Trauma Flashcards
Goals of prehospital
- ensure patent airway
- adequate ventilation
- control ext. bleed (CABC)
first step in primary survey
Rapid assessment
physical exam
monitor
ultrasound/radiography (F.A.S.T)
FAST: primary survey
focused assessment sonography in Trauma
FAST: primary survey
early imaging to detect bleeding
within 6 minutes of arrival
2-4 step in primary survey
- Iv access
- Stat labs
- ABCDEs: airway, breathing, circulation, disability, exposure.
what is secondary survery goal?
if fast is negative !
Goal: to determine if any patient injuries may have been missed during the primary survey
complete head-to-toe assessment + neuro exam
primary goal of anesthesia team
facilitate rapid surgical management: get the patient to sleep
meds to intubate
ketamine 1
etomidate 0.2
succinylcholine 1
rocuronium 1.2
induction RSI
cricoid pressure 10-20 30-40 newtons
induction
OGT after ETT confirmed (not w basilar skull fracture)
contraindications to succinylcholine
burns
spinal cord injury
renal failure
hyperkalemia
pneumothorax s/s
hypotension
hypoxia
tachycardia
increased CVP
increased airway pressure
absence of breath sounds 1 side.
tension pneumothorax decompression
14-gauge into the 2nd or 3rd IC space anteriorly
OR
the 4th or 5th IC space laterally.
etiology of ARDS in trauma
consequence of high-volume resuscitation.
Pulmonary contusions can develop or “blossom” over a range of time and ultimately may develop into ARDS.
Pathology of ARDS
Protein-rich fluid leaks from the pulmonary capillaries.
Leakage is compounded by embolic events, which further increase intracapillary pressure and intensify interstitial leakage
culminates in hypoxia and decreased pulmonary compliance.
ARDS VENTILATION
low tidal volume/high RR
permissive hypercapnia
conservative fluid strategies
prone positioning
neuromuscular blockade
ECMO (extracorporeal membrane oxygenation) for those who do not respond to initial therapy
CIRCULATORY MANAGEMENT
-6 PRBC, 6 FFP, 1 PLT
2-3 large bore IVs
Arterial line
Hemodynamic support via vasopressors
Tranexamic Acid (TXA) dose
1 gram bolus followed by infusion (1g/8 hours)
Newtons first law
An object in motion stays in motion.
As the body decelerates abruptly, internal organs continue forward at the original velocity and are torn from their attachments by way of rotary and shearing forces.
severity of penetrating trauma 3 determinants
velocity of missile
instrument
type of tissue passed through
what stage in the continuum of trauma care would FAST happen?
Primary survey
What are anesthetic implications of blunt trauma?
There may be a lot of internal bleeding.
Lethal Triad
Hypothermia
Acidosis
Coagulopathy
Defined as a pathologic event that is triggered by the loss of circulating blood volume and results in a reduction in oxygen delivery to the tissue.
hemorrhagic stock
s/s of hemorrhagic shock
hypotension
tachycardia and cold
clammy skin
why are hemorrhagic shock patients cold and clammy?
shunting the blood away from periphery and into vital organs
hemorrhagic shock resuscitation
Two whole blood right away with positive fast
OR –> MTP
1:1:1
RBC and clotting
40% of patients with blunt trauma present with a
tension pneumo
blunt abdominal trauma needs
fluid
40% of deaths in the first 24 hours of trauma
hemorrhage
acidosis causes
coagulopathy –> acidosis
cell ischemic leads to
anaerobic metabolism –> lactate –> acidosis
1:1:1
mimics whole blood
6 PRBC, 6u FFP, 6pk platelets
A negative feedback control mechanism of the circulation tries to return the cardiac output and arterial pressure to normal levels.
compensated shock
don’t correct HR