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My APA 2 > Trauma And Anesthesia (Jerry) > Flashcards

Trauma And Anesthesia (Jerry) Flashcards

1
Q

What are the three areas with highest incidence of recall?

A
  • cardiovascular
  • OB: crash C sections
  • Trauma: too unstable for anesthetics
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2
Q

T/F Ortho trauma is not an emergent trauma.

A

True

Emergent traumas are massive bleed, MI, GSW, TBI

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3
Q

What are the 5 criteria for potential cervical spine injury?

A
  1. ) neck pain
  2. ) severe distracting pain
  3. ) any neurological signs and symptoms
  4. ) intoxication
  5. ) loss of consciousness at the scene
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4
Q

To intubate a patient with a cervical spine injury the best way is _________ __________ _________.

A

Manual inline stabilization (MILS)

** make sure to chart it **

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5
Q

Is it best practice to use nitrous oxide during a trauma?

A

NO- best practice do not use

It accumulates in closed spaces—> avoid in patients with pneumothorax, pneumocephalus, or pneumoperitoneum

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6
Q

What does succinylcholine increase if administered 24 hours after a burn, spinal cord or crush injury?

A

Potassium levels

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7
Q

What happens to your body’s acid base balance after massive blood transfusion?

A

Metabolic alkalosis

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8
Q

If transfusion rate exceeds 1 unit/5 minutes you can see cardiac depression caused by ___________________.

A

Hypocalcemia- from calcium binding to citrate in donated blood

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9
Q

How are hemolytic blood reactions recognized in the anesthetized patient?

A
  • increased temp
  • tachycardia
  • hypotension
  • hemoglobinuria
  • oozing at the field
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10
Q

What is the main thing we gained from the Vietnam war?

A

Helicopter evacuation (FFL)

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11
Q

What main problems does hypothermia cause?

A
  • worsens acid-base balance
  • coagulopathies- platelet sequestration and RBC deformities
  • risking MI
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12
Q

What is a common cause of bleeding after massive transfusion?

A

DILUTIONAL THROMBOCYTOPENIA

Know this for boards

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13
Q

What is the half life of crystalloids? Colloids?

A

Crystalloids: 20-30 minutes

Colloids: 3-6 hours

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14
Q

____________ _____________ is less likely to cause hyperkalemic acidosis than is ___________ ___________.

A

Lactated ringers

Normal saline

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15
Q

What electrolyte in LR makes it less compatible with blood transfusions ?

A

Calcium - it binds with the citrate preservative in donated blood

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16
Q

Why are dextrose solutions contraindicated in trauma?

A

Dextrose may exacerbate ischemic brain damage

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17
Q

T/F

LR is slightly hypotonic and with large volumes can cause cerebral edema.

A

True

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18
Q

Which colloids can cause coagulopathy?

A

Dextran and hetastarch

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19
Q

Which type of blood can be administered without type and cross?

A

Type O negative

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20
Q

Which clotting factor can decrease 50% after 2 days in storage?

A

Factor VIII

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21
Q

How does hypovolemia affect anesthetics?

A
  • IV anesthetics effects are exaggerated (smaller volume= greater drug effect)
  • alveolar concentration is increased in shock pts—> IA concentration will be greater
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22
Q

Which induction agents are recommended for a hypovolemic trauma patient?

A

Ketamine and Etomidate

23
Q

You notice your patient has hematuria. What types of injuries are you worried about?

A

Injury to kidneys or lower urinary tract

24
Q

Cervical spine injury occurs in _____ of all trauma patients.

A

2%

25
Q

T/F trauma patients are not at risk of aspiration.

A

False

Trauma patients are ALWAYS at risk of aspiration

26
Q

What causes shock?

A

Circulatory failure leading to inadequate vital organ perfusion and oxygenation

27
Q

What must be considered in any patient with altered consciousness?

A

Brain injury

28
Q

What are clues that your patient may have a brain injury?

A

GCS
Restlessness
Convulsions
Cranial nerve dysfunction (non-reactive pupils)

29
Q

What is Cushing’s Triad and what does it signify?

A

Hypertension
Bradycardia
Respiratory disturbances
—> late signs brain herniation has occurred

30
Q

What anesthetic considerations are there for brain injury?

A
  • No sedatives or analgesics d/t the need for frequent neuro exams
  • avoid anticholinergic meds (Robinal, spiriva, atrovent) as they induce pupillary dilation
31
Q

What is Beck’s triad and when is it seen?

A
  • neck vein distention
  • hypotension
  • muffled heart tones
    —> seen in cardiac tamponade
  • will also see pulsus paradoxus - 10mmHg drop in BP during spontaneous ventilation
32
Q

You see distended neck veins in your patient and suspect pericardial tamponade. What is one drug you definitely DO NOT want to give?

A

Propofol- drops BP even more- can kill

33
Q

If you see ectopy during a pericardialcentesis what has occurred?

A

The myocardium has been punctured - needle to far in myocardium

34
Q

What is the main thing to prepare for in an exploratory laparotomy during abdominal trauma?

A

HYPOTENSION
A closed abdomen causes its own tamponade—> open it up an now everything has a place to go—> massive blood loss
- can preload with IVF bolus, especially if already hypotensive
- have large bore IVs and blood ready

35
Q

During abdominal trauma which organs are also likely to be involved?

A
  • vascular
  • hepatic
  • splenic
  • renal
  • pelvis
    • remember hyperkalemia with massive transfusions
36
Q

Pelvic fractures lead to _________________ ________.

A

Hypovolemic shock

Very long surgical procedure also

37
Q

How much blood loss can a femur fracture mean?

A

3 units of blood loss

38
Q

What is a person at risk of with fractures?

A

Fat embolism

39
Q

What labs will you expect to be abnormal with fat embolism?

A
  • elevated serum lipase
  • fat in urine
  • thrombocytopenia
40
Q

How is a spinal/regional block beneficial with extremity reattachment?

A
  • increases blood flow (vasodilation)

Watch for hypotension

41
Q

Why should you avoid shivering on emergence?

A

Helps with reperfusion

42
Q

Know Laforte 1, 2 and 3 fractures.

A

Laforte I: involves upper lip
Laforte II: across bridge of nose and bilateral cheeks
Laforte III: across top of face through both eyes and through bridge of nose—> can intubate the brain if laceration in the soft palate

43
Q

How is intracranial hypertension controlled?

A
  • fluid restrictions
  • diuretics (mannitol)
  • hypocapnia (PaCO2 26-30mmHg)
  • treat hypertension or tachycardia with fentanyl or lidocaine
44
Q

Which anesthetic agent increases ICP?

A

Ketamine

45
Q

T/F

Mild hypothermia can assist saving brain tissue in a head injury.

A

True

46
Q

A high cord injury causes _________ _________, which manifests as:

A

Spinal shock (loss of sympathetic tone)

  • hypotension
  • warm to the touch
  • Bradycardia
  • areflexia
  • GI atony
47
Q

C3,4,5 do what?

A

Keep the man alive- innervate the diaphragm- phrenic nerve

48
Q

T1-T4????

A

Cardiac accelerators

49
Q

What is autonomic hyperreflexia and how does it manifest?

A
  • a reaction of the autonomic (involuntary) nervous system to overstimulation—> seen in a patient with paralysis (not drug induced) during incision or similar noxious stimuli
  • not associated in the first 48 hours
    S/S
  • high blood pressure
  • change in HR
  • skin color changes (pale, red, blue/gray)
  • ## excessive sweating
50
Q

Where do you needle decompress a tension pneumothorax?

A

At the 2nd intercostal space midclavicular line
With a 14 gauge needle
(Then get a chest tube)

51
Q

How does a simple pneumo turn into a tension pneumo?

A

Positive pressure

52
Q

Why do you put in a double lumen ETT with a hemothorax?

A

To isolate bleeding lung from healthy lung

53
Q

What are the causes of ARDS?

A 
Delayed lung response to trauma
- sepsis
- thoracic injury
- aspiration
- fat emboli
- massive transfusion
*** mortality is 50% ***
Treat with high pressures, low volumes (PCV)

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