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Principles 3 > Trauma > Flashcards

Trauma Flashcards

1
Q

What are the ABCDE’s of trauma care?

A 
A - airway
B - breathing
C - circulation
D - Disability (neuro)
E - environment
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2
Q

What should you do after primary survey completed with trauma pt?

A

complete head-to-toe and neuro exam

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3
Q

Direct impact,
abrupt deceleration, continuous pressure,
shearing and rotational forces

A

blunt trauma

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4
Q

important thing to consider about trauma victims?

A

assume unstable c-spine until confirmed!!

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5
Q

thoracic blunt trauma consideration?

A

40% have pneumothorax that can’t be seen so avoid N2O!!

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6
Q

Hypotension, sub-cu emphysema, unilateral ↓BS, ↓ chest wall motion, distended neck veins, tracheal shift

A

tension pneumo

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7
Q

Rx for tension pneumo?

A

emergent needle aspiration 2nd ICS (above 3rd rib), MCL and chest tube

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8
Q

precaution you should take regarding meds used with pericardial tamponade pts?

A

careful during induction - dont want to knock out compensation - use ketamine, etomidate.
no prop/versed/etc

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9
Q

where is subxiphoid approach pericardiocentesis?

A

between xiphoid process and L costal margin 30-45 d angle

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10
Q

lethal triad?

A

acidosis
hypothermia
coagulopathy

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11
Q

damaged control surgery components

A

immediate control of bleeding
prevent lethal triad
limit crystalloid, increase products

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12
Q

what is FAST and why is it used?

A

focused assessment with sonography in trauma

-rapid assessment of blood to look for internal bleeding, cost effective and sensitive

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13
Q

A (ABCDE’s) major assumptions

A

no turning back, full stomach, c - spine concerns

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14
Q

best way to intubate trauma pt?

A

RSI with paralytic, stabilize neck!

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15
Q

B - breathing goals?

A

↓ TV, ↓ PIP (< 32 cm H20), avoid 02 toxicity

prevent barotrauma and ards

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16
Q

most deaths r/t to circulation are due to

A

coagulopathies, not on admit

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17
Q

stage I shock

A

blood volume normalized by shifting fluids

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18
Q

CV depression d/t ischemia,

thrombosis, toxins, cellular damage

A

Stage II (progressive) hem shock

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19
Q

Stage III (irreversible) hem shock

A

ATP depleted,
cellular death
[pt will die immediately or later down the road]

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20
Q

Minimize bleeding by maintaining
SBP

A

85-90 mmHg

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21
Q

When bleeding controlled, maintain bp

A

SBP >100 mmHg and HR <100

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22
Q

Replace EBL with

A

1:1 PRBCs, 3:1 crystalloid

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23
Q

using these fluids result in rapid restoration but ↑ risk of pulmonary
edema and bleeding.

A

Colloids

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24
Q

fluids best for perfusion

A

Isotonic crystalloids

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25
Q

Maintain BG __ for suspected TBI or

cerebral edema.

A

<150 mg/d

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26
Q

Elevated PT on admission tells us pt more likely to have

A

massive hemorrhage, injury and poor perfusion

state

27
Q

causes of Trauma-Induced Coagulopathy (TIC)

A

Dilution
Hypothermia & acidosis
TBI
Shock

28
Q

how to AVOID DILUTIONAL

COAGULOPATHY

A

Damage control resuscitation (DCR)

- DCS, rewarming, restricted crystalloids, permissive hypotension, balanced transfusion, massive transfusion protocol

29
Q

Until targeted transfusion is available, empirically transfuse:

A

PRBCs/plasma/platelets at 1:1:1 (units) infusion

30
Q

ASA recommends INR and plt count?

A

INR of ≤1.5*, PLT ct >50,000

31
Q

Hypothermia probably alters

A

plt function and decreases fibrin formation

32
Q

1°C drop causes

A

5% ↓ in
clotting reactions

33
Q

2 things in trauma pt that cause significant coagulopathy

A

Acidosis (pH <7.l) + hypothermia

34
Q

pH of 7.2 does what to clotting

A

clotting function ↓ to 50% of noraml

35
Q

pH of 6.8 does what to clotting

A

↓ to 20% of normal clotting

36
Q

what does the T-T complex do?

A

activated protein C (APC) pathway

37
Q

activated protein C (APC) pathway

A

Inhibits V & VIII
Promotes fibrinolysis
results in systemic anticoagulation

38
Q

4 components of Assessment of blood consumption (ABC) score

A

Penetrating injury
SBP <90
HR >120
Positive FAST

39
Q

ABC score ≥ 2 =

A

↑ risk of needing massive

transfusion

40
Q

TXA dose >12 years

A

1 gm bolus then 1 gm over 8 hrs

41
Q

txa dose <12 years

A

5 mg/kg bolus then 2 mg/kg/hr for 8 hrs

42
Q

timeframe TXA must be administered

A

<3 hours post-injury

43
Q

according to BROHI what should you do?

A

check and make sure TXA bolus has been given! if not, then give bolus over 10 mins

44
Q

Code red pack A MTP

A

6 U PRBCs

4U FFP

45
Q

code red pack B MTP

A

6 U prbc
4 u FFP
10 plt
2 cryo pools

46
Q

what GCS should you intubate?

A

<8

47
Q

C HTN = ICP

A

> 10; Treat ICP >25 mmHg

48
Q

clinical targets of neuro trauma pt

A

-Maintain MAP at 70-75 mmHg to
maintain CPP at >50 mmHg
-Moderate hyperventilation
(PaCO2 of 30-35 mmHg)
-Ventriculostomy (EVD) for
monitoring and venting

49
Q

drugs to avoid neuro trauma?

A

N2O
ketamine
etomidate

50
Q

how to treat increased ICP?

A

ncremental propofol, moderate
hyperventilation, mannitol (0.25–1 gm/kg),
furosemide, head elevation.

51
Q

TREAT ALL TRAUMA PTS AS

A

C-SPINE INJURED

UNTIL PROVEN OTHERWISE.

52
Q

consideration when using succ with spinal chord injuries?

A

Fasciculations

can worsen SCIs

53
Q

spinal shock triad?

A

Hypotension, bradycardia, hypothermia

54
Q

anesthesia considerations for spinal chord injury pts?

A

prepare difficult intubation
document pre op deficits
heavy blood loss

55
Q

anesthesia med considerations for spinal chord injury?

A

avoid succ and N2O

consider ket and dexmed

56
Q 
Massive SNS response d/t stimulus below level of 
spinal injury (frequently r/t bladder), most common above T5
A

AUTONOMIC HYPERREFLEXIA

57
Q

AUTONOMIC HYPERREFLEXIA triad

A

Hypertension, bradycardia,
dysrhythmias

58
Q

AUTONOMIC HYPERREFLEXIA can occur

A 
during N2O/opioid GA or                                             
regional anesthesia (not seen with                                              
volatile agents)
59
Q

rx HTN crisis with

A

direct acting vasodilators

60
Q

Major risks: ortho

A

Hemorrhage, shock,
fat emboli, PE emboli (especially
with pelvic and long bones)

61
Q

Injury to areas
“junctional” to the trunk (pelvis, groin, perineum,
axilla, neck)

A

JT is non-compressible

62
Q

what does JUNCTIONAL

TOURNIQUET do

A

Compresses the aorta at the umbilical level

63
Q

Most intra-op trauma deaths r/t

A

hyperkalemia, hypocalcemia,

acidosis.

64
Q

later deaths from trauma r/t

A

PIICS (persistent inflammatory,
immunosuppressed catabolic syndrom

Principles 3 (3 decks)

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