Trauma and Perioperative Care

Question 1

Patients who need permissive hypotension in trauma

Answer 1

Penetrating torso injuries

Question 2

Trial and resuscitation that showed decreased mortality in patients with permissive hypotension and delayed volume resuscitation in penetrating trauma patients

Answer 2

Damage control resuscitation (NEJM 1994)

Question 3

Goal systolic pressure in patients with traumatic hemorrhagic shock WITHOUT traumatic brain injury

Answer 3

80-90

Question 4

Goal systolic pressure in patients with traumatic hemorrhagic shock WITH traumatic brain injury

Answer 4

> 120

Question 5

Study that showed 1:1:1 massive transfusion protocol had lower mortality and better hemostasis than 2:1:1

Answer 5

PROPRR (JAMA 2015)

Question 6

Number of blood products in a 1:1:1 transfusion protocol

Answer 6

6 units PRBC

6 units plasma

1 unit platelets (6 pooled donor)

Question 7

Should TXA be used in severely injured trauma patients to control bleeding in massive traumatic hemorrhage

Answer 7

Yes

Question 8

Drug used to reverse coumadin in trauma patients

Answer 8

4 factor prothrombin complex

Question 9

Treatment of an intra-parenchymal chest tube

Answer 9

place a functioning chest tube prior to removal of the parenchymal first

Question 10

Treatment of an intra-fissural chest tube

Answer 10

reposition

Question 11

Most common cause of fever in the first 24-48hours post op

Answer 11

Surgical wound inflammation (goes away on its own)

Question 12

Most common causes of fever 2-7 days post op

Answer 12

Sepsis/infection, VTE

Question 13

Most common causes of fever > 1 week post op

Answer 13

Line infections, VAP

Question 14

Type of surgery that should be ventilated like ARDS patients

Answer 14

Abdominal surgery patients

Question 15

BP goal in patients undergoing abdominal surgery

Answer 15

Levo to keep BP within 10% of the pre-op BP

Question 16

In abdominal surgery patients who develop respiratory failure after extubation post-op, what treatment reduces risk of reintubation?

Answer 16

BIPAP

Question 17

6 enhanced recovery after surgery (ERAS) protocols

Answer 17

1. Oral intake of liquids same day of surgery
2. Enteral nutrition on post-op day #1 or sooner
3. Remove NG tube immediately post-op
4. Remove urinary catheter post-op day #1 or sooner
5. Mobilization same day of surgery
6. Opioid-sparing pain control measures

Question 18

Grade 1 abdominal compartment syndrome pressure range and treatment

Answer 18

Pressure 12-15

sedate, diurese, loosen abdominal closure device

Question 19

Grade 2 abdominal compartment syndrome pressure range and treatment

Answer 19

Pressure 16-20

Sedate, diurese, loosen abdominal closure device

Question 20

Grade 3 abdominal compartment syndrome pressure range and treatment

Answer 20

Pressure 21-25

Paralyze, loosen abdominal closure device, decompressive laparotomy

Question 21

Grade 4 abdominal compartment syndrome pressure range and treatment

Answer 21

Pressure > 25

Decompressive laparotomy

Question 22

Cause of hyperammonemia in a lung transplant patient

Answer 22

Infection with urease producing bacteria (mycoplasma, ureaplasma, parvum)

Treat with levofloxacin and doxycycline