Trauma and Bariatric Patients

Question 1

What size IV catheter will you use to treat a tension pneumothorax? Where do you insert it? What do you insert after you decompress the pneumothorax?

Answer 1

14-16 gauge inserted into 2nd or 3rd intercostal space

Then do a chest tube

Question 2

Two possible treatments for flail chest:

Answer 2

NIV or mechanical ventilation

Question 3

For every liter of blood lost, give ___ liters of crystalloid fluids.

Answer 3

3

Question 4

A CT scan with ___ will increase ICP and should be avoided.

Answer 4

Contrast dye

Question 5

What’s the most common type of TBI?

What’s the pathophysiology?

Answer 5

Subdural hematoma

Results from tearing of veins between brain and venous sinuses.

Question 6

If a patient has a head CT and it shows a crescent shaped hyperdensity that follows the contour of the brain, that patient has a/an ___.

Answer 6

Subdural Hematoma

Question 7

This kind of injury is associated with a skull fracture.

Answer 7

Epidural Hematoma

Question 8

In TBI patients, ICP should be maintained no higher than ___.

Answer 8

20-26 mm Hg

Question 9

In TBI patients, the mean arterial pressure should be ___.

Answer 9

Greater than 90.

Question 10

In TBI patients, the cerebral perfusion pressure (CPP) should be ___.

Answer 10

Greater than 60.

Question 11

What’s the best treatment for an epidural hematoma?

Answer 11

Surgical evacuation

Question 12

What’s a normal ICP?

Answer 12

4-10

Question 13

What’s an important drug treatment for neurological shock?

When/how long should you give it?

Answer 13

Methylprednisolone within 8 hrs of injury for 23 hours

Question 14

This type of ventilation is contraindicated for spinal cord injury patients.

Answer 14

NIV

Question 15

In spinal cord injury patients, ___, ___ intubation is a good idea.

Answer 15

Early, elective

Question 16

BMI greater than ___ is obesity.

Answer 16

30

Question 17

Common problem for really heavy bariatric patients with pressure induced injuries.
Monitor this lab value:

Answer 17

Rhabdomyolysis

CPK

Question 18

When mechanically ventilating bariatric patients, you may have to increase ___ to offset chest weight.
When you do this, you have to monitor ___.

Answer 18

PEEP

Signs of decreased cardiac output (BP)

Question 19

Bariatric patients are often difficult to intubate. When you have a difficult to intubate patient, what should you do?

Answer 19

Obtain additional equipment (Glidescope)

Question 20

Mallampati scores of ___ are difficult to intubate.

Answer 20

3 or 4

Question 21

SCI patients may not be given this type of ventilation:

Answer 21

NIV