Trauma Flashcards
What is compensated (hemorrhagic) shock?
As pressures fall:
- Angiotensin constricts peripheral arteries
- Vasopressin constricts veins
- Both increase water retention
What is progressive (hemorrhagic) shock?
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
What is the last stage of shock in hemorrhagic shock/
Irreversible
Blood volume in tibia or humerus?
750 ml (1.5 units)
Blood volume in a femur?
1,500 ml (3 units)
Blood volume in a pelvis or retroperitoneal hematoma?
Several liters
What two lab values would you expect to see in a large hemorrhage?
- Increased lactate (not reliable in patients with hepatic dysfunction)
- Base deficit
What is the best indicator of preload?
Left-ventricular end diastolic volume (but invasive)
What is the most commonly used measure of preload currently?
CVP which estimates volume staus
US of IVC with inspiration-expiration becoming more common
For each liter of fluid infused, how much stays in the intravascular system?
1/3. This means if a patient has 1L of blood loss, they really need 3 liters to keep their pressures up.
In transfusion, what is the ideal blood option
Type and cross-matched
In transfusion, after type and cross, what is next best blood option
Type-specific and unmatched
In a female transfusion that you can’t type, what is best option?
O-neg
In a male transfusion that you can’t type, what is the best option?
O-pos
What is typically added in massive transfusion protocol?
- FFP
2. Platelets
In a trauma situation where blood is needed but not available, what is the best option?
7.5% HTS
As it keeps more blood intravascularly (up to 500 ml instead of 300 ml)
What are indications for a thoracotomy in a trauma patient?
- Initial chest tube output > 1,500 ml
- > 200 ml/hr over next 4 hours
- Hemopericardium (seen in fast)
What is most reliable sign of injury to kidneys/ureter/bladder?
Hematuria
What is a good test to look for vascular injury in an extremity after a trauma?
ABI (
Should steroids be used for patients with spinal cord injury?
Their use is becoming more limited. Get neurosurgery involved early to make this decision.
Why must all auricular hematomas be treated?
Can turn into cauliflower ear if not
Why must all nasal septal hematomas be treated?
Can lead to pressure necrosis if not with secondary saddle nose deformity
