Trauma Flashcards
What are the 5 criteria for potential cervical spine injury?
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
What is the best way to intubate a patient with a cervical spine injury?
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
T/F: N2O is the drug of choice for cervical spine injury
False, it tends to accumulate in closed spaces
Succinylcholine can increase serum potassium levels if administered 24 hours after what?
A burn, spinal cord or crush injury
Postop after massive transfusions, do patients get metabolic alkalosis or acidosis?
Metabolic alkalosis
If transfusion rate exceeds 1 unit every 5 minutes you can see cardiac depression caused by what?
Hypocalcemia (the preservative in blood, citrate, binds to calcium)
In an anesthetized patient, how are hemolytic reactions recognized by?
Increased temp, tachycardia, hypotension, hemoglobinuria, and oozing at the field
Does hypothermia improve or worsen acid/base balance?
Worsen
What is a common cause of bleeding after massive transfusions?
Dilutional thrombocytopenia
What is the half life of crystalloids and colloids?
Crystalloids: 20-30 minutes
Colloids: 3-6 hours
T/F: LR is less likely to cause hyperkalemic acidosis than is normal saline
True
Why are dextrose solutions contraindicated in traumas?
May exacerbate ischemic brain damage
Which 2 colloids can cause coagulopathy?
Dextran and hetastarch
Which type of blood can be given to the moribund trauma patient requiring immediate blood transfusion that has not been typed and crossed?
O negative
What can decrease by 50% in blood that has been stored for 2 days?
Factor VIII
Do hypovolemic patient need more or less anesthetics?
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
What are the induction agents used in hypovolemic trauma patients?
Ketamine and Etomidate
What can cause hematuria?
Injury to kidneys or lower urinary tract
How often does cervical spine injury occur in trauma patients?
2% of all trauma patients
Signs of brain injury include?
Restlessness
Convulsions
Altered consciousness
Cranial nerve dysfunction (non reactive pupils)
What is cushing’s triad?
HTN
Bradycardia
Respiratory disturbances
-The triad are late signs and is preceded by brain herniation
Which meds may induce pupillary dilation in brain injury patients?
Anticholinergics
T/F: No sedatives or analgesics in brain injury patients if there will be an expected neuro exam
True
What is Beck’s triad?
Neck vein distension
Hypotension
Muffled heart tones
Which drug can be lethal with pericardial tamponade?
Diprivan
What is a sign of pericardial tamponade?
Distended neck veins
What is pulsus paradoxus?
> 10 mmHg decline on BP during spontaneous ventilation
Do pts normally have hypo or hypertension with exploratory laparotomies?
Hypotension when they open the abdomen
What is usually involved in trauma to the abdomen?
Vascular Hepatic Splenic Renal Pelvis
Do you have hypo or hyperkalemia with massive transfusions?
Hyperkalemia
What are the labs associated with fat embolism?
Elevation of serum lipase
Fat in urine
Thrombocytopenia
What happens to blood flow when a spinal or regional is used with extremity reattachment?
Increases blood flow
Watch hypotension with decreases blood flow
What do you do for extremity reattachment with patients receiving general?
Keep warm
Avoid shivering on emergence to help reperfusion
How is intracranial hypertension controlled?
Fluid restrictions
Diuretics (mannitol)
Hypocapnia (paCO2 26-30 mmHg)
Research is now saying normocapnea
How do you treat hypertension or tachycardia during intubation with LeFort fractures?
Lidocaine or fentanyl
Which med do you avoid with Lefort fractures because it causes increased intracranial pressure?
Ketamine
T/F: Mild hyperthermia can assist saving brain tissue in a head injury
False, mild hypothermia
Which spinal cord injury can cause apnea?
C3-C5
If you have a high cord injury what can you develop?
Spinal shock, loss of sympathetic tone, hypotension, warm to the touch, bradycardia, areflexia and GI atony
A reaction of the autonomic (involuntary) nervous system to overstimulation
Autonomic hyperreflexia
What are the s/s of autonomic hyperreflexia?
HTN
Change in HR
Skin color changes (paleness, redness, blue-grey skin color)
Excessive sweating
What is a simple pneumothorax?
Air in the parietal and visceral pleura
What is the treatment for a simple pneumothorax?
Chest tube 4th or 5th intercostal
What is a tension pneumothorax?
Air in pleural space trapped and increases with inspiration and not escape with expiration- see the tracheal shift
T/F: Simple pneumo can be turned to tension pneumo with positive pressure (bagging or ventilator)
True
What is the treatment for a tension pneumo?
14 guage needle at second intercostal space at midclavicular line then a chest tube (like a simple pneumo)
What do you do for a hemothorax?
DLT to isolate bleeding lung from healthy lung
What are some causes of ARDS?
Sepsis Thoracic injury Aspiration Head injury Fat emboli Massive transfusion
What is the mortality for ARDS?
~50%
T/F: You need low airway pressures for ARDS
False, you need high
