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Advanced Anesthesia II > Trauma > Flashcards

Trauma Flashcards

1
Q

What is the leading cause of death for patients ages ____ to _____

A

Trauma
ages 1 - 45
US

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2
Q

Leading cause of death worldwide between ages 15 and 44?

A

Still trauma

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3
Q

Name the three components of an initial evaluation

A
  1. Rapid Overview
  2. Primary Survey - ABCDE
  3. Secondary Survey
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4
Q

Primary Survey

A
  1. Airway Patency (obstruction?)
  2. Breathing
  3. Circulation (skin temp, color, 2 large bore IVs)
  4. Disability (GCS)
  5. Exposure
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5
Q

Airway Patency Assessment

A

Are they talking?
Agitated? = Hypoxia
Gargling? = Tracheobronchial injury

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6
Q

Flail Chest

A

3 or more fractured ribs associated w/costrochondral separation

resp insufficiency and hypoxemia over several hours w/deterioration of CXR and ABG
pain management > mechanical ventilation
CPAP or BiPAP may be helpful

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7
Q

Tension Pneumothorax

A

due to air leaking from the lung, or chest wall into the pleural space

pneumothorax presents in 40% of blunt thoracic injuries
this is why nitrous oxide is c/i in thoracic trauma

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8
Q

Massive hemothorax

A

> 1500 mL

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9
Q

pneumothorax s/s (6)

A 
hypotension
hypoxia
tachycardia
diminished breath sounds
SQ emphysema
distended neck veins
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10
Q

GCS Scale - Eye Opening

A

4 points = spontaneous
3 = to verbal
2 = to pain
1 = not at all

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11
Q

GCS Scale - Verbal

A 
5 = normal conversation
4 = responds, but doesn't make sense
3 = responds, incomprehensible
2 = no words, moans
1 = no response
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12
Q

GCS Scale - Pain

A 
6 = follows commands
5 = localizes pain
4 = withdraws from pain
3 = decorticate
2 = decerebrate
1 = does nothing
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13
Q

GCS < 8

A

intubate

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14
Q

GCS > 13

A

mild brain injury

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15
Q

GCS 9 - 12

A

moderate brain injury

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16
Q

Secondary Survey

A

Begins after critical life saving actions have begun i/e/ (intubation, chest tubes, fluids)

Focus includes: history, LAMP

DM? Low blood glucose?

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17
Q

Airway Evaluation

A

Assume patient absolutely requires an airway and cannot be re-awakened electively

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18
Q

Jaw broken

A

can you mask ventilate? maybe just NRB and intubate from that

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19
Q

Direct airway injury

A

maybe no edema now.. but there will be later

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20
Q

Airway obstruction considerations (8)

A
  1. cervical deformity
  2. cervical hematoma
  3. foreign bodies
  4. dyspnea, hoarseness, stridor, dysphonia
  5. SQ emphysema + crepitation (tracheal tear?)
  6. Hemoptysis (no fiberoptic w/active bleeding)
  7. Tracheal deviation - tension pneumo + death
  8. JVD - cardiac tamponade
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21
Q

Cardiac tamponade s/s

A

narrowed pulse pressure
muffled heart sounds
hypoperfusion

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22
Q

Some considerations for airway management (3)

A

Full stomach
Oral ett > nasal ett b/c airway pressures
C-Spine stability

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23
Q

Major contraindications for a nasal intubation

A

basilar skull fracture

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24
Q

s/s basilar skull fracture

A

battle sign
CSF leakage
raccoon eyes

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25
Q

Indication for ETT intubation (7)

A
  1. cardiac/resp arrest
  2. Deteriorating respiratory condition (contusion/pneumo/burns)
  3. Need for deep sedation
  4. GCS < 8
  5. CO poisoning - need that 100% FiO2
  6. Uncooperative/intoxicated pt
  7. Transient hyperventilation for a head injury
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26
Q

Tracheotomy

A

takes longer to perform

need neck extension (c/i c-spine injury)

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27
Q

Cricothyroidotomy contraindications (2)

A

c/i in those < 12 y.o.

laryngeal damage - c/i

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28
Q

How long can a cricothyroidotomy last?

A

72 hours

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29
Q

Cricothyrotomy supplies

A
  1. Scalpel - 2.5cm vertical incision, keep < 1.3 cm deep
  2. Dilator
  3. Tracheal Hook - Keep dilator in until tracheal hook placed
  4. 10 cc syringe + trach cuff
  5. Trach tube (< 7 ) or ETT 6.0
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30
Q

Instances you do a cric (5)

macey

A
  1. massive trauma to the face
  2. angioneurotic edema
  3. supraglottic obstruction
  4. croup/epiglottitis
  5. inhalational injury
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31
Q

Gold standard for C-Spine injury

A

fiberoptic intubation - awake (pt gotta be cooperative tho)

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32
Q

LMA

A

contraindicated for a definitive airway

33
Q

etomidate

A

0.2 - 0.3 mg/kg (if severly compromised, you will still see a drop in BP)

34
Q

ketamine

A

2 - 4 mg/kg (c/i in head injury)
4 - 10 mg/kg IM

  • direct cardiac depressant; usually masked by catechols*
  • great choice for tamponade pt*
35
Q

Sux

A

1 - 1.5 mg/kg IV
30 second onset; fasiculate
5 - 12 m duration

c/i w/globe injury or head injury
pre-treat w/rocuronium 5 mg

36
Q

Roc

A

1.2 mg/kg IV
30 - 60 s onset; 60 - 90 m duration
may need gentle mask ventilation (MRSI)

37
Q

Scopalamine

A

0.4 mg/mL
Dose = 5 - 10 mcg/kg
c/i in pregnancy

38
Q

How to clear a c-spine pt

A

Complete xray C1 - C7

pt not obtunded or under influence

39
Q

manual in-line stabilization

A

(MILS)

hold mastoid process

40
Q

Name the 3 factors that influence a penetrating injury

A
  1. type of instrument
  2. velocity
  3. characteristics of the tissue through which it passes through
41
Q

laryngotracheal damage s/s (7)

A 
hoarseness
muffled voice
dyspnea
stridor
dysphagia
cervical pain/tenderness
flattened thyroid cartilage
42
Q

why do you intubate w/c4 or c5 lesion

A

diaphragm

43
Q

why do you intubate w/c6 or c7 lesions

A

pt cannot cough or clear secretions with those

44
Q

pulmonary contusion

A

bruising of alveoli allowing protein rich fluid to escape and increase alveolar capillary membrane distance

leading to ARDS
keep pplat < 32

45
Q

hemothorax

A

make sure you havee adequate fluids on board prior to ct placement

s/s: hypotension, hypoxemia, tachycardia, increased CVP

46
Q

anesthesia considerations for a hemothorax

A

one lung ventilation

use regular ett first

47
Q

name the 3 types of a pneumothorax

A

simple
communicating
tension

48
Q

when do you treat a pneumo

A

> 20% of the lung collapsed
needle decompression at 2nd/3rd rib - mid clavicle
14 or 16 gauge

49
Q

initial response to shock

A

mediated by neuroendocrine system
hypotension - catecholamine + vc
-heart kidney brain preserved

50
Q

name all the hormones released during shock

A 
renin/AT
vasopressin
ADH
GH
glucagon
cortisol
epi/NE
51
Q

Lungs + Shock

A

the destination of inflammatory byproducts that accumulate in capillary beds leading to ARDS

52
Q

Trigger for MOSF

A

likely the gut b/c hypoperfusion

53
Q

coagulopathies explained (4)

A

hypotension, tissue injury
inflammatory response
endothelial activation of protein C
hyperfibrinolysis d/t APC

54
Q

what does APC do

A

blocks factor 5/8 to limit clot propagation in normals.

55
Q

why do trauma pt have coagulopathies (4)

A
  1. dilution
  2. hypothermia/acidosis
  3. TBI
  4. hemorrhagic shock
56
Q

PRBC Hct?

A

55%

57
Q

Plt (50 ml) =

A

5.5 x 10^10

58
Q

Plasma =

A

80% coags

59
Q

What is base deficit?

A

reflects the severity of shock, oxygen debt, changes in oxygen delivery, fluid resuscitation adequacy ?

60
Q

Base deficit of 2 - 5 =

A

mild shock

61
Q

base deficit of 6 - 14

A

modereate shock

62
Q

what is severe shock

A

base deficit > 14

63
Q

blood lactate level

A

leess specific than base deficit, but still important

elevated levels correlate w/hypoperfusion
normal 0.5 - 1.5 and half life is 3 hours

64
Q

plasma lactate > 5 =

A

significant lactic acidosis

65
Q

how do you assess systemic perfusion?

A
  1. vs - not indicate occult hypoperfusion
  2. UO - can be inaccurate d/t diuretics, renal injury, intoxication
  3. acid-base balance - confounded by resp. status
  4. lactate clearance - timing
  5. CO - need PA cath
  6. SVO2 - accurate marker, hard to get
  7. SVV
66
Q

how long can an IO stay?

A

2 - 3 days

67
Q

Goals for EARLY resuscitation (24 - 48h)

A
  1. SBP 80 - 100
  2. HCT 25 - 30
  3. PTT (25 - 35) and PT (11 - 13) WNL
  4. PLT > 50
  5. Normal Ionized Calcium 4.6 - 5.2
  6. Core temp > 35
  7. prevent worsening lactate, acidosis
  8. keep them without pain and under anesthesia
68
Q

Risks of aggressive volume replacement during early resuscitation

A 
increased BP
decreased viscosity
decreased hct
decreased clotting factor conceentration
need more tx
lytes out of wack
direct immune suppression
premature reperfusion
69
Q

Goals for LATE resuscitation

A

SBP > 100 and HR < 100

  1. maintain hct at individualized level
  2. normalize coags/lytes/body temp
  3. good urine output
  4. reverse systemic acidosis
  5. good CO
  6. seerial lactate. if it does not decrease, something else. is going on
70
Q

What is the end point for resuscitation

A

Lactate < 2mmol
Base Deficit < 3
Gastric intramucosal pH > 7.33

71
Q

No type and cross - what do you give ?

A

RH negative, esp if woman is of childbearing eyars

72
Q

FFP:PRBC

A

2 u FFP to every 4 u PRBC

73
Q

what can you mix w.blood

A

NS

plasmalyte

74
Q

how fast can you give fluids

A

1500 mL/m
crystalloid, colloid, PRBCs, plasma
all mix together in reservoir
38 - 40 degrees Celsius

75
Q

what is the lethal triad

A

coagulopathy
acidosis
hypothermia

76
Q

what does hypothermia do ? (6)

A
  1. acid base d/o
  2. coagulopathy (inhibits thrombin and fibrinogen, impairs platelet, abnormal calcium and K hemostasis)
  3. myocardial dysfunction
  4. oxy-hgb to left
  5. decreases metabolism of lactate, citrate, and some anesthetic drugs
  6. causes vasoconstriction - BP appears higher
77
Q

29 degrees c PT and PTT

A

increase by 50%

78
Q

29 degrees C platelets

A

decrease 40%

Advanced Anesthesia II (9 decks)

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