Multi-organ Failure

Question 1

Name five physiological triggers that would warrant a trauma call?

Answer 1

Airway compromise
RR <10//>29
S.BP <90
HR >130
GCS <14

Question 2

Name nine anatomical triggers that would warrant a trauma call?

Answer 2

Flail chest
Penetrating trauma
>2 proximal long bone #
Amputation (proximal to wrist/ankle)
Suspected and significant pelvic #
Significant burns
Paralysis
Age >65
Trauma >1 body zone

Question 3

Under which two other circumstances would a trauma call be triggered?

Answer 3

High risk mechanism of injury

Multiple trauma victims

Question 4

Describe the three main physiological responses to a significant haemorrhage?

Answer 4

Reduced mean arterial pressure:

1. Baro-receptor response = increased SNS
2. Endocrine response = adrenalin and steroid release
3. Reduced renal perfusion = RAAS activation (H20 retention)

Question 5

Ongoing haemorrhage can end up in which 5 places?

Answer 5

Abdominal cavity
Chest
Pelvis
Long bone
Floor

Question 6

Under the immediate investigations which three things will you be looking for?

Answer 6

Hb - unreliable in very early period
Glucose (BM)
ABG - most commonly the pt will have metabolic acidosis

Question 7

Within the haemorrhage management - in restoring volume what should be administered?

Answer 7

WARM (prevent hypothermia):
Fluids
Blood
FFP (clotting factors)
Cryoprecipitants (source of fibrinogen) 
Platlets

Question 8

Describe the ‘traumatic bleeding triangle’?

Answer 8

1. Blood clotting (coagulopathy)
Increased lactic acid within the blood
2. Acidosis (acidic blood)
Decreased heart performance
3. Hypothermia (low body temp)
Decreased coagulation

Question 9

How does acidosis occur within acute haemorrhage?

Answer 9

Vasoconstriction
Hypotension
Hypoperfusion
All lead to anaerobic metabolism and the build up of lactic acid

Question 10

Name five imaging modalities considered in an acute trauma call?

Answer 10

X-ray
U/S
Fluroscopy
FAST-scan = of the abdomen sonography looking for fluid within the abdominal cavity//pericardial space//pleural space

Question 11

Describe three typical features of 2nd brain injuries?

Answer 11

1. Distortion of vital structures
2. Intracranial inflammation (raised ICP)
3. Inadequate cerebral blood flow
   Often all three leading to hypoxia

Question 12

Define cerebral blood flow and at which point is it very worrying?

Answer 12

Cerebral blood flow = 750 ml/min
(= 50mls/100grams of brain tissue)
- As it falls <20mls/100grams - the supply and ability to auto-regulate (vasodilation/vasoconstriction) starts to become ineffective

Question 13

Define cerebral perfusion pressure?

Answer 13

CPP = (mean arterial pressure - intracranial pressure)

Question 14

Which structures take up volume within the cranium?

Answer 14

Brain tissue (paranchyma)
CSF
Blood

Question 15

Describe the effects of a haematoma/mass lesion?

Answer 15

Something that produces brain swelling - initially the brain is able to compensate - as CSF can be squeezing into the spinal space.
However at a certain point mechanisms will be overwhelmed and ICP will increase + CPP will therefore decrease

Question 16

Name four clinical features of brain-stem herniation?

Answer 16

1. CN 3 palsy
2. Motor posturing (decorticate/decerebrate)
3. Lower limb rigidity
4. Hyperventilation

Question 17

Name five clinical features of raised ICP?

Answer 17

1. Decreased GCS
2. Pressor (Cushing’s) response
3. Projectile vomiting
4. CN 6 palsy
5. Papilloedema

Question 18

Name three ways in which to measure ICP?

Answer 18

Ventriculostomy
Brain tissue O2 probe
Fiber-optic intraparanchymal ICP monitor
All INVASIVE and reserved for GCS <9

Question 19

What is normal ICP?

Answer 19

5-15

Be worried if >20

Question 20

Name four methods of controlling ICP?

Answer 20

Surgery (remove mass lesion)
Reduce CSF volume (drain)
Reduce paranchymal volume (hypertonic solution)
Reduce cerebral blood volume:
1. Arterial: sedation, avoid fever, mechanical ventilation
2. Venous: head up, avoid JV compression

Question 21

.What is the taget CPP and what effects do high and low pCO2 have on the cerebral blood flow?

Answer 21

CPP target = 60mmHG
High pCO2 = Vasoconstriction of cerebral blood flow
Low pCO2 = Vasodilation of cerebral blood flow

Question 22

Which seven things would be investigated with the sepsis protocol?

Answer 22

1. Blood cultures
2. Urine dp
3. ABG
4. CXR
5. ECG
6. Lactate
7. Urine output

Question 23

What are the risk factors for sepsis? (7)

Answer 23

1. O2 - maintain sats at >90%
2. RR>25
3. Lactate >2
4. S.BP <90
5. Purpuric rash
6. HR >130
7. AVPU