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Sim Lab 3 > Trauma > Flashcards

Trauma Flashcards

1
Q

What is ATLS

A

Advanced Trauma Life Support

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2
Q

ATLS Primary Assesment

ABCDE

A
  • A: Airway
  • B: Breathing
  • C: Circulation
  • D: Disability
  • E: Exposure
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3
Q

A: Airway - what are we looking for?

A
  • Airway noises
  • Position of head
  • Foreign Body
  • Fluids / Secretions
  • Edema
  • Aspirations
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4
Q

A: Airway - How do we treat it?

A
  • Suction #1
  • open
  • secure
  • O2
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5
Q

A: Airway - Securing the airway?

A

Combitube - EMS usually uses this
Intubation

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6
Q

What is a combitube?

A

Dual lumen tube. Distal portion is placed into the esophagus and a ballon is inflated. The proximal balloon is inflated in the oral cavit. The distal balloon helps reduce aspiration while ventilaiton is achieved by the proximal balloon.

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7
Q

B: Breathing - what are we looking for?

A
  • Look - Listen - Feel
  • Respiratory rate and effort
  • Breath and any sounds assocated
  • Subcu emphysema
  • symmetry of chest movements
  • tracheal deviation
  • jugular vein distention
  • cyanosis
  • TBI induced respiratory depression
  • Shock
  • Hypothermia
  • Aspiriation
  • Pulmonary Contusion (R-L shuting)
  • Smoke inhalation (bronchospams)
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8
Q

B: Breathing - how do we treat it?

A
  • Supplemental O2
  • Pneumothorax decompression
  • Inhalation therapy
  • ventilation if needed
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9
Q

C: Circulation - what are we looking for?

A
  • HR
  • BP
  • capillary refill
  • bleeding
  • skin color
  • diuresis

Shock!!!

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10
Q

C: Circulation - how do we treat

A
  • IV or IO access
  • control bleeding
  • fluids
  • drugs
  • transfusion
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11
Q

C: Circulation - assessment ↦ Chest

A
  • CT of chest
  • Chest tube output
  • CXR
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12
Q

C: Circulation - Treatment ↦ Chest

A
  • Observe
  • Surgery
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13
Q

C: Circulation - assessment ↦ Abdomen

A
  • Ultrasound FAST scan
  • Abdominal CT
  • Physcial Exam
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14
Q

C: Circulation - treatment ↦ Abdomen

A
  • Observe
  • Surgical ligation
  • angiography
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15
Q

C: Circulation - assessment ↦ retroperitoneum

A
  • Angiogram
  • CT Scan
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16
Q

C: Circulation - treatment ↦ retroperitoneum

A

Angiogram

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17
Q

C: Circulation - assessment ↦ long bones

A
  • Physical exam
  • X-ray of bones
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18
Q

C: Circulation - treatment ↦long bones

A
  • fix fx
  • ligation
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19
Q

C: Circulation - assessment ↦ outside the body

A

Physcial exam

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20
Q

C: Circulation - treatment ↦ outside the body

A

Applied pressure
ligation

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21
Q

D: Disability - what are we looking for?

A
  • AVPU / GCS
  • reactivity and symetry of pupils
  • Glucose level
  • C-Spine / stabilization
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22
Q

D: Disability - how do we treat

A
  • Glucose if hypo
  • insulin if hyper
  • antidotes
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23
Q

AVPU?

A
  • Alert = awake
  • Verbal = responds to verbal stim only
  • Pain = responds to pain stim only
  • Unresponsive
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24
Q

GCS Quick Numbers

A
  • 3-8 = severe
  • 9-12 = Moderate
  • 13-15 = Mild
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25
Q

E: Exposure - what are we looking for?

A
  • Head to toe exam
  • History
  • Temp
  • Injuries
  • Drug abuse?
  • Infection?
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26
Q

E: Exposure - how do we treat

A
  • Identify the cause
  • thermo-management
  • NG tube
  • Compartment syndrome
  • Antibiotics
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27
Q

Levels of urgency to send to surgery

A
  1. Airway: Cricothyroidotomy
  2. Control exsanguination: Ex-Lap, Ex Thoracotomy, Pelvic Ex-Fix
  3. Intracrania Mass: Epidural hematoma, subdural hematoma with midline shift
  4. Sepsis / Loss of limb / Loss of eyesight / Continued hemorrhage (not massive amounts)
  5. Early patient mobilization / cosmetic
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28
Q

Adam’s secondary assessment: SAMPPLLE

A
  • Signs and symptoms
  • Allergies
  • Medications
  • Past Medical History
  • Pictures (CXR, CT, U/S)
  • Last meal
  • Lab values
  • Events
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29
Q

FAST Scan: What is it?

A

Focused Assessment with Sonography in Trauma is a rapid bedside ultrasound examination performed by surgeons, emergency physicians, and paramedics as a screening test for blood around the heart (pericardial effusion) or abdominal organs (hemoperitoneum) after trauma.

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30
Q

FAST Scan Order: 1-6

A
  1. Pericardium
  2. RUQ
  3. LUQ
  4. Suprapubic
  5. R Anterior thoracic
  6. L Anterior thoracic
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31
Q

FAST: Pericardium ↦ what are we looking for and where?

A

Subxiphoid
Aimed U/S at heart just inferior and (to the patients) right of xiphoid cartilage.

Looking for cardiac tamponade cause by effusion

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32
Q

FAST: RUQ ↦ what are we looking for and where?

A

Looking for blood from liver and right sided retroperitoneal bleeding

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33
Q

FAST: LUQ ↦ what are we looking for and where?

A

Splenic/Pancreatic and retroperitoneal bleeding in LUQ

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34
Q

FAST: Suprapublic ↦ what are we looking for and where?

A

looking for blood in and around the bladder in the pelvis

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35
Q

FAST: R/L Anterior Thoracic ↦ what are we looking for and where?

A

Looking for presence of pneumo or hemothorax

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36
Q

Indications for intubation in trauma

CARD-IFF

A
  • Cardiac or Respiratory arrest
  • Airway protection
  • Respiratory insufficiency
  • Deep sedation or high narcs
  • ICP too high, hyperventilation required
  • FiO2 100% for CO posioning
  • Facilitate workup for intoxicated or uncooperative patient
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37
Q

Ultrasound for NPO: Transducers

A

Adults: Curvilinear
Pedi: Linear

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38
Q

Ultrasound for NPO: Transducer positioning

A

Supine
Transducer long axis in subxiphoid
Fan right to left to get view of antrum

Repeat in Right lateral decubitus

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39
Q

Ultrasound for NPO: Stomach Layers

A
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40
Q

Ultrasound for NPO: Anatomy

A
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41
Q

Ultrasound for NPO: Empty Stomach

A
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42
Q

Ultrasound for NPO: Fluid in Stomach

A

Hypoechoic

Stary night effect = carbinated

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43
Q

Ultrasound for NPO: Solid in Stomach

A

Hyperechoic and shadow

44
Q

Ultrasound for NPO: Fluid and Solid in Stomach

A

Hyper and Hypoechoic

45
Q

Ultrasound aspiration risk: No fluid in antrum in supine

A

Low risk

46
Q

Ultrasound aspiration risk: Just fluid in right lateral but not supine

A

Low risk

47
Q

Ultrasound aspiration risk: Fluid in both supine and right lateral

A

Higher risk

48
Q

Ultrasound aspiration risk: Solid matter in either supine or right lateral

A

Higher risk

49
Q

Signs of tension pneumo

A
  • Increased airway pressure
  • Jugular distension
  • Hypotension
  • tachycardia
50
Q

Emergency airway: Percutaneous Translaryngeal Ventilation

technically this is oxygenation only

6 steps

A
  1. Hyperextend neck, palpate cricothyroid membrane
  2. With a 14ga angiocath on a saline filled syringe. Insert the needle caudally at a 30-45°
  3. Aspirate as you advance, stop once air bubbles are seen
  4. Advance catheter to the hub into the trachea
  5. Remove needle
  6. Attach to O2 supply then start oxygenation
51
Q

Emergency airway: Melker Percutaneous Cricothyrotomy

This is ventilation

4 step

A
  1. Palpate cricothyroid membrane and advance needle at 45° in caudal direction. Aspiriate with saline filled syrine for air bubbles.
  2. Advance catheter then remove needle. Thread guidewire through catheter into trachea. Remove catheter
  3. Knick the skin at guidewire entry
  4. Place dilator into the airway catheter and thread over guidewire. Advance until level with skin. Remove guidewire and dilator. Secure
52
Q

One Unit of PRBC will raise Hg and Hct by how much?

One unit = 350 mL

A

Hg 1 g/dL

Hct 3%

53
Q

When should we transfuse PRBC?

A

Hg < 6 g/dL

When Hg 6-10 consider patient status before transfusion. Bleeding, ishemia, IV volume status, or inadequate oxygenation

54
Q

One Unit of platelets will raise plt # by how much?

One unit = 200-250 mL

A

5-10,000 μL

ABO compatability not needed

55
Q

One Unit of FFP will raise clotting factor by how much?

One unit = 200-250 mL

A

2-3%

ABO needed / Rh not

56
Q

One Unit of cryoprecipitate will raise fibrinogen by how much?

One unit = 10-20 mL

A

5-7 mg/dL

ABO compatability not needed

57
Q

Minimum IV sizes for blood admin

A

Adult 20 ga
Pedi 24 ga

58
Q

What is something all shocks have in common?

A

Hypotension and decreased CO

59
Q

Name the 4 shocks

DOC-H

A
  • Distributive
  • Obstructive
  • Cardiogenic
  • Hypovolemic
60
Q

Hypovolemic shock: Define

A

Not enought fluid in circulation

61
Q

Obstructive Shock: Define

A

blood is blocked, usually by a pulmonary emolism or collapse lung

62
Q

Cardiogenic shock: Define

A

Heart can not pump enough blood to meet demand. Think heart attack

63
Q

Distributive Shock: Define

A

When the blood vessels lose tone and organ perfusion is reduced

64
Q

3 Different Distributive Shocks

A
  • Neurogenic
  • Anaphylactic
  • Septic
65
Q

The two steps to shock: Macro and Mircocirculatory

A
  • Macro: vascoconstriction and catecholamine surge
  • Micro: Ischemic cells take up interstitial fluid ⇀ cellular edema ⇀constricting capillary flow ⇀ more ischemia ⇀ free radical and lactate production
66
Q

What does lactate do to contractability?

A

Decrease it

67
Q

Hemorrhagic shock stages: detailed

5 total

A

Stage 1: mild/stable
Stage 2: Moderate/stabilized (responsive to fluid test)
Stage 3: Hypotensive shock (not responsive to fluid test)
Stage 4: Shock with heart and brain ischemia (≥40% blood loss)
Stage 5: Cardiac arrest by exsanguination

68
Q

Hemorrhagic shock stages: Overview

A

Stage 1: Stable HS
Stage 2: Stabilized, compensated HS
Stage 3: Progressive, Unstable
Stage 4: Critical HS, impending cardiac arrest
Stage 5: Cardiac arrest by exsanguination

HS = Hemorrhagic Shock

69
Q

What 9 goals do we have for early resuscitation goals in hemorrhagic shock?

CHAPPS-NNF

A
  • Core temp > 35°C
  • Hematocrit 25-30%
  • Adequate anesthesia and analgesia
  • Platelets > 50,000
  • Prevent lactate increase
  • SBP 80-100 mmHg
  • Normal PT and PTT
  • Normal ionized calcium
  • Functional pulse ox
70
Q

What are the two lactate levels Adam gives?

A

Normal: < 2mmol/L
Acidosis: > 5mmol/L

71
Q

Why don’t we just give fluids to help with volume in a trauma situation?

A

We aren’t incresing RBC’s and oxygen delivery

Causing dilutional anemia and coagulapathy

72
Q

Normal calcium levels (Total and Ionized)

A
  • Total: 8.6-10.3 mg/dL
  • Ionized: 4.6-5.2 mg/dL
73
Q

What does ionized mean?

A

free in serum and available for use by the body

74
Q

Adams obession with the 16ga IV

A

Not much time is gained from the 14 ga angiocath or 6 Fr sheath introducer

75
Q

Rapid transfuser benefits

WAARRP-FC

A
  • Warms Fluids
  • Accurate recording of volumes and pressures
  • Able to pump through multiple lines
  • Rates up to 1500 mL/min
  • Reservoir allows mixing of products
  • Portable for travel
  • Fail-safe to prevent air infusion
  • Compatable with all fluids and blood products execpt platelets
76
Q

Rapid transfuser: Fluids and Blood products

A
  • Crystalloid
  • Colloids
  • PRBC’s
  • Washed Salvaged Blood
  • FFP
77
Q

Prothrombin Time (PT)

Extrinsic pathway (INR)

A

11.5-14.5 sec

78
Q

Partial Prothrombin Time (PPT)

Intrinsic pathway

A

24.5-35.2 secs

79
Q

Thrombin Time

Time to clot once thrombin added

A

22.1-31.2 secs

80
Q

Activated CLotting Time (ACT)

Test tube reagent clotting

A

70-180 sec

81
Q

Platelets

Pure count in blood

A

150-450K

82
Q

P2Y12

Plavix inhibition test

A

180-376 PRU

83
Q

What is INR?

A

International Normalized Ratio

makes each PT test standardized

84
Q

TBI anestetic goals

A
  • Maintain CPP (80-100mmHg)
  • Treat increased ICP (20 mmHG and above)
  • Avoid hypoxemia
  • Avoid hyper and hypocapnea
  • Avoid hyper and hypoglycemia
85
Q

Which steroid is contraindicated in TBI?

A

125mg or more of methylprednisolone

86
Q

Toxicology: Cannabis

A

Acute: drowsy, possible MI or arrythmias
Chronic: cough and respiratory issues, possible heart ischemia
Withdrawal med: Benzos

87
Q

Toxicology: Cocaine

A

Acute: vasoconstriction, hyperthermia, tachy, hypertension, arrhythmias, stroke, cardiomyopathy, seizure Chronic: Epistaxs, bowel ischemia, aspiration pneumonia, pulmonary htn Withdrawl med: propranolol

Acute: mydriasis or dilated pupils

these folks are catecholomine depleted so we would need to use Epi not ephedrine if they go hypotensive

88
Q

Toxicology: Heroin

A

Acute: slow bretahing, brady, nausea
Chronic: Abcesses, endocarditis, liver and renal dz, pulmonaey edmea, pulmoary emobilisms
Withdrawal Med: Methodone

Acute: miosis or constricted pupils

89
Q

Toxicology: Ketamine

A

Acute: Hallucinations, increased BP, slow breathing
Chronic: Stomach pain, cystitis
Withdrawl meds: none

90
Q

Toxicology: MDMA

A

Acute: Increased HR and BP, teeth clenching, hyperthermia, rhabdo, hyponatermia, ESLD, ESRD, CHF
Chronic: Anxiety and aggression
Whithdrawl meds: antidepressants

91
Q

Toxicology: Meth

A

Acute: High energy, tachypnea, tachycardia, hypertension, hyperthermia
Chronic: Violent, dental issues, anxiety
Whidrawal: Antidepressnats

Like cocaine, catecholamine depleted

92
Q

Toxicology: Herbal meds

A

Basic jist, platelet inhibition so increased bleeding time

93
Q

TEG: full name and breakdown

A

Thromboelastography
Thrombo: thrombus or clot
Elast: ability to change
Graphy: record of

94
Q

St Luke’s Process for TEG

A
  • Call blood bank
  • draw sample and put in blue top
  • date and time tube
  • send asap
  • Initial results in 15 mins
  • complete in 30-45
95
Q

Componets of a TEG

5 things

A
  • Reaction time (R time)
  • Kinetics time (K Time)
  • Alpha angle
  • Maximum amplitude (MA)
  • Lysis at 30 mins (LY30)
96
Q

R time or Reaction Time

A
  • Start of clot formation
  • Normal is 5-10 mins
  • Prolonged R time indicates a deficient coagulation factors
  • Treatment: FFP
97
Q

K time or Kinetics time

A
  • Time from end of R time to when a clot reaches an amplitude of 20mm
  • Measures strength of clot
  • Normal is 1-3 mins
  • Prolonged K time indicates fibrinogen deficiency
  • Treatment: Cryoprecipitate
98
Q

Alpha angle

A
  • Speed of fibrin accumulation
  • Normal is 53-72 degrees
  • Low angle indicates fibrinogen deficiency
  • Treatment: Cryoprecipitate
99
Q

MA or Maximum amplitude

A
  • Measures the strength of fully formed clot
  • Normal value is 50-70mm
  • Lower value indicates a platelet deficiency
  • Treatment: Platelets or DDVAP
100
Q

LY30 or Lysis 30

A
  • Measures fibrinolysis after 30 mins
  • Normal is 0-8%
  • higher numbers indicate hyper fibrinolytic
  • Treatment: TXA
101
Q

TEG picture examples

A
102
Q

Benefits of TEG

WRTS

A
  • Whole blood used
  • Real time results
  • Treatment guide
  • Shows if patient is clotting
103
Q

Limitations of TEG

FUN-DV

A
  • Familiarity with results
  • Uremia, vW Dz, or aspirirn not indicated
  • Needs frequent calibration
  • Doesn’t test platelet adhesion
  • Venous coagulaiton only
104
Q

DIC

A

Disseminated Intravascular Coagulation

105
Q

TACO

A

Transfusion associated circulatory overload

More blood is administered than the CO can account for

106
Q

TRALI

A

Transfucsion related acute lung injury

Similar to ARDS

Usually from plt/FFP admin

Sim Lab 3 (6 decks)

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