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AP Final Exam > Trauma > Flashcards

Trauma Flashcards

1
Q

Common trauma surgeries

A

Gunshot wounds, knife wounds, Penetrating injuries to the lower leg with vascular injuries

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2
Q

ABC’s of prioritizing trauma

A

Airway, Breathing, Circulation

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3
Q

What two comorbidities are easy to fluid overload?

A

CAD and CHF

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4
Q

Information about trauma patients do you need in a two minute period?

A

Allergies, medications, past surgical and medical history, NPO status (assume full stomach), and events leading up tot he injury

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5
Q

Dosing Propofol/Etomidate during trauma

A

Use 1/10-1/2 of a normal dose

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6
Q

Succinylcholine vs. Rocuronium in trauma cases

A

Sux is used in 95% of cases

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7
Q

Intubating trauma patients

A

Glidescope

Risk of aspiration and neck injury are secondary to establishing a patent airway

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8
Q

Symptoms of a tension pneumothorax

A

High airway pressures, low volume, hypoxia, and cardiovascular collapse

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9
Q

Indications of circulation problems

A

No pulse or tachycardia
Blanched coloring
Hypertensive

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10
Q

Solutions to circulation problems

A

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

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11
Q

Problems caused by patient hypothermia

A

Coagulopothy

Effect on how drugs work

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12
Q

*How to deal with patient hypothermia

A

*Fluid warmer, *Bair hugger, heat lamps, room temp, head cover, and low flows

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13
Q

Trauma management goals

A

Fluid resuscitation, oxygen delivery, coagulopathy

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14
Q

Crystalloid vs. blood products

A

crystalloid can cause dilution cagulopathy and hypotension

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15
Q

Blood product delivery to restore oxygen carrying capacity

A

1:1:1

PRCB, fresh frozen, and plasma

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16
Q

Massive Transfusion Protocol: Idea

A

Preemptively assume that the patient is going through coagulopathy and needs to fight base deficit

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17
Q

Massive Transfusion Protocol: Product Typing

A

No cross-match!
PRCB: O- for child-bearing age women and O+ for men and post-menopausal women
Plasma: AB

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18
Q

Massive Transfusion Protocol: Ratio

A

Usually 1:1

2:1 if Hg is dropping rapidly

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19
Q

*Massive Transfusion Protocol: Switching to Type-Specific Blood Products

A

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

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20
Q

Massive Transfusion Protocol: Complications

A

Transfusion related acute lung injury (TRALI), hemolytic transfusion reactions, hypocalcemia, hyperkalemia, acidosis, hypomagnesemia, hypothermia, fluid overload, put patients into DIC, and citrate toxicity

21
Q

Highest Incidence complication of MTP

A

Transfusion Related Acute Lung Injury (TRALI)

22
Q

Cause of hypocalcemia during blood transfusion

A

Citrate bings to free calcium

23
Q

Cause of hyperkalemia during blood transfusion

A

There is an increase in potassium levels in stored blood equal to about 1 mmol per day

24
Q

Cause of hypothermia during blood transfusion

A

Non-warmed transfusion blood decreases core temperature by about 0.25 deg C

25
Q

Massive Transfusion Protocol: Effect of Oxygen Dissociation Curve

A

Shifts towards lower dissociation

26
Q

Decreased ATP levels during MTP leads to

A

decreased circulation to capillary beds and delivery impedance

27
Q

Up to what percentage of infused RBCs are non-functioning?

A

25%

28
Q

*Hemorrhage Class I

A

No hemodynamic changes
Less that 15% blood loss
Stable BP and HR

29
Q

*Hemorrhage Class II

A

Increased diastolic BP
15%-30% blood loss
Managed with crystalloids

30
Q

*Hemorrhage Class III

A

Decreased BP
30%-40% blood loss
Metabolic acidosis
Blood transfusions required

31
Q

*Hemorrhage Class IV

A

Greater than 40% blood loss
Damage control surgery needed
MTP
Acute traumatic coagulopathy

32
Q

Damage Control Surgery

A

Abbreviated procedure intended to stop bleeding and abdominal contamination
Patients often left open

33
Q

Damage Control Resuscitation

A

Blood product therapy, blood therapy and MTP to presume coagulopathy

34
Q

Acute Trauma Coagulopathy: Causes

A

Believed to occur at onset of injury, acidosis, and hypoxia

35
Q

*Acute Trauma Coagulopathy: Best Indicator

A

Base deficit of greater than 6

36
Q

Glasglow Coma Scale (GCS)

A

Eye Response, Motor Response and Verbal Response levels given assigned points
15 point max

37
Q

Injury Severity Score (ISS)

A

Has some predictability on trauma coagulopathy

38
Q

Early vs. Late Resuscitation

A

Early: While there is active bleeding, in the OR
Late: Bleeding is under control, in the ICU

39
Q

What percentage of normal clotting factor is needed to maintain homeostasis

A

20%

40
Q

What blood product aids coagulopathy

A

Fresh Frozen Plasma

41
Q

*First problem you see when giving blood transfusions

A

Hypofibrinogenemia

42
Q

Blood product used to treat Hypofibrinogenemia

A

cryoprecipitate

43
Q

After how many units of PRCB transfusion do patients experience Hypofibrinogenemia and require cryoprecipitate?

A

10

44
Q

Thrombocytopenia: Target levels

A

100,000 in major trauma and 50,000 in minor trauma

45
Q

Thrombocytopenia: Start replacing after…

A

1.5-2 blood volumes

46
Q

Which organs can replace platelets?

A

Spleen, lungs and bone marrow

47
Q

T/F Acute liver damage can cause electrolyte imbalance

A

True

48
Q

T/F Liver cirrhosis can cause an increase in clotting factors

A

False! Decrease in clotting factors!

AP Final Exam (4 decks)

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