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Principles-Other > Trauma > Flashcards

Trauma Flashcards

1
Q

What are the 3 areas with the highest recall?

A

-CV
-OB
-Trauma

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2
Q

what are the 5 criteria for potential cervical spine injury?

A

1.) neck pain
2.) severe distracting pain
3.) any neurologic signs or symptoms
4.) intoxication
5.) loss of consciousness at the scene

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3
Q

What is the best way to intubate a pt with cervical spine injury?

A

Manual inline stabilization (MILS)

-can be used with glide scope

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4
Q

what inhalation agent should not be used in trauma?

A

NITROUS OXIDE (n2o)

-accumulates in closed spaces. avoid in trauma pts w pneumothroax, pneumocephalus or pneumoperitoneum

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5
Q

What are the circumstances when succinylcholine can increase potassium?

A

24 hours after a burn
spinal cord injury
crush injury

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6
Q

What acid-base imbalance will pts show after mass transfusion?

A

METABOLIC ALKALOSIS

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7
Q

What will you see when the rate of a mass transfusion exceeds 1 unit every 5 minutes?

A

cardiac depression d/t hypocalcemia

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8
Q

How are hemolytic reactions recognized in the anesthetized pt?

A

-increased temp
-tachycardia
-HoTN
-hemoglobinuria
-oozing at the field

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9
Q

What worsens acid/base balance?

A

hypothermia

-coagulopathies- plt sequestration and red blood deformities

-risking myocardial function

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10
Q

What is a common cause of bleeding after mass transfusion?

A

DILUTIONAL THROMBOCYTOPENIA

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11
Q

What is the half-life of crystalloids?

A

20-30 mins

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12
Q

What is the half-life of colloids?

A

3-6 hours

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13
Q

What is the advantage of using LR over NS for fluid resuscitation?

A

LR is less likely to cause a hyperkalemic acidosis

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14
Q

Why should you use NS for transfusions instead of LR?

A

calcium in LR makes it less compatible w blood transfusions

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15
Q

When are dextrose solutions contraindicated?

A

trauma d/t ischemic brain damage

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16
Q

Why would LR aggravate cerebral edema ?

A

its slightly hypotonic

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17
Q

What kind of fluid should you use for a head trauma?

A

NS

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18
Q

What are the colloids?

A

albumin
dextran
hetastarch

dextran and hetastarch can cause coagulopathy

colloids are effective in rapidly restoring intravascular volumes

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19
Q

What is the universal blood that can be released to the trauma pt?

A

O NEGATIVE

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20
Q

What factor can be decreased after 2 days in storage?

A

Factor 8 can decrease by 50% after 2 days in storage

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21
Q

What are the anesthetic considerations for the hypovolemic pt?

A

Require less anesthetics

increased alveolar concentration d/t shock and decrease in CO and increased ventilation

Smaller intravascular volume so IV anesthetics are exaggerated.

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22
Q

What are the best induction drugs for hypovolemic trauma pts?

A

KETAMINE
ETOMIDATE

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23
Q

What is the most likely cause for hematuria in a trauma pt?

A

Injury to kidneys or lower urinary tract

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24
Q

Cervical spine pts are always at risk for:

A

Aspiration

25
Q

Less than Glasgow score 8:

A

INTUBATE!

26
Q

What are some signs of brain injuries?

A

Any trauma pt w an alter consciousness- consider a brain injury

-restlessness
-convulsions
-cranial nerve dysfunction (non-reactive pupils)

27
Q

What is Cushing’s triad

A

-HTN
-Bradycardia
-respiratory disturbances

= late signs! Precede brain herniation

28
Q

If a neuro exam is expected no:

A

sedatives or analgesics

29
Q

Which meds induce pupillary dilation?

A

anticholinergics: robinol, sprivia, atrovent

30
Q

What is beck’s triad?

A

Tamponade:

-neck vein distention
-HoTN
-muffled heart tones

-pulsus paradoxus= 10mmhg decline in bp during spontaneous ventilation

31
Q

What drug should not be given if a pt has tamponade?

A

PROPOFOL

32
Q

What should you expect to happen during an exploratory laparotomy when they open the abdomen?

A

HYPOTENSION

33
Q

What is most often injured during an abdominal trauma?

A

-vascular
-hepatic
-splenic
-renal
-pelvis

34
Q

Mass transfusions can cause:

A

-hyperkalemia
-hypocalcemia
- metabolic alkalosis
- dilutional thrombocytopenia

35
Q

What is the risk with femur fractures?

A

fat embolism

36
Q

What labs will help diagnose a fat embolism?

A

-elevation of serum lipase
-fat in urine
-thrombocytopenia

37
Q

How is intracranial hypertension controlled?

A

fluid restrictions
diuretics (mannitol)
hypocapnia (paco2 26-30 mmhg)

38
Q

How can HTN during intubation be treated?

A

fentanyl and lidocaine

39
Q

What anesthetics increase intracranial pressure?

A

KETAMINE

Mild hypothermia can assist in saving brain tissue in a head injury

40
Q

what are the cardiac accelerators

A

T1-T4

41
Q

When can someone loose sympathetic tone?

A

High cord injury = spinal shock

-HoTN
-Warm to the touch
-bradycardia
-areflexia
-GI atony

42
Q

What is autonomic hyperreflexia?

A

not associated in the first 48 hrs
-succinylcholine ok at this point

-a reaction of the autonomic nervous system to overstimulation. This reaction may include:
-HTN
- change in HR
-skin color changes (paleness, redness, blue)
-excessive sweating

43
Q

Where should a chest tube be placed?

A

4th or 5th intercostal space

44
Q

C3, C4, C5 are important to?

A

breathing (diaphragm) 3, 4, 5 keep you alive

45
Q

What can make a simple pneumothorax turn into a tension?

A

positive pressure- bagging or ventilator

46
Q

What are the causes of ARDS?

A

-sepsis
-thoracic injury
-aspiration
-head injury
-fat emboli
-mass transfusion

47
Q

Which of the following agents would be least appropriate for use in an acute trauma patient?

A. Thiopental
B. Desflurane
C. Rocuronium
D. Nitrous oxide

A

D. Nitrous oxide

48
Q

Which patient would be most likely to exhibit warm, pink extremities?

A. A patient who is hypotensive due to a malignant arrhythmia
B. A patient in hemorrhagic shock
C. A patient in cardiogenic shock caused by an acute myocardial infarction
D. A patient in spinal shock

A

D. A patient in spinal shock

49
Q

Which of the following hemodynamic patterns is consistent with hypovolemic shock?

A. Increased heart rate, low cardiac output, low systemic vascular resistance
B. Increased heart rate, low cardiac output, high systemic vascular resistance
C. Increased heart rate, high cardiac output, low systemic vascular resistance
D. Decreased heart rate, high cardiac output, low systemic vascular resistance

A

B. Increased heart rate, low cardiac output, high systemic vascular resistance

50
Q

Which of the following interventions would NOT be appropriate for the treatment of intracranial hypertension in a trauma patient during the first 24 hours following head injury?

A. Maintaining a normal to high serum glucose level
B. Maintain a MAP of 75 mmHg
C. Reverse Trendelenburg position
D. Placement of a lumbar CSF drain

A

A. Maintaining a normal to high serum glucose level

51
Q

A trauma patient exhibits distended neck veins, hypotension despite vigorous fluid resuscitation, and subcutaneous emphysema over the neck and chest. These symptoms are consistent with

A. Fat embolus from a long-bone fracture
B. Tension pneumothorax
C. Tracheal injury
D. Hepatic laceration

A

B. Tension pneumothorax

52
Q

Which of the following drugs would be the least appropriate for the intravenous induction of a trauma patient with a head injury?

A. Etomidate
B. Propofol
C. Ketamine
D. Thiopental
A

C. Ketamine

53
Q

A patient with severe traumatic injuries is suspected of also having ischemic brain damage. Which fluid would be the least appropriate for fluid resuscitation?

A. D5 1/2 NS
B. Lactated Ringer’s solution
C. 3% saline
D. Normal saline

A

A. D5 1/2 NS

54
Q

The loss of sympathetic tone and concomitant administration of corticosteroids in patients with spinal cord injury can predispose the patient to

A. hypoglycemia
B. peptic ulceration
C. subarachnoid hemorrhage
D. hypocalcemia
A

B. peptic ulceration

55
Q

A patient with a suspected cervical spine injury is transported to the emergency department by ambulance. On arrival, an LMA is in place. The patient exhibits no spontaneous respirations and is unconscious, but you are able to bag-ventilate the patient with ease. You should

A. replace the LMA with an endotracheal tube
B. connect the LMA to a ventilator
C. prepare for a cricothyrotomy
D. continue ventilating via ambu bag until a cervical injury is confirmed by CT

A

A. replace the LMA with an endotracheal tube

56
Q

Spinal shock is consistent with which of the following?

A. Warm, pink extremities
B. Exaggerated hyperkalemic response to succinylcholine within 3 hours of injury
C. Shock symptoms typically resolve within 6 hours
D. Hypertension

A

A. Warm, pink extremities

57
Q

Which of the following is NOT a component of the Glasgow Coma Scale?

A. Eye response
B. Blood pressure
C. Motor response
D. Verbal response
A

B. Blood pressure

58
Q

What fluid would be the most appropriate for use in the treatment of hemorrhagic shock in a patient with traumatic brain injury?

A. Normal saline
B. Hetastarch
C. D5 Lactated Ringer’s
D. Albumin

A

A. Normal saline

Principles-Other (6 decks)

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