Trauma

Question 1

When is blunt genitourinary trauma life threatening?

Answer 1

if kidneys or renal vascular injured

Question 2

SVR (inc/dec) in hypovolemic shock?

Answer 2

increases

Question 3

SVR (inc/dec) in cardiogenic shock?

Answer 3

increases

Question 4

SVR (inc/dec) in septic shock?

Answer 4

decreases

Question 5

Preload (inc/dec) in hypovolemic shock?

Answer 5

decreases

Question 6

Preload (inc/dec) in cardiogenic shock?

Answer 6

increases

Question 7

Cardiac index or pump function (inc/dec) in cardiogenic shock

Answer 7

DECREASES

Question 8

Cardiac index or pump function (inc/dec) in septic shock?

Answer 8

increases

Question 9

What is Beck’s triad?

Answer 9

JVD, dec heart sounds, dec BP

from cardiac tamponade

Question 10

What is Bergman’s triad?

Answer 10

for fat emboli:

mental status changes, petechiae in axilla/thorax, dyspnea

Question 11

What is Cullen’s sign?

Answer 11

bluish skin around umbilicus from retro-peritoneal hemorrhage - comes through fascial planes

Question 12

What are the ways that retroperitoneal hemorrhage can present?

Answer 12

Grey Turner’s sign - discoloration of flank

Fox’s sign - ecchymosis of inguinal ligament

Cullen’s sign - blue belly button

Question 13

Duodenal hematomas are more often seen in ___ patients.

Answer 13

young

thinner abd wall/musculature

Question 14

What is management of duodenal hematoma?

Answer 14

resolve in 1-2 weeks with decompression via NG tube + parenteral nutrition

Question 15

How do you manage ventilation?

Answer 15

with tital volume and RR

min ventilation = TV x RR

Question 16

What does end-tital CO2 measure?

Answer 16

should be about 40

measures tube placement

Question 17

What is the SBP to define hypotension?

Answer 17

<90 (MAP <65)

Question 18

What is definition of oliguria?

Answer 18

urinary output <0.5 cc/kg/hr

Question 19

What are the three signs of shock?

Answer 19

dec SBP
dec urinary output
pale/cool/diaphoretic

Question 20

mean arterial pressure = ___ x ___

Answer 20

CO x SVR

Question 21

CO = ___ x ___

Answer 21

HR x SV

SV = preload x contractility

Question 22

What are the three etiologies for decreased preload?

Answer 22

hemorrhage
tension pneumo
pericardial tamponade

Question 23

What are the etiologies of decreased SVR?

Answer 23

depsis
anaphylaxis
anesthesia
spinal trauma

All lead to vasodilation –> hypotension and WARM extremities

Question 24

What are presenting signs of hemorrhage?

Answer 24

flat veins, nl heart, nl lungs, tachycardic

Question 25

What are presenting signs of tension pneumo?

Answer 25

crushes IVC –> engorged neck veins (JVD), nl heart, dec breath sounds + hyper-resonance
tracheal deviation

Question 26

Do you need a CXR for suspected tension pneumo?

Answer 26

NO - if you have signs/symptoms do a needle decompression

Question 27

What are presenting signs of pericardial tamponade?

Answer 27

engorged neck veins, nl lung sounds, distant heart sounds, hypotension
(BECK’s triad)

Question 28

“Abdomen” begins at what spinal level?

Answer 28

T4 = nipple line

so if gun shot below nipple line - in abdomen!

Question 29

When do you not take penetrating wounds to the OR?

Answer 29

if it did NOT penetrate the peritoneum

probe penetrating wounds

Question 30

How much blood can the chest hold?

Answer 30

500 cc per side –> 1L total

Question 31

How much blood can the pelvis hold?

Answer 31

2L

Question 32

How much blood can each leg hold?

Answer 32

1 L

Question 33

How much blood can your abdomen hold?

Answer 33

1500 cc

Question 34

What is the pringle maneuver

Answer 34

compress the pancreatoduodeneal ligament
portal vein
hepatic artery
(take away blood supply to slow bleeders)

Question 35

Hypovolemia leads to ___ central venous pressure –> ____ venous return –> ____ cardiac output

Answer 35

ALL decreased

Question 36

What happens to a patient with hypovolemia after mechanical ventilation is started?

Answer 36

Increase in intrathoracic pressure –> collapse of venous vessels like IVC –> NO venous return

Question 37

Gunshot wound below ____ –> potential for abdominal involvement.

Answer 37

nipple line (4th/5th dermatome)