Trauma Flashcards
Respiratory cause of ICP in trauma
Elevated CO2 → vasodilation of carotid a
Cushings triad
HTN, bradycardia, irregular/low respirations
Treat traumatic ICP
- Immediate surgery
- Elevate head of bed to 30
- Hypertonic saline (250 ml over 10 minutes)
- Mannitol
Signs to indicate emergent thoracotomy
- Initial output 1-1.5L
- 150-200mL/hr for 2-4 hours
- Failure to evacuate hematoma
- Persistant hemodynamic instability
Best dx of diaphragmatic injury
Direct visualization (endoscopy)
Goals of adequate resuscitation
> .5 mL/kg/H urine output
CVP 8-12 mm Hg
MAP 65-90
ScvO2 >70%
MTP
Usually initiated if >10 units needed/after 10 units given
1:1:1
PRBC, FFP and platelets
Blood transfusion in peds
10 mL/kg PRBC
Pain control in peds
fentanyl 1 μg/kg
morphine 0.05-0.1 mg/kg
Describe needle decompression
14G, 4.5cm over the needle catheter into 2nd intercostal space at midclavicular line
Size of tube for tube thoracostomy
24-28 F
Assume what in trauma patient with subq emphysema
pneumothorax
US finding in pneumothroax
Loss of sliding pleura
Area at risk for diaphragm injury in penetrating trauma
Nipple to umbilicus
Most common injured portion of heart in trauma
Rt ventricle
Commotio cordis
Vfib with no myocardial injury usually due to direct trauma to chest
Most common site of blunt aortic injury
Proximal descending between left subclavian and ligaments arteriosum
Treat HTN in traumatic arotic injury
Narcotics
Esmolol titrated to 100-120 mm Hg, HR 60
Add Na nitroprusside if bradycardia w/ a BB for reflex tachycardia
Lowest space for thoracentesis
Between 8 and 9th ribs
Preferred approach: posterior at midscapular line
Trauma lethal triad
Hypothermia, coagulopathy, metabolic acidosis
Prophylax open fractures
- <10 cm: cefazolin (1st gen cefa)
- extensive soft tissue injury, exposed bone, vascular injury: cefaolin + gent
Tube thoracostomy placement in 3rd trimester
Never below 4th intercostal space
Chance fx
Seatbelt fx: high impact flexion
All three columns
Associated with small bowel or pancreatic injury
Meds that can go in an ET
Lidocaine Atropine Naloxone Epi \+vasopressin for adults
