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Patho 2 > Shock/Trauma Anesthesia > Flashcards

Shock/Trauma Anesthesia Flashcards

1
Q

What is (LD)50

A

lethal dose

the burn size lethal to 50% of the population

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2
Q

Why do third degree burns require grafting, but not second?

A

In third degree, the basement membrane of the epithelium AND the dermis appendages are destroyed

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3
Q

According to the ABA, what qualifies as a major burn?

A
  1. 2D with > 10% TBSA
  2. 3D with more than 10% TBSA
  3. Any electrical burn
  4. burn complicated by smoke inhalation
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4
Q

What is the ABA mortality estimate tool?

A

Patient Age + %TBSA

If > 150, mortality is 80%

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5
Q

How does smoke inhalation impact mortality of a burn injury?

A

doubles it

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6
Q

What are the four types of burns

A

Chemical

Electrical

Thermal

Inhalation

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7
Q

What is the most damaging type of burn?

A

Electrical

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8
Q

Why are patients with electrical burns at high risk for renal failure?

A

Myoglobinemia

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9
Q

What is the most common burn in kids < 4?

Kids > 5?

A

Scald

Flame

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10
Q

What are the three types of inhalation injury?

A
  1. upper airway
  2. lower airway injuries caused by chemical and particulate constituents of smoke
  3. metabolic asphyxiation from CO or Hydrogen Cyanide
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11
Q

What are the three phases of burn treatment?

A
  1. resuscitative
  2. debridement and grafting
  3. reconstructive
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12
Q

What usually causes inhalation damage below the cords: heat or particles?

A

Particles

Heat really only damages the upper airways because it gets dissipated

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13
Q

In a pediatric burn patient, what size tube should be used?

A

One size smaller than is recommended for that child’s height and weight

Cuffed if < 8 yrs old

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14
Q

When is it unsafe to do an RSI with Succ for a burn victim?

Why?

A

Generally if they’re greater than 24 hours out

The body up-regulates acetylcholine receptors, increasing the amount of potassium released

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15
Q

What kind of nebs can aid in burn healing?

A

Heparin and N-Acetylcysteine

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16
Q

What percent of fire deaths are due to CO?

A

50-60%

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17
Q

What is the half life of CO in a patient that’s been put on 100% O2?

A

30 min to 2.5 hours

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18
Q

How does hydroxycobolamin aid in CO?

A

Converts CO to CO2

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19
Q

Why does cyanide poisoning cause hypoxia?

A

blocks intracellular use of oxygen:

binds to the terminal cytochrome in the ETC

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20
Q

How does hydroxycobalamin neutralize Hydrogen cyanide?

A

binds with cyanide, forming cyanocobalamin, which can be easily excreted by the kidneys

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21
Q

When are fluid losses highest after a burn?

When do they start to stabilize?

A

12 hours

24 hours

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22
Q

Pretty much all burn resuscitation formulas are based on two things:

A

weight

%TBSA

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23
Q

Why are colloid solutions not recommended in the first 24 hours?

A

Capillary permeability is too high. Those proteins will seep right out and take the fluid with it

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24
Q

What is the prime resuscitation fluid for burn patients?

25
Q

Intrabdominal hypertension is defined as:

26
Q

Abdominal compartment syndrome is defined as:

A

IABP > 20 mmHg with evidence of new organ dysfunction (usually oliguria)

27
Q

What are some treatments for Abdominal Compartment Syndrome?

A

Paralytics

Increased sedation

escharotomies

diuretics

Decompressive laparotomy

28
Q

What are the primary mediators of the profound hypermetabolic state associated with burns?

A

Catecholamines and corticosteroids

29
Q

What are the three big causes of anemia in burn patients?

A
  1. Hemolysis of blood cells that get thrombosed in burned tissue
  2. Bone marrow suppression
  3. Surgical debridements
30
Q

How do burn patients respond to non-depolarizing paralytics?

A

Resistant to NDMRs

Higher and more frequent dosing is often needed

(more acetylcholine receptors that are less sensitive)

31
Q

Which anesthetic should be avoided in patients with thoracic trauma?

A

Nitrous

d/t the risk of an occult pneumothorax

32
Q

If you suspect a massive hemothorax, when do you want to put in chest tubes?

A

Only after you’ve achieved adequate fluid resuscitation or at least have good access and are well on your way

33
Q

Why is etomidate not an ideal drug for a trauma induction?

A

Adrenal suppression

34
Q

How much propofol should be used during a trauma induction?

A

Ideally 10-50% of the normal dose

35
Q

What is the most common traumatic lung injury?

A

Pulmonary Contusion

36
Q

What are pulmonary contusions?

A

Damage to the alveoli, but not gross disruption of pulmonary structure

37
Q

What respiratory dysfunction does a pulmonary contusion cause?

A

contusion (basically a bruise) causes exudate that settles into the alveolar membrane

Increase the distance between air and capillaries, impairing gas exchange

38
Q

Why does hypothermia cause coagulopathies?

A

Inhibits initiation of thrombin generation

inhibits fibrinogen synthesis

essentially: slowly makes a fragile clot that is unable to stop bleeding

39
Q

Acidosis generally doesn’t impact coagulation, except when:

A

It is paired with hypothermia

40
Q

Early management of TBI includes:

A

rapid administration of plasma

(rFVIIa is also effective)

41
Q

Why is it that bleeding leads to coagulopathy?

A

Thrombomodulin-Thrombin complexes form

Lead to activated Protein C and clotting factor inactivation

42
Q

_____carbia increases ICP

43
Q

In a patient with increased ICP, the goal is to keep CPP at:

A

> <60 mmHg and < 70 mmHg

44
Q

Which anesthetic is not a good choice for patients with increased ICP?

A

Ketamine

Raises ICP

45
Q

What is the most common site of cervical injury?

46
Q

If a patient arrives hypoxic and needs to be intubated, what should be done?

A

Face mask ventilation with cricoid pressure until intubation (rather than a traditional RSI)

47
Q

Why should succinylcholine be avoid in patients with spinal injury?

A

Fasciculations may worsen the spinal cord instability

Also potassium

48
Q

In spinal shock, describe:

BP

HR

Skin

A

Low

Low

Warm/Pink

49
Q

Innervation of the primary muscles of respiration emerge at:

50
Q

The intercostal mm are innervated by nerves originating at:

51
Q

Where is the vertebral artery most susceptible to injury?

A

At its entry point into the C-6 foramen

52
Q

The inductions most commonly used in trauma are:

A

etomidate, ketamine, propofol

53
Q

Autonomic dysreflexia is found in patients who suffer an SCI above:

54
Q

Autonomic dysreflexia is characterized by:

A

severe hypertension

seizures

pulmonary edema

MI

AKI

Intracranial hemorrhage

55
Q

What causes autonomic dysreflexia?

A

sudden activation of sympathetic response as a result of noxious stimuli (colorectal or bladder distention)

56
Q

Most traumatic injuries are caused by two things:

A

Falls

MVCs

57
Q

What are the chances that a patient with one fractured femur will get a fat embolus?

Two fractured femurs?

58
Q

When are fat emboli typically seen?

A

24-72 hours after the initial injury

59
Q

What is a landmark the anesthetist can use to determine if volume resuscitation is complete?

A

If the patient can tolerate a bolus of fentanyl without it tanking their BP, their hypovolemic state has probably been corrected

Patho 2 (24 decks)

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