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APA Foundations 2 > Trauma > Flashcards

Trauma Flashcards

1
Q

What is the leading cause of death in trauma patients?

A 
#1 hemorrhage shock
#2 TBI
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2
Q

What is the “lethal triad” of trauma?

A
  • Acidosis, Hypothermia, coagulopathy

- Each one has negative effect on the other

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3
Q

What is the purpose of a ATLS trauma assessment?

A

Provides a logical and sequential treatment strategy for rapidly assessing the patient

Basically, it is to ensure a provider does not miss a injury by being distracted by a larger injury (ex. not realizing a patient has a pneumothorax because they arrived with a traumatic leg amputation)

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4
Q

Proper trauma assessment is made up of a primary and secondary survey? Wha is included in the primary survey?

A

ABCDE

Airway
Breathing
Circulation
Disability
Exposure (get the patient trauma naked)
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5
Q

What is the goal of primary survey?

A

To identify and rapidly manage life-threatening conditions or injuries

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6
Q

What is involved in the secondary survey?

A

Complete head-to-toe assessment, full set of vitals, medical history and current meds

It is imperative to remain vigilant during a secondary survey to determine if any patient injuries may have been missed during the primary survey

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7
Q

What is historically worse, blunt or penetrating trauma? Why so? Give examples of each

A
  • Blunt, b/c more energy is required to disrupt an organ

Blunt: Falls, Assaults, MVA’s
- Direct impact, deceleration, continuous pressure, shearing, and rotary forces

Penetrating: GSW, stab wounds

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8
Q

What is the standard induction method for trauma patients?

A

RSI with cricoid pressure

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9
Q

What is associated with the highest overall rate of successful airway management and provides the greatest possibility for rapidly securing the airway?

A

Muscle relaxation

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10
Q

What is greatest difference between routine induction and RSI?

A

The use of a muscle relaxant before knowing whether the patient can be mask ventilated

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11
Q

If a trauma patient needs an airway device, what should be used?

A
  • ETT only!!!
  • If a patient arrives via EMS with a airway adjunct or supraglottic airway in place, switch it out to an ETT
  • If a patient arrives via EMS with a ETT in place, it is imperative to check that it is working properly and in the right location. Confirm with ETCO2, stethoscope, and CXR
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12
Q

What type of trauma is the leading cause of morbidity and mortality among all age groups?

A

Blunt abdominal trauma

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13
Q

What is major concern with administering induction agents in a trauma patient?

A

The dose-dependent decrease in BP assoc. with the drug coupled with the already hypotensive trauma patient

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14
Q

The use of apneic ventilation is based on which gas law?

A
  • Boyles
  • Gas leaves the facemark, fills the lungs, and exchanges in the lungs based upon the concentration gradient of gases in alveoli
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15
Q

Has fiberoptic intubation proven to be superior to DL in trauma patients?

A

No

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16
Q

What 2 things are involved in the airway management of an “emergent” cervical spine injury?

A

Manual In-line Stabilization (MILS)

RSI

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17
Q

What is the most common lung injury ?

A

Pulmonary contusion

Mostly associated with blunt thoracic trauma

These are injuries to the alveoli without gross disruption to the pulmonary architecture

Initially it is a “bruised” lung, but it typically progresses to much larger swelling and leads to ARDS

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18
Q

How should ARDS be managed?

A
  • Low TV
  • Plateau pressures of less than 32 cm H2O
  • Permissive hypercapnia
  • Conservative fluid strategies
  • Prone positioning
  • NMB’s
  • ECMO
  • Do not increase FiO2 to increase low SaO2 levels (can have toxic effects, worsen gas exchange)
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19
Q

Which paralytic is the drug of choice in RSI trauma indications?

A

Succinylcholine

Caution in patients with neurological injuries or burns. It is safe to administer in the first 24 hours after injury, but can cause lethal hyperkalemia 24-48 hrs after injury

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20
Q

What 3 types of procedures have the highest incidence of recall?

A
  • CABG (#1)
  • OB
  • Trauma
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21
Q

What are the 5 criteria points for a potential C-spine injury?

A
  • neck pain
  • severe distracting pain
  • any neurological signs and symptoms
  • intoxication (always check for a C-spine injury)
  • loss of consciousness at the scene
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22
Q

What is the best way to intubate a trauma patient with c-spine injury?

A

Manual In-Line Stabilization (MILS)

This is when some elsse secures the c-spine with their hands while you intubate

Be sure to document to that the head was held in neural portion with MILS so you CYA

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23
Q

T/F

Most intubations in a trauma patient happen pre-hospital by EMS

A

True

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24
Q

What info do you want to obtain if a patient arrives with a c-collar on ?

A
  • Any neurological deficits
  • Why was the c-collar placed
  • Was a cercival CT scan done and what were the results
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25
Q

T/F

You can use a glide scope to intubate a patient with a suspected c-spine injury

A

True

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26
Q

Should you avoid N2O in trauma patients? Why?

A

Yes

Tends to accumulate in closed spaces (pneumothorax, pneumocephalus, pneumoperitoneum)

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27
Q

T/F

Succinylcholine can increase serum potassium levels if administered 24 hours AFTER a burn, spinal cord or crush injury.

A

True

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28
Q

What acid-base disturbance is associated with massive transfusions?

A

Metabolic alkalosis

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29
Q

When would you see cardiac depression caused by hypocalcemia from a massive transfusion?

A

If rate of transfusion exceeds 1 unit every 5 minutes

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30
Q

Signs of hemolytic transfusion reaction in anesthetized patient?

A
  • Increased temp
  • Tachycardia
  • Hypotension
  • Hemoglobinuria
  • Oozing at surgical field
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31
Q

How does hypothermia contribute to trauma death?

A
  • Worsens acidosis
  • Coagulopathies (platelet sequestration and red blood cell deformities)
  • Risking myocardial function

ALL FLUIDS IN TRAUMA NEED TO BE WARMED

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32
Q

What is the most common cause of bleeding after a massive transfusion?

A

Dilutional thrombocytopenia

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33
Q

What is the half-life of crystalloids?

A

2-30 mins

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34
Q

What is the half-life of colloids?

A

3-6 hrs

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35
Q

What is benefit of LR over NSS in traumas?

A

LR less likely to cause hyperkalemic acidosis

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36
Q

What is a drawback to LR in traumas?

A

Contains Ca+, so can’t use it to transfuse blood

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37
Q

Can you administer dextrose solutions in trauma patients?

A

No, can exacerbate ischemic brain damage/swelling

38
Q

LR is slightly _____ and with large volumes can aggravate cerebral edema

A

hypotonic

39
Q

Which two colloids can cause coagulopathy?

A
  • Dextran

- Hetastarch

40
Q

What blood type is typically given in emergent massive transfusions?

A

O negative (universal donor)

41
Q

Factor VIII can decrease by ____ after two days in storage.

A

50%

42
Q

T/F

**Dilutional thrombocytopenia quickly develops when a patient is massively transfused.

A

True

** Jerry said to know this

43
Q

Do hypovolemic patients need more of less anesthetics? Why?

A

Less

  • b/c alveolar concentration is increased in shock patients r/t a decrease in cardiac output and increased ventilation
  • So more is being pumped into lungs and less blood flow to remove it from the alveoli
  • Smaller intravascular volume so the intravenous anesthetics are exaggerated
44
Q

What is the best induction agent for traumas?

A

ketamine

45
Q

When should you not use ketamine in a trauma?

A

TBI’s

  • can increase ICP
46
Q

Which induction agent is the most hemodynamically stabl?

A

Etomidate

According to Nagelhout, it should not be used b/c of adrenal suppression but I’ve always seen it used without any problems

47
Q

What can cause hematuria in a trauma patient?

A

Injury to the kidneys or lower urinary tract

48
Q

Cervical spine injury occurs in ___ of all trauma patients

A

2%

49
Q

For airway management, trauma patients are always at risk for ____

A

aspiration

50
Q

What is the definition of shock?

A

Inadequate vital organ perfusion and o2 delivery r/t circulatory failure

51
Q

What should be considered in a trauma patient who suffered LOC?

A

TBI

52
Q

What is good tool to asses neurocognitive function of a trauma patient?

A

GCS (“less than 8, intubate”)

53
Q

Signs of a TBI

A
  • Restlessness
  • Convulsions
  • Cranial nerve dysfunction (non reactive pupils)
54
Q

3 components of Cushing’s Triad

A
  • Hypertension
  • Bradycardia
  • Respiratory disturbances

These are very late signs and means that the brain is herniating into foramen magnum

55
Q

What should you avoid giving if a neuro exam is going to be done?

A
  • Sedatives or analgesics
56
Q

How do anticholinergics affect neurons exams?

A

Induce pupillary dialtion

  • Suggamedex is good reversal agent to prevent this from happening
57
Q

What is Beck’s Triad? What does it indicate?

A
  • Neck vein distension (1st sign)
  • Hypotension
  • Muffled heart tones
  • Indicates cardiac tamponade
58
Q

Which induction agent do you not want to give to trauma patient with cardiac tamponade?

A

Propofol

59
Q

What is pulsus paradoxes?

A

> 10mmHg decline in BP during spontaneous ventilation

Indicates cardiac tamponade

60
Q

What do you need to watch for if a percardial centesis is done to relieve cardiac tamponade?

A

Watch for PVC’s on EKG monitor

Occurs when the myocardium is penetrated

61
Q

What type of surgery is needed for abdominal trauma?

A

Ex-lap

62
Q

What do you need to expect when the adbomen is opened up during a ex-lap?

A

Hypotension.

All the blood that accumulated in the peritoneum spills out

63
Q

What type of injuries are associated with abdominal trauma?

A
  • Vascular
  • Hepatic
  • Splenic
  • Renal (be mindful of hyperkalemia from massive transfusions)
  • Pelvis
64
Q

What two ortho injuries are associated with large blood loss?

A
  • Pelvic injuries

- Femur fractures (Up to 3 units of blood can accumulate in the upper leg)

65
Q

What is major complication that can occur with fractures?

A

Fat emboli

66
Q

What lab changes are associated with fat emboli?

A
  • Elevation of serum lipase
  • Fat in urine
  • Thrombocytopenia
67
Q

Why are spinal/regional blocks good for extremity reattachments?

A

They increase blood flow

Watch out for hypotension which decreases blood flow

68
Q

If a general anesthetic is used for extremity reattachment, what are two anesthetic considerations?

A
  • Keep warm (GA’s inhibit ability to auto regulate temp and shiver)
  • Avoid shivering on emergence to help reperfussion
69
Q

T/F

Never do a nasal intubation or NGT with Left fracture II or III

A

True

70
Q

What other type of injury do you want to avoid nasal intubation or NGT’s?

A

Basilar skull fractures

71
Q

What is the hallmark sign of a basilar skull fracture?

A

Ecchymosis around periorbital areas

aka “Raccoon eyes”

72
Q

How is intracranial hypertension controlled?

A
  • Fluid restrictions
  • Diuretics (Mannitol)
  • Hypocapnia (PaCO2 26-30 mmHg)

Increased resp rate decreases CO2, which leads to decreased cerebral blood flow (vasoconstriction)

73
Q

What are two induction agents that be given to minimize hypertension and tachycardia if a pt has increased ICP?

A
  • Lidocaine

- Fentanyl

74
Q

Which induction agent increaes ICP?

A

ketamine

75
Q

Mild ____ can assist saving brain tissue in a TBI

A

hypothermia

76
Q

What levels are associated with apnea in a c-spine injury?

A

C3-C5

(3,4,5 keeps the diaphragm alive)

77
Q

How will SC injuries to T1-T4 manifest?

A

bradycardia

78
Q

Explain spinal shock associated with a high SC injury

A
  • Vessels lose their sympathetic tone and vasodilator
  • Hypotension
  • Bradycardia
  • Hypothermia
  • extremities are warm to touch
  • Areflexia
  • GI atony
79
Q

What is autonomic reflexia?

A
  • Reaction of the autonomic (involuntary) nervous system to overstimulation
  • This reaction may include:
  • HTN
  • Change in heart rate
  • Skin color changes (paleness, redness, blue-grey skin color
  • Excessive sweating.
80
Q

When will you see automonic reflexia occur?

Why is this important for anesthetic considerations?

A
  • Usually after 48hrs

- It is ok to give succinylcholine before it sets in

81
Q

Two types o pneumothorax

A

Simple and Tension

82
Q

What is the anatomical location for a chest tube?

A

4th or 5th IC space, mid-axillary line

83
Q

What is the hallmark sign of a tension pneumothorax?

A

Tracheal deviation to opposite side

Air is trapped, increases with inspiration and DOES NOT escape with expiration

84
Q

Can a simple pneumothorax turn into a tension pneumothorax?

A

Yes, with PPV (ambu-bag or ventilator)

85
Q

What is the immediate, emergent treatment for a tensions pneumothorax?

A

Needle decompression

  • Need a long 14g IV
  • Site for insertion is 2nd IC space, mid-clavicullary line

If this is needed, pt will need a chest tube ASAP

86
Q

What airway equipment is needed for a hemothorax?

A

Doube Lumen Tube (DLT)

To isolate bleeding lung from healthy lung

87
Q

Is ARDS an immediate or delayed response to trauma?

A

Delayed

88
Q

What are causes of ARDS in trauma?

A
  • Sepsis
  • Thoracic injury (mainly from pulmonary contusions)
  • Aspiration
  • Head injury
  • Fat emboli
  • Massive transfusion (TRALI)
89
Q

If a patient has ARDS, how will this manifest in the OR?

How will this impact your anesthetic plan?

A

High pressure alarms

  • Need better ventilator with higher FGF’s r/t their poor lung compliance
  • Need higher airway pressures
90
Q

Classic triad of symptoms for spinal shock

A
  • Bradycardia
  • Hypotension
  • Hypothermia

APA Foundations 2 (5 decks)

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