Trauma And Anesthesia (Jerry) Flashcards
What are the three areas with highest incidence of recall?
- cardiovascular
- OB: crash C sections
- Trauma: too unstable for anesthetics
T/F Ortho trauma is not an emergent trauma.
True
Emergent traumas are massive bleed, MI, GSW, TBI
What are the 5 criteria for potential cervical spine injury?
- ) neck pain
- ) severe distracting pain
- ) any neurological signs and symptoms
- ) intoxication
- ) loss of consciousness at the scene
To intubate a patient with a cervical spine injury the best way is _________ __________ _________.
Manual inline stabilization (MILS)
** make sure to chart it **
Is it best practice to use nitrous oxide during a trauma?
NO- best practice do not use
It accumulates in closed spaces—> avoid in patients with pneumothorax, pneumocephalus, or pneumoperitoneum
What does succinylcholine increase if administered 24 hours after a burn, spinal cord or crush injury?
Potassium levels
What happens to your body’s acid base balance after massive blood transfusion?
Metabolic alkalosis
If transfusion rate exceeds 1 unit/5 minutes you can see cardiac depression caused by ___________________.
Hypocalcemia- from calcium binding to citrate in donated blood
How are hemolytic blood reactions recognized in the anesthetized patient?
- increased temp
- tachycardia
- hypotension
- hemoglobinuria
- oozing at the field
What is the main thing we gained from the Vietnam war?
Helicopter evacuation (FFL)
What main problems does hypothermia cause?
- worsens acid-base balance
- coagulopathies- platelet sequestration and RBC deformities
- risking MI
What is a common cause of bleeding after massive transfusion?
DILUTIONAL THROMBOCYTOPENIA
Know this for boards
What is the half life of crystalloids? Colloids?
Crystalloids: 20-30 minutes
Colloids: 3-6 hours
____________ _____________ is less likely to cause hyperkalemic acidosis than is ___________ ___________.
Lactated ringers
Normal saline
What electrolyte in LR makes it less compatible with blood transfusions ?
Calcium - it binds with the citrate preservative in donated blood
Why are dextrose solutions contraindicated in trauma?
Dextrose may exacerbate ischemic brain damage
T/F
LR is slightly hypotonic and with large volumes can cause cerebral edema.
True
Which colloids can cause coagulopathy?
Dextran and hetastarch
Which type of blood can be administered without type and cross?
Type O negative
Which clotting factor can decrease 50% after 2 days in storage?
Factor VIII
How does hypovolemia affect anesthetics?
- IV anesthetics effects are exaggerated (smaller volume= greater drug effect)
- alveolar concentration is increased in shock pts—> IA concentration will be greater
Which induction agents are recommended for a hypovolemic trauma patient?
Ketamine and Etomidate
You notice your patient has hematuria. What types of injuries are you worried about?
Injury to kidneys or lower urinary tract
Cervical spine injury occurs in _____ of all trauma patients.
2%
T/F trauma patients are not at risk of aspiration.
False
Trauma patients are ALWAYS at risk of aspiration
What causes shock?
Circulatory failure leading to inadequate vital organ perfusion and oxygenation
What must be considered in any patient with altered consciousness?
Brain injury
What are clues that your patient may have a brain injury?
GCS
Restlessness
Convulsions
Cranial nerve dysfunction (non-reactive pupils)
What is Cushing’s Triad and what does it signify?
Hypertension
Bradycardia
Respiratory disturbances
—> late signs brain herniation has occurred
What anesthetic considerations are there for brain injury?
- No sedatives or analgesics d/t the need for frequent neuro exams
- avoid anticholinergic meds (Robinal, spiriva, atrovent) as they induce pupillary dilation
What is Beck’s triad and when is it seen?
- neck vein distention
- hypotension
- muffled heart tones
—> seen in cardiac tamponade - will also see pulsus paradoxus - 10mmHg drop in BP during spontaneous ventilation
You see distended neck veins in your patient and suspect pericardial tamponade. What is one drug you definitely DO NOT want to give?
Propofol- drops BP even more- can kill
If you see ectopy during a pericardialcentesis what has occurred?
The myocardium has been punctured - needle to far in myocardium
What is the main thing to prepare for in an exploratory laparotomy during abdominal trauma?
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
During abdominal trauma which organs are also likely to be involved?
- vascular
- hepatic
- splenic
- renal
- pelvis
- remember hyperkalemia with massive transfusions
Pelvic fractures lead to _________________ ________.
Hypovolemic shock
Very long surgical procedure also
How much blood loss can a femur fracture mean?
3 units of blood loss
What is a person at risk of with fractures?
Fat embolism
What labs will you expect to be abnormal with fat embolism?
- elevated serum lipase
- fat in urine
- thrombocytopenia
How is a spinal/regional block beneficial with extremity reattachment?
- increases blood flow (vasodilation)
Watch for hypotension
Why should you avoid shivering on emergence?
Helps with reperfusion
Know Laforte 1, 2 and 3 fractures.
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
How is intracranial hypertension controlled?
- fluid restrictions
- diuretics (mannitol)
- hypocapnia (PaCO2 26-30mmHg)
- treat hypertension or tachycardia with fentanyl or lidocaine
Which anesthetic agent increases ICP?
Ketamine
T/F
Mild hypothermia can assist saving brain tissue in a head injury.
True
A high cord injury causes _________ _________, which manifests as:
Spinal shock (loss of sympathetic tone)
- hypotension
- warm to the touch
- Bradycardia
- areflexia
- GI atony
C3,4,5 do what?
Keep the man alive- innervate the diaphragm- phrenic nerve
T1-T4????
Cardiac accelerators
What is autonomic hyperreflexia and how does it manifest?
- 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
Where do you needle decompress a tension pneumothorax?
At the 2nd intercostal space midclavicular line
With a 14 gauge needle
(Then get a chest tube)
How does a simple pneumo turn into a tension pneumo?
Positive pressure
Why do you put in a double lumen ETT with a hemothorax?
To isolate bleeding lung from healthy lung
What are the causes of ARDS?
Delayed lung response to trauma - sepsis - thoracic injury - aspiration - fat emboli - massive transfusion *** mortality is 50% *** Treat with high pressures, low volumes (PCV)
