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Principles IV > Test #2 Trauma in the OR-Josh > Flashcards

Test #2 Trauma in the OR-Josh Flashcards

1
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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2
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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3
Q

Trauma Scoring:

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

A
  • BP
  • GCS
  • RR
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4
Q

Trauma Scoring:

what is the points range?

A
  • 4
  • 3
  • 2
  • 1
  • 0
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5
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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6
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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7
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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8
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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9
Q

put trauma table here

A
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10
Q

put other trauma table here

A
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11
Q

War and the advancement of trauma resuscitation:

when were blood transfusions developed

A

WWI

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12
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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13
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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14
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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15
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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16
Q

True or False

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

A

true

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17
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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18
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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19
Q

what are 3 PREVENTABLE causes of combat death

A
  • Hemorrhage from extrmity wounds
  • tension Pneumothorax
  • Airway obstruction (facial trauma)
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20
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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21
Q

What are some examples of hemostatis agents (5)

A
  • hemCon bandage
  • HemCon Chitoflex tape
  • QuikClot Powder
  • QuickClot ACS
  • Celox
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22
Q

what are the 3 Blood prodects to give for trauma

A

FFP

Platelets

Cryo

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23
Q

what does Cryo have that others dont?

A
  • Factor VIII and I
  • vWf and Fibrinogen
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24
Q

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

A

Belmont

Rapid infuser

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25
Q

what is the trauma Triad of death

A

Hyperthermia

Acidosis

Coagulopathy

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26
Q

why does Hypothermia happen:

what are teh 4 ways we lose heat

A
  • Evaporation
  • Radiation
  • Convection
  • Conduction
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27
Q

Hypothermia:

Hypothermia causes increased what? (3 complications)

A
  • Mortality
  • Bloodloss
  • Blood transfusion
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28
Q

Hypothermia:

what 2 physiological clotting complications can occur

A
  • Platelet dysfunction
  • Coagulopathy (biggest complication)
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29
Q

Hypothermia:

A
  • <32 degrees C
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30
Q

Hypothermia-Cardiac effects

what occur at 33-36 C

A
  • Increased HR, BP, CO
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31
Q

Hypothermia-Cardiac effects

what happens at 32-33 C

A

opposite effect

  • DECREASED HR, BP, CO
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32
Q

Hypothermia-Cardiac effects

< 31 C

A
  • Inc atrial and Ventricular irritability
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33
Q

Hypothermia-Cardiac effects

< 30 C

A

Bradycardia profound and Vfib is likely

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34
Q

Hypothermia-Cardiac effects

19-20 C

A

Asystole usually occurs

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35
Q

Hypothermia-Renal function:

renal fx is dependent of what?

A

Cardiac Output

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36
Q

Hypothermia-Renal function:

At 33-35 C ______ pressure increases secondary to systemic vasoconstriction

A

Afferent

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37
Q

Hypothermia-Renal function:

@ temps < 33 C, GFR _____. and impairment of distal tubular reabsorption can cause ______.

A
  • Decreases
  • Polyuria
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38
Q

Hypothermia-Renal function:

in almost ALL states of HYPOthermia you will get ___uria

A

Polyuria

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39
Q

Hypothermia-Hematological effects:

what happens to HCT?

A

Increases

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40
Q

Hypothermia-Hematological effects:

whay does HCT increase

A
  • results from fluid shift to interstitial space and loss of fluid due to decreased distal tubular reabsorption
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41
Q

Hypothermia-Hematological effects:

what happens to bleeding times?

A

Increased

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42
Q

Hypothermia-Hematological effects:

what are bleeding times increased?

A
  • Platelets are sequestered in the spleen and liver resulting in increased bleeding times
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43
Q

Hypothermia Prevention:

what is a HPMK

A

Hypothermia prevention and Management Kit

Comes w/

  • Reflective cap
  • Self heating blanket
  • heat reflecting shell
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44
Q

Acidosis and Outcomes:

pH < 7.2 postop in the ICU what % lived

A

0%

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45
Q

Acidosis and Outcomes:

pH of > 7.33 postop in the ICU what % lived

A

88%

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46
Q

Acidosis:

what are the actual causes? (5)

A
  • Shock/ O2 delivery
  • Coagulopathy
  • Hypotension/Catecholamine receptor “uncoupling”
  • Arrhythmias
  • Decreased CO
47
Q

Acidosis:

what actually perfuses the tissue SPO2 or PaO2

A
  • PaO2
  • O2 dissolves across cell and oxygenates the cell
48
Q

Acidosis:

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

A
  • Right (slight)
  • B/c the right shift increases PaO2 thus increases O2 perfusion to the tissues
49
Q

Coagulopathy of Trauma:

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

A

Prothrombic

50
Q

Coagulopathy of Trauma:

what does being Pro-Thrombic cause?

A
  • DVT
  • PE
51
Q

Coagulopathy of Trauma:

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

A

Need anticoagulation

52
Q

Coagulopathy of Trauma:

Pro-thrombic pts are a real problem in what type of trauma pt’s?

A

Hemorrhagic

53
Q

Coagulopathy of Trauma:

Since most pts are prothrombic and are prone to clots they are usually given what?

A

heparin

54
Q

Coagulopathy of Trauma:

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

A

Coagulopathic

55
Q

Coagulopathy of Trauma:

what is the problem associated with Coagulopathic pt

A

Bleeding and Death

56
Q

Coagulopathy of Trauma:

what do the Coagulopathic pt need

A

DCR

57
Q

Hemostasis:

How does platelet adhesion occur?

A
  • Damage to endothelial surface > subendothelial collagen exposure
  • production/ release of vWF from endothelial cells
  • vWF anchors platelets to subendothelial collagen vascular wall
58
Q

Hemostasis:

what is the most common inherited coagulation defect

A

Von Wilebrands Disease

59
Q

what is the tx for Von Willebrands Dz

A

DDAVP

60
Q

how does DDAVP work

A

releases vWF from endothelial cells

61
Q

Platelet activation:

Prothrombin > _________ (___) whoch activatees platelets

A

Thrombin (IIa)

62
Q

Platelet activation:

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

A
  • TX2
  • ADP
63
Q

Platelet activation:

TX2 and ADP promote _____ aggregation

A

Platelet

64
Q

Platelet activation:

TX2 and ADP “uncover” the fibrinogen receptor what?

A

GPIIb/IIIa

65
Q

Platelet activation:

the “uncovering” of fibrinogen receptor GPIIb/IIIa. what does that receptor do?

A
  • Allows Fibrinogen (I) to bind to the receptor and further aggregate platelets
66
Q

Platelet activation:

After platelets aggregate, ______ are woven into platelets and crosslinked

A

Fibrin

67
Q

Platelet activation:

After platelets aggregate, fibrin are woven into platelets and crosslinked. The cross linage requires _____

A

Fibrin Stabilizing factor (XIII)

68
Q

Damage Control:

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

A
  • Pulse
  • Mental status
69
Q

Damage Control:

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

A

Clotting

70
Q

Damage Control:

what is the trilogy of damage control

A
  • Abbreviated operation
  • Resuscitation in ICU
  • Return for the operatinf room for definitive operation
71
Q

Damage Control:

what is the abbreviated laparotomy

A
  • Stop bleeding
  • Stop contamination
  • Leave abdomen open
72
Q

Standard Resuscitation:

you want to Dx and treat what 2 things?

A
  • hypothermia
  • Acidosis
73
Q

Standard Resuscitation:

What should you give following LR administration

A

PRBCs

74
Q

Standard Resuscitation: LR

is it designated for trauma resucitation?

A

nope

75
Q

Standard Resuscitation: LR

can it make you acidodic or alkolotic

A

Acidodic

76
Q

Standard Resuscitation: LR

does it have clotting factors

A

you better say no

77
Q

Standard Resuscitation: LR

how much is left from a liter 60 min after infusion

A

200 mL’s

78
Q

Standard Resuscitation: LR

LR is proinflammatory. T/F

A

True

79
Q

Standard Resuscitation:

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

A

<90

80
Q

Standard Resuscitation: LR

the endpoint of resuscitation is often what?

A

Normal BP

81
Q

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

A

Colloids

82
Q

Standard Resuscitation: LR

what is the resuscitation protocol or what is the standard massive transfusion protocol

A
  • 6 PRBCs
  • 6 FFP 1:1 ratio
  • 6 unit platelets
  • 10 units cryo
  • Factor VIIa
  • Whole blood
  • Minimize Crystaloid******
83
Q

what is the formula for O2 delivery

A

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

84
Q

What is teh formula for O2 uptake

A

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

85
Q

what is the oxygen extraction ratio formula

A

oxygen uptake / Oxygen delivery

86
Q

what are some indications to initiate the MT protocol?

A
  • SBP < 90
  • Temp <96
  • Hgb < 11
  • INR > 1.5
  • Base deficit > 6
  • More than 1 proximal amputation
  • Truncal injury w/ significant shock or coagulopathy
87
Q

Transfuse RBC:FFP:PLT in what ratio

A

8:8:1

88
Q

what should the MT be in the ER ASAP

A
  • Emergency release of O-
  • Thawed Plasma
  • Easly rFVIIa (90 mcg/kg) and (cry 10U)
  • Continue w/ 6 U RBC and FFP
  • 1 unit platelete
89
Q

when do u stop the Massive Transfusion protocol

A
  • When bleeding stops
  • Adequate CO
  • Mixed venous sat 70%
  • Resolving Lactate or base deficit
90
Q

what do you always minimize in trauma

A

Crystalloids

91
Q

what is thawed plasma

A

FFP

92
Q

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

A

5

93
Q

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

A

Coagulopathy

94
Q

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

A

the pt’s biological tyoe

95
Q

rFVIIa:

why is it used

A

correct acidosis

96
Q

rFVIIa:

There is a decreased efficacy when pH is what

A

pH < 7.2

97
Q

rFVIIa:

for it to work you need adequate what?

A
  • Fibrinogen
  • Platelets
98
Q

rFVIIa:

what is the dose

A
  • 90-120 mcg.kg
99
Q

rFVIIa:

how often can you adminiter it

A

Q2 hours

100
Q

rFVIIa:

what are the relative indications

A
  • 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
101
Q

Burns:

the chance of survival drops after what %

A

30%

102
Q

Burns:

Direct inhalational thermal injury results in what

A
  • pulm edema
103
Q

Burns:

the deactivation of surfactant leads to what?

A

Atelectasis

104
Q

Burns:

CO shifts the Oxy heme curve to the???

A

LEFT

105
Q

Burns:

______ changes cause massive fluid shifts

A
  • Permeability
106
Q

Burns:

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

A

24

107
Q

Burns:

Fluid replacement normal

A
  • 2-4 mL/kg / %body burned
108
Q

Burns:

the parkland formula

A
  • Volume over 24 hours = kg x 4 x %BSA
  • 1/2 in first 8 hours
  • 25% next 8 hours
  • 25% final * hours
109
Q

Burns:

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

A

Elevated

110
Q

Burns:
Tissue destruction releases extra _____ into Circulation complicating resuscitation

A

K+

111
Q

Burns:

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

A

Hypokalemia

112
Q

Burns:

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

A
  • Myoglobinuria
113
Q

Burns:

what NMB is contraindicated in burn pt’s and why?

A

Suxs

Hyperkalemia

114
Q

Burns:

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

A

increased

Principles IV (18 decks)

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