Trauma

Question 1

What results from the decreased cardiac output and MAP that results from hemorrhagic shock?

Answer 1

(Tissue hypoperfusion)

Question 2

In shock cases, patients’ cells and tissues become deprived of oxygen and anaerobic metabolism will begin to compensate, what diagnostic test can indicate that has started to occur?

Answer 2

(Blood lactate)

Question 3

You get a sample of abdominal fluid in your polytrauma case and it’s pale yellow so you suspect it may be a uroabdomen; what can you do right now to help you be more confident in that finding? And no, your little suburban GP practice moonlighting as an ER doesn’t have a CT machine.

Answer 3

(Test the fluid creatinine (urine strips do this) and compare it to blood creatinine (chem panel), if the fluid creatinine is more than 2x blood = highly suggestive of a uroabdomen)

Question 4

What is the goal of intravenous fluid resuscitation?

Answer 4

(Restore tissue perfusion and oxygen delivery all to prevent organ failure)

Question 5

What effects does hypertonic saline have on the heart?

Answer 5

(Increased heart rate and contractility)

Question 6

What is the purpose of hypotensive fluid resuscitation?

Answer 6

(To prevent clots that have formed from being knocked loose by normal blood pressure)

Question 7

Blood product use in trauma cases should be reserved for what types of patients?

Answer 7

(Those that do not respond to conventional fluid resuscitation)

Question 8

What is the main purpose of the drugs (tranexamic acid, aminocaproic acid) used to treat acute traumatic coagulopathy?

Answer 8

(They prevent fibrinolysis; acute traumatic coagulopathy is not simply a dilutional or consumptive coagulopathy, there is an imbalance between pro and anticoagulant factors, platelets, the endothelium, and fibrinolysis)