Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

FFICM > resuscitation > Flashcards

resuscitation Flashcards

1
Q

major trauma

A

life threatening injury
may result in disability
ISS > 15

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

major trauma centre

A

hospital providing tertiary trauma care characterised by
- training
- 24/7 trauma lead and team
- specific specialties within 30 mins - neuro, spine, vascular, general, trauma, ENT, IR, anaesthesia, ICM
- resuscitative thoracotomy
- major haemorrhage
- relevant diagnositcs

TARN
- trauma audit and research network
- independent clinical audit with performance report and standards.
- e.g. RSI < 45 mins, CT < 1 hr if GCS < 13, consultant within 5 mins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Injury severity score

A

anatomical 6 regions
- face
- head and neck
- thorax
- abdomen and pelvis
- extremeties
- external

each region - abbreviated injury scale 1-6
square the 3 highest scores and add together - max 75
if any 6 = 75 (unsurvivable)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

trauma surveys

A

primary = identify immediately life threatening injuries c-ACBCE
secondary = meticulous head-toe examination for other potential causes of severe illness
tertiary = documentation of all injuries post investigation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Priorities in airway and c-spine

A

cervical spine protection alongside airway management
RSI - agitation, low / declining GCS, oxygenation, ventilation failure, humanitarian
challenges - MILS, facial injury, laryngeal injury, decompensation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Lethal 6 injuries

A
  • airway obstruction
  • tension PTX
  • open PTX
  • Massive harm-thorax
  • cardiac tamonade
  • flail Chet
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

pre-hospital interventions

A

haemorrhage - pressure, tourniquet, binder
intubation
thoracotomy
IV IO access
volume resuscitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

critical care priorities

A

initial
- assess resucitation needs and correct
- correct coagulopathy
- reverse O2 debt
ongoing
- reassessment
- secondary / tertiary survey
- definitive management of haemorrhage
- analgesia
- acid base status
- nutritional status

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Pelvic injury

A

Tile categories
A - stable
B - rotationally unstable, vertically stable open book
C - rotationally and vertically unstable

pelvic binder - greater trochanters, remove 24hrs max
CT angio
fixation
IR embolisation of bleeding vessel
damage control and packing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Blast injury

A

blast wave - rapidly expanding then contracting wave of energy
primary - direct effect of abnormal pressure
secondary - surrounding objects become projectile
tertiary - impact of person against surrounding object
secondary and tertiary lead to multi-trauma - shearing effects at tissue interfaces and direct injury

blast lung - disrupted alveolar-capillary membrane. haemorrhage, inflammation. ARDS, haemoptysis, air leak.
gas exchange failure, systemic gas embolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

resuscitative thoracotomy

A

penetrating chest trauma
- peri-arrest unable to go to theatre
- cardiac arrest with other signs of life
- established cardiac arrest, short down time
unlikely to be successful in penetrating trauma > 15 mins cpr, blunt trauma > 10 mins cpr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

massive haemothorax

A

1.5L on insertion of drain or
200ml/hr
likely arterial –> surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

definitions of major haemorrhage and massive transfusion

A

Major haemorrhage:
50% circulating volume in 2 hours
100% in 24 hours
150ml.min
haemodynamic instability
Massive transfusion
whole blood volume in 24 hours
50% blood volume in 4 hours
40ml/kg in paediatrics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

damage control resuscitation

A

permissive hypotension - circulatory support titrated to central pulse
haemostatic resuscitation - blood products, minimise crystalloid, prevent coagulopathy
damage control surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

damage control surgery

A

goal is to provide physiological and metabolic stability, not anatomical
- haemorrhage control
- decompression of compartments
- decontamination of wounds
- splinting of fractures
operating time < 90 mins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

trauma induced coagulopathy

A

imbalance of pro and anti coagulants
hyperfibrinolysis
raised anticoagulant factors
platelet dysfunction
exacerbated by hypothermia, citrate, dilution
INR > 1.2

diamond of death
- hypothermia
- acidosis
- coagulopathy
- hypocalcaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

investigation of major haemorrhage

A

source as per history and examination
CT as guided by stability
x-match
POC - ABG (hb, calcium)
Visoelastic testing
clotting studies / platelet count

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Severe bleeding management

A
  1. source control - direct pressure, surgical, IR
  2. General measures - avoid hypothermia, hypocalcaemia, acidosis. transfusion of blood products according to thresholds. permissive hypotension.
  3. blood products
    - 1:1:1
    - cryoprecipitate / fibrinogen concentrate
    - PCC e..g warfarin therapy
  4. pharamcological - dsmopressin, TXA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

DOAC reversal agents

A

dabigatram: idarucizumab
rivaroxaban, apixaban: andexenet alpha

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

major haemorrhage transfusion targets

A

Hb > 100 (ongoing active bleeding)
Hb > 70 when controlled
Platelets > 75
INR < 1.5
fibrinogen > 1.5
Ca > 1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

options to rise fibrinogen by 1g/l

A

FFP 15ml/kg
cryoprecipitate 2 pools
fibrinogen concentrate 3-4g

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

complications of major haemorrhage

A
  1. hypo perfusion (AKI, ALI, CNC, MI, GI ischaemia, MODS)
  2. coagulopathy - trauma induced, consumptive, dilutional
  3. hypothermia
  4. biochemical - hypocalcaemia, acidosis, hyperkalaemia
  5. transfusion reactions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

transfusion in critical care

A

restrictive - 70g/l
liberal - 80/90g/l in ACS

TRICC - 70 vs 100 - lower in hospital mortality
TRISS 70 vs 90 septic shock - no difference in mortality

24
Q

drowning

A

primary respiratory impairment following submersion in liquid.co

25
Q

cold water shock

A

phases of following immersion in cold water - respiratory and autonomic
1. cold shock 0-3min - thermoreceptors sensing rapid kin cooling and increase CO. inhalation gasp, tachypnoea, impaired breath holding, tachycardia vasoconstriction
2. short term immersion 3-15 min - extremity cooling, tetany from hyperventilation, shivering, swimming failure
3. long term immersion > 15 mins - hypothermia, ataxia, dysarthria
4. circumrescue collapse - hypovolaemai , sympathetic slump

26
Q

subermision injury

A

protective measures
- initial breath holding
- overwhelmed by co2 retention causing inhalation and mass aspiration
- laryngospasm and bronchospasm
- hypoxia, failed gas exchange
- hyperaemic LOC, cardiac arrest
- lung injury - surfactant washout, bronchospasm alveolar oedema

27
Q

resuscitation in drowning

A

general trauma, risk assessment, supine, dry, warm, remove clothing
cardiac arrest - warming
- defibrillate 3 times then stop until temp > 30
- adrenaline every 8-10 mins 30-35 degrees, withhold below 30

28
Q

critical care management drowning

A

LPV
haemodynamics
neuroprotection
electrolyte abnormalities
antimicrobials if contaminated water
poor prognostics
- immersion > 10 mins
- time to BLS > 10 mins
- core temp > 33 on arrival
- water temp > 10 degrees

29
Q

concerns regarding management of burns

A
  • other injuries
  • airway / inhalation injuries
  • difficult airway
  • inhaled substance toxicity
  • fluid shifts
  • pain
30
Q

estimating burns %

A

Wallace rule of 9
Lund-Browder chart
mersey burn app
include partial and full thickness only

31
Q

pathophysiology

A

zone of coagulation
- direct injury leading to tissue death
zone of stasis
- vasoconstriction, hypo perfusion - vulnerable to ischaemia, necrosis, infection
zone of hyperaemia
- inflammation, vasodilation, vascular permeability
systemic effects
- SIRS
- burns shock
- rhabdo
- hypermetabolism

32
Q

burns patient management

A

respiratory support per inhalation injury
fluid per parkland formula. albumin if > 6ml/kg/%TBSA
immediate surgery - fasciotomy, escharotomy
metabolic modulation - early feeding, analgesia, temp control
early excision to reduce necrotic load
toxin - carbon monoxide give O2 until < 3%. tydroxycobalamin if worsening lactic acidosis (cyanide)

33
Q

revised baux score

A

age + % TBSA + 17 for inhalation injury
point of futility now 160

34
Q

challenges of ongoing burns care

A
  • skin integrity
  • pain
  • frequent dressing changes
  • sepsis
  • inhalation injury
  • hyper metabolism
  • psychosocial
  • significant LOS
  • nutrition
35
Q

nutrition in burns

A

started within 12 hours
protein 1.5-2g/kg/day
oxandrolone - increase protein synthesis

36
Q

Sources of electrical injury

A

faulty equipment
complication of therapeutic electricity e.g. diathermy, DCCV
domestic appliances
lightening strike

37
Q

injury mechanisms in electrical injury

A
  • resistive coupling - tissue completes a circuit
  • capacitive coupling - tissue acting as capacitor
  • processes - electrocution, burns, burns from electrical fire, traumatic complications (falls)

electricity disrupts intrinsic electrical currents - myocardium, voltage gated channels.
thermal injury from conversion of energy to heat

38
Q

factors affecting severity of electrical injury

A
  • voltage
  • current type (AC worse than DC)
  • duration
  • current path e.g. through myocardium
  • environment - humidity
  • pre-morbid state
39
Q

Venous gas embolism

A

entrainment of gas from environment into the circulation with systemic effects. air / o2 / co2 / helium
arterial - coronary / cns ischaemia. cvs procecudres, pulmonary veins e.g. chest trauma, paradoxical from right-left shunt
venous - embolises to RA / RV / lungs - obstructive shock, right heart failure. venous line insertion, insufflation of body cavities

procedures - sitting craniotomy, posterior fossa, laparoscopy, cvc insertion

40
Q

pathophysiology of gas embolism

A

gas bubbles act as foreign substance - coagulation cascade activated, microcirculation dysfunction
damage to BBB, raised ICP
arterial - large volume - coronary, cerebral embolism and death. 0.02ml/kg potentially fatal
large volume venous - cardiac output cessation

41
Q

removal of cvc

A

trendelenburg position
firm pressure 5 mins
occlusive dressing
remain flat for 1 hour

42
Q

VGE diagnosis

A

clinical. TTE / TOE
suspected in periprocedural stroke
cvs - dyspnoea, pain, shock mill wheel murmur
neuro - reslteless, anxiety, focal neurology

43
Q

VGE management

A

prevent further entrainment
- flood surgical field, seal defect, check infusion devices
reduce embolism size
- 100% FiO2, aspirate cvc
supportive care
- durant maneouvre (left lateral decubitus)
- cpr may break up
hyperbaric oxygen - reduces size of embolism, denitrogenation, improve o2 delivery to ischaemic penumbra

44
Q

Fat embolism syndrome

A

syndrome following identifiable insult associated with release of fat into circulation
orthopaedic trauma - femoral / pelvic
mechanical theory - small emboli cause platelet aggregation, pulmonary capillary obstruction. large emboli causing macrovascular obstruction
biochemical theory - fat –> FFA, glycerol, proinflammatory cascade

45
Q

FES symptoms

A

12-72hr post insult
hypoxaemia, neurological features, petechiae
Gurd criteria 1 major + 4 minor
major - petechial rash, respiratory symptoms, CNS signs
minor - tachycardia, retinal fat deposits, pyrexia, fat in sputum, thrombocytopenia
management supportive
early fracture fixation reduces risk

46
Q

hypothermia classifications

A

core body temp < 35
32-35 mild
mod 28 -32
severe < 28

47
Q

causes of hypothermia

A

excess heat loss - surgery, trauma, environmental, skin disease
insuffivient production - hypometabolism e.g. hypothyroid
disordered thermoregulation - intoxication, hypothalmic disease

48
Q

clinical effects of hypothermia

A

A - loss of cough reflex
B - depression, hypoventilation. apnoea < 24
C - mild - vasoconstriction then tachycardia –> bradycardia. < 33 - bradycardia, AF. VF/VT < 28
D - mild - reduced CMRO2, loss of pupil response and tendon reflexes with severe
E - 7% BMR per 1 degree. shivering at 35 degrees, lost at 32
F - diuresis
other - increased blood viscosity, reduced WCC, impaired immunity

49
Q

cardiac arrest in hypothermia

A

3 shocks for VF then stop until temp > 30
no drugs until 30
double interval 30 -35

50
Q

warming hypothermic patients

A

passive - remove cold clothing, blankets, warm environment
active - forced air warmers, warm IV fluid, intravascular devices, extra-corporeal

51
Q

core vs peripheral temperature

A

1-2 degree higher core
core includes deep structures - intra-abdominal

52
Q

elevated temperature definitions

A

hyperthermia - imbalance of heat production, regulation and loss, temp > 37.5. no response to antipyretics and extreme elevation more common. heat stroke, thyrotxocosis, NMS, MH
fever - hypothalamic set point raised. infectious, non infectious (VTE, drug reaction, autoimmune, neoplastic)
pyrexia - elevated measured temperature
hyperpyrexia - temp > 41

53
Q

MH

A

progressive drug reaction caused by specific anaesthetic agents
MH susceptibility is genetic predisposition to develop MH when n contact with trigger
autosomal dominant
RYR1 / DHPR receptors

54
Q

MH presentation

A

unexplained tachycardia
rising ETCO2
rise in temperature
muscle rigidity
can be fulminant, mild, moderate, massetter spasm with or without rhabdo, peripherative death

55
Q
A

FFICM (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions