protect your license

Unfortunately, everything is blamed on “ANESTHESIA” in the OR suite and no NAR would like to be blamed from exacerbating a c-spine injury that was present in the first place

Please stabilize and document that intervention! ALWAYS!

Question 22

_{Understanding the Trauma Patient}

T/F: Trauma patients require both invasive and non-invasive monitoring

Answer 22

True

Question 23

_{Understanding the Trauma Patient}

Access required to assist with resuscitative efforts by the CRNA

Answer 23

Cordis (central venous sheath)

These patients usually require a cordis (central venous sheath) to assist with resuscitative efforts by the CRNA

Two large bore peripheral IVs

Although a cordis is frequently placed in these patients, a good rule of thumb is to place two large bore peripheral IVs

Question 24

_{Understanding the Trauma Patient}

Trauma patients require frequent monitoring of:

Answer 24

Urinary output

Chest tube output (if applicable)

ETCO2 monitoring

Temperature

Blood pressure via arterial line and NIBP

SPO2

EKG

Many trauma centers monitor CVP, CO etc. during the trauma process

Question 25

_{Understanding the Trauma Patient} Advanced hemodynamic monitoring is used for:

Answer 25

To guide fluid/blood resuscitation

Question 26

_{Understanding the Trauma Patient} There also needs to be frequent lab work completed to

Answer 26

Guide blood administration and Guide usage of electrolyte replacement such as calcium, etc In the OR; we usually do serial I-STATs every 30 minutes until patient is stabilized

Question 27

_{Understanding the Trauma Patient} In the OR; we usually do serial **I-STATs** how frequently until patient is stabilized?

Answer 27

**every 30 minutes**

Question 28

Most Common Problems in Trauma

Answer 28

1. Hypotension 2. Desaturation 3. Hypertension 4. Tachyarrhythmias and Brady-arrhythmias 5. Sudden Cardiac Arrest

Question 29

_{Most Common Problems in Trauma} Hypotension is u sually caused by

Answer 29

**Hypovolemia** It is imperative that the CRNA or NAR initiate _fluid resuscitation_ to combat hypotension _Vasoactive medications_ are usually utilized to help maintain adequate acceptable MAP goals Be certain to _rule out major vessel tears_ that can be the primary cause of hypotension In rare situations, trauma patients are transported to the Interventional _Radiology (IR)_ suite to both located and eliminate a major vessel tear

Question 30

_{Most Common Problems in Trauma} In rare situations, where are trauma patients transported to both located and eliminate a major vessel tear?

Answer 30

**Interventional Radiology** (IR) suite

Question 31

_{Most Common Problems in Trauma} Desaturation - When desaturation occurs check for

Answer 31

Adequate FIO2, ventilation, and perfusion Look for signs of a pneumothorax (distended neck veins, tracheal deviation) Rule out pulmonary contusions, mucous plugs etc. Patient may require a STAT chest x-ray to rule out more pertinent issues

Question 32

_{Most Common Problems in Trauma} Hypertension - When do Trauma Patients frequently become hyperdynamic?

Answer 32

After **resuscitation**

Question 33

_{Most Common Problems in Trauma} How is Hypertension is mostly treated?

Answer 33

By **deepening the anesthetic** or offering **opioid therapy**

Question 34

_{Most Common Problems in Trauma​} What should be considered first when these issues Tachyarrhythmias and Brady-arrhythmias arise?

Answer 34

**Hypoxemia** and **hypercarbia** Monitoring lab work for **electrolyte imbalances** should also be utilized for prompt correction

Question 35

_{Most Common Problems in Trauma​} Sudden cardiac arrest is often a strong indication for

Answer 35

**Open thoracotomy** To inspect the heart for pericardial tamponade Surgeons often have to open the chest and perform a cardiac massage

Question 36

_{Most Common Problems in Trauma​} In addition to monitoring lab work for trauma patients; the CRNA must pay close attention to **blood glucose levels** - why?

Answer 36

Trauma patients may need insulin to bring glucose levels to an acceptable level in the OR On the other hand, trauma patients rapidly consume their gluconeogenic substrate which causes significant hypoglycemia to occur However, these patients are more likely to experience **hyperglycemia** than hypoglycemia Data has shown that preexisting hyperglycemia increases damage of ischemic/hypoxic events

Question 37

_{Most Common Problems in Trauma​} What are the most common causes of coagulopathy in the trauma patients?

Answer 37

Dilutional **thrombocytopenia** ## Footnote **Hypofibrinogenemia**

Question 38

_{Most Common Problems in Trauma​} Dilutional thrombocytopenia is the most common cause of coagulopathy in the trauma patient, followed by hypofibrinogenemia. These conditions are treated with

Answer 38

Platelets, FFP, and cryo as indicated In the OR we use the level one infuser via **massive transfusion protocol** (MTP) [1:1 PRBCs/FFP] until the patient is stabilized

Question 39

_{Most Common Problems in Trauma​} T/F: Remember when giving platelets to never run them through the warmer

Answer 39

**True** Never run them through the warmer!!!

Question 40

_{Trauma management in Anesthesiology} For trauma patients its very important to know the pathophysiology behind the mechanism of injury - Trauma caused by high-velocity or low-velocity impact, generally from dull objects is known as:

Answer 40

**Blunt trauma**

Question 41

_{Trauma management in Anesthesiology} For trauma patients its very important to know the pathophysiology behind the mechanism of injury - Trauma that results from the piercing of tissues by sharp objects such as knives or bullets is known as:

Answer 41

**Penetrating trauma**

Question 42

_{Trauma management in Anesthesiology} In which type of injuries are Mixed blunt and penetrating trauma often seen?

Answer 42

**Impalement injuries**

Question 43

_{Trauma management in Anesthesiology} Falls from substantial heights can cause which types of injuries?

Answer 43

**Vertical high-velocity** injuries

Question 44

_{Burn Management in Anesthesiology} Burns are caused by which types of exposures?

Answer 44

Thermal, electrical, or chemical exposure

Question 45

_{Burn Management in Anesthesiology} Airway burns and smoke inhalation injuries are often associated by poisoning from which gas?

Answer 45

**Carbon monoxide**

Question 46

_{Burn Management in Anesthesiology​} T/F: Chemical, biological, and nuclear injuries are other forms of trauma

Answer 46

**True**

Question 47

_{Burn Management in Anesthesiology​} Environmental injuries can be caused by events such as

Answer 47

Poisonous insect bites Animal bites Venomous snake bites

Question 48

Common Mechanisms of Injury in the Trauma Patient

Answer 48

1. Penetrating Injury/Blunt Trauma 2. Motor Vehicle Accident Trauma 3. Thoracic Trauma 4. Abdominal Trauma 5. Orthopedic Trauma 6. Head Injury 7. Spinal Cord Injury

Question 49

_{Penetrating Injury/Blunt Trauma} Unfortunately the CRNA may experience this type of trauma from:

Answer 49

**Gun shots** or **stab** wounds These injuries are often fatal unless thorough assessment and interventions for stabilization are used

Question 50

_{Penetrating Injury/Blunt Trauma} These patients usually undergo an open-chest or open abdomen by the trauma surgeon to assess for

Answer 50

**Major vessel tears**

Question 51

_{Penetrating Injury/Blunt Trauma} These patients my have to have **chest tubes** - why?

Answer 51

often times the **bullets penetrate the lungs** which **compromises** **oxygenation** in these patients The patient suffering from these type of injuries must have their organs assessed for damages that could lead to irreversible damage if missed

Question 52

_{Penetrating Injury/Blunt Trauma} Some patients experience this type trauma from head injuries and may require

Answer 52

an **emergency craniotomy**

Question 53

_{Penetrating Injury/Blunt Trauma} As a CRNA you have to be ready for anything that hits the door - Gun shots wounds to the chest and head are extremely stressful cases - When you are in these cases sometimes very little help is available to stabilize these patients - You have to be on your A-game and intervene quickly - Many times you will have to use your critical-care background to guide care - Answering which important questions could guide care delivery?

Answer 53

Does the patient needs a bi-carb drip? Did I start TXA? Did we give antibiotics? Does the patient need to have a vasopressin gtt started? Does the patient need to be transported to IR? Is the patient bleeding somewhere else that the surgeon may have missed or overlooked? Is the blood pooling in the peritoneum? All of this falls on you as the CRNA

Question 54

_{Penetrating Injury/Blunt Trauma} As a CRNA you have to be ready for anything that hits the door - Gun shots wounds to the chest and head are extremely stressful cases - When you are in these cases sometimes very little help is available to stabilize these patients - You have to be on your A-game and intervene quickly - Many times you will have to use your critical-care background to guide care - You have to be very aggressive and firm in your decision-making - Why?

Answer 54

**One near-miss can lead to a fatal outcome**

Question 55

_{Motor Vehicle Accident Trauma} These are the patients who come in with multi-system deviations due to the impact associated with motor vehicle crashes (MVCs) - These deviations include:

Answer 55

**Orthopedic injuries** These patients usually suffer from a variety orthopedic injuries **Cervical spine injury** The cervical spine absorbs a large energy impact and may be compromised **Severe head injuries & Laryngeal fractures** Patients hitting the dashboard can suffer from severe head injuries and could possible have laryngeal fractures direct impact on the trachea **Spinal cord injury** Further spinal cord injury occurs from hyperflexion, hyperextension, or direct compression

Question 56

_{Motor Vehicle Accident Trauma} Unfortunately, when the body moves forward during impact which part of the body suffers the first point of contact?

Answer 56

the **Head**

Question 57

_{Motor Vehicle Accident Trauma​} Chances of survival are decreased significantly in patients who do not wear

Answer 57

a **seat belt**

Question 58

_{Thoracic Trauma} Blunt thoracic trauma often results when drivers do not wear a [.......] and collide with the [.........] during the MVC

Answer 58

Blunt thoracic trauma often results when drivers do not wear a **seatbelt** and collide with the **steering wheel** during the MVC

Question 59

_{Thoracic Trauma} Injuries to thoracic structures compromise anesthesia care by affecting

Answer 59

**Gas exchange** & **Cardiac output** Chest injuries may be the result of continued hemodynamic and ventilatory compromise

Question 60

_{Thoracic Trauma} Which Life threatening conditions may develop when the pleural cavity is punctured, and presents as creation of a one-way valve that controls the flow of air into this cavity

Answer 60

**Tension pneumothorax** _{Life threatening conditions such as tension pneumothorax may develop when the pleural cavity is punctured, creating a one-way valve that controls the flow of air into this cavity}

Question 61

_{Thoracic Trauma} How does Tension pneumothorax manifest?

Answer 61

With each breath more air becomes trapped in this the pleural cavity, **increasing intrapleural pressure** to the point that it eventually exceeds all other intrathoracic pressures This causes the **ipsilateral lung to collapse** and shift structures of the mediastinum (trachea, great vessels, heart) into the opposite hemothorax which compresses the contralateral lung

Question 62

_{Thoracic Trauma} Which ventilation technique increases the size of the pneumothorax?

Answer 62

**Positive pressure ventilation** ^{The size of the pneumothorax rapidly increases during positive pressure ventilation}

Question 63

_{Thoracic Trauma} Why is the use of nitrous oxide contraindicated in these patients?

Answer 63

it helps to **expand the already present pneumothorax**

Question 64

_{Thoracic Trauma} Patients with a pneumothorax often present with which S/S?

Answer 64

Hypotension Subcutaneous emphysema of the neck or chest Unilateral decrease in breath sounds Diminished chest-wall motion Distended neck veins Tracheal shift

Question 65

_{Thoracic Trauma} Which will provide a definite diagnosis for pneumothorax?

Answer 65

**A chest x-ray**

Question 66

_{Thoracic Trauma​} A chest x-ray will provide a definite diagnosis but in emergency situations, what can be done to relieve tension from the pneumothorax?

Answer 66

a **large-bore intravenous catheter** is inserted into the second superior portion of the intercostal space along the midclavicular line

Question 67

_{Thoracic Trauma​} Another life threatening emergency caused by bleeding from the heart and great vessels is known as

Answer 67

**Massive Hemothorax**

Question 68

_{Thoracic Trauma​} The life threatening emergency that restricts filling of the cardiac chambers during diastole and produces a fixed low cardiac output is known as

Answer 68

**Pericardial tamponade** Immediate correction is needed which require a _pericardiocentesis_

Question 69

_{Abdominal Trauma} Extremely unstable patients with abdominal trauma usually come to the OR for which procedure?

Answer 69

**Exploratory laparotomy**

Question 70

_{Abdominal Trauma} Extremely unstable patients with abdominal trauma usually come to the OR for and Exploratory laparotomy. What's an appropriate initial intervention for the CRNA?

Answer 70

Drop an **NG/OG tube** to decompress the stomach

Question 71

_{Abdominal Trauma} Retroperitoneal injuries can damage which structures?

Answer 71

Abdominal aorta Inferior vena cava Kidneys Pancreas Duodenum

Question 72

_{Abdominal Trauma} Intraperitoneal injuries can occur to which organs?

Answer 72

Spleen, liver, stomach, small bowel, colon, or rectum

Question 73

_{Abdominal Trauma} Anesthetic problems in patients with abdominal trauma include

Answer 73

hemorrhage, hypothermia, sepsis, and interference with ventilation

Question 74

_{Abdominal Trauma} Hypothermia is a common complication of abdominal trauma surgery because of

Answer 74

increased heat loss through the open mesentery and reduced heat production associated with shock

Question 75

_{Abdominal Trauma} For all trauma patients all fluids should be warmed -why?

Answer 75

Hypothermia is a common complication of abdominal trauma surgery

Question 76

_{Abdominal Trauma} Which drugs are used to prevent shivering?

Answer 76

Neuromuscular blocking agents Do not be afraid to have the circulating RN to turn up the temperature in the room

Question 77

_{Abdominal Trauma} Why must shivering be prevented in trauma patients?

Answer 77

Shivering increases oxygen consumption by 200-400% without improving oxygen delivery Do not be afraid to have the circulating RN to turn up the temperature in the room

Question 78

_{Orthopedic Trauma} Ideal time to repair open fractures operatively is

Answer 78

within the first few hours after injury

Question 79

_{Orthopedic Trauma} Certain secondary vascular injuries commonly occur because

Answer 79

Sharp edges of fractured bones are forced into neighboring blood vessels and nerves Assessment for nerve damage should be included in the plan of care for these patients

Question 80

_{Orthopedic Trauma} Massive hemorrhage can associated with pelvic fractures - why?

Answer 80

Pelvic fractures can cause major blood loss into the retroperitoneal space Although blood loss from pelvic fractures involving the iliac artery is notorious, significant blood loss can also occur from fractures associated with disruption of axillary, brachial, femoral, and popliteal arteries

Question 81

_{Orthopedic Trauma} Which respiratory complication is common from long-bone factrures? what's its cause?

Answer 81

**Hypoxic respiratory failure** The hypoxia results from continuous seeding of marrow fat into the venous circulation Long-bone fractures also carryout the risk the patient developing a FAT EMBOLISM It is imperative to have serial blood gases/I-stat lab work to guide care to initiate therapy

Question 82

_{Orthopedic Trauma} What's the Theory #1 (mechanical) Pathophysiology for Fat Embolism?

Answer 82

Large fat droplets are released into the venous system These droplets are deposited in the pulmonary capillary beds and travel through arteriovenous shunts to the brain Microvascular lodging of droplets produces local ischemia and inflammation, with concomitant release of inflammatory mediators, platelet aggregation, and vasoactive amines

Question 83

_{Orthopedic Trauma} What's the Theory #2 (biochemical) Pathophysiology for Fat Embolism?

Answer 83

Hormonal changes caused by trauma and/or sepsis induce systemic release of free fatty acids as chylomicrons Acute-phase reactants, such as C-reactive proteins, cause chylomicrons to coalesce and create the physiologic reactions described above The biochemical theory helps explain nontraumatic forms of fat embolism syndrome

Question 84

_{Orthopedic Trauma} What are the Signs of Fat Embolism Under General Anesthesia?

Answer 84

Acute decrease in ETCO2 Hypoxia/increased A-a gradient Tachycardia Petechial rash on the upper portions of the body (petechiae occur in only 20-50% of patients but are virtually diagnostic) Pulmonary compliance will likely decrease PA pressures will rise and cardiac output will fall

Question 85

_{Orthopedic Trauma} Although there is no literature that provides a treatment regimen for fat embolism, which Protocol can be utilized to treat fat embolism?

Answer 85

A-OK protocol (off-label protocol) may assist with stabilization **A = atropine 1mg IV** (blocks the vagal reflexes and prevents systemic hypotension) **O = ondansetron 8mg IV** (Impedes serotonin activity in the lungs and inflammatory system resulting from platelet activation) **K = Ketorolac 30mg IV** (Inhibits thromboxane and halts activation of the coagulation cascade) _Also use appropriate vasoactive drugs to help stabilize the patient_

Question 86

_{Head Injury} Anesthesia management of the head-injured patient includes

Answer 86

Early control of the airway to maintain SPO2 greater than 90% Establishing cardiovascular stability Intracranial hypertension (\> 20mmHg) and systolic hypotension (\<90 mmHg) should be avoided

Question 87

_{Head Injury} Which Neuro assessment data should be carefully documented before therapeutic maneuvers are initiated

Answer 87

Baseline evaluation of Glasgow Coma Scale (GCS) score, Pupillary reactivity and Motor function

Question 88

_{Head Injury} What may Patients with head injury need to have placed to monitor and troubleshoot rising intracranial pressures (ICP)?

Answer 88

**External Ventricular Drain** (EVD)

Question 89

_{Head Injury} As an NAR you will have to know how to care for the patient that is undergoing a craniotomy - These are very critical operations and prompt interventions need to occur to get the patients safely through surgery and to the Neuro-ICU afterwards - Which drugs should be avoided during these procedures?

Answer 89

**KETAMINE** and **Nitrous oxide**

Question 90

_{Spinal Cord Injury (SCI)} The leading cause of death in patients with Spinal Cord Injury (SCI) is:

Answer 90

**Aspiration pneumonia**

Question 91

_{Spinal Cord Injury (SCI)} SCI have many devastating physical and psychological effects - Avoidance of hypoxia and systemic hypotension is crucial in these patients because

Answer 91

it can **further compromise neural function** Hypoxia and hypercarbia can further accentuate the damage sustained with SCIs

Question 92

_{Spinal Cord Injury (SCI)} REMEMBER THAT INJURIES AT C1 AND C2 level result in

Answer 92

**Complete Respiratory Paralysis** Death can happen quickly if an airway isn’t established Tubing these patients are critical

Question 93

_{Spinal Cord Injury (SCI)} Why is Succinylcholine is not recommended for intubation of the patient with acute SCI?

Answer 93

Muscle fasciculation may exacerbate the SCI

Question 94

_{Spinal Cord Injury (SCI)} The CRNA/NAR should be aware of the six (6) conditions that are highly correlated with SCIs:

Answer 94

1. Paralysis 2. Pain 3. Position 4. Paresthesias 5. Ptosis 6. Priapism

Question 95

_{Spinal Cord Injury (SCI)} Why it is imperative to have someone hold in-line stabilization of the head to intubate these patients and to get a cervical collar ordered STAT for these patients?

Answer 95

Care should be used to avoid extension, flexion, or rotation of the neck Consider using a **GlideScope** to minimize neck movement with someone holding c-spine

Question 96

_{Spinal Cord Injury (SCI)} What vertebral level is the most common site of injury for SCI patients?

Answer 96

**C-7**

Question 97

_{Spinal Cord Injury (SCI)​} Patient with SCIs at which level have **severely impaired CNS function**?

Answer 97

**T6 level or higher**

Question 98

_{Spinal Cord Injury (SCI)​} CV effects of Spinal Cord Injury (SCI)​ include:

Answer 98

Decreased cardiac output Hypotension The SCI also interrupts sympathetic pathways from the hypothalamus (temperature control center) to peripheral blood vessels

Question 99

_{Spinal Cord Injury (SCI)​} Respiratory effects of Spinal Cord Injury (SCI)​ include:

Answer 99

Rapid development of pulmonary edema if their fluids are vasoactive drug therapy is not guided

Question 100

_{Spinal Cord Injury (SCI)​} What makes neurologic recovery from SCI very difficult but possible?

Answer 100

Spinal cord flow is disrupted from injury There may be decreased blood flow to needed vessels This can lead to irreversible damage

Question 101

_{Spinal Cord Injury (SCI)​} Which complication from Spinal Cord Injury (SCI)​ manifest as a sudden massive sympathetic discharge resulting from stimulation below the level of spinal-cord transections

Answer 101

**Autonomic Hyperreflexia**

Question 102

_{Spinal Cord Injury (SCI)​​} Hyperreflexia is seen in 85% of SCI patients with lesions above

Answer 102

**T5**

Question 103

_{Spinal Cord Injury (SCI)​​} Signs and symptoms of Autonomic Hyperreflexia include:

Answer 103

Paroxysmal hypertension Bradycardia Cardiac dysrhythmias in response to stimuli below the level of the transection

Question 104

_{Spinal Cord Injury (SCI)​​} Signs and symptoms of Autonomic Hyperreflexia are not usually seen until after

Answer 104

The spine shock phase has passed

Question 105

_{Spinal Cord Injury (SCI)​​} The CRNA/NAR must control the massive hypertensive spikes of these patients by

Answer 105

Deepening anesthesia or Giving a medication to treat hypertension