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Pharm Final review > RUPP TRAUMA > Flashcards

RUPP TRAUMA Flashcards

1
Q

What are the three areas of highest incidence of recall?

A
  1. Cardiovascular – (CABG)
  2. OB – (crash C-sections)..every second counts..
  3. Trauma
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2
Q

What are the 5 criteria for potential cervical spine injury?

A

1) neck pain
2). severe distracting pain
3) any neurological signs and symptoms
4) intoxication (treat as if spine injury if drunk)
5) loss of consciousness at the scene

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3
Q

What is the best way to intubate a patient with a cervical spine injury?

A

Manual inline stabilization (MILS). Can be used with glide scope.

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4
Q

Do you use nitrous Oxide(N2O) on any trauma?

A

NO!!!! It can increase pressure in closed spaces

It tends to accumulate in closed spaces. Avoid in trauma patients with a pneumothorax, pneumocephalus, or pneumoperitoneum. Best practice do not use.

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5
Q

What trauma patients do you specifically avoid N20 with?

A

pneumothorax
pneumocephalus
pneumoperitoneum

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6
Q

Succinylcholine can increase serum potassium levels if administered ___ hours after a burn, spinal cord or crush injury.

A

24 hours

burn, spinal cord or crush injury.

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7
Q

Transfusion info

A

Postop after massive transfusions patients get metabolic alkalosis

If transfusion rate exceeds 1 unit every 5 minutes you can see cardiac depression caused by hypocalcemia

In an anesthetized patient-hemolytic reactions are recognized by increased temp, tachycardia, hypotension, hemoglobinuria, and oozing at the field

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8
Q

What ABG imbalance do patients get after massive transfusions?

A

metabolic alkalosis

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9
Q

What rate of transfusion can you see cardiac depression caused by hypocalcemia?

A

rate exceeds 1 unit every 5 minutes

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10
Q

How are patient-hemolytic reactions recognized in the anesthetized patient?

A

by increased temp, tachycardia, hypotension, hemoglobinuria, and oozing at the field

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11
Q

Warm fluids

A

In Erie —hypothermic traumas

Hypothermia worsens acid/base balance

Coagulopathies – platelet sequestration and red blood cell deformities
*Risking myocardial function

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12
Q

What is a common cause of bleeding after massive transfusions?

A

Dilutional thrombocytopenia

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13
Q

What is the half-life of colloids and crystalloids?

A

Crystalloids- half life of 20 – 30 minutes

Colloids half life of 3 – 6 hours

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14
Q

What is less likely to cause hyperkalemic acidosis than normal saline?

A

Lactated Ringers

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15
Q

Are dextrose solutions contraindicated in trauma, because it may exacerbate ischemic brain damage?

A

YES! Avoid dextrose solutions

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16
Q

Does calcium in the LR make it less or more compatible with blood transfusions?

A

LESS

NEVER HANG LR WITH BLOOD.

Only with NS

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17
Q

LR is slightly _____ and with large volumes can aggravate cerebral edema

A

Hypotonic

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18
Q

Are colloids effective in rapidly restoring intravascular volumes?

A

YES

Albumin
Dextran
Hetastarch

*Dextran and hetastarch can cause coagulopathy

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19
Q

What type of blood can be released to the moribund trauma patient requiring immediate blood transfusion that HAS NOT been typed and crossed?

A

Type O negative blood

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20
Q

Factor ____ can decrease by __% after two days in storage.

Dilutional _______ quickly develops when a patient is massively transfused.

A

Factor VIII can decrease by 50% after two days in storage.

Dilutional thrombocytopenia (low platelets) quickly develops when a patient is massively transfused.

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21
Q

Does the hypovolemic patient need less or more anesthetics?

A

Need LESS anesthetics

Alveolar concentration IS UP in shock patients r/t a decrease in C.O. and increased ventilation

Smaller intravascular volume so the intravenous anesthetics are EXAGGERATED

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22
Q

What are the best induction agents for the trauma patient?

A

ketamine, etomidate

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23
Q

Injury to _____ or lower urinary tract can cause ________.

A

Injury to KIDNEYS or lower urinary tract can cause HEMATURIA.

24
Q

Cervical spine injury occurs in ___% of all trauma patients

A

2%

25
Q

Circulatory failure leading to inadequate vital organ perfusion and oxygen delivery = _______

A

SHOCK

26
Q

Other signs of BRAIN injury include

A

Restlessness
Convulsions
Cranial nerve dysfunction (non reactive pupils)

27
Q

What are the classic Cushing’s Triad signs?

A

Hypertension

Bradycardia

Respiratory disturbances

**The Triad are late signs and is preceded by brain herniation

28
Q

Do you use sedatives or analgesics if you have a patient with suspected neuro issues?

A

No sedatives or analgesics if expected Neuro exam

Anticholinergic meds-induces pupillary dilation (robinol, spiriva, atrovent)

29
Q

Anticholinergic meds-induces _____ _____ (robinol, spiriva, atrovent)

A

pupillary dilation

(robinol, spiriva, atrovent)

30
Q

Signs of Beck’s Triad (cardiac tamponade)

A

Neck vein distension (jvd)

Hypotension

Muffled heart tones

31
Q

Distended neck veins may signal ____ _____ …. ____ can kill.

A

pericardial tamponade….Diprivan can kill.

32
Q

Pulsus paradoxus?

A

10mmHg decline on BP during spontaneous ventilation

33
Q

What do you watch for when doing a pericardiocentesis?

A

watch for electrocardiographic changes when needle goes to far into myocardial tissue

34
Q

Abdominal trauma key points

A

Usually need an exploratory laparotomy

HYPOTENSION when they open the abdomen

Large IV and blood…..fluid resuscitation

35
Q

What do you get with massive transfusions?

A

hyperkalemia and hypocalcemia

36
Q

Pelvic fractures can lead to _____ shock

A

hypovolemic

37
Q

Femur fracture can mean ___units of blood loss

A

3 units of blood loss

38
Q

Fat ______ risks with fractures

A

embolism

39
Q

Fat embolism–labs

A

Elevation of serum lipase

Fat in urine

Thrombocytopenia

40
Q

Spinal or regional for extremity attachment

A

can Increase blood flow

Watch hypotension with decreases blood flow

41
Q

General for extremity attachment

A

Keep warm!

Avoid shivering on emergence to help reperfusion

42
Q

Le forte fractures

A

See photo

43
Q

What is intracranial hypertension is controlled by?

A

fluid restrictions

diuretics (mannitol)

hypocapnia (paCO2 26-30 mmHg)

44
Q

Anesthetic agents that increase intracranial pressure avoid ____

A

KETAMINE

45
Q

Mild _______ can assist saving brain tissue in a head injury

A

HYPOTHERMIA

46
Q

C__ - C__ injury can cause apnea

A

C3-C5

3,4,5 keep you alive

47
Q

T1-T4-???

A

cardiac accelerators

48
Q

High cord injury you have ____ shock—loss of sympathetic tone —-hypotension, warm to the touch, bradycardia, areflexia and GI atony

A

High cord injury you have spinal shock—loss of sympathetic tone —-hypotension, warm to the touch, bradycardia, areflexia and GI atony

49
Q

Autonomic hyperreflexia

A

Autonomic Dysreflexia (AD), sometimes referred to as Autonomic Hyperreflexia, is a potentially life-threatening medical condition that many people with spinal cord injury (SCI) experience when there is a pain or discomfort below their level of injury, even if the pain or discomfort cannot be felt.

50
Q

Autonomic hyperreflexia

A

Not associated in first 48 hours

Succinylcholine OK at this point

Autonomic hyperreflexia is a reaction of the autonomic (involuntary) nervous system to overstimulation. This reaction may include high blood pressure, change in heart rate, skin color changes (paleness, redness, blue-grey skin color), and excessive sweating.

51
Q

What is the treatment fora simple pneumothorax?

A

Chest tube 4th or 5th intercostal

Simple pneumo - air in the parietal and visceral pleura. Lung collapse causes vent/perf mismatch and hypoxia

52
Q

What is a tension pneumo? And what is the treatment?

A

Air in pleural space trapped and increases with inspiration and not escape with expiration

Tracheal shift away from the affected side

Simple can be turned to tension with positive pressure (bagging or Ventilator)

Treatment—*14 gauge needle at second intercostal space at midclavicular line then a chest tube like for a simple pneumo

53
Q

Hemothorax- ___ to isolate bleeding lung from healthy lung

A

Hemothorax - double lumen tube (DLT) to isolate bleeding lung from healthy lung

54
Q

Acute Respiratory Distress Syndrome (ARDS)

A

Delayed lung response to trauma

Causes:

Sepsis
Thoracic injury
Aspiration
Head injury
Fat emboli
Massive transfusion

Mortality 50%!!!!!!

55
Q

How can ARDS manifest in the OR?

A

As alarms on anesthesia machines—need a better ventilator with higher gas flows r/t their poor lung compliance

Need high airway pressures

Pharm Final review (24 decks)

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