TRAUMA Flashcards
WHAT CAN YOU DO FOR A TENSION PNEUMO?
PUT 22G AT 4TH INTERCOSTAL SPACE.
WHAT IS THE DISTRIBUTION OF DEATHS FROM TRAUMA?
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.
WHAT DO YOU SEE IN THE 1ST STAGE OF SHOCK?
NOT MUCH BECAUSE THEY ARE COMPENSATING….CO AND ART PRESSURE MAINTAINED THROUGH BARORECEPTORS, CNS, VASOCONSTRICTION, ADH/ANGIOTENSEN RELEASE, MOBILIZATION OF FLUIDS FROM ALT SPACES.
WHAT DO YOU SEE AT 2ND STAGE OF SHOCK?
CV FAILS. PT ISCHEMIC, VASOMOTOR FAILS, THROMBOSIS, LEAKY CAPILLARIES, ENDOTOXINS RELEASED. START PRESSORS AFTER FLUID RECESSITATION.
WHAT DO YOU SEE 3RD STAGE OF SHOCK?
USUALLY DYING IN ICU FROM IRREVERSIBLE SHOCK. ATP RESERVES ARE DEPLEATED AND DEATH WILL RESULT WITHOUT INTERVENTION.
DESCRIBE THE 4 TYPES OF SHOCK.
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.
WHAT TYPE OF TRAUMA INJURY IS ASSOCIATED WITH HIGH LEVEL OF INJURY?
BLUNT TRAUMA. INJURY IS DISPERSED EVERYWHERE. IE SHEARING, FALL, MVA, DECELERATION.
WHAT DOES CO2 DO TO OXYHEMOGLOBIN CURVE AND WHY?
SHIFT TO LEFT BECAUSE CO2 HAS GREATER AFFINITY FOR HGB THAN O2. O2 GETS BUMPED OFF AND TISSUES DONT GET ENOUGH O2.
WHAT ARE S/S OF TENSION PNEUMO?
OFTEN POST MVA. HYPOTENSION, SQ EMPHYSEMA, DISTENDED NECK VEINS, TRACH SHIFT. TREAT WITH CHEST TUBE.
WHAT IS BECKS TRIAD?
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.
WHAT ARE S/S OF FAT EMBOLISM SYNDROME?
PETECHIAL RASH, MENTAL STATUS CHANGE, RESP INSUFFICIENCY. IT OCCURS 12-24 HRS POST INJ/SURGERY.
FOR A HEAD INJURY WHAT DRUGS DO YOU WANT TO AVOID?
KETAMINE AND SUX DUE TO INC. ICP.
IF SOMEONE HAS A LEFORTE 2/3 FRACTURE WHAT SHOULD YOU THINK?
THEY HAVE A BASAL SKULL FRACTURE……AVOID NASAL INSTRUMENTATION.
WHAT DO YOU SEE WITH SPINAL SHOCK?
HYPOTENSION, BRADYCARDIA, AND HYPOTHERMIA
WHAT DO YOU SEE WITH AUTONOMIC HYPERREFLEXIA?
MASSIVE SNS DISCHARGE. HIGH BP 250/130. DUE TO LESION ABOVE T5.
WHAT WILL YOU SEE AT VARYING LEVELS OF BLOOD LOSS?
MILD 40%: SEVERE MET ACIDOSIS, RESP ACIDOSIS, USUALLY OBTUNDED, RAPID/DEEP RESPIRATIONS TO COMP. FOR ACIDOSIS. THEY ARE DECREASING PERFUSION TO BRAIN AND HEART.
WHAT CONSTITUTES A MASSIVE BLOOD TRANSFUSION?
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.
WHAT WILL YOU SEE WITH TRALI?
PULM EDEMA POST TRANSFUSION. S/S 1-2 POST INFUSION PEAKS WITHIN 6 HRS.
THEYLL BE HYPOXIC, SOB, FEVER, MAY SEE FLUID IN ETT.
WHAT WILL YOU SEE WITH HYPOTHERMIA?
ARRYTHMIAS, INC PVR, LEFT SHIFT CURVE, COAGULOPATHY, DECR. DRUG METABOLISM, POOR WOUND HEALING, INC INFECTION.
WHY IS N2O USUALLY AVOIDED IN TRAUMA?
MAXIMIZE O2, MYOCARDIAL DEPRESSION, POSSIBILITY TO MAKE INJURIES WORSE IE BOWEL/PNEUOS
