Review deck Flashcards
The circle of Willis is made up of
vertebral & internal carotid flow
Normal ICP is
5 to 15
Calculation of CPP is
CPP= MAP-ICP
CVP may be substituted for ICP
Increased CPP causes cerebral _________
vasoconstriction limiting CBF
Normal CPP is
80-100 mmHg
* consider what you would need to keep MAP at to achieve this
CBF remains constant at a MAP of
60-160 due to autoregulation
Total volume of CSF is
150 mL
The role of CSF is to
protect CNS from trauma
The Monro-Kellie hypothesis:
blood, CSF, and brain tissue are in a state of volume equilibrium such that any increase in volume of one of the cranial constituents must be compensated by a decrease in volume of another to prevent a rise in ICP
Cushing’s triad:
irregular respirations
hypertension
bradycardia
If a cerebral aneurysm rupture occurs, give ______ for brain protection
propofol
Adverse effects of Mannitol include
acidosis
pulmonary edema
Avoid giving this drug to patients with head trauma
ketamine
_______ is a good drug to give for patients with burns who have to undergo repeat dressing changes
ketamine
If a patient is on phenytoin, a NMBD will
last longer
Describe the sensitivity of VAE monitoring from most sensitive to least sensitive
TEE precordial doppler ETCO2 PAP CVP MAP
A concern with intubating a patient with maxillofacial injuries is
putting a breathing tube into the brain
-can also cause sinusitis & meningitis
For a patient after pituitary tumor removal who develops diabetes insipidus, treat with
vasopressin or desmopressin
This treatment can be used for vasospasm and ruptured cerebral aneurysm
triple H:
hypertension (SBP 160-200 mmHg)
hemodilution with Hct 33%
hypervolemia with CVP >10 mmHg
Considerations for neuro surgery include:
do not give benzos preoperatively
want them to be able to wake up early to participate in neuro exam
keep ETCO2 at 30
Describe the following as 1st, 2nd, 3rd, or 4th degree burns: very painful extends to bones & ligaments destruction of epidermis may result in contractures
painful-2nd
bones & ligaments-4th
destruction of epidermis- 1st
contractures-3rd
Describe the rule of 9’s to estimate percent burn of patient.
head- 9% arms- 9% each legs-18% each torso- 18% each groin- 1%
Treatment for CO poisoning includes
100% fiO2 & hyperbaric chamber
CO has _________ affinity for hemoglobin as ______ and shifts the oxygen dissociation curve ______
200 x
O2
LEFT
S/s of inhalational injury include
facial burns
singed facial hair
hoarseness
difficulty swallowing
After 24-48 hours, patients with burn injuries experience a
hyperdynamic state where CO is 2x higher
Fluid resuscitation goals for patients with burns include
UO: 0.5-1.0 mL/kg/hr HR: 80-140 MAP: adults >60 mmHg base deficit <2 Normal Hct
For each % area that is excised, blood loss is
200-400 mL
Patients who have undergone burns should not receive
succinylcholine 24 hours to 1 year post-burn to avoid massive release of K+, ventricular dysrythmias, and cardiac arrest
Patients with flail chest benefit from
epidural or paravertebral blocks
The primary survey for trauma victims includes
rapid evaluation for functions crucial to survival and includes ABCDE (airway patency, breathing, circulation, disability, and exposure)
Emergency intubation for patients with potential C-spine injury includes
100% O2 administered
simple chin lift with manual in-line stabilization
If a pregnant trauma patient comes in,
primary focus is mom
OB consult for management
lay them left lateral decubitus in the 2nd or third trimester
if Rh negative will need to give Rhogam if fetus is positive
Cardiac tamponade s/s is
Beck’s triad: narrow pulse pressure, JVD, muffled heart sounds, & hypotension
Indications for ETT intubation for trauma patient include
GCS <8
facilitate workup in uncooperative patient
For a trauma patient with a head injury & lower BP, you can give
etomidate
Needle decompression for tension pneumothorax is at:
2nd intercostal space midclavicular line
5th intercostal space midaxillary line
Hallmark symptoms of tension pneumothorax include
hypotension, hypoxemia, tachycardia, increased CVP, diminished BS on the affected side
JVD & tracheal deviation
Goals for early fluid resuscitation for trauma patient do not include
SBP >100 mmHg
The lethal triad post blood administration is
acidosis, hypothermia, coagulopathy
Hypothermia causes worsening of
acid base disorders
coagulopathy
shifts oxygen hemoglobin curve to the left
decreases metabolism of drugs, impairs platelet, and clotting enzyme function
The modified Brooke formula is
2 mLs x TB surface area burned x weight
then give over 24 hours: 1/2 in first 8, 1/4th in next 8, 1/4th in last 8
