RUPP TRAUMA Flashcards
What are the three areas of highest incidence of recall?
- Cardiovascular – (CABG)
- OB – (crash C-sections)..every second counts..
- Trauma
What are the 5 criteria for potential cervical spine injury?
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
What is the best way to intubate a patient with a cervical spine injury?
Manual inline stabilization (MILS). Can be used with glide scope.
Do you use nitrous Oxide(N2O) on any trauma?
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.
What trauma patients do you specifically avoid N20 with?
pneumothorax
pneumocephalus
pneumoperitoneum
Succinylcholine can increase serum potassium levels if administered ___ hours after a burn, spinal cord or crush injury.
24 hours
burn, spinal cord or crush injury.
Transfusion info
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
What ABG imbalance do patients get after massive transfusions?
metabolic alkalosis
What rate of transfusion can you see cardiac depression caused by hypocalcemia?
rate exceeds 1 unit every 5 minutes
How are patient-hemolytic reactions recognized in the anesthetized patient?
by increased temp, tachycardia, hypotension, hemoglobinuria, and oozing at the field
Warm fluids
In Erie —hypothermic traumas
Hypothermia worsens acid/base balance
Coagulopathies – platelet sequestration and red blood cell deformities
*Risking myocardial function
What is a common cause of bleeding after massive transfusions?
Dilutional thrombocytopenia
What is the half-life of colloids and crystalloids?
Crystalloids- half life of 20 – 30 minutes
Colloids half life of 3 – 6 hours
What is less likely to cause hyperkalemic acidosis than normal saline?
Lactated Ringers
Are dextrose solutions contraindicated in trauma, because it may exacerbate ischemic brain damage?
YES! Avoid dextrose solutions
Does calcium in the LR make it less or more compatible with blood transfusions?
LESS
NEVER HANG LR WITH BLOOD.
Only with NS
LR is slightly _____ and with large volumes can aggravate cerebral edema
Hypotonic
Are colloids effective in rapidly restoring intravascular volumes?
YES
Albumin
Dextran
Hetastarch
*Dextran and hetastarch can cause coagulopathy
What type of blood can be released to the moribund trauma patient requiring immediate blood transfusion that HAS NOT been typed and crossed?
Type O negative blood
Factor ____ can decrease by __% after two days in storage.
Dilutional _______ quickly develops when a patient is massively transfused.
Factor VIII can decrease by 50% after two days in storage.
Dilutional thrombocytopenia (low platelets) quickly develops when a patient is massively transfused.
Does the hypovolemic patient need less or more anesthetics?
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
What are the best induction agents for the trauma patient?
ketamine, etomidate
Injury to _____ or lower urinary tract can cause ________.
Injury to KIDNEYS or lower urinary tract can cause HEMATURIA.
Cervical spine injury occurs in ___% of all trauma patients
2%
Circulatory failure leading to inadequate vital organ perfusion and oxygen delivery = _______
SHOCK
Other signs of BRAIN injury include
Restlessness
Convulsions
Cranial nerve dysfunction (non reactive pupils)
What are the classic Cushing’s Triad signs?
Hypertension
Bradycardia
Respiratory disturbances
**The Triad are late signs and is preceded by brain herniation
Do you use sedatives or analgesics if you have a patient with suspected neuro issues?
No sedatives or analgesics if expected Neuro exam
Anticholinergic meds-induces pupillary dilation (robinol, spiriva, atrovent)
Anticholinergic meds-induces _____ _____ (robinol, spiriva, atrovent)
pupillary dilation
(robinol, spiriva, atrovent)
Signs of Beck’s Triad (cardiac tamponade)
Neck vein distension (jvd)
Hypotension
Muffled heart tones
Distended neck veins may signal ____ _____ …. ____ can kill.
pericardial tamponade….Diprivan can kill.
Pulsus paradoxus?
10mmHg decline on BP during spontaneous ventilation
What do you watch for when doing a pericardiocentesis?
watch for electrocardiographic changes when needle goes to far into myocardial tissue
Abdominal trauma key points
Usually need an exploratory laparotomy
HYPOTENSION when they open the abdomen
Large IV and blood…..fluid resuscitation
What do you get with massive transfusions?
hyperkalemia and hypocalcemia
Pelvic fractures can lead to _____ shock
hypovolemic
Femur fracture can mean ___units of blood loss
3 units of blood loss
Fat ______ risks with fractures
embolism
Fat embolism–labs
Elevation of serum lipase
Fat in urine
Thrombocytopenia
Spinal or regional for extremity attachment
can Increase blood flow
Watch hypotension with decreases blood flow
General for extremity attachment
Keep warm!
Avoid shivering on emergence to help reperfusion
Le forte fractures
See photo
What is intracranial hypertension is controlled by?
fluid restrictions
diuretics (mannitol)
hypocapnia (paCO2 26-30 mmHg)
Anesthetic agents that increase intracranial pressure avoid ____
KETAMINE
Mild _______ can assist saving brain tissue in a head injury
HYPOTHERMIA
C__ - C__ injury can cause apnea
C3-C5
3,4,5 keep you alive
T1-T4-???
cardiac accelerators
High cord injury you have ____ shock—loss of sympathetic tone —-hypotension, warm to the touch, bradycardia, areflexia and GI atony
High cord injury you have spinal shock—loss of sympathetic tone —-hypotension, warm to the touch, bradycardia, areflexia and GI atony
Autonomic hyperreflexia
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.
Autonomic hyperreflexia
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.
What is the treatment fora simple pneumothorax?
Chest tube 4th or 5th intercostal
Simple pneumo - air in the parietal and visceral pleura. Lung collapse causes vent/perf mismatch and hypoxia
What is a tension pneumo? And what is the treatment?
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
Hemothorax- ___ to isolate bleeding lung from healthy lung
Hemothorax - double lumen tube (DLT) to isolate bleeding lung from healthy lung
Acute Respiratory Distress Syndrome (ARDS)
Delayed lung response to trauma
Causes:
Sepsis
Thoracic injury
Aspiration
Head injury
Fat emboli
Massive transfusion
Mortality 50%!!!!!!
How can ARDS manifest in the OR?
As alarms on anesthesia machines—need a better ventilator with higher gas flows r/t their poor lung compliance
Need high airway pressures
