Surgery Flashcards
What are the ABCs of Trauma Evaluation?
Airway
Breathing
Circulation
Characteristics of a patient with a PROTECTED airway
Awake and conscious
Normal tone of voice
Characteristics of a patient with an UNPROTECTED airway
Coma (GCS < 8)
Expanding hematoma or emphysema in neck
Noisy breathing/Difficulty breathing
Methods for establishing an airway in the field
Intubation
Cricothyroidotomy
Methods for establishing an airway in the Emergency Department
Rapid induction
Intubation
Pulse oximetry monitoring
Routes for intubation
Oral tube
Nasal tube (via bronchoscopy)
Cricothyroidotomy
Tracheostomy
Minimum age of patient to do cricothyroidotomy?
12 years old
Why is cricothyroidotomy not performed in children?
Small cricoid cartilage
Possible airway collapse
In the Trauma Setting:
For VENTILATION check ______________
For OXYGENATION check ______________
Breath Sounds
Pulse Oximetry
What is hypoxia?
Condition of low oxygen in body cells and tissues
Causes of hypoxia in the setting of trauma?
Hemorrhage/Blood loss
Collapsed airway
Lung parenchymal injury
Decreased ventilatory drive (neurologic)
What is shock?
Condition of low blood perfusion to body tissues and organs, resulting in multiple organ failure
Most common types of shock in the setting of trauma?
Hypovolemic Shock
Obstructive Shock
Clinical criteria of Shock
SBP < 90 mmHg
HR > 100
Urine Output < 0.5 ml/kg/hr
Causes of hypovolemic shock in the setting of trauma
Hemorrhage Burns Massive diarrhea Peritonitis Pancreatitis
Causes of obstructive shock in the setting of trauma
Tension pneumothorax
Cardiac tamponade
Recommended fluid resuscitation in traumatic hypovolemic shock
Establish 2 IV lines - large bore (Gauge 16 for Adults)
IV Plain Lactated Ringer’s solution
How to administer blood products for resuscitation in traumatic hypovolemic shock?
Typically in 1:1:1 ratio of pRBC, PC, and FFP
Clinical signs of a cranial base hemorrhage
Raccoon’s Eyes sign
Battle sign
Rhinorrhea
Otorrhea
Clinical findings in a patient with tension pneumothorax
Decreased breath sounds on affected side
Deviated trachea (not midline)
Dyspnea
What is the classic triad of cardiac tamponade?
BECK’S TRIAD
Low blood pressure
Distended neck veins
Muffled heart sounds
Treatment for a patient with tension pneumothorax
Pleural cavity decompression
Subsequent insertion of chest tube
Therapeutic procedures for a patient with cardiac tamponade?
Pericardiocentesis
Subxiphoid pericardial window
Thoracotomy
Minimum MAP for a patient with uncontrolled hemorrhage to maintain cerebral perfusion
60 mmHg
In the setting of trauma, identify the purpose of:
- Primary Survey
- Secondary Survey
- Stabilize the patient
2. Determine the etiology of the patient’s condition
A period of unconsciousness, followed by a lucid interval (return to normal functioning), with a subsequent return of unconsciousness, with fixed eye dilation and development of hemiparesis is the classic clinical picture of a patient with: _________________
Acute Epidural Hematoma
Classic CT scan finding in a patient with Acute Epidural Hematoma
Lens-shaped, convex hematoma
Classic CT scan finding in a patient with Acute Subdural Hematoma
Crescent-shaped hematoma
3 components of neurologic damage caused by trauma
- Initial blow
- Hematoma expansion
- Cerebral edema
How is cerebral perfusion pressure calculated?
Mean arterial pressure - intracranial pressure
Non-surgical measures to decrease intracranial pressure?
Head elevation
Hyperventilation
Avoidance of fluid overload
Diuretics
TRUE or FALSE
Uncontrolled cerebral hemorrhage often leads to hypovolemic shock
FALSE
The limited volume within the skull, along with autoregulation of cerebral vasculature, limits the amount of hemorrhage and thus, does not usually lead to hypovolemic shock
Classic CT scan finding of Diffuse Axonal Injury
Punctate hemorrhages
Loss of gray-white matter differentiation
