Trauma Flashcards
What is lethal triad?
Acidosis
Hypothermia
Coagulopathy
Trauma stats, pt population
- 3rd leading cause of death in US age 1-44
- WHO projects 40% increase in deaths caused by injury
- Trauma pt spend more time in the hospital than heart & cancer pt
What are the most important therapeutic maneuvers in head injured patients
Normalization of ICP,
cerebral perfusion
Oxygen delivery
Most common cause of traumatic death
Head injury and hemorrhagic shock
What is blunt cardiac injury
Same as myocardial contusion
Encompasses varying degrees of myocardial damage, coronary artery injury, rupture of the cardiac free wall, the septum, or valve.
In trauma pt persistent hypotension is result of…
Bleeding, tension PTX, neurogenic shock, cardiac injury such as pericardial tamponade or myocardial contusion
What is the most threatening consequence of head injury
Brain ischemia
cerebral vasoconstriction & hyperventilation can further aggrevate ischemia
Trimodal distribution
- Initial peak death within sec or min
- brain stem, upper spinal cord, heart & aorta - Within first 2 hrs of injury “golden hour”
- SDH, SEH, hemoPTX, ruptured spleen, liver lac, fx femur, sig blood - Death occurs days or weeks after
- sepsis & multi organ failure, ARDS, ICU pt
Injuries types & occurrence
- -Severe 5%, but 50% death
- -Urgent 10-15%, can become life threatening or result in sig disability
- -Nonurgent 80% of all injuries
A for airway
Mallapati
C-collar
Full stomach, peristalsis stops when trauma present
Airway trauma
If complicated airway surgeon should be in a room for induction
What does MILS stand for
Manual in line stabilization
Most effective
Assistant hands on both side, holds down the occiput, prevents head rotation
B breathing & Blood
Ventilation: cyanosis, flail chest, SQ emphysema, tracheal shift
PTX, HTX
Do u have a type and cross?
C circulation
Signs of poor circulation
Decreased urine output
Decreased EtCO2–20, crapy B/P
Hg on ABG
FLUIDS: crystalloids, colloids, blood products: O-, unmatched blood
What is shock
Circulatory inadequacy due to poor perfusion & inadequate delivery of oxygen & nutrients to tissue
Stage I of shock
Compensatory by negative feedback mechanism
CO & BP are maintained
Baroreceptor & CNS ischemic response
Vasoconstriction
Release of ADH & angiotensin
Mobilization of fluids from alternative space
Stage 2 of shock
Progressive shock
Fail of CV system, caused by: ischemia, vasomotor failure, thrombosis, capillary permeability, release of endotoxins
Lactic acid
Stage 3 of shock
Irreversible shock Adenosine triphosphate (ATP) reserves are depleted Death results if no intervention
Pt with wide open levo/epi going to ICU
Hypovolemic shock
Loss of blood, intravascular volume
S/S: tachy, narrow pulse pressure, cold, clammy skin from vasoconstriction
Rx: crystalloids x2L, unstable BP, give blood
Cardiogenic shock
Pump failure, acute valvular dysfunction, dysrythmias
Rx: fluids, vasodilators, inotropes
Obstructive shock
Tension PTX
Pulmonary embolism
Obstructive valve disease
Rx: release of air with 14 gauge catheter, chest tube
Distributive shock
Septic, anaphylactic, neurogenic shock
Spinal cord injury, IV dye in CT
Rx: fluid, inotropes, and vasopressors
Causes of Blunt trauma
Direct impact Deceleration coup-contra coup injuries Continuous pressure Shearing and rotary forces All associated with high levels of energy
Beck’s triad
Neck vein distention,
hypotension
Muffled heart sounds
Pulsus paradoxus
> 10 mmHg decline in SBP with inspiration
Tension PTX
S/S & Rx
Pleural cavity in punctured & pressure increases causing a shift of mediastinal structures & collapsed lung
S/S: hypotension, SQ emphysema, affected BS, distended neck veins, tracheal shift
Rx. Needle decompression, chest tube
Pericardial tamponade
Definition, s/s
Restricts filling of cardiac chambers which results in
decreased: CO, BP, & SV
Cardiac tamponade
May require elevated pressures to keep CO
Ketamine & etomidate are good choice
Propofol not good
What are some spinal & renal protective measures?
Sodium bicarb
Mannitol
Thoracic aortic dissection
DLT needed Fem/rad Aline L heart bypass Massive fluid management Spinal and renal protective measures
Anasthesia for Abdominal trauma
Management of hemorrhage, hypothermia, sepsis, ventilation
Major hemorrhage associated with injuries to liver, spleen, kidneys
Multiple visits to OR
Orthopedic trauma major problem
Fat embolism syndrome
Shock, thromboembolic hypoxia resp failure
Spinal shock s/s
Hypotension
Tachycardia
Hypothermia
When is hyperreflexia seen?
Seen with lesions above T5
Massive sympathetic discharge from stimulation below level of injury
Mild hemorrhage
Decreased peripheral perfusion Normal arterial ph <20% blood loss C/o feeling cold Postural hypotension Cool pale moist skin Collapsed neck veins
Moderate hemorrhage
20-40% blood loss
Thirst, oliguria, Anuria
Metabolic acidosis
Decreased central perfusion of liver, gut, kidneys
Severe hemorrhage
>40% blood volume loss Decreased perfusion of brain & heart Severe metabolic acidosis + respiratory acidosis Agitation, confusion, obtunded Supine hypotension & tachycardia Rapid and deep respirations
Massive transfusion protocol
4-2-1 Thrombocytopenia Hypocalcemia - cardiac depression Hypothermia Metabolic acidosis Hyperkalemia
S/S of transfusion related acute lung injury
TRALI
Noncardiogenic pul edema
S/S appear 1-2 hrs after transfusion & peak w/in 6 hrs
Hypoxia, fever, dyspnea, & fluid in ETT
Effects of hypothermia
Cardiac arrhythmias Increased PVR L shift of oxyHgb Reversible coagulopathy Decreased drug metabolism Poor wound healing Increased infection
