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ANES 477 Clinical Decisions > Trauma and Burn Patients > Flashcards

Trauma and Burn Patients Flashcards

1
Q

The initial trauma survey consists of “A, B, C, D, E.” What do these letters stand for?

A

A - airways, B - breathing, C - circulation, D - disability, E - exposure

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2
Q

What are the five criteria that increase the likelihood of c-spine instability? (if any of these are met, c-spine injury should be assumed in trauma)

A

neck pain, severe distracting pain, neurological signs or symptoms, intoxication, loss of consciousness at scene

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3
Q

Which is better in c-spine instability patients - jaw thrust or chin lift?

A

jaw thrust

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4
Q

What practice should be followed during laryngoscopy of c-spine injury patients?

A

manual inline stabilization

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5
Q

What is the worst case scenario when nasally intubating a patient with midface or basillar skull fractures?

A

ETT entering the brain!

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6
Q

What are basic signs of inadequate circulation?

A

tachycardia, weak pulse, HoTN, pale/cold extremities

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7
Q

Bleeding from chest trauma is usually a result of rupture of what arteries? how can it be fixed?

A

intercostal arteries; chest tubes

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8
Q

What is tamponade? (not cardiac tamponade) In which area of the body does this usually occur by itself?

A

closure or blockage (as of a wound or body cavity) as if by a tampon especially to stop bleeding; the abdomin

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9
Q

What is the most common cause of shock in trauma?

A

hypovolemia

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10
Q

Hypovolemia corresponds with wide or narrow pulse pressure?

A

narrow

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11
Q

What are the best vasopressors to deal with sever HoTN?

A

NE and vasopressin

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12
Q

Why can giving NS lead to hypercholermic acidosis?

A

Cl- and HCO3 compete for reabsorption at proximal tubule. Additional Cl- means less HCO3 will be reabsorbed.

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13
Q

What is a Belmont?

A

a device that allows rapid fluid administration

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14
Q

What is a FAST scan? what is it used for?

A

Focused Assessment with Sonography for Testing; used to identify intraperitoneal hemorrhage or pericardial tamponade

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15
Q

What are the four most common areas where fluids will build up after a traumatic injury?

A

perihepatic, persplenic, pelvis, pericardium

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16
Q

What does the secondary survey consist of?

A

studies (labs, CXR, CT scan, FAST scan etc.), further evaluation for c-spine injury

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17
Q

What does the tertiary survey consist of?

A

evaluation and listing all injuries

18
Q

Which anticholinergic can cause amnesia?

A

scopolamine

19
Q

What are signs of basilar skull fractures?

A

bruising of eyelids or mastoid, CSF rhinorrhea

20
Q

What is Cushing’s triad (Cushing’s reflex)? what is it a sign of?

A

HTN, tachycardia, irregular respiration; response to increased ICP often due to traumatic head injury and often results in brain herniation

21
Q

Restlessness, convulsions, and non-reactive pupils are signs of what?

A

brain damage

22
Q

Injury to which vertebrae may cause apnea? why?

A

C3-6; this is where the L & R phrenic nerves originate and they control diaphram and receive information from it

23
Q

Injury to what vertebrae are associated with bradycardia? why?

A

T1-T4; this is where cardiac accelerator fibers are located

24
Q

What are symptoms of spinal shock?

A

HoTN, bradycardia, areflexia, GI atony

25
Q

What is spinal shock? what is it the result of?

A

lost sympathetic tone in the capacitance and resistance vessels; high spinal cord injury

26
Q

Where should a chest tube be placed for PTX?

A

between the 4th and 5th intercostal

27
Q

What is Beck’s triad? what comprises it?

A

signs of cardia tamponade; distended neck veins, HoTN, muffled heart sounds

28
Q

What is pulsus paradoxus?

A

a large decrease in systolic BP during inspiration (normal is 10mmHg)

29
Q

What are some causes of pulsus paradoxus?

A

cardiac tamponade, pericarditis, obstructive lung disease

30
Q

What is pericardiocentesis?

A

procedure where fluid is aspirated from the pericardium

31
Q

What is the pathophysiology of cardiac tamponade?

A

Fluid accumulates in the pericardium and less and less blood enters the ventricles. As the increasing pressure presses on the heart, the septum bends into the left ventricle, leading to decreased stroke volume.

32
Q

What are causes of ARDS?

A

sepsis, thoracic injury, aspiration, head injury, fat embolism, massive transfusion, oxygen toxicity

33
Q

What organ is most often injured in penetrating abdominal injuries?

A

the liver

34
Q

What is compartment syndrome?

A

An increase in the fascial pressure, resulting in decreased arterial pressure to an extremity.

35
Q

What is a visual manifestation of compartment syndrome?

A

swelling

36
Q

What is the treatment for compartment syndrome?

A

fasciotomy (opening tissue to allow expansion and relieve pressure on arteries)

37
Q

What part of the skin does a first degree burn affect? second degree? third degree?

A

first - epidermis; second - dermis; third - subcutaneous

38
Q

List the body parts regarding the “rule of nines.”

A

head 9%, back 18%, chest/abdomen 18%, each arm 9%, each leg 18%, dick 1%

39
Q

Carbon monoxide causes what shift in the OxyHb dissociation curve?

A

left

40
Q

What is a hyperbaric chamber?

A

a tube-like vessel that one can be in that is at higher than atmospheric pressure and contains 100% O2

41
Q

How much crystalloid do you give a burn patient? why?

A

2-4cc/kg per % BSA burned; because fluid shifts from vasculature to interstitium after burns (esp w/in first 24 hrs)

42
Q

Why is hyperkalemia observed in burn patients? hypokalemia?

A

hyperkalemia due to tissue destruction; hypokalemia occurs later due to renal wasting

ANES 477 Clinical Decisions (8 decks)

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