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Surgery Final > Trauma > Flashcards

Trauma Flashcards

1
Q

Indications for surgery?

A

Severe pancreatitis
Cholangitis
Ruptured aneurysm
Major trauma/burns

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2
Q

What is a trauma “rainbow panel”?

A 
CBC
Coags
CMP
Cardiac enzymes
Type and Screen
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3
Q

What does a pulmonary artery catheter measure?

A 
Swan-Ganz catheter:
PAP
CO
PCWP
SVR
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4
Q

What is shock due to?

A

Drop in blood pressure

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5
Q

What characterizes traumatic shock?

A

Hypovolemia with direct shock tissue damage and bone fractures

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6
Q

What will CVP/PAWP, CO and SVR be in hypovolemic shock?

A

CVP/PAWP: low
CO: low
SVR: High

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7
Q

Treatment for hypovolemic shock?

A

2-3 L crystalloid IV over 10-30 mins

Blood products if pt. doesn’t respond

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8
Q

What type of output most accurately reflects volume status?

A 
Urine output
Class I shock: over 30 mL/hr
II: 20-30
III: 5-15
IV: none
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9
Q

What will CVP/PCWP, CO and SVR be in traumatic shock?

A

CVP/PCWP: low
CO: high or low
SVR: high or low

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10
Q

Treatment for traumatic shock?

A

Volume and pressors?

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11
Q

What will CVP/PCWP, CO, and SVR be in cardiogenic shock?

A

CVP/PCWP: high
CO: low
SVR: high

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12
Q

What can cause compressive cardiogenic shock?

A

Tamponade

Overventilation

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13
Q

Treatment for tension pneumothorax?

A

Emergency needle decompression and tube thoracostomy

Don’t have time for imaging

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14
Q

What is Beck’s Triad?

A

Diagnoses cardiac tamponade

  • Low arterial BP
  • Distended neck veins
  • Distant muffled heart sounds
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15
Q

Treatment for a cardiac tamponade?

A

Pericardiocentesis

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16
Q

What is hyper dynamic or high output septic shock?

A

PCWP/CVP: low
CO: high
SVR: low
Vasodilation

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17
Q

What is cold or low output septic shock?

A

Cold, mottled extremities
CO: low
SVR: high

18
Q

Treatment for septic shock?

A

Broad spectrum ABX
Volume
Inotropes/vasoconstrictors
Operate: drain and debride

19
Q

What will PCWP/CVP, CO and SVR be in neurogenic shock?

A

All low
Patient will have warm and well-perfused extremities
Tachycardia and hypotension

20
Q

Treatment for neurogenic shock?

A

Volume

Vasopressors

21
Q

How does hypo adrenal shock present?

A

Refractory shock in surgery patients

22
Q

What type of shock could present with hyperthermia?

A

Hypoadrenal shock

23
Q

Treatment for hypo adrenal shock?

A

Volume
Pressors
Hydrocortisone

24
Q

What are some examples of vasopressors?

A

Epinephrine/Norepinephrine
Dopamine
Phenylephrine
Vasopressin

25
Q

Which vasopressor can cause ishcemia of mesenteric arteries? Myocardial depression?

A

A) Phenylephrine

B) Vasopressin

26
Q

What is SIRS?

A

Systemic inflammatory response syndrome:
Fever or hypothermia
Tachycardia and Tachypnea
High WBC or could be low

27
Q

Causes of SIRS?

A

Sepsis
Trauma
Inflammation
Ischemia

28
Q

What is MODS?

A

Multi Organ Dysfunction Syndrome: 2 or more of vital organ systems
Risk factors: shock, SIRS, massive transfusion

29
Q

Treatment for MODS?

A

Supportive

Aimed at underlying illness

30
Q

Pathologic hallmark of ARDS?

A

Diffuse alveolar damage (DAD)

-Results in non-cardiogenic pulmonary edema

31
Q

What will pulmonary wedge pressure be like in ARDS?

A

Low to normal

32
Q

What will PaO2/FIO2 be like in ARDS?

A

<300 is acute lung injury (ALI)

33
Q

Treatment for ARDS?

A

Treat underlying condition

Ventilation: low tidal volume and high PEEP

34
Q

Indications for mechanical ventilation?

A

RR>36, labored breathing, tachycardia, accessory muscles
Heavy sedation
ABG: PaO2 less than 60 with supplemental O2 >50%
PaCO2>45: ventilation failure

35
Q

What do tidal volume and RR affect on ABG?

A

pCO2

36
Q

What do FIO2 and PEEP affect on ABG?

A

Oxygen

37
Q

How is renal failure diagnosed?

A

Rising creatinine

38
Q

How is insulin affected in hospitalized patients?

A

Pts. often develop insulin resistance

39
Q

What diagnostic test can diagnose location renal failure?

A

FENa: Fractional excretion of Sodium
Normal: 2-3%: renal

40
Q

Treatment for pre-renal renal failure?

A

Fluids if hypovolemic

Don’t give fluids if pt. has cardiogenic shock; give Lasix

Surgery Final (5 decks)

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