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Advanced Principles III > Trauma and burns powerpoint highlights > Flashcards

Trauma and burns powerpoint highlights Flashcards

1
Q

Maxilifacial injuries are dynamic which may pose what challenges in ariway management?

A
  1. Airway oclusion as a result of a hematoma or edema of the face, tongue, or neck that may expand during the first several hours after injury.
  2. Serious airway compromise may develop within a few hours in up to 50% of patients with major penetrating facial injuries or multiple trauma, caused by progressive inflammation or edema resulting from liberal administration of fluids.
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2
Q

Liberal administration of fluids in patients with maxilofacial injuries may lead to?

A

Serious airway compromise may develop within a few hours in up to 50% of patients with major penetrating facial injuries or multiple trauma, caused by progressive inflammation or edema resulting from liberal administration of fluids.

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3
Q

Which maxilofacial injury patients should be trached or intubated as an intitial measure to avert airway compromise

A

Patients who have massive hemorrhage from:

  1. Internal maxillary artery or its branches
  2. Facial artery
  3. External carotid artery
  4. Sphenopalatine artery.
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4
Q

The typical clinical presentation of a patient with cervical airway injury includes?

A
  1. Hoarseness
  2. muffled voice
  3. dyspnea
  4. stridor
  5. dysphagia
  6. odynophagia
  7. cervical pain and tenderness
  8. ecchymosis
  9. subcutaneous emphysema
  10. flattening of the thyroid cartilage protuberance (Adam’s apple).
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5
Q

In patients with cervical airway injuries, an FOB intubation should be performed whenever posible or the airway should be surgicaly secured because?

A
  • Attempts at blind tracheal intubation may produce further trauma to the larynx and complete airway obstruction if the endotracheal tube enters a false passage or disrupts the continuity of an already tenuous airway.
  • The presence of cartilaginous fractures or mucosal abnormalities necessitates awake intubation with an FOB or awake tracheostomy.
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6
Q

Whereas penetrating trauma can cause damage to any segment of the intrathoracic airway blunt injury usually involves?

A

´the posterior membranous portion of the trachea and the main stem bronchi, usually within approximately 3 cm of the carina.

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7
Q

In a patient with thoracic airway injury ____may produce airway obstruction

A
  1. Anesthetics
  2. Atempts at awake intubation
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8
Q

Anesthetics, and especially muscle relaxants, may produce irreversible obstruction in a patient with thoracic airway injury, presumably because of?

A

relaxation of peritracheal or peribronchial structures that maintain airway patency in the awake patient.

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9
Q

In a patient with thoracic aiway injuries, attempts at awake intubation may lead to airway loss due to

A
  1. Further distortion of the airway by the endotracheal tube
  2. Patient agitation
  3. Rebleeding into the airway.
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10
Q

Of the several causes that may alter respiration after trauma_______, _________and _____________ are immediate threats to the patient’s life and therefore require rapid diagnosis and treatment

A
  1. Tension pneumothorax
  2. Flail chest
  3. Open pneumothorax
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11
Q

These causes of breathing abnormalities can interfere with gas exchange and deteroriate into life threatening complications.

A
  1. Hemothorax
  2. closed pneumothorax
  3. pulmonary contusion
  4. diaphragmatic rupture with herniation of abdominal contents into the thorax
  5. atelectasis from a mucous plug, aspiration, or chest wall splinting
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12
Q

What are the classic signs of tension pneumothorax?

A
  1. Cyanosis
  2. tachypnea
  3. hypotension
  4. neck vein distention
  5. tracheal deviation
  6. diminished breath sounds on the affected side
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13
Q

Of the classic signs of tension pneumothorax, ____________ may be absent in hypovolemic patients and ____________ may be difficult to appreciate.

A
  1. Neck vein distention
  2. Tracheal deviation may be difficult to appreciate
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14
Q

__________ is ussualy diagnostic of tension pneumothorax in the supine position

A

The deep salcus sign which results from the tendency of pleural air to track in the lateral and caudal regions

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15
Q

__________ is the definitive diagnosis of tension pneumothorax.

A

CT scanning

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16
Q

In hypoxemic and hypotensive patients with a tension pneumothorax, there is no time for radiologic confirmation in this setting. What intervention should performed.

A

Immediate insertion of a 14-gauge angiocatheter through the fourth or fifth intercostal space in the midaxillary line or, at times, through the second intercostal space at the midclavicular line is essential.

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17
Q

In a patient with a flail chest _________________ is the main cause of respiratory insufficiency or failure and resulting hypoxemia.

A

An underlying pulmonary contusion with increased elastic recoil of the lung and increased work of breathing

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18
Q

A flail chest results from?

A

fractures at two or more sites of at least three adjacent ribs, or rib fractures associated with costochondral separation or sternal fracture.

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19
Q

´Overzealous infusion of fluids and transfusion of blood products may result in deterioration of oxygenation by?

A

worsening the underlying pulmonary injury.

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20
Q

Unless the clinical evidence suggests imminent cerebral herniation, hyperventilation must be avoided in head-injured patients because?

A

It increases cerebral vasoconstriction, thus decreasing perfusion, with accumulation of cerebral lactic acid immediately after its institution.

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21
Q

What are the indications of tracheal intubation in a trauma patient with breathing abnormalities

A

Severe pulmonary contusion

Respiratory insufficiency or failure despite adequate analgesia

Clinical evidence of severe shock

Associated severe head injury or injury requiring surgery

Airway obstruction

Significant pre-existing chronic pulmonary disease

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22
Q

In hypovolemic patients, _________ may interfere with venous return and cardiac output, leading to hypotension, further decrease in organ perfusion, and even cardiac arrest.

A

hyperventilation

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23
Q

What appears to be the best pattern of ventilation to prevent hemodynamic deterioration and decrease the likelihood of ARDS.

A

Ventilation with low tidal volumes (6 to 8 mL/kg) and moderate positive end-expiratory pressure (PEEP), producing low inspiratory alveolar or plateau pressures.

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24
Q

patients require ____________ and ____________ before airway manipulation.

A

deep anesthesia

profound muscle relaxation

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25
Q

Preferred anesthetic sequence in head and eye injury patients not hemodynamically compromised includes

A

preoxygenation and opioid loading followed by large doses of intravenous anesthetic and muscle relaxant

26
Q

_________________ may occur whether cerebral autoregulation is present or absent in patients with head injuries

A
  1. Systemic hypotension
  2. ICP elevation
  3. Decreased CPP
27
Q

C spine clearance via nexus

A

No posterior midline neck tenderness and focal neurologic deficit, in an injured patient with a normal level of alertness, and no evidence of intoxication, and painful distracting injury indicates a low probability of a C-spine injury.

28
Q

CT is recomended in combination with NEXUS. Probably the reason for the lower reliability of the NEXUS criteria is

A

the difficulty of evaluating distracting injuries.

29
Q

Which one is more reliable in C-spine clearance between nexia and canadian C-spine rule

A

Canadian rule is more reliable than NEXUS in diagnosing C-spine injury

30
Q

proper answers to the following three questions eliminate the possibility of injury and the need for radiographic studies in canadian C-spine rule:

A

Is there any high-risk factor mandating radiography?

Are there low-risk factors that permit safe evaluation of the range of motion of the neck?

Can the patient rotate the neck laterally for 45 degrees in each direction without pain?

31
Q

Almost all airway maneuvers, including jaw thrust, chin lift, head tilt, and airway placement, result in some degree of?

A

C-spine movement.

32
Q

´To secure the airway with direct laryngoscopy, of the neck is the standard of care for patients in the acute phase.

A

manual inline stabilization (MILS)

33
Q

____________ is the most common cause of traumatic hypotension and shock and is, after head injury, the second most common cause of mortality after trauma.

A

Hemorrhage

34
Q

The purpose of damage control resuscitation is to prevent ____________ attributed to administration of large volumes of resuscitative crystalloids.

A
  1. pulmonary edema
  2. ARDS
  3. coagulopathy
  4. multiple organ failure (MOF) and
  5. Abdominal compartment syndrome
35
Q

The concept of damage control resuscitation has replaced

A

the classic crystalloid resuscitation

36
Q

According to damage control resuscitation the severity of hemorrhage is estimated using?

A

the combination of clinical, laboratory, ultrasonographic, and radiologic diagnostic measures

37
Q

Features of damage controll rescusitation

A
  1. Permissive hypotension;
  2. Rapid control of any bleeding source;
  3. minimal crystalloid infusion;
  4. 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
  5. tranexamic acid
38
Q

In the hemorhaging patinet_________ is deferred until after normalization of the patient’s physiologic condition.

A

Definitive surgery

39
Q

_________ and blood ___________ are the most useful and practical tools during all phases of shock, including the earliest

A
  1. the base deficit
  2. lactate level
40
Q

The base deficit reflects____________ with reasonable accuracy in previously healthy adult and pediatric trauma patients.

A
  1. the severity of shock,
  2. the oxygen debt,
  3. changes in O2 delivery,
  4. the adequacy of fluid resuscitation, and
  5. the likelihood of MOF (multi organ failure) and survival
41
Q

Elevation of the blood lactate level is less specific than base deficit as a marker of tissue hypoxia because it can be generated in well-oxygenated tissues by?

A
  1. epinephrine-induced skeletal muscle glycolysis,
  2. accelerated pyruvate oxidation,
  3. decreased hepatic clearance of lactate, and
  4. early mitochondrial dysfunction.
42
Q

In most trauma victims an elevated lactate level correlates with other signs of hypoperfusion, rendering it an important marker of?

A

dysoxia (abnormal tissue oxygen utilization) and an end point of resuscitation.

43
Q

Normal lactate is?

A

0.5-1.5

44
Q

Lactate levels above _____ indicate significant lactic acidosis

A

5

45
Q

Most trauma patients are ________ when admitted to the ED and do not develop coagulopathy when administration of hemostatic agents is delayed.

A

hypercoagulable

46
Q

In pediatric patients currently the actual trigger for activating the MTP is ___________

A

a high injury severity score.

47
Q

Although intracranial bleeding, if not accompanied by another injury, is not likely to cause hypotension in adults, it can cause significant hypotension in _________

A

the pediatric age group.

48
Q

One of the principal goals during early management of the hemorrhaging trauma victim is to avoid the development of the so-called vicious cycle or lethal triad of?

A

acidosis, hypothermia, and dilutional coagulopathy.

49
Q

the success rate of external cardiac massage in hypovolemic trauma victims is ________

A

likely to be low

50
Q

The primary objective of the early management of brain trauma is?

A

to prevent or alleviate the secondary injury process

51
Q

These insults cause exacerbation of trauma-induced cerebral ischemia and metabolic derangements, worsening the outcome.

A
  1. systemic hypotension,
  2. hypoxemia,
  3. anemia,
  4. raised ICP,
  5. acidosis, and possibly
  6. hyperglycemia (serum glucose >200 mg/dL).
52
Q

The most important therapeutic maneuvers in brain trauma patients are aimed at

A

normalizing ICP, CPP, and oxygen delivery

53
Q

current recommendations are to maintain glucose levels of?

A

110 to 180 mg/dL

54
Q

Nearly 75% of severely brain-injured patients who die expire within?

A

the first 3 days following the initial trauma.

55
Q

Can inhalation induction be used in trauma?

A

No study to compare, preserving vital signs is more important than specific means employed to accomplish this.

56
Q

Spinal shock is manifested by?

A
  1. Absolute flacidity
  2. Loss of reflexes
  3. probably caused by direct trauma to the spinal cord
  4. Usually subsides within days to weeks
57
Q

Neurogenic shock is

A
  1. Its defined as hypotension and bradycardia caused by the loss of vasomotor tone and sympathetic innervation of the heat as a result of functional depression of the descending sympathetic pathways of the spinal cord.
  2. ´It is usually present after high thoracic and cervical spine injuries and
  3. improves within 3 to 5 days.
58
Q

The spinal cord, a microcosm of the brain, is also vulnerable to a secondary injury process that may be a product of?

A

hypotension, hypoxia, and probably other physiologic complications.

59
Q

Injuries at __________ are usually associated with normal tidal volumes because the function of the diaphragm is intact, whereas patients with injuries _______________ may require permanent ventilatory assistance.

A

C5 or lower

at C4 or above

60
Q

____________ is central to management.

A

Effective pain relief, preferably with continuous thoracic epidural anesthesia or paravertebral or intercostal block,

61
Q

Tension pneumothorax involving over 50% of a hemithorax presents with ?

A
  1. dyspnea,
  2. tachycardia,
  3. cyanosis,
  4. agitation,
  5. diaphoresis,
  6. neck vein distention,
  7. tracheal deviation, and
  8. displacement of the maximal cardiac impulse to the contralateral side.
62
Q

The classic findings of pericardial tamponade—tachycardia, hypotension, distant heart sounds, distended neck veins, pulsus paradoxus, or pulsus alternans—are difficult to appreciate or may be absent in a hypovolemic trauma patient.

A

Advanced Principles III (11 decks)

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