Trauma

Question 1

Indication for Massive blood transfusion protocol

Answer 1

• penetrating mechanism
• positive FAST
• arrival systolic blood pressure 90 mm Hg
• arrival pulse >120 bpm

Question 2

indications for immediate thoracotomy

Answer 2

1) more than 1500 mL of blood drained on chest tube insertion,
(2) 150 to 200 mL/hr of drainage for two to four consecutive hours, or
(3) persistent hemodynamic instability in the setting of ongoing transfusion requirement.
(4) massive air leak with associated pneumothorax
(5) drainage of esophageal or gastric contents from the chest tube.

Question 3

criteria for patients that should be referred to a designated burn center

Answer 3

1. Partial-thickness burns greater than 10% TBSA.
2. Burns involving the face, hands, feet, genitalia, perineum, or
   major joints.
3. Any full-thickness burn.
4. Electrical burns, including lightning injury.
5. Chemical burns.
6. Inhalation injury.
7. Burns in patients with preexisting medical disorders that
   could complicate management, prolong recovery, or affect
   outcome.
8. Any patient with burns and concomitant trauma (such as frac-
   tures) in which the burn injury poses the greater immediate risk of morbidity and mortality. In such cases, if the trauma poses the greater immediate risk, the patient may be initially stabilized in a trauma center before being transferred to a burn unit. Physician judgment is necessary in such situations and should be in concert with the regional medical control plan and triage protocols.
9. Burned children in hospitals without qualified personnel or equipment to care for children.
10. Burns in patients who will benefit from special social, emo- tional, or long-term rehabilitative intervention.

Question 4

Burn classifications.

Answer 4

1. Causes of Injury
   - Flame—damage from superheated oxidized air by convection and radiation
   - Scald—damage from contact with hot liquids
   - Contact—damage from contact with hot or cold solids
   ============>
   induce cellular damage primarily by the transfer of energy, inducing coagulative necrosis (except for cold injuries, which do not engen- der protein denaturation).
   (==============)
   - Chemical—contact with noxious chemicals
   - Electrical—conduction of electrical current through tissues
   ===============>
   cause direct injury to cellular membranes in addition to the transfer of heat.
   (===============)
2. Depth of Injury
   - Superficial—injury confined to the epidermis
   (painful, erythematous, and blanch to the touch with an intact epidermal barrier)

• Superficial partial-thickness—injury to the epidermis and papillary dermis
  (erythematous, painful, blanch to touch, and often blister).
• Deep partial-thickness—injury to the epidermis and reticular dermis
  (more pale and mottled, do not blanch to touch, but remain painful to pinprick.)
• Full-thickness—injury extending through the epidermis and dermis into subcutaneous fat
  ( hard leathery eschar that is painless and black, white, or cherry red in color )

Question 5

The area of cutaneous injury has been divided into three zones (burn)

Answer 5

1. zone of coagulation - zone of direct injury with necrosis and disrupted cells. This tissue is irreversibly damaged at the time of injury.
2. zone of stasis - the area immediately surrounding the necrotic zone has a moderate degree of insult with decreased tissue perfusion.
   - depending on the wound environment, can either survive or go on to coagulative necrosis.
   - associated with vascular damage and vessel leakage.
3. zone of hyperemia - characterized by vasodilatation from inflammation surrounding the burn wound. This region contains the clearly viable tissue from which the healing process begins and is generally not at risk for further necrosis.

Question 6

Системные эффекты при сильных ожогах

Answer 6

• повышенная проницаемость сосудов и отек
• иммунносупрессия
• повышенная проницаемость слизистой ЖКТ
• гемодинамический нарушения
  гиперметаболизм
• снижение кровоснабжения почек

Question 7

ebb and flow phases of response to illness and trauma

Answer 7

1. The ebb phase is characterized by low metabolic rate, hypothermia, and low cardiac output.
2. The flow phase, which is characterized by high cardiac output and oxygen consumption, increased heat production, hyperglycemia, and an elevated metabolic rate.

Question 8

Nutrition for urning patient

Answer 8

Curreri formula - 25 kcal/kg/day plus 40 kcal per percent TBSA burned per day.
1 to 2 g/kg/day of protein,