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Co-Exisiting Disease 2 > Trauma > Flashcards

Trauma Flashcards

1
Q

Shock trauma requires what 2 things?

A

Resuscitation and interventions

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2
Q

4 goals for trauma?

A
  1. Keep pt alive
  2. Identify life threatening injury
  3. Stop ongoing bleeding
  4. Complete definitive treatment as early as possible
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3
Q

5 initial trauma management steps:

A
  1. Preparation space, equipment, PPE, staff
  2. Assumption of care from prehospital providers
  3. Primary survey (ABCDEs)
  4. Secondary survey
  5. Definitive care
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4
Q

What does ABCDE stand for?

A 
Airway 
Breathing
Circulation
Disability 
Environment
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5
Q

What intubation is considered for trauma patients?

A

RSI; increased aspiration risk due to full stomach

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6
Q 
For pneumothorax unassisted breathing: 
SpO2
Pleural flap valve
RR
BP
Venous return
A

82 (low)
One way
Tachypnea
Maintained due to compensatory mechanisms
Maintained due to increasingly negative intrathoracic pressure

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7
Q 
For pneumothorax assisted breathing: 
SpO2
Pleural flap valve
RR
BP
Venous return
A 
82 (low)
More air forced out into pleural space 
Controlled
Hypotension leading to cardiac arrest 
Decrease
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8
Q

Treating tension pneumothorax quickly and definitive:

A

Bilateral needle decompression (14ga at 2nd intercostal space at midcalvicular line)
Chest tube at 6-7 intercostal space at mid axillary line

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9
Q

4 quick assessments for circulation:

A

Palpate, skin temp/moisture, skin color, obvious signs of bleeding

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10
Q

FAST exam means:

A

Focused assessment with sonography in trauma

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11
Q

Assessment of blood consumption score (4):

A

HR >120bpm
SBP <90mmHg
Positive FAST exam
Penetrating injury

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12
Q

What does the score need to be to have a high mortality, trauma-induced coagulopathy, and require a massive transfusion?

A

2 or greater

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13
Q

Class 1 hemorrhage (3)

A

> 15% loss of circulating volume
HR/BP do not change
Resuscitation not required

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14
Q

Class 2 hemorrhage (4)

A

15-30% loss of circulating volume
HR increase
DBP increase
Replacement with IV fluids

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15
Q

Class 3 hemorrhage (4)

A

30-40% loss of circulating volume
BP decrease/HR increase
Metabolic acidosis
Transfusion necessary

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16
Q

Class 4 hemorrhage (4)

A

> 40% loss of circulating volume
Profound HTN
Trauma induced coagulopathy (TIC)
Require massive transfusion

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17
Q

Thrombin is generated primarily via what pathway?

A

Extrinsic

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18
Q

When thrombomodulin (TM) is presented by the endothelium, it complexes thrombin which is no longer available to cleave what?

A

Fibrinogen

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19
Q

Anticoagulant thrombin activates protein C inhibits what 2 cofactors?

A

5 and 8

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20
Q

tPA is released from the endothelium by injury and hypoperfusion and cleaves plasminogen to initiate what?

A

Fibrinolysis

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21
Q

Tranexamic acid needs to be given when to be effective?

A

Early — within 3 hrs of injury

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22
Q

Loading dose of TXA:

A

1g ove 10 min (by slow IV injection or an isotonic IV infusion)

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23
Q

Maintenance dose of TXA:

A

1g over 8hrs (in an isotonic IV infusion)

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24
Q

Brief neurological exam performed fo what 3 things:

A

Level of consciousness
Pupillary size/reaction
Potential spinal cord injury

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25
Q

Persistently depressed levels of consciousness should be considered a what injury until proven otherwise?

A

CNS

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26
Q

Glascow coma scale grades what 3 things:

A

EMV
Eye opening
Best motor response
Verbal response

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27
Q

Minimum and max Glasgow coma scale:

A

3 and 15

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28
Q

What is patient at risk of when considering environment?

A

Hypothermia

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29
Q

Hypothermia is minimized by what 3 things?

A

OR/ER bay near body temp
Warm fluids and blood products
Body warmers

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30
Q

What 2 things should be emphasized on when getting consent from conscious trauma pt?

A

Blood transfusion

Possible intraop awareness

31
Q

Induction of trauma (3)

A 
100% FiO2
RSI
Meds 
-etomidate (.3-.4)
-ketmine (1-2)
-sux (1-2)
-RSI roc (1.2)
32
Q

Ventilation for maintenance of trauma:

A

Low VT, lung protective strategy

33
Q

Fluid management for maintenance of trauma

A

Crystalloid preferred

34
Q

Early access to what to deposit coils or foam within the vessels to control hemorrhage?

A

Interventional radiology (IR)

35
Q

Massive transfusion protocols definition (4)

A

20 units PRBCs in 24 hrs (1blood volume of 70kg)
Loss of 50% of blood volume in 3 hrs
Need of >4units PRBCs in 1 hr
BLOOD LOSS >150ML/HR

36
Q

What 8 things are needed for blood bank to provide first MTP pack?

A 
CBC
ABG
BMP
Lactate
PT
PTT
INR
Fibrinogen
37
Q

Type and screen time and reaction risk?

A

45 min

1%

38
Q

Type and cross time and reaction risk?

A

<1 hr

0%

39
Q

Emergency blood administration is what type of blood?

A

0 neg

40
Q

If you give more than how many units of emergency blood should you continue with type O blood?

A

8 units

41
Q

Balanced administration of pRBC:FFP:PLT

A

1:1:1

42
Q

What does FFP include?

A

All clotting factors

43
Q

What blood products should NOT be warmed?

A

Platelets

44
Q

What does cryoprecipitate contain?

A

Fibrinogen, factor 8, 13, and xWF

45
Q 
Target resuscitation goals: 
SBP
Temp
Hb
pH
BE
Lactate 
Ca++
PLTs
PT/PTT
INR
Fibrinogen
A 
80-100
>35
>7
>7.2
>-6
<4
>1.1
>50,000,000
<1.5 x normal 
<1.5
>1
46
Q

How often should you get labs rechecked when resuscitation?

A

60mins

47
Q

Thromboelastography (TEG) point of care test that can assess what time?

A

Whole blood coagulation

48
Q

Normal reaction time:

A

4-10min

49
Q

MTP complications (5)

A 
Hyperkalemia 
Citrate toxicity (hypocalcemia and acid base balance)
Coagulopathy 
Hypothermia 
TACO
50
Q

Hyperkalemia becomes problematic when infusion exceeds what?

A

100ml/min

51
Q

Symptoms of hyperkalemia (2)

A

Arrhythmias (peak T wave)

Skeletal muscle weakness

52
Q

How do you prevent hyperkalemia?

A

Use fresh blood when possible

53
Q

Symptoms of hypocalcemia (3)

A

Parasthesia
HTN
Arrhythmias

54
Q

Cardiac depression of hypocalcemia from citrate toxicity is unlikely unless transfusion rate exceeds what?

A

1 unit every 5 min

55
Q

Which type of pts are more prone to hypocalcemia?

A

Hepatic dysfunction

56
Q

Which acid base balance is more UNCOMMON?

A

Metabolic acidosis due to rapid metabolism of citrate by the liver

57
Q

Metabolic alkalosis can lead to what?

A

Hypokalemia

58
Q

What is the most common cause of non surgical bleeding following MTP?

A

Dilutional thrombocytopenia

59
Q

How to fix dilution of clotting factors?

A

Add cryoprecipitate

60
Q

What is hypothermia most likely to cause with arrhythmias?

A

Vfib

61
Q

Blood products given at a rate greater than pts CO and occurs when provider has not recognized that the source of bleeding has stopped?

A

Transfusion associated circulatory overload (TACO)

62
Q

Symptoms of TACO (6)

A 
Dyspnea 
Orthopnea
Peripheral edema 
Increased BP
Pulmonary edema 
CV changes
63
Q

Transfuse only when Hb is what and how to treat when above?

A

<7

If Hb >7 treat hypotension with fluids

64
Q

What do you prevent for cervical spine injuries?

A

Any flexion of neck, chin lift and head tilt

65
Q

4 primary brain injury?

A

Sub dural hematoma, epidural hematoma, intraparenchy mal injuries, diffuse neuronal injury

66
Q

4 secondary brain injury

A

HTN, hypoxia, hypercarbia, hypothermia

67
Q

Equation for CPP?

A

MAP-ICP

68
Q

Recommended CPP?

A

50-70

69
Q

recommended ICP?

A

<20

70
Q

Method to decrease cerebral BF?

A

Decrease arterial CO2 causing cerebral vasoconstriction and decreasing CBF

71
Q

Method to increase CBF?

A

Increase arterial CO2 causes cerebral vasodilation and increases CBF

72
Q

CBF is directly related to what levels?

A

CO2

73
Q

7 things to reduce ICP?

A

Drain, lasix, hyperventilate, avoid HTN, elevate head (30), avoid PEEP, mannitol

Co-Exisiting Disease 2 (11 decks)

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