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Critical Care > Trauma > Flashcards

Trauma Flashcards

1
Q

What is primary prevention of trauma?
List some examples

A

Prevent the event

Ex: driving safety classes, speed limits

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2
Q

What is secondary prevention of trauma?
List some examples

A

Minimize the impact

Ex: seatbelts, helmets, airbags, car seats

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3
Q

What is tertiary prevention of trauma?

List some examples

A

Maximize outcomes through treatment strategies (take place in facility for trauma)

Ex: emergency response, medical care, rehab

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4
Q

What is major trauma defined as?

A

Multi-system
Needs immediate intervention to prevent loss of life or limb
Needs to be managed at trauma center

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5
Q

What is minor trauma defined as?

A

Single system injury
Doesn’t pose a threat to life or limb
Can be managed in local hospital

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6
Q

What are the differences between level I - level IV trauma care?

A

Level I: comprehensive trauma care, trauma specialists in house
Level II: supportive, receives trauma when level I is full
Level III: only immediate emergency care / stabilization, then transfer
Level IV: free standing ERs, resuscitate and transfer only

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7
Q

What is the purpose of trauma triage?

A

Determines need for level of hospital by sorting patients by severity of injury

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8
Q

What is the most critical part of disaster prepardeness?

A

Communication

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9
Q

What are the 4 categories of mass casualty triage during a disaster and what do they each stand for?

A

Red = emergent, life-threatening
Yellow = urgent, needs care within 1 hour
Green = pt can self treat and should go home
Black = dead/near death, not able to treat

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10
Q

What is the most crucial assessment tool in trauma care?

A

Primary survey

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11
Q

What is primary survey?

A

Assessment tool used in trauma care
Done in 1-2 mins
Designed to seek out life-threatening injuries

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12
Q

What are all aspects of the primary survey assessment?

A

A - airway patency (with c-spine immobile)
B - breathing effectiveness
C - circulation, including hemorrhage and pulses
D - obvious disabilities? Including neurological status
E - exposure / environment (contaminated? Etc.)
F - family present, full set of vitals
G - get equipment/labs

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13
Q

What is a secondary survey?

A

Head to toe assessment
Performed after life-threatening injuries are identified and treated

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14
Q

What are all aspects of the secondary survey assessment?

A

added onto head to toe assessment:
F - full set of vitals, foley, NGT, ECG, SpO2, lab, family presence
G - give comfort measures (start comfort care)
H - history, head-to-toe assessment
I - inspect posterior surfaces (look for wounds/exit points)

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15
Q

How should airway be managed?

A

Check for patency (tongue, facial fix, bleeding, vomiting, decreased sensorium)

Use oral or nasopharyngeal airways if needed (spontaneously breathing pts only)

Endotracheal intubation often needed

If unable to intubate = emergency cricothyrotomy

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16
Q

How can the cervical spine be protected during intubation procedures?

A

Stabilization

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17
Q

What type of shock do trauma patients need to be monitored for?

A

*Hypovolemic shock

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18
Q

Type of fluid needed for treatment of hypovolemic shock?

A

Crystalloids:
- NS is best choice b/c most like blood
- LR

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19
Q

How to monitor for shock in trauma patients

A

Ongoing assessment of:
Vital signs
Urine output
Mental status
Hemodynamic parameters

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20
Q

Treatment of hypovolemia

A

Stop bleeding (using pressure, elevate extremity)

Replace circulating blood volume:
- insert 2 large-bore IVs, CVC if possible, OI if needed
- administer crystalloids and blood products

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21
Q

How much fluid should be administered for hypovolemic shock?

A

1-2 L as rapidly as possible (3 mL per 1 mL loss)

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22
Q

How much blood given could cause complications of massive blood resuscitation?

A

> 10 units of PRBC in 24 hours

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23
Q

Possible complications of massive blood resuscitation

A

Volume overload —> third spacing
Organ dysfunction
Coagulopathies - clotting or bleeding
Hypothermia - need to rewarm slowly
Fluid-electrolyte imbalances
Acid-base abnormalities: metabolic acidosis

24
Q

*What should be monitored to determine patient’s response to treatment?

A

UOP
LOC
HR
BP
Cap refill

(All s/s of poor perfusion)

25
Q

Categories for how patients respond to treatment

A

Rapid responders - respond quickly and remain stable

Transient responders - respond quickly, deteriorate when IVF is low or pt still bleeding or surgery needed

Minimal or no responders - don’t respond or need emergent surgery to stop bleeding

26
Q

Surgery to look inside of pt to determine where bleeding is coming from

A

Exploratory laparotomy

27
Q

Symptoms of deterioration

A

Aka s/s of decreasing perfusion:
Falling hematocrit
Falling PaO2
Decreasing UOP
*Increased serum lactate levels

28
Q

Most common damage with abdominal injuries

A

Liver damage

29
Q

How are abdominal injuries diagnosed?

A

Diagnostic peritoneal lavage (DPL)
Ultrasounds
CT of abdomen

30
Q

What is DPL?

A

Diagnostic peritoneal lavage
Needle inserted into abdomen, flushed with saline and pulled back out.
If frank bleeding, pt needs emergent laparotomy

31
Q

What causes cardiac tamponade in trauma patients?

A

Bleeding into pericardial space as result of blunt or penetrating trauma to chest

32
Q

S/S of cardiac tamponade

A

Beck’s triad: decreased BP, JVD, muffled heart sounds
(Impairs pumping ability of heard)

33
Q

How is cardiac tamponade treated?

A

*Pericardiocentesis / surgery (pericardial window)

34
Q

What is aortic disruption?

A

Life-threatening injury from blunt chest trauma, requiring emergency surgical intervention

35
Q

What are the symptoms of aortic disruption?

A

Weak femoral pulses (b/c blood going into abd, not down legs)
Pain
Hoarseness
Dyspnea
Dysphagia

36
Q

Diagnosis of aortic disruption

A

Chest x-ray shows widened mediastinum and Trachial deviation

Confirmed by aortogram

37
Q

What makes a musculoskeletal injury unstable?

A

Pelvic fractures and femur fracture
Can result in a large amount of blood loss

38
Q

What is compartment syndrome?

A

Condition where structure such as nerve or tendon is being confined within a space

39
Q

First symptom of compartment syndrome

A

Severe pain unrelieved by narcotics

40
Q

Treatment for compartment syndrome

A

Fasciotomy

41
Q

Symptoms of a fat embolism

A

Decreased LOC
Fever
Tachycardia
New onset respiratory distress
Decreased BP
PO2 <60
Petechiae

42
Q

*Treatment for fat embolism

A

Oxygen
Intubation
Ventilation
PEEP

43
Q

*Prevention of fat embolism

A

Stabilization of fracture

44
Q

Secondary complications of trauma

A

ARDS
DVT/PE
Infection
AKI
Altered nutrition

45
Q

What is MODS?

A

Huge inflammatory response brought on by trauma
(1st thing that occurs is vasodilation from histamine)

Causes Multisystem organ failure

46
Q

*Risks for MODS

A

Sepsis
Extensive trauma and tissue damage
Hypotension and hemorrhagic shock
Inadequate fluid resuscitation
Multiple transfusions

47
Q

Prevention of MODS

A

Treating infections
Maintaining oxygenation
Nutritional support

48
Q

What is damage control surgery?

A

Operative repair of life-threatening injuries
Intra-abdominal within 24-48 hrs

49
Q

What is DIC?

A

Life-threatening disorder of coagulation

50
Q

What occurs with DIC?

A

*Exaggerated clotting (liver releases too much clothing factors)
Depleted clotting factors (b/c all used up)
*Subsequent bleeding (from every orafice)

51
Q

Causes of DIC

A

*Sepsis
Multitrauma
Burns

Infection
ARDS
Anoxia
Acidosis

52
Q

*Symptoms of DIC

A

Occult bleeding (stool, emesis, urine)
Petechiae, ecchymoses
Overt oozing to massive hemorrhage
Decreased organ perfusion:
- change in LOC
- aural cyanosis (tips of fingers/toes fall off)
- infarction of digits/nose
- angina
- decreased UOP

53
Q

*Lab findings that are only seen with DIC

A

Decreased antithrombin III
Increased FDP/FSP
Increased d-dimer

54
Q

Treatment for DIC

A

1st: treat the underlying cause
2nd: control bleeding
3rd: stop abnormal coagulation

55
Q

How is bleeding controlled with DIC?

A

1st: give platelets - highest priority
2nd: give FFP - provides all clotting factors
3rd: give cryoprecipitate - factor VIII pulled from donated blood
4th: packed RBCs
5th: vitamin k

56
Q

How to stop abnormal coagulation

A

*Heparin (inhibits thrombin) low dose - *Lovenox

Critical Care (35 decks)

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