test 2: trauma

Question 1

4 steps of trauma

Answer 1

eliminate immediate threats to life

rapid initial examination and resuscitation

stabilization, through re-evaluation

definitive repair

Question 2

3 systems to check for immediate threat to life

Answer 2

central nervous system
respiratory
cardiovascular

Question 3

sucking chest wound first step

Answer 3

intubate
chest tube, cover hole
return chest to negative pressure

Question 4

when to put in chest tube

Answer 4

if you tapped more then twice

Question 5

how to place chest tube

Answer 5

incision into plura
second incision in skin, pull tube under skin to skin cut, close original hole

Question 6

VQ mismatch

Answer 6

blood into lungs vs air exchange not equal

in fractured rib, blood fills alveoli no gas exchange, deoxygenated into body circulation

Question 7

massive blood loss triggers

Answer 7

peripheral vasoconstriction
increased cardiac output

conserves blood to heart and brain

CRT >2, pale mucous membranes

Question 8

oxygen is needed for

Answer 8

ATP synthesis

Question 9

oxygen delivered = — x —

Answer 9

arterial oxygen content (CaO2)

cardiac output (CO

Question 10

to increase perfusion

Answer 10

optimize hemoglobin (carries most of the O2 in the body)

stroke volume(how much blood per heart beat)

Question 11

– will rapidly redistribute to entire interstitial space

Answer 11

crystalloids (LRS)

extracellular fluid will leave vessels and pool in interstitial space

Question 12

— will pull fluid from interstitial space into the vessels

Answer 12

hypertonic saline
dextran

(effect lasts 45 minutes)

Question 13

when not to give dextran

Answer 13

dehydration
closed compartment hemorrhage
ongoing hemorrhage

hypertonic saline- pulls fluid into the vessels- positive inotropic effect

Question 14

colloids are — and cause fluid to —

Answer 14

artificial plasma

pull fluid back into vessels

Question 15

tension pneumo will cause

Answer 15

lung to collapse

decrease venous return to the heart

Question 16

wound treatment starts with

Answer 16

Stabilize patient systemically

Pressure bandage to control bleeding- Avoid
torniquets if possible

No ointments or antiseptics

Sterile dressing to minimize further contamination

Question 17

stages of wound healing

Answer 17

coagulation- platelets and fibrin

inflammation- macrophages

proliferation - fibroblast

remodeling

Question 18

local factors that affect wound healing

Answer 18

ischemia
infection
foreign body
edema

Question 19

systemic factors affecting wound healing

Answer 19

DM
steroids
nutrition
sepsis
chemo

Question 20

how to prep wound

Answer 20

KY jelly
clip
scrub surrounding area

Question 21

— is ineffective against bacteria and can be damaging to cells

Answer 21

peroxide

Question 22

wound debridement is most effective —

Answer 22

soon after injury

Question 23

during debridement you want to retain as much —-

Answer 23

skin as possible

Question 24

lavage is a combo of —

Answer 24

pressure and high volume

Question 25

close wound right away

Answer 25

primary closure

Question 26

when to do primary closure

Answer 26

all infected material removed

minimal dead space

minimal tension on wound edges

Question 27

when to do delayed primary closure

Answer 27

wound several days old

fresh wound too contused or contaminated

Question 28

when to do second intention healing

Answer 28

very contaminated

not enough tissue to close

depends on contraction

Question 29

when to use antibiotics

Answer 29

severe contamination
open joint
fracture

must culture and sensitivity at time of initial debridement