Principles of Anesthesia Quiz #2 Flashcards
What is a primary survey for a trauma patient?
Takes 2-5 minutes ABCDE sequence of trauma -Airway -Breathing -Circulation -Disability -Exposure
What is a secondary survey to a trauma patient?
Begins only when ABCs are stabilized
Examine from head to toe and obtain studies
What is a tertiary survey for a trauma patient?
To avoid missed injuries
Identifies all injuries
Typically within 24 hours
Awake patient more able to commnicate
What is always the top priority of assessing a patient?
Establishing/maintaining a patent airway.
All patients with a severe trauma or head injury should be assumed that they have a what?
Unstable cervical spine fracture
Unconscious patient with major trauma is always at increased risk for ___ and must be ___ ASAP
aspiration
intubated
What does MILS stand for?
Manual in-line stabilization
If patient arrives with ETT in place, you must verify and document correct ___
position Neck extension or lateral rotation -moves ETT away from carina Neck flexion -moves ETT toward carina
List five criteria that increase the risk for potential instability of C-spine
Neck pain Severe distracting pain Any neurological signs and symptoms Intoxication Loss of consciousness
What are three assessment skills?
Look, listen, feel approach
What are three signs of adequate circulation? Inadequate circulation?
Adequate
-HR, Pulse amplitude, blood pressure, signs of peripheral perfusion
Inadequate
-Tachycardia, weak/unable to palpate peripheral pulses, hypotension, pale cool cyanotic extremities
What is the most common cause of shock in trauma patients?
Hypovolemia
-tachycardia, poor cap refill, decreased blood pressure, hypotension, tachypnea, delirium
What is not an accurate indicator of acute blood loss?
Hct, Hgb
-Dilutional hematocrit
In a patient with hypotension related to hypovolemic shock, how should you treat it?
IVF and blood products, not pressors.
Getting a Type and cross takes ___, a type and screen ___, uncrossed O-negative PRBC ___.
45-60 min
5-10 min
Immediately
What is the crystalloid of choice?
LR
NS leads to hyperchloremic acidosis
When using colloids, what is the best option?
Albumin over hespan or dextran
Remember to warm all fluids, cold fluids can exacerbate v-fib
When assessing disability, what does AVPU stand for in a rapid neurological assessment?
Awake
Verbal response
Painful response
Unresponsive
List things included in a secondary survey
Glasgow coma scale
CT for pneumothorax
Pericardiocentesis for pericardial tamponade
Check extremities for fractures
Foley and NGT placed
CXR obtained in all patients with major trauma
Tertiary survey is usually done within ___ hours of initial injuries.
24
What are four common induction agents for a trauma related patient?
Ketamine (1-2 mg/kg)
Etomidate (0.2-0.3 mg/kg)
Propofol (dose greatly decreased)
Pentothal
What are treatments for heard trauma patients?
Fluid restriction, unless hypovolemic Diuretics Bariturates Deliberate hypocapnia -Hyperventilate
What are things to avoid in head traumas?
Anesthetic agents that increase ICP Hyperglycemia Hypertension Hypotension Trendelenburg position Pre-medications Anticholinergics
What is cushing’s triad?
Hypertension (widening pulse pressure)
Bradycardia
Respiratory depression
What are signs of increasing ICP?
Early warnings: Change in LOC, irritability, mild confusion, pupillary change, decrease in Glasgow Coma Score
Late signs: Difficult to arouse, coma, posturing, fixed pupils, ECG changes, Cushing’s response.
Treatments for increased ICP?
Diuretics - Mannitol 0.5 g/kg Steroids - Decadron 1 mg/kg Barbiturates Deliberate hypocapnia (PaCO2 28-32) Mild hypothermia Intraventricular drain (IVD)
How do you calculate CPP?
CPP = MAP - (CVP or ICP)
keep > 60 mmHg
What high thoracic injuries will eliminate sympathetic innervation of the heart/vessels?
T1-T4
Spinal shock, acute injury higher than ___ will lead to severely impaired CNS function
T6
What is the triad of spinal shock?
Hypotension
Bradycardia
Hypothermia
Sux is safe to use during the first ___ hours following spinal injury
24-48
Autonomic hyperreflexia occurs when injury happens where?
Above T5 (85%)
What are symptoms of autonomic hyperreflexia?
Severe hypertension
Bradycardia
Cardiac dysrhythmias
What do you avoid with autonomic hyperreflexia?
Avoid anectine
What do you avoid with pneumothorax?
N2O
What do you do to turn a pneumo into an open pneumo?
14g into 2nd intercostal space at midclavicular line
Where are most bronchial ruptures located with a hemothorax?
2.5 cm of the carina
What is Beck’s triad and what does it identify?
Neck vein distention, hypotension, muffled heart tones.
Cardiac tamponade
What is common with cardiac tamponade?
Pulsus paradoxus - 10 mmHg decrease in BP during spontaneous respiration.
Best induction agent - ketamine
List meds you would give for patients with delayed gastric emptying
Tagamet - decreases H+ Antacid - neutralize existing acid Reglan - decreases gastric emptying time -10 mg po > 1 hours before induction -10 mg iv over 1-2 min
What is the most important factor to consider with gastric emptying time?
The between last po intake and time of trauma
What is a common assessment to guesstimate the area of burn on a patient?
Rule of 9s
What are the different depths and gradings of burns?
1st degree -Epithelium only 2nd degree -Extend into dermis; most painful 3rd degree -Destroy entire skin thickness and nerve endings 4th degree -Destroys muscle, tendon, ligament, and bone
What direction does carbon monoxide inhalation shift the oxyhemoglobin curve?
Left
What are interventions to treat carbon monoxide inhalation?
Administration of 100% O2 will shorten the half-life of COhb from 4 hours in room air to < 1 hour
What is the Parkland formula for fluid replacement in burn patients?
Crystalloid 2-4 ml/%BSA burned/kg over 24 hours
Typically use the high end of the range
4ml/%BSA burned/kg in 24 hours
Where does fluid shift in a burn patient?
From intravascular to interstitial space
What are key considerations when caring for a burn patient?
Increased metabolism
- increased O2 consumption and CO2 production
Hyperkalemia from tissue destruction
Heat loss is serious problem
