TRAUMA

Question 0

WHAT CAN YOU DO FOR A TENSION PNEUMO?

Answer 0

PUT 22G AT 4TH INTERCOSTAL SPACE.

Question 1

WHAT IS THE DISTRIBUTION OF DEATHS FROM TRAUMA?

Answer 1

1ST PEAK: DIE IN FIELD SEC TO MIN POST TRAUMA D/T BRAIN SPINAL CORD USUALLY.

2: 1-2 HRS POST INJ. D/T LARGE BLOOD LOSS.
3: DAYS-WKS IN ICU. FROM SEPSIS ORGAN FAIL.

Question 2

WHAT DO YOU SEE IN THE 1ST STAGE OF SHOCK?

Answer 2

NOT MUCH BECAUSE THEY ARE COMPENSATING….CO AND ART PRESSURE MAINTAINED THROUGH BARORECEPTORS, CNS, VASOCONSTRICTION, ADH/ANGIOTENSEN RELEASE, MOBILIZATION OF FLUIDS FROM ALT SPACES.

Question 3

WHAT DO YOU SEE AT 2ND STAGE OF SHOCK?

Answer 3

CV FAILS. PT ISCHEMIC, VASOMOTOR FAILS, THROMBOSIS, LEAKY CAPILLARIES, ENDOTOXINS RELEASED. START PRESSORS AFTER FLUID RECESSITATION.

Question 4

WHAT DO YOU SEE 3RD STAGE OF SHOCK?

Answer 4

USUALLY DYING IN ICU FROM IRREVERSIBLE SHOCK. ATP RESERVES ARE DEPLEATED AND DEATH WILL RESULT WITHOUT INTERVENTION.

Question 5

DESCRIBE THE 4 TYPES OF SHOCK.

Answer 5

HYPOVOLEMIC: EXTREME IV LOSS. USUALLY GUN SHOT, TRAUMA.
CARDIOGENIC: PUMP FAIL. GO INTO DEADLY ARRYTHMIA.
OBSTRUCTIVE: DEADLY OBSTRUCTION OF FLOW IE PE, TENSION PNEUMO, OBSTR. VALVE DISEASE. COULD BE STAB WOUND.
DISTRIBUTIVE: SEPTIC, ANAPHALAXIS, NEUROGENIC.

Question 6

WHAT TYPE OF TRAUMA INJURY IS ASSOCIATED WITH HIGH LEVEL OF INJURY?

Answer 6

BLUNT TRAUMA. INJURY IS DISPERSED EVERYWHERE. IE SHEARING, FALL, MVA, DECELERATION.

Question 7

WHAT DOES CO2 DO TO OXYHEMOGLOBIN CURVE AND WHY?

Answer 7

SHIFT TO LEFT BECAUSE CO2 HAS GREATER AFFINITY FOR HGB THAN O2. O2 GETS BUMPED OFF AND TISSUES DONT GET ENOUGH O2.

Question 8

WHAT ARE S/S OF TENSION PNEUMO?

Answer 8

OFTEN POST MVA. HYPOTENSION, SQ EMPHYSEMA, DISTENDED NECK VEINS, TRACH SHIFT. TREAT WITH CHEST TUBE.

Question 9

WHAT IS BECKS TRIAD?

Answer 9

NECK VEIN DISTENTION, HYPOTENSION, MUFFLED HEART SOUNDS. YOU SEE THIS WITH PERICARDIAL TAMPONADE.
YOU NEED TO MAINTAIN ELEVATED FILLING PRESSURES TO KEEP CO UP….KETAMINE IS A GOOD IDEA, AVOID PROPOFOL.

Question 10

WHAT ARE S/S OF FAT EMBOLISM SYNDROME?

Answer 10

PETECHIAL RASH, MENTAL STATUS CHANGE, RESP INSUFFICIENCY. IT OCCURS 12-24 HRS POST INJ/SURGERY.

Question 11

FOR A HEAD INJURY WHAT DRUGS DO YOU WANT TO AVOID?

Answer 11

KETAMINE AND SUX DUE TO INC. ICP.

Question 12

IF SOMEONE HAS A LEFORTE 2/3 FRACTURE WHAT SHOULD YOU THINK?

Answer 12

THEY HAVE A BASAL SKULL FRACTURE……AVOID NASAL INSTRUMENTATION.

Question 13

WHAT DO YOU SEE WITH SPINAL SHOCK?

Answer 13

HYPOTENSION, BRADYCARDIA, AND HYPOTHERMIA

Question 14

WHAT DO YOU SEE WITH AUTONOMIC HYPERREFLEXIA?

Answer 14

MASSIVE SNS DISCHARGE. HIGH BP 250/130. DUE TO LESION ABOVE T5.

Question 15

WHAT WILL YOU SEE AT VARYING LEVELS OF BLOOD LOSS?

Answer 15

MILD 40%: SEVERE MET ACIDOSIS, RESP ACIDOSIS, USUALLY OBTUNDED, RAPID/DEEP RESPIRATIONS TO COMP. FOR ACIDOSIS. THEY ARE DECREASING PERFUSION TO BRAIN AND HEART.

Question 16

WHAT CONSTITUTES A MASSIVE BLOOD TRANSFUSION?

Answer 16

TRANSFUSING 1/2 X A PTS BLOOD VOL. (10-20 UNITS OF BLOOD)

WITH THIS YOU’LL SEE THROMBOCYTOPENIA (SO GIVE PLTS), LOW CALCIUM, HYPOTHERMIA, MET ACIDOSIS, AND INCR K.

Question 17

WHAT WILL YOU SEE WITH TRALI?

Answer 17

PULM EDEMA POST TRANSFUSION. S/S 1-2 POST INFUSION PEAKS WITHIN 6 HRS.
THEYLL BE HYPOXIC, SOB, FEVER, MAY SEE FLUID IN ETT.

Question 18

WHAT WILL YOU SEE WITH HYPOTHERMIA?

Answer 18

ARRYTHMIAS, INC PVR, LEFT SHIFT CURVE, COAGULOPATHY, DECR. DRUG METABOLISM, POOR WOUND HEALING, INC INFECTION.

Question 19

WHY IS N2O USUALLY AVOIDED IN TRAUMA?

Answer 19

MAXIMIZE O2, MYOCARDIAL DEPRESSION, POSSIBILITY TO MAKE INJURIES WORSE IE BOWEL/PNEUOS