Trauma Flashcards
When is blunt genitourinary trauma life threatening?
if kidneys or renal vascular injured
SVR (inc/dec) in hypovolemic shock?
increases
SVR (inc/dec) in cardiogenic shock?
increases
SVR (inc/dec) in septic shock?
decreases
Preload (inc/dec) in hypovolemic shock?
decreases
Preload (inc/dec) in cardiogenic shock?
increases
Cardiac index or pump function (inc/dec) in cardiogenic shock
DECREASES
Cardiac index or pump function (inc/dec) in septic shock?
increases
What is Beck’s triad?
JVD, dec heart sounds, dec BP
from cardiac tamponade
What is Bergman’s triad?
for fat emboli:
mental status changes, petechiae in axilla/thorax, dyspnea
What is Cullen’s sign?
bluish skin around umbilicus from retro-peritoneal hemorrhage - comes through fascial planes
What are the ways that retroperitoneal hemorrhage can present?
Grey Turner’s sign - discoloration of flank
Fox’s sign - ecchymosis of inguinal ligament
Cullen’s sign - blue belly button
Duodenal hematomas are more often seen in ___ patients.
young
thinner abd wall/musculature
What is management of duodenal hematoma?
resolve in 1-2 weeks with decompression via NG tube + parenteral nutrition
How do you manage ventilation?
with tital volume and RR
min ventilation = TV x RR
What does end-tital CO2 measure?
should be about 40
measures tube placement
What is the SBP to define hypotension?
<90 (MAP <65)
What is definition of oliguria?
urinary output <0.5 cc/kg/hr
What are the three signs of shock?
dec SBP
dec urinary output
pale/cool/diaphoretic
mean arterial pressure = ___ x ___
CO x SVR
CO = ___ x ___
HR x SV
SV = preload x contractility
What are the three etiologies for decreased preload?
hemorrhage
tension pneumo
pericardial tamponade
What are the etiologies of decreased SVR?
depsis
anaphylaxis
anesthesia
spinal trauma
All lead to vasodilation –> hypotension and WARM extremities
What are presenting signs of hemorrhage?
flat veins, nl heart, nl lungs, tachycardic
What are presenting signs of tension pneumo?
crushes IVC –> engorged neck veins (JVD), nl heart, dec breath sounds + hyper-resonance
tracheal deviation
Do you need a CXR for suspected tension pneumo?
NO - if you have signs/symptoms do a needle decompression
What are presenting signs of pericardial tamponade?
engorged neck veins, nl lung sounds, distant heart sounds, hypotension
(BECK’s triad)
“Abdomen” begins at what spinal level?
T4 = nipple line
so if gun shot below nipple line - in abdomen!
When do you not take penetrating wounds to the OR?
if it did NOT penetrate the peritoneum
probe penetrating wounds
How much blood can the chest hold?
500 cc per side –> 1L total
How much blood can the pelvis hold?
2L
How much blood can each leg hold?
1 L
How much blood can your abdomen hold?
1500 cc
What is the pringle maneuver
compress the pancreatoduodeneal ligament
portal vein
hepatic artery
(take away blood supply to slow bleeders)
Hypovolemia leads to ___ central venous pressure –> ____ venous return –> ____ cardiac output
ALL decreased
What happens to a patient with hypovolemia after mechanical ventilation is started?
Increase in intrathoracic pressure –> collapse of venous vessels like IVC –> NO venous return
Gunshot wound below ____ –> potential for abdominal involvement.
nipple line (4th/5th dermatome)
