Trauma and Perioperative Care Flashcards
Patients who need permissive hypotension in trauma
Penetrating torso injuries
Trial and resuscitation that showed decreased mortality in patients with permissive hypotension and delayed volume resuscitation in penetrating trauma patients
Damage control resuscitation (NEJM 1994)
Goal systolic pressure in patients with traumatic hemorrhagic shock WITHOUT traumatic brain injury
80-90
Goal systolic pressure in patients with traumatic hemorrhagic shock WITH traumatic brain injury
> 120
Study that showed 1:1:1 massive transfusion protocol had lower mortality and better hemostasis than 2:1:1
PROPRR (JAMA 2015)
Number of blood products in a 1:1:1 transfusion protocol
6 units PRBC
6 units plasma
1 unit platelets (6 pooled donor)
Should TXA be used in severely injured trauma patients to control bleeding in massive traumatic hemorrhage
Yes
Drug used to reverse coumadin in trauma patients
4 factor prothrombin complex
Treatment of an intra-parenchymal chest tube
place a functioning chest tube prior to removal of the parenchymal first
Treatment of an intra-fissural chest tube
reposition
Most common cause of fever in the first 24-48hours post op
Surgical wound inflammation (goes away on its own)
Most common causes of fever 2-7 days post op
Sepsis/infection, VTE
Most common causes of fever > 1 week post op
Line infections, VAP
Type of surgery that should be ventilated like ARDS patients
Abdominal surgery patients
BP goal in patients undergoing abdominal surgery
Levo to keep BP within 10% of the pre-op BP
In abdominal surgery patients who develop respiratory failure after extubation post-op, what treatment reduces risk of reintubation?
BIPAP
6 enhanced recovery after surgery (ERAS) protocols
- Oral intake of liquids same day of surgery
- Enteral nutrition on post-op day #1 or sooner
- Remove NG tube immediately post-op
- Remove urinary catheter post-op day #1 or sooner
- Mobilization same day of surgery
- Opioid-sparing pain control measures
Grade 1 abdominal compartment syndrome pressure range and treatment
Pressure 12-15
sedate, diurese, loosen abdominal closure device
Grade 2 abdominal compartment syndrome pressure range and treatment
Pressure 16-20
Sedate, diurese, loosen abdominal closure device
Grade 3 abdominal compartment syndrome pressure range and treatment
Pressure 21-25
Paralyze, loosen abdominal closure device, decompressive laparotomy
Grade 4 abdominal compartment syndrome pressure range and treatment
Pressure > 25
Decompressive laparotomy
Cause of hyperammonemia in a lung transplant patient
Infection with urease producing bacteria (mycoplasma, ureaplasma, parvum)
Treat with levofloxacin and doxycycline
