Trauma

Question 1

What is compensated (hemorrhagic) shock?

Answer 1

As pressures fall:

1. Angiotensin constricts peripheral arteries
2. Vasopressin constricts veins
3. Both increase water retention

Question 2

What is progressive (hemorrhagic) shock?

Answer 2

Arterial pressures fall as blood loss overcomes compensatory mechanisms. Leads to cardiac depression from decreased perfusion which causes a feedback loop.

You eventually get loss of sympathetic tone due to decreased blood flow to CNS

Question 3

What is the last stage of shock in hemorrhagic shock/

Answer 3

Irreversible

Question 4

Blood volume in tibia or humerus?

Answer 4

750 ml (1.5 units)

Question 5

Blood volume in a femur?

Answer 5

1,500 ml (3 units)

Question 6

Blood volume in a pelvis or retroperitoneal hematoma?

Answer 6

Several liters

Question 7

What two lab values would you expect to see in a large hemorrhage?

Answer 7

1. Increased lactate (not reliable in patients with hepatic dysfunction)
2. Base deficit

Question 8

What is the best indicator of preload?

Answer 8

Left-ventricular end diastolic volume (but invasive)

Question 9

What is the most commonly used measure of preload currently?

Answer 9

CVP which estimates volume staus

US of IVC with inspiration-expiration becoming more common

Question 10

For each liter of fluid infused, how much stays in the intravascular system?

Answer 10

1/3. This means if a patient has 1L of blood loss, they really need 3 liters to keep their pressures up.

Question 11

In transfusion, what is the ideal blood option

Answer 11

Type and cross-matched

Question 12

In transfusion, after type and cross, what is next best blood option

Answer 12

Type-specific and unmatched

Question 13

In a female transfusion that you can’t type, what is best option?

Answer 13

O-neg

Question 14

In a male transfusion that you can’t type, what is the best option?

Answer 14

O-pos

Question 15

What is typically added in massive transfusion protocol?

Answer 15

1. FFP

2. Platelets

Question 16

In a trauma situation where blood is needed but not available, what is the best option?

Answer 16

7.5% HTS

As it keeps more blood intravascularly (up to 500 ml instead of 300 ml)

Question 17

What are indications for a thoracotomy in a trauma patient?

Answer 17

1. Initial chest tube output > 1,500 ml
2. > 200 ml/hr over next 4 hours
3. Hemopericardium (seen in fast)

Question 18

What is most reliable sign of injury to kidneys/ureter/bladder?

Answer 18

Hematuria

Question 19

What is a good test to look for vascular injury in an extremity after a trauma?

Answer 19

ABI (

Question 20

Should steroids be used for patients with spinal cord injury?

Answer 20

Their use is becoming more limited. Get neurosurgery involved early to make this decision.

Question 21

Why must all auricular hematomas be treated?

Answer 21

Can turn into cauliflower ear if not

Question 22

Why must all nasal septal hematomas be treated?

Answer 22

Can lead to pressure necrosis if not with secondary saddle nose deformity