Trauma Flashcards
Common trauma surgeries
Gunshot wounds, knife wounds, Penetrating injuries to the lower leg with vascular injuries
ABC’s of prioritizing trauma
Airway, Breathing, Circulation
What two comorbidities are easy to fluid overload?
CAD and CHF
Information about trauma patients do you need in a two minute period?
Allergies, medications, past surgical and medical history, NPO status (assume full stomach), and events leading up tot he injury
Dosing Propofol/Etomidate during trauma
Use 1/10-1/2 of a normal dose
Succinylcholine vs. Rocuronium in trauma cases
Sux is used in 95% of cases
Intubating trauma patients
Glidescope
Risk of aspiration and neck injury are secondary to establishing a patent airway
Symptoms of a tension pneumothorax
High airway pressures, low volume, hypoxia, and cardiovascular collapse
Indications of circulation problems
No pulse or tachycardia
Blanched coloring
Hypertensive
Solutions to circulation problems
Large bore IV access (14, 16, ports, central lines)
Arterial line (IV access higher priority)
Fluid management
Blood Products
Drugs (Tranexamic acid w/in 3 hours of the event)
Rapid infusion
Problems caused by patient hypothermia
Coagulopothy
Effect on how drugs work
*How to deal with patient hypothermia
*Fluid warmer, *Bair hugger, heat lamps, room temp, head cover, and low flows
Trauma management goals
Fluid resuscitation, oxygen delivery, coagulopathy
Crystalloid vs. blood products
crystalloid can cause dilution cagulopathy and hypotension
Blood product delivery to restore oxygen carrying capacity
1:1:1
PRCB, fresh frozen, and plasma
Massive Transfusion Protocol: Idea
Preemptively assume that the patient is going through coagulopathy and needs to fight base deficit
Massive Transfusion Protocol: Product Typing
No cross-match!
PRCB: O- for child-bearing age women and O+ for men and post-menopausal women
Plasma: AB
Massive Transfusion Protocol: Ratio
Usually 1:1
2:1 if Hg is dropping rapidly
*Massive Transfusion Protocol: Switching to Type-Specific Blood Products
M&M: After 8 units switch to type-specific
Article: After 1 unit you should stick with un-crossed
Grady: By the time you take another blood sample it will probably come back as type O, so stick to un-crossed in the OR
Massive Transfusion Protocol: Complications
Transfusion related acute lung injury (TRALI), hemolytic transfusion reactions, hypocalcemia, hyperkalemia, acidosis, hypomagnesemia, hypothermia, fluid overload, put patients into DIC, and citrate toxicity
Highest Incidence complication of MTP
Transfusion Related Acute Lung Injury (TRALI)
Cause of hypocalcemia during blood transfusion
Citrate bings to free calcium
Cause of hyperkalemia during blood transfusion
There is an increase in potassium levels in stored blood equal to about 1 mmol per day
Cause of hypothermia during blood transfusion
Non-warmed transfusion blood decreases core temperature by about 0.25 deg C
Massive Transfusion Protocol: Effect of Oxygen Dissociation Curve
Shifts towards lower dissociation
Decreased ATP levels during MTP leads to
decreased circulation to capillary beds and delivery impedance
Up to what percentage of infused RBCs are non-functioning?
25%
*Hemorrhage Class I
No hemodynamic changes
Less that 15% blood loss
Stable BP and HR
*Hemorrhage Class II
Increased diastolic BP
15%-30% blood loss
Managed with crystalloids
*Hemorrhage Class III
Decreased BP
30%-40% blood loss
Metabolic acidosis
Blood transfusions required
*Hemorrhage Class IV
Greater than 40% blood loss
Damage control surgery needed
MTP
Acute traumatic coagulopathy
Damage Control Surgery
Abbreviated procedure intended to stop bleeding and abdominal contamination
Patients often left open
Damage Control Resuscitation
Blood product therapy, blood therapy and MTP to presume coagulopathy
Acute Trauma Coagulopathy: Causes
Believed to occur at onset of injury, acidosis, and hypoxia
*Acute Trauma Coagulopathy: Best Indicator
Base deficit of greater than 6
Glasglow Coma Scale (GCS)
Eye Response, Motor Response and Verbal Response levels given assigned points
15 point max
Injury Severity Score (ISS)
Has some predictability on trauma coagulopathy
Early vs. Late Resuscitation
Early: While there is active bleeding, in the OR
Late: Bleeding is under control, in the ICU
What percentage of normal clotting factor is needed to maintain homeostasis
20%
What blood product aids coagulopathy
Fresh Frozen Plasma
*First problem you see when giving blood transfusions
Hypofibrinogenemia
Blood product used to treat Hypofibrinogenemia
cryoprecipitate
After how many units of PRCB transfusion do patients experience Hypofibrinogenemia and require cryoprecipitate?
10
Thrombocytopenia: Target levels
100,000 in major trauma and 50,000 in minor trauma
Thrombocytopenia: Start replacing after…
1.5-2 blood volumes
Which organs can replace platelets?
Spleen, lungs and bone marrow
T/F Acute liver damage can cause electrolyte imbalance
True
T/F Liver cirrhosis can cause an increase in clotting factors
False! Decrease in clotting factors!
