Trauma and Burn Patients Flashcards
The initial trauma survey consists of “A, B, C, D, E.” What do these letters stand for?
A - airways, B - breathing, C - circulation, D - disability, E - exposure
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)
neck pain, severe distracting pain, neurological signs or symptoms, intoxication, loss of consciousness at scene
Which is better in c-spine instability patients - jaw thrust or chin lift?
jaw thrust
What practice should be followed during laryngoscopy of c-spine injury patients?
manual inline stabilization
What is the worst case scenario when nasally intubating a patient with midface or basillar skull fractures?
ETT entering the brain!
What are basic signs of inadequate circulation?
tachycardia, weak pulse, HoTN, pale/cold extremities
Bleeding from chest trauma is usually a result of rupture of what arteries? how can it be fixed?
intercostal arteries; chest tubes
What is tamponade? (not cardiac tamponade) In which area of the body does this usually occur by itself?
closure or blockage (as of a wound or body cavity) as if by a tampon especially to stop bleeding; the abdomin
What is the most common cause of shock in trauma?
hypovolemia
Hypovolemia corresponds with wide or narrow pulse pressure?
narrow
What are the best vasopressors to deal with sever HoTN?
NE and vasopressin
Why can giving NS lead to hypercholermic acidosis?
Cl- and HCO3 compete for reabsorption at proximal tubule. Additional Cl- means less HCO3 will be reabsorbed.
What is a Belmont?
a device that allows rapid fluid administration
What is a FAST scan? what is it used for?
Focused Assessment with Sonography for Testing; used to identify intraperitoneal hemorrhage or pericardial tamponade
What are the four most common areas where fluids will build up after a traumatic injury?
perihepatic, persplenic, pelvis, pericardium
What does the secondary survey consist of?
studies (labs, CXR, CT scan, FAST scan etc.), further evaluation for c-spine injury
What does the tertiary survey consist of?
evaluation and listing all injuries
Which anticholinergic can cause amnesia?
scopolamine
What are signs of basilar skull fractures?
bruising of eyelids or mastoid, CSF rhinorrhea
What is Cushing’s triad (Cushing’s reflex)? what is it a sign of?
HTN, tachycardia, irregular respiration; response to increased ICP often due to traumatic head injury and often results in brain herniation
Restlessness, convulsions, and non-reactive pupils are signs of what?
brain damage
Injury to which vertebrae may cause apnea? why?
C3-6; this is where the L & R phrenic nerves originate and they control diaphram and receive information from it
Injury to what vertebrae are associated with bradycardia? why?
T1-T4; this is where cardiac accelerator fibers are located
What are symptoms of spinal shock?
HoTN, bradycardia, areflexia, GI atony
What is spinal shock? what is it the result of?
lost sympathetic tone in the capacitance and resistance vessels; high spinal cord injury
Where should a chest tube be placed for PTX?
between the 4th and 5th intercostal
What is Beck’s triad? what comprises it?
signs of cardia tamponade; distended neck veins, HoTN, muffled heart sounds
What is pulsus paradoxus?
a large decrease in systolic BP during inspiration (normal is 10mmHg)
What are some causes of pulsus paradoxus?
cardiac tamponade, pericarditis, obstructive lung disease
What is pericardiocentesis?
procedure where fluid is aspirated from the pericardium
What is the pathophysiology of cardiac tamponade?
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.
What are causes of ARDS?
sepsis, thoracic injury, aspiration, head injury, fat embolism, massive transfusion, oxygen toxicity
What organ is most often injured in penetrating abdominal injuries?
the liver
What is compartment syndrome?
An increase in the fascial pressure, resulting in decreased arterial pressure to an extremity.
What is a visual manifestation of compartment syndrome?
swelling
What is the treatment for compartment syndrome?
fasciotomy (opening tissue to allow expansion and relieve pressure on arteries)
What part of the skin does a first degree burn affect? second degree? third degree?
first - epidermis; second - dermis; third - subcutaneous
List the body parts regarding the “rule of nines.”
head 9%, back 18%, chest/abdomen 18%, each arm 9%, each leg 18%, dick 1%
Carbon monoxide causes what shift in the OxyHb dissociation curve?
left
What is a hyperbaric chamber?
a tube-like vessel that one can be in that is at higher than atmospheric pressure and contains 100% O2
How much crystalloid do you give a burn patient? why?
2-4cc/kg per % BSA burned; because fluid shifts from vasculature to interstitium after burns (esp w/in first 24 hrs)
Why is hyperkalemia observed in burn patients? hypokalemia?
hyperkalemia due to tissue destruction; hypokalemia occurs later due to renal wasting
