Trauma and Burns Exam 1 Flashcards
Phases used to evaluate the trauma patient? (3)
rapid overview - stable, unstable, and dead or dying.
primary survey - airway, breathing, circulation, neurologic function, examination of undressed patient. (essential laboratory and radiologic examination)
secondary survey - detailed and systematic evaluation of injury to each anatomic region and resuscitation at any time, if necessary.
signs and symptoms of airway obstruction?
Signs of upper and lower airway obstruction include dyspnea, cyanosis, hoarseness, stridor, dysphonia, subcutaneous emphysema and hemoptysis
what symptoms may present FIRST when someone has airway obstruction?
Cervical deformity, edema, crepitation, tracheal tug and/or deviation, or jugular venous distention may be present first.
In a patient with eye obit injury who IS HEMODYNAMICALLY STABLE, preferred anesthetic sequence to achieve depth you want is?
preoxygenation and opioid loading followed by large doses of intravenous anesthetic and muscle relaxant
Why is ketamine advantageous for head and open eye injuries?
How could it be bad?
it maintains the systemic blood pressure and does not cause an appreciable increase in ICP and IOP.
By increasing systemic blood pressure it can, however, cause dislodgement of a hemostatic plug, initiating bleeding in vascular injuries.
Which C spine evaluation is more reliable in diagnosing C spine injury in a responsive patient?
Canadian rule
What are the high risk factors mandating radiography according to the Canadian C spine rule? (3)
age equal to or greater than 65
dangerous mechanism
paresthesia in extremities
What are the low risk factors allowing neck range of motion according to the Canadian C spine rule? (4)
simple rear end MVA
ability to sit or ambulate in ED
No immediate-onset neck pain
No midline C spine tenderness
What is the final evaluation to rule out C spine injury in the Canadian C spine rule?
able to rotate neck 45 degrees left to right?
If unable then need CT
The probable reason for the lower reliability of the NEXUS criteria?
difficulty of evaluating distracting injuries
What would rule a person out from having FOB awake sedated patient intubation performed?
full stomach
time constraints
uncooperative patient
If a person is in a rigid collar or neck stabilizing device, what complications can occur?
pressure ulceration, increased ICP, compromised central venous access.
Most common cause of traumatic hypotension and shock - and is, after head injury, the second most common cause of mortality after trauma?
Hemorrhage
Why might tachycardia not always present in the hypovolemic trauma patient?
(up to 30% of patients)
activated Bezold–Jarisch reflex,
increased vagal tone,
chronic cocaine use, or other reasons.
If a patient is hypovolemic and unable to elevate their heart rate in order to compensate for the blood/fluid lost, what does that indicate/show?
considered a predictor of increased mortality independent of severity of injury, systemic blood pressure, or presence of a head injury.
What age group is more likely to have normal blood pressure but have significant tissue hypo-perfusion.
age greater than 65 (elderly)
Assessment of Blood Consumption (ABC) score, which asks four yes/no questions are?
penetrating mechanism of injury
SBP of 90 mmHg or less
heart rate of 120/min or greater
and a positive FAST finding.
Shock index (SI), a value derived by WHAT CALCULATION appears to be another accurate indicator of early hemorrhagic shock and a predictor of mortality.
dividing the heart rate by the SBP
Transient or no blood pressure response to this maneuver suggested major hemorrhage and dictates administration of blood products, explain the maneuver?
Classic crystalloid resuscitation.
The response to initial fluid resuscitation with lactated Ringer’s (LR) or normal saline solution of about 2 L, or 20 mL/kg in children, over a period of 15 to 30 minutes allowed estimation of the severity of hemorrhage.
Explain damage control resuscitation?
brief permissive hypotension;
rapid control of any bleeding source;
minimal crystalloid infusion; early administration of plasma and other blood products in a balanced ratio (preferably 1:1:1) of packed red blood cells (PRBCs), plasma, and platelets by activation of the MTP;
and tranexamic acid.
If indicated, damage control surgery may be required to control bleeding and sources of contamination.
Definitive surgery is deferred until after normalization of the patient’s physiologic condition.
purpose of damage control resuscitation is?
prevent the pulmonary edema,
ARDS,
coagulopathy, multiple organ failure (MOF),
and abdominal compartment syndrome attributed to administration of large volumes of resuscitative crystalloids
Over infusing fluids before control of the hemorrhage may lead to further bleeding how?
increasing arterial and venous pressures,
displacing a hemostatic plug,
diluting clotting factors and platelets,
reducing body temperature,
and decreasing blood viscosity.
Markers for organ perfusion, you have base deficit and blood lactate levels, which one is a better indicator?
base deficit
The base deficit reflects the severity of shock, the oxygen debt, changes in O2 delivery, the adequacy of fluid resuscitation, and the likelihood of MOF (multi organ failure) and survival with reasonable accuracy in previously HEALTHY adult and pediatric trauma patients.
recommended target Hgb concentration in all phases of trauma management?
7-9 g/dL
What type of un-crossmatched blood can be available for patients with sever hemorrhage? (satisfactory in most situations)
O Rh- positive PRBCs and AB negative FFP
For children the term massive hemorrhage is relatively new and is considered if transfusion volume exceeds ?
40mL/kg
The 1:1:1 ratio that is often applied to adults translates to what ratio for children?
20 mL/kg of PRBCs, 20 mL/kg of FFP, and 10 mL/kg of platelets in children.
If a patient has sever injuries you should place venous access with large-bore cannulae where?
peripheral veins that drain both above and below the diaphragm is essential for adequate fluid resuscitation in the patient who is severely injured.
If a patient has isolated facial injuries do they require emergent tracheal intubation?
No, Surgery may be delayed for as long as a week with no adverse effect on the repair.
nasogastric or nasotracheal intubation should be avoided when what types of fractures are suspected?
why?
basilar skull or maxillary fractures
possibility of the tube entering the cranium or the orbit.
If you have an increase in Hct the first day after a burn what does that suggest?
inadequate fluid resuscitation because hemolysis and sequestration are actually expected to cause a decrease in this parameter.
What are the Hct % limits for burn victims before they need blood replacement?
Blood replacement is usually not initiated until the Hct is decreased to 20% to 24% in healthy patients requiring limited operations.
approximately 25% in those who are healthy but need extensive procedures
30% or more when there is a history of pre-existing cardiovascular disease
thermal trauma caused by flames in a closed space is likely to be associated with?
airway damage
The presence of a lung injury markedly increases the fluid requirements and the mortality rate from thermal injuries, what is the increase % of fluid?
30-50%
If a patient is moderately to severely burned what decides if you apply 02 by face mask or immediate tracheal intubation?
02 by facemask at the highest possible concentration if they have a patent airway.
if the patient has stridor, respiratory distress, hypoxemia, hypercarbia, loss of consciousness, or altered mentation, immediate tracheal intubation is indicated.
