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APA 2 New Stuff > Trauma > Flashcards

Trauma Flashcards

1
Q

What are the 5 criteria for potential cervical spine injury?

A

1) Neck pain
2) Severe distracting pain
3) Any neuro signs and symptoms
4) Intoxication (muscle reflexes are slower, cannot react as fast)
5) LOC at the scene

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2
Q

What is the best way to intubate a patient with a cervical spine injury?

A

Manual inline stabilization
Can be used with glide scope. C collar can come off in OR if 2 people are doing anesthesia, one person holds head neutral the entire time, the other person uses glide scope

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3
Q

T/F: N2O is the drug of choice for cervical spine injury

A

False, it tends to accumulate in closed spaces

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4
Q

Succinylcholine can increase serum potassium levels if administered 24 hours after what?

A

A burn, spinal cord or crush injury

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5
Q

Postop after massive transfusions, do patients get metabolic alkalosis or acidosis?

A

Metabolic alkalosis

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6
Q

If transfusion rate exceeds 1 unit every 5 minutes you can see cardiac depression caused by what?

A

Hypocalcemia (the preservative in blood, citrate, binds to calcium)

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7
Q

In an anesthetized patient, how are hemolytic reactions recognized by?

A

Increased temp, tachycardia, hypotension, hemoglobinuria, and oozing at the field

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8
Q

Does hypothermia improve or worsen acid/base balance?

A

Worsen

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9
Q

What is a common cause of bleeding after massive transfusions?

A

Dilutional thrombocytopenia

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10
Q

What is the half life of crystalloids and colloids?

A

Crystalloids: 20-30 minutes
Colloids: 3-6 hours

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11
Q

T/F: LR is less likely to cause hyperkalemic acidosis than is normal saline

A

True

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12
Q

Why are dextrose solutions contraindicated in traumas?

A

May exacerbate ischemic brain damage

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13
Q

Which 2 colloids can cause coagulopathy?

A

Dextran and hetastarch

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14
Q

Which type of blood can be given to the moribund trauma patient requiring immediate blood transfusion that has not been typed and crossed?

A

O negative

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15
Q

What can decrease by 50% in blood that has been stored for 2 days?

A

Factor VIII

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16
Q

Do hypovolemic patient need more or less anesthetics?

A

Less because alveolar concentration is up in shock patients r/t a decrease in CO and increased ventilation. Smaller intravascular volume so the intravenous anesthetics are exaggerated

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17
Q

What are the induction agents used in hypovolemic trauma patients?

A

Ketamine and Etomidate

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18
Q

What can cause hematuria?

A

Injury to kidneys or lower urinary tract

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19
Q

How often does cervical spine injury occur in trauma patients?

A

2% of all trauma patients

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20
Q

Signs of brain injury include?

A

Restlessness
Convulsions
Altered consciousness
Cranial nerve dysfunction (non reactive pupils)

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21
Q

What is cushing’s triad?

A

HTN
Bradycardia
Respiratory disturbances
-The triad are late signs and is preceded by brain herniation

22
Q

Which meds may induce pupillary dilation in brain injury patients?

A

Anticholinergics

23
Q

T/F: No sedatives or analgesics in brain injury patients if there will be an expected neuro exam

A

True

24
Q

What is Beck’s triad?

A

Neck vein distension
Hypotension
Muffled heart tones

25
Q

Which drug can be lethal with pericardial tamponade?

A

Diprivan

26
Q

What is a sign of pericardial tamponade?

A

Distended neck veins

27
Q

What is pulsus paradoxus?

A

> 10 mmHg decline on BP during spontaneous ventilation

28
Q

Do pts normally have hypo or hypertension with exploratory laparotomies?

A

Hypotension when they open the abdomen

29
Q

What is usually involved in trauma to the abdomen?

A 
Vascular
Hepatic
Splenic
Renal
Pelvis
30
Q

Do you have hypo or hyperkalemia with massive transfusions?

A

Hyperkalemia

31
Q

What are the labs associated with fat embolism?

A

Elevation of serum lipase
Fat in urine
Thrombocytopenia

32
Q

What happens to blood flow when a spinal or regional is used with extremity reattachment?

A

Increases blood flow

Watch hypotension with decreases blood flow

33
Q

What do you do for extremity reattachment with patients receiving general?

A

Keep warm

Avoid shivering on emergence to help reperfusion

34
Q

How is intracranial hypertension controlled?

A

Fluid restrictions
Diuretics (mannitol)
Hypocapnia (paCO2 26-30 mmHg)
Research is now saying normocapnea

35
Q

How do you treat hypertension or tachycardia during intubation with LeFort fractures?

A

Lidocaine or fentanyl

36
Q

Which med do you avoid with Lefort fractures because it causes increased intracranial pressure?

A

Ketamine

37
Q

T/F: Mild hyperthermia can assist saving brain tissue in a head injury

A

False, mild hypothermia

38
Q

Which spinal cord injury can cause apnea?

A

C3-C5

39
Q

If you have a high cord injury what can you develop?

A

Spinal shock, loss of sympathetic tone, hypotension, warm to the touch, bradycardia, areflexia and GI atony

40
Q

A reaction of the autonomic (involuntary) nervous system to overstimulation

A

Autonomic hyperreflexia

41
Q

What are the s/s of autonomic hyperreflexia?

A

HTN
Change in HR
Skin color changes (paleness, redness, blue-grey skin color)
Excessive sweating

42
Q

What is a simple pneumothorax?

A

Air in the parietal and visceral pleura

43
Q

What is the treatment for a simple pneumothorax?

A

Chest tube 4th or 5th intercostal

44
Q

What is a tension pneumothorax?

A

Air in pleural space trapped and increases with inspiration and not escape with expiration- see the tracheal shift

45
Q

T/F: Simple pneumo can be turned to tension pneumo with positive pressure (bagging or ventilator)

A

True

46
Q

What is the treatment for a tension pneumo?

A

14 guage needle at second intercostal space at midclavicular line then a chest tube (like a simple pneumo)

47
Q

What do you do for a hemothorax?

A

DLT to isolate bleeding lung from healthy lung

48
Q

What are some causes of ARDS?

A 
Sepsis
Thoracic injury
Aspiration
Head injury
Fat emboli
Massive transfusion
49
Q

What is the mortality for ARDS?

A

~50%

50
Q

T/F: You need low airway pressures for ARDS

A

False, you need high

APA 2 New Stuff (2 decks)

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