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Trauma Flashcards

1
Q

leading causes of trauma mortality

A
  1. head trauma - 40%
  2. hemorrhagic shock
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2
Q

2-4% of blunt traumas have

A

concurrent C-Spine injuries

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3
Q

70% of blunt airway injuries

A

also have C-Spine injuries

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4
Q

flail chest diagnosed with

A
  • two or more sites of at least three adjacent rib fractures
  • rib fractures associated with costochondral separation or sternal fracture
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5
Q

open pneumothorax is a concern for

A

vascular air entrainment

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6
Q

definitive tx of trauma shock

A

operative control of bleeding

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7
Q

expect major bleeding with

A
  1. falls from greater than 6 feet
  2. high energy deceleration injury
  3. high velocity GSW
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8
Q

C/I to cricothyroidotomy

A
  1. children under 12 - permanent laryngeal damage may occur
  2. suspsected laryngeal trauma - uncorrectable airway trauma may occur
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9
Q

Blunt Airway Injury Symptoms

A
  1. hoarseness
  2. muffled voice
  3. dyspnea
  4. stridor
  5. dysphagia
  6. odynophagia
  7. cervical pain
  8. tenderness
  9. ecchymosis
  10. subQ emphysema
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10
Q

Airway management of blunt/penetrating airway trauma

A
  1. CT if feasible
  2. FOB or surgical airway
    • Laryngeal damage precludes cricothyroidotomy - trach distal to penetrating wound
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11
Q

Interventions for tension pneumothorax

A
  1. needle decomprssion 2nd ICS at mid clavicular line - inferior border of 2ICS
  2. CT, mid-axillary line, 5th ICS
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12
Q

flail chest diagnosis

A
  • 2 or more sites of at least 3 adjacent rib fractures
  • rib fractures are either sternal fracture or costochondral separation
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13
Q

flail chest interventions

A
  1. will deteriorate over 3-6 hours
  2. ARDS is very likley if lung contusion >20%
  3. better to focus on analgesia and maintain adequate excursion and oxygenation
  4. may need epidural or thoracic paravertebral block
  5. evaluate for co-existing trauma (hemothorax, pneumothorax)
  6. Automatic intubation - NOT reccomended, O2 supplementation + Non invasive PPV
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14
Q

sx of tension pneumo

A
  1. cyanosis
  2. tachypnea
  3. hypotension
  4. neck vein distention
  5. tracheal deviation
  6. diminished breath sounds on affected sides
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15
Q

blunt thoracic trauma that arrives pulseless has survival rate of

A

<1%

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16
Q

Tachycardia may be absent in hypotensive trauma patients

A
  • up to 30%
  • because of Bezold-jarisch reflex
  • increased vagal tone
  • chronic cocaine use
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17
Q

injury without compensation of tachyardia

A

increases mortality

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18
Q

most consistent pediatric VS change for early volume loss

A

narrow pulse pressure

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19
Q

pediatric pts only decompensate after

A

35-40% of blood volume loss

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20
Q

Base Defecit

A
  • -2 to -5: mild shock
  • -6 to -9: moderate shock
  • over -10: severe shock
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21
Q

lactate, free radicals, and other humoral factors released by ischemic cells

A

all act as negative inotropes

22
Q

cardiac dysfunction in shock

A

is a late and often terminal sign.

Cardiac is preserved from ishcemia r/t neuroendocrine response to hemorrhagic shock.

23
Q

Gut response to hemorrhagic shock

A

One of the earliest organs affected by hypoperfusion; may be the prime trigger of MSOF.

24
Q

skeletal muscle response to shock

A
  • release lactic acid adn ree radicals, tolerate ischemia better than other organs
25
Q

no cross-match and severe hemorrhage:

A
  1. O+ positive PRBCs (except women of childbearing age)
  2. AB- FFP
26
Q

normal lactate

A
  • normal lactate = 0.5 to 1.5 mmol/L
  • levels over 5 mmol/L = significant lactic acidosis
27
Q

permissive hypotension not possible with

A
  1. TBI
  2. SCI
  3. elderly with chronic hypertension
28
Q

administration of large volumes of LR/NS

A

administration of large volumes of lacatate/NS

  • LR: increases lactate
  • NS: increases base defecit
29
Q

large volumes of crystalloid infusion found to be an independent cause of

A
  1. ARDS
  2. abdominal compartment syndrome
30
Q

components of the coagulopathy of the trauma patient

A
  1. ATC: acute trauma coagulopathy
    • develops shortly after trauma and is caused by hyperfibrinolysis and severe tissue injury that releases tissue factors, which in turn activates the coagulation pathways
      • this type of coagulopathy appears to be independent of hypothermia/diluation of factors
  2. RAC: resuscitation associated coagulopathy
    • caused by hypothermia, fluids, and possibly other resusctation related factors
31
Q

Primary objective of the early management of brain trauma

A

prevent or alleviate the secondary injury process that may follow any complication that d ecreases the oxygen supply to the brain, inlcuding:

  1. systemic hypotension
  2. hypoxemia
  3. anemia
  4. raised ICP
  5. acidosis
  6. possibly hyperglycemia >200 mg/dL
32
Q

Patients with GSC <8 have a 40% likelihood

A

of an intracranial hematoma

33
Q

most important therapeutic maneuvers in brain injury patients:

A

avoid hypotension, hypoxemia, anemia, raised ICP, acidosis, glucose

normalize:

  1. BP - MAP >80 mmHg
  2. PaO2 >95%
  3. ICP <20 to 25 mmHg
  4. CPP at 50-70 mmHg (MAP - ICP)
34
Q

preferred fluid for head trauma

A

NS > LR

  • LR is slightly hypotonic
35
Q

mannitol/hypertonic NS

A
  • mannitol - 0.25 - 0.5 g/kg over 30-60 minutes
  • hypertonic: 15%NS, 0.42ml/kg
36
Q

most damaging insult to brain:

A

hypotension/hypoxia

37
Q

brown-sequard syndrome

A
  • ipsilateral motor and contralateral sensory defecit below the injury
38
Q

tx for pericardial tamponade

A
  1. must maintain preload
  2. must maintain contractility
  3. prefer to evacuate under local anesthesia
39
Q

s/sx of abdominal compartment syndrome

A
  1. tense, severely distended abdomen
  2. increased peak airway pressure
  3. CO2 retention
  4. oligura
  5. intra abdominal pressure >20-25 mmHg signals decrased perfusion and may require surgical decompresion
40
Q

25% of pelvic fractures

A
  • lead to major hemmorhage (major cause of mortality)
  • exsanguination occurs in 1% of all injuries
  • most cases, bleeding results from venous disruptions by fragments of bone
  • approx 18-20% of pts havebleeding that does not stop (needs embolization)
41
Q

R value =

A
  • reaction time, initial fibrin formation
  • rough approximateion of PT/aPTT/intrinsic clotting

problem here = coagulation factors, give FFP

42
Q

K time

A

K time

  • time taken to minimal sufficinet clot strenth
  • depends on fibrinogen
  • tx with Cryo (fibrinogen)
43
Q

alpha angle

A
  • slope between R and K
  • fibrin build up and cross linking takes place
  • depends mostly on fibrinogen level
  • if problem: cryo
44
Q

MA

A

maximum amplitude

  • represents the utlimate strength of the fibrin clot, overall stability of the clot. Depends on fibrinogen and plt function
  • if problem; plts and/or DDAVP
45
Q

Protein C inhibits

A
  • clotting factors V and VIII
  • contributes to coagulopathy
  • decreases the inhibition of TPA
46
Q

FDP >40mg/mL

A

Is suggestive of DIC

47
Q

cryoprecepitate contians

A
  1. factor 8
  2. fibrinogen (1)
  3. VWB
  4. fibronectin
  5. Factor 13

used primarily to replace fibrinogen

48
Q

effects of hypothermia

A
  • acidosis, hypotension, coagulopathy
  • cardiac depression and ischemia
  • arrthymias
  • peripheral vasoconstriction
  • impaired tissue oxygenation delivery
  • elevated oxygen consumption during rewarming
  • blunted responses to cathecholamines
  • increased blood viscosisty
  • elevated acidosis, electrolyte imbalances,
  • reduced drug clearance
  • infection
49
Q

occult hypoperfusion syndrome

A

common in post operative trauma patients, particularly young ones.

Syndrome is characterized by a normal BP maintained by systemic vasoconstriction; decreased intravascular volume and CO and organ ischemia

50
Q

kleihauer-Betke test

A

has fetal blood entered mom’s circulation?

If yes and Mom is Rh- carrying an Rh+ fetus, then give Rhogam.

Advanced Principles (8 decks)

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