Test #2 Trauma in the OR-Josh Flashcards by Diana Hathaway

Q

Trauma is a severe blunt or penetrating injury primarily caused by what?

A

Automobile Crashes
Gunshots
Knife wounds
Falls
Battery
Burns

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Q

B/t the ages of ____ to ____ trauma kills more people than any other diesease

A

birth to 30 y.o.

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Q

Trauma Scoring:

What are the 3 categories the scoring system is based off?

A

BP
GCS
RR

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Q

Trauma Scoring:

what is the points range?

A

4
3
2
1
0

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Q

Trauma Scoring:

Give the correct Values for BP

4
3
2
1

A

>90
76-89
50-75
1-49
0

(0-50-25-15-10)

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Q

Trauma Scoring:

Give values for GCS

4
3
2
1
0

A

13-15
9-12
6-8
4-5
3

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Q

Trauma Scoring:

Givw the values for RR

4
3
2
1
0

A

10-29
>29
6-9
1-5
0

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Q

Trauma Scoring:

what are the chances of survival based on thre following trauma scores

8
6
4
2
1
0

A

98
92
60
17
7
3

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Q

put trauma table here

A

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Q

put other trauma table here

A

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Q

War and the advancement of trauma resuscitation:

when were blood transfusions developed

A

WWI

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Q

War and the advancement of trauma resuscitation:

what was created in WWII (2 things)

A

Antibiotic use
reduce transport time to 4 hours

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Q

War and the advancement of trauma resuscitation:

what was created in the Korean war (2 things)

A

Air ambulances
early vascular repair

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Q

War and the advancement of trauma resuscitation:

what was the advancement made in the vietnam war? (2 things)

A

helicopter use (reduced time of injury to surgery to 1 hour)
More regulated guidlines for resuscitation tech

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Q

War and the advancement of trauma resuscitation:

what was the advancement made in fluid resuscitation in the vietnam war

A

Aimed at avoiding renal failure and other consequences of hypotension
However the asanguinous resuscitational fluids further diluted remaining plateletes and coag factors

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Q

True or False

The majority of deaths on the modern battlefield are non-survivable?

A

true

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Q

The improved methods of __ or _____-_____, noncompressible hemostasis combined w/ rapid evacuation to surgery may increase survival

A

IV

Intra-cavitary

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Q

What was 4 of the Major findings from the 2003 research on fluid rescusitation in Modern combat causualty care:

A

Stop bleeding w/ tourniquets and better dressings
Most casualties do not require resuscitation (use hextand)
Titrate to radial pulse and mental status
Use no more than 1000mLs of colloid

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Q

what are 3 PREVENTABLE causes of combat death

A

Hemorrhage from extrmity wounds
tension Pneumothorax
Airway obstruction (facial trauma)

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Q

what is a CAT

A

not a thing that is all nibbly bibbly and meows in a damn tree

It’s a combat Application Tourniquet

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Q

What are some examples of hemostatis agents (5)

A

hemCon bandage
HemCon Chitoflex tape
QuikClot Powder
QuickClot ACS
Celox

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Q

what are the 3 Blood prodects to give for trauma

A

FFP

Platelets

Cryo

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Q

what does Cryo have that others dont?

A

Factor VIII and I
vWf and Fibrinogen

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Q

what are 2 machines that can assist you in getting blood into pt fast

A

Belmont

Rapid infuser

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what is the trauma Triad of death

Hyperthermia Acidosis Coagulopathy

why does Hypothermia happen: what are teh 4 ways we lose heat

* Evaporation * Radiation * Convection * Conduction

Hypothermia: Hypothermia causes increased what? (3 complications)

* Mortality * Bloodloss * Blood transfusion

Hypothermia: what 2 physiological clotting complications can occur

* Platelet dysfunction * Coagulopathy (biggest complication)

Hypothermia: \<\_\_\_ degress C on admission = 100% mortality

* \<32 degrees C

Hypothermia-Cardiac effects what occur at 33-36 C

* Increased HR, BP, CO

Hypothermia-Cardiac effects what happens at 32-33 C

opposite effect * DECREASED HR, BP, CO

Hypothermia-Cardiac effects \< 31 C

* Inc atrial and Ventricular irritability

Hypothermia-Cardiac effects \< 30 C

Bradycardia profound and Vfib is likely

Hypothermia-Cardiac effects 19-20 C

Asystole usually occurs

Hypothermia-Renal function: renal fx is dependent of what?

Cardiac Output

Hypothermia-Renal function: At 33-35 C ______ pressure increases secondary to systemic vasoconstriction

Afferent

Hypothermia-Renal function: @ temps \< 33 C, GFR \_\_\_\_\_. and impairment of distal tubular reabsorption can cause \_\_\_\_\_\_.

* Decreases * Polyuria

Hypothermia-Renal function: in almost ALL states of HYPOthermia you will get \_\_\_uria

Polyuria

Hypothermia-Hematological effects: what happens to HCT?

Increases

Hypothermia-Hematological effects: whay does HCT increase

* results from fluid shift to interstitial space and loss of fluid due to decreased distal tubular reabsorption

Hypothermia-Hematological effects: what happens to bleeding times?

Increased

Hypothermia-Hematological effects: what are bleeding times increased?

* Platelets are sequestered in the spleen and liver resulting in increased bleeding times

Hypothermia Prevention: what is a HPMK

Hypothermia prevention and Management Kit Comes w/ * Reflective cap * Self heating blanket * heat reflecting shell

Acidosis and Outcomes: pH \< 7.2 postop in the ICU what % lived

0%

Acidosis and Outcomes: pH of \> 7.33 postop in the ICU what % lived

88%

Acidosis: what are the actual causes? (5)

* Shock/ O2 delivery * Coagulopathy * Hypotension/Catecholamine receptor "uncoupling" * Arrhythmias * Decreased CO

Acidosis: what actually perfuses the tissue SPO2 or PaO2

* PaO2 * O2 dissolves across cell and oxygenates the cell

Acidosis: what is a better shift on the Oxyhemoglobin curve? right or left

* Right (slight) * B/c the right shift increases PaO2 thus increases O2 perfusion to the tissues

Coagulopathy of Trauma: majority of trauma pts (90%) are what? pro-thrombic or coagulopathic

Prothrombic

Coagulopathy of Trauma: what does being Pro-Thrombic cause?

* DVT * PE

Coagulopathy of Trauma: what is the major need of trauma pt since they are usually pro-thrombic?

Need anticoagulation

Coagulopathy of Trauma: Pro-thrombic pts are a real problem in what type of trauma pt's?

Hemorrhagic

Coagulopathy of Trauma: Since most pts are prothrombic and are prone to clots they are usually given what?

heparin

Coagulopathy of Trauma: only a minority (10%) of trauma pts are what? Pro-thrombic or Coagulapathic

Coagulopathic

Coagulopathy of Trauma: what is the problem associated with Coagulopathic pt

Bleeding and Death

Coagulopathy of Trauma: what do the Coagulopathic pt need

DCR

Hemostasis: How does platelet adhesion occur?

* Damage to endothelial surface \> subendothelial collagen exposure * production/ release of vWF from endothelial cells * vWF anchors platelets to subendothelial collagen vascular wall

Hemostasis: what is the most common inherited coagulation defect

Von Wilebrands Disease

what is the tx for Von Willebrands Dz

DDAVP

how does DDAVP work

releases vWF from endothelial cells

Platelet activation: Prothrombin \> _________ (\_\_\_) whoch activatees platelets

Thrombin (IIa)

Platelet activation: thrombin (IIa) is responsiable for shape change and release of what 2 mediators

* TX2 * ADP

Platelet activation: TX2 and ADP promote _____ aggregation

Platelet

Platelet activation: TX2 and ADP "uncover" the fibrinogen receptor what?

GPIIb/IIIa

Platelet activation: the "uncovering" of fibrinogen receptor GPIIb/IIIa. what does that receptor do?

* Allows Fibrinogen (I) to bind to the receptor and further aggregate platelets

Platelet activation: After platelets aggregate, ______ are woven into platelets and crosslinked

Fibrin

Platelet activation: After platelets aggregate, fibrin are woven into platelets and crosslinked. The cross linage requires \_\_\_\_\_

Fibrin Stabilizing factor (XIII)

Damage Control: Teh medic titrates fluids given to casulty based upon what 2 peramiters?

* Pulse * Mental status

Damage Control: the goal is to avoid excessive fluid administration which can inhibit what?

Clotting

Damage Control: what is the trilogy of damage control

* Abbreviated operation * Resuscitation in ICU * Return for the operatinf room for definitive operation

Damage Control: what is the abbreviated laparotomy

* Stop bleeding * Stop contamination * Leave abdomen open

Standard Resuscitation: you want to Dx and treat what 2 things?

* hypothermia * Acidosis

Standard Resuscitation: What should you give following LR administration

PRBCs

Standard Resuscitation: LR is it designated for trauma resucitation?

nope

Standard Resuscitation: LR can it make you acidodic or alkolotic

Acidodic

Standard Resuscitation: LR does it have clotting factors

you better say no

Standard Resuscitation: LR how much is left from a liter 60 min after infusion

200 mL's

Standard Resuscitation: LR LR is proinflammatory. T/F

True

Standard Resuscitation: the ruscitation trigger was after CV collapse. which is a SBP of what

\<90

Standard Resuscitation: LR the endpoint of resuscitation is often what?

Normal BP

Standard Resuscitation: LR Crystalloid will get BP up but will not deliver O2 to tissue, thus ______ are better choices. If there is no CO- give crystalloids to increase forward flow

Colloids

Standard Resuscitation: LR what is the resuscitation protocol or what is the standard massive transfusion protocol

* 6 PRBCs * 6 FFP 1:1 ratio * 6 unit platelets * 10 units cryo * Factor VIIa * Whole blood * Minimize Crystaloid\*\*\*\*\*\*

what is the formula for O2 delivery

Do2= CI x (1.34 x Hb x SaO2) x 10

What is teh formula for O2 uptake

VO2= CI x 1.34 x Hb x (SaO2 - SvO2) x 10

what is the oxygen extraction ratio formula

oxygen uptake / Oxygen delivery

what are some indications to initiate the MT protocol?

* SBP \< 90 * Temp \<96 * Hgb \< 11 * INR \> 1.5 * Base deficit \> 6 * More than 1 proximal amputation * Truncal injury w/ significant shock or coagulopathy

Transfuse RBC:FFP:PLT in what ratio

8:8:1

what should the MT be in the ER ASAP

* Emergency release of O- * Thawed Plasma * Easly rFVIIa (90 mcg/kg) and (cry 10U) * Continue w/ 6 U RBC and FFP * 1 unit platelete

when do u stop the Massive Transfusion protocol

* When bleeding stops * Adequate CO * Mixed venous sat 70% * Resolving Lactate or base deficit

what do you always minimize in trauma

Crystalloids

what is thawed plasma

FFP

Thawed plasma is FFP that is lept up to ___ Days at 4 C

5

FFP (Thawed Plasma) not only addresses the metabolic abnormality of shock, but initiates the reversal of the early _____ of trauma

Coagulopathy

Once an ABO blood tyoe is available the use of group O uncrossmatched red cells is converted to what?

the pt's biological tyoe

rFVIIa: why is it used

correct acidosis

rFVIIa: There is a decreased efficacy when pH is what

pH \< 7.2

rFVIIa: for it to work you need adequate what?

* Fibrinogen * Platelets

rFVIIa: what is the dose

* 90-120 mcg.kg

rFVIIa: how often can you adminiter it

Q2 hours

rFVIIa: what are the relative indications

* Severe Bleeding * at rick for MT * Temp \< 96 * SBP \<90 * Hb \<11 * Intracranial hemorrhage with AMS * Double amputee * Chest tube output \> 1000 ml's or 200mL's/hr * Major truncal injury w/ positive FAST

Burns: the chance of survival drops after what %

30%

Burns: Direct inhalational thermal injury results in what

* pulm edema

Burns: the deactivation of surfactant leads to what?

Atelectasis

Burns: CO shifts the Oxy heme curve to the???

LEFT

Burns: \_\_\_\_\_\_ changes cause massive fluid shifts

* Permeability

Burns: Contraction of Intravascular volume is highest during the 1st ____ hours

24

Burns: Fluid replacement normal

* 2-4 mL/kg / %body burned

Burns: the parkland formula

* Volume over 24 hours = kg x 4 x %BSA * 1/2 in first 8 hours * 25% next 8 hours * 25% final \* hours

Burns: blood pressure and HR are usually what (elevated or Decreased)

Elevated

Burns: Tissue destruction releases extra _____ into Circulation complicating resuscitation

K+

Burns: in later phases, renal wasting and gastric losses lead to what

Hypokalemia

Burns: electrical burns are associated w/ ______ which often leads to Acute renal failure

* Myoglobinuria

Burns: what NMB is contraindicated in burn pt's and why?

Suxs Hyperkalemia

Burns: NDMR doses have to be ______ d/t protein binding and more extrajunctional acetylcholine receptors

increased