Trauma Flashcards
What are the 3 areas of highest recall?
- CV
- OB
- Trauma
5 criteria for C-Spine injury
- Neck Pain
- Severe distracting pain
- Neuro signs
- Intoxication
- LOC at scene
What is the best way to intubate C-spine injury?
- Manual inline stabilization
- Glidescope
Why should N2O be avoided in trauma situations?
-It accumulates in closed spaces
N2O should not be used in what types of injuries?
- Pneumocephalus
- Pneumoperitoneum
- Pneumothorax
Succs can increase what if administered after what 3 things?
- Potassium
- Burn, spinal cord or crush injury
After massive transfusions patients can develop what?
- Metabolic alkalosis
- Hyperkalemia
If transfusions exceeds 1 unit every 5 minutes, what can be seen?
-Cardiac depression due to hypocalcemia (calcium binds to citrate preservatives)
Hemolytic reactions are recognized by what symptoms?
- Increased temp
- Tachycardia
- Hypotension
- Hemoglobinuremia
- Oozing
Hypothermia problems
- Worsen acid base balance
- Coagulopathies
- Increase MI risk
What is a common cause of bleeding after massive transfusion.
-Dilutional thrombocytopenia**
Half life of crystalloid? Colloids?
- Crystalloid = 20-30 mins
- Colloids = 3-6 hours
Lactated ringers is less likely to cause what when compared to NS?
-Hyperkalemic acidosis
Calcium in LR makes it less compatible with what?
-Blood transfusions
What type of solutions are contraindicated in trauma due to exacerbation of brain damage?
-Dextrose solutionns
LR is slightly _____ and with large volumes can aggravate __________
- Hypotonic
- Ceberal edema
Colloids are effective in rapidly restoring ___________
-Intravascular volumes
What 2 colloids can cause coagulopathy?
-Dextran and hetastarch
What type of blood can be released to the moribund trauma patient requiring immediate blood transfusion that has not been typed and crossed.
-Type O negative
What factor decrease by 50% after 2 days in storage? And this decrease causes what?
- Factor VIII
- Dilutional thrombocytopenia
Why does a hypovolemic patient need less IV anesthetic? Volatile agent?
- Smaller intravascular volume
- Decreased CO and increased ventilation
Best induction agents for hypovolemic trauma patients?
- Ketamine
- Etomidate
C-spine injury occurs in ___ of all trauma patients
-2%
What is the definition of shock?
-Circulatory failure = inadequate organ perfusion and oxygenation
What is cushing’s triad?
- Hypertension
- Bradycardia
- Respiratory disturbances
When is cushing’s triad seen?
-Late signs preceded by brain herniation
What type of meds would be avoided with suspected neuro exam?
- Sedatives
- Analgesia
What type of meds produce pupillary dilation?
-Anticholinergics
robinol, sprivia, atrovent
What triad is present with cardiac tamponade? and what are the symptoms?
- Beck’s triad
- Neck vein distension
- Hypotension
- Muffled heart tones
Distended neck veins may signal _________, what med must be avoided?
- Pericardial tamponade
- Diprovan
What is pulsus paradoxus?
-Decrease in at least 10mmHg of BP upon inhalation
During a pericardialcentesis what should be monitored and for what?
- ECG
- Needle too far into myocardial tissue
What is to be expected with abdominal trauma upon opening of the abdomen?
-Hypotension
Pelvic fx can lead to what?
Hypovolemic shock
How much blood loss can occur with femur fx?
-3 units
What 3 things are seen with a fat embolism
- Elevated serum lipase
- Fat in urine
- Thrombocytopenia
What should be avoided with extremity reattachment and GA?
-Shivering (reduces reperfusion)
How is intracranial hypertension controlled?
- Fluid restrictions
- Diuretics
- Hypocapnia
Hypertension or tachycardia and be treated during intubation with what drugs?
- Lidocaine
- Fentanyl
What anesthetic agent increases intracranial pressure?
-Ketamine
Mild hypothermia can assist in saving what?
-Brain tissue with a head injury
Injury to which section of the spinal column can cause apnea?
-C3,4,5
In relation to sensory block, where would the autonomic level be? Motor?
Autonomic = 2 above sensory Motor = 2 below sensory
What is autonomic hyperreflexia?
-Reaction of the autonomic nervous system to overstimulation.
Autonomic hyperreflexia signs.
- High BP
- Change in HR
- Skin color changes
- Sweating
How can a simple pneumo turn in to a tension pneumo?
-Positive pressure (bagging or vent)
how would you treat a tension pneumo?
- 14 gauage needle @ 2nd intercostal space at midclavicular line.
- Then chest tube
How to treat hemothorax?
-Double lumen tube to isolate bleeding lung from healthy lung
What is needed with ARDS?
- High gas flows
- High airway presures
