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trauma anes, burns Flashcards

0
Q

T/F: avoid ventilation between administration of medication and intubation

A

True

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1
Q

Indication for endo tracheal intubation

A 
CRAFTeDD
Cardiac or respiratory arrest
Respiratory insuff
Airway protection
Facilitation for diagnostic work up (uncoop, intoxicated)
Transient hyperventilation (increase ICP)
Deep sedation or analgesia
Delivery of 100% O2 (CO poisoning)
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2
Q

T/f: administer particulate antacid prior to induction

A

False. Nonparticulate

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3
Q

Maneuver to be applied during airway management

A

Cricoid pressure or sellick maneuver

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4
Q

T/f: do mri of cervical spine if have neck pain or have cervical tenderness to palpations

A

True

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5
Q

High risk factors mandating c-spine radiography

A

> 65y/o
Dangerous mechanism
Paresthesia on extremities

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6
Q

Low risk factors allowing neck range of motion

A

Simple rear-end MVA
No immediate neck pain
No midline c-spine tenderness
Ability to sit or ambulate in ER

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7
Q

Unable to rotate neck (how many degrees) left and right for c-spine radiography

A

45 degrees

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8
Q

T/f: direct laryngoscopy cause cervical motion and the potential to exacerbate sc injury

A

True

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9
Q

Uncleared cervical spine mandates..

A

In-line stabilization (no traction)

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10
Q

T or F: the front of cervical collar cannot be removed for greater mouth opening and jaw displacement

A

False. Can be removed.

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11
Q

Minutes of hypoxia before permanent brain injury and death

A

5-10 min hypoxia

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12
Q

Airway/breathing, which is the most immediate threat to life?

A

Hypoxia

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13
Q

Protection of cervical spine.

T or F: Emergency awake fiber optic intubation requires less manipulation of the neck

A

True

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14
Q

Emergency awake fiber optic intubation is generally difficult becoz…

A

Hemorrhage
Airway secretions
Rapid desaturation
Lack of PTS coop

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15
Q

Propofol/ etomidate/ ketamine/ midazolam/ scopolamine/ ms relaxant alone:
Vasodilator
(-) inotropic effect

A

Propofol

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16
Q

Propofol/ etomidate/ ketamine/ midazolam/ scopolamine/ ms relaxant alone:
Potentiate hypotension or cardiac arrest

A

Propofol

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17
Q

Propofol/ etomidate/ ketamine/ midazolam/ scopolamine/ ms relaxant alone:
Increased cvs stability

A

Etomidate

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18
Q

Propofol/ etomidate/ ketamine/ midazolam/ scopolamine/ ms relaxant alone:
Direct myocardial depressant

A

Ketamine

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19
Q

Propofol/ etomidate/ ketamine/ midazolam/ scopolamine/ ms relaxant alone:
Catecholamine release

A

Ketamine

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20
Q

Propofol/ etomidate/ ketamine/ midazolam/ scopolamine/ ms relaxant alone:
Hypertension or tachycardia

A

Ketamine

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21
Q

Propofol/ etomidate/ ketamine/ midazolam/ scopolamine/ ms relaxant alone:
Reduced awareness

A

Midazolam

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22
Q

Propofol/ etomidate/ ketamine/ midazolam/ scopolamine/ ms relaxant alone:
Hypotension

A

Propofol

Midazolam

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23
Q

Propofol/ etomidate/ ketamine/ midazolam/ scopolamine/ ms relaxant alone:
Inhibits memory formation

A

Scopolamine

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24
Q

Propofol/ etomidate/ ketamine/ midazolam/ scopolamine/ ms relaxant alone:
Recall of intubation / recall of emergency procedures

A

Ms relaxant alone

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25
Q

Neuromuscular blocking drug

A

Succinylcholine

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26
Q

Onset of action of succinylcholine

A

Fastest onset

<1 min

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27
Q

Duration of succinylcholine

A

Shortest duration

5-10min

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28
Q

What are increased in succinylcholine?

A

Increase potassium level (0.5-1mEq/L) (5mEq/L after 24hr)
Increased IOP
Increased ICP

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29
Q

Consequence of hemorrhage

A

Shock

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30
Q

T or F: cancel airway management when difficulty arise

A

False. It is not an option.

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31
Q

When difficult arise in intubation, do…

A

Awake intubation

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32
Q

Of unsuccessful ventilation after gen anes

A

Standard: awake is always an option
Trauma: seldom an option

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33
Q

If surgical airway decision

A

Standard: only if awake intubation failed/ failed ventilation
Trauma: first and best choice

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34
Q

If management of recognized diff airway

A

Standard: awake ventilation
Trauma: only if uncoop, stable and spont. ventilating

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35
Q

If failed awake ventilation

A

Standard: cancel is an option
Trauma: requires gen anes with or without spont. ventilation

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36
Q

T or F: due to urgency, there is NO time for pharma to decrease gastric volume and acidity

A

True

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37
Q

MRI of cspine can not be done in (hours)

A

First 24 hrs

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38
Q

MRI Cspine contraindication

A

Metallic skeletal fixators

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39
Q

T or F: airway maneuver can cause Cspine movement

A

True

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40
Q

T or F: pressure in tongue during airway manipulation affects Cspine.

A

True. Indirectly

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41
Q

Standard care for Cspine injury

A

MILS, manual in-line immobilization

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42
Q

Consist of primary cellular injury due to hypoperfusion and the secondary inflammation response that follows.

A

Shock

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43
Q

Deaths in trauma is due to

A

Shock -50%
Hemorrhage -40%
MOSF -10%

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44
Q

Patho physio of lost airway/ pulmonary injury on shock

A

O2 does not reach circulation

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45
Q

Patho physio of tension pneumothorax

A

Decrease blood return to heart

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46
Q

Patho physio of cardiac tamponade

A

Decrease blood return to the heart

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47
Q

Patho physio of hemorrhage

A

Decrease O2 carrying capacity

Decrease intravascular vol

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48
Q

Patho physio of cardiac injury

A

Decrease pump action

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49
Q

Patho physio of spinal cord injury

A

Decrease pump action

Decrease vasodilation

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50
Q

Patho physio of poisoning

A

Decrease vasodilation

Direct failure of cellular

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51
Q

Patho physio of sepsis

A

Decrease vasodilation

Direct failure of cellular

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52
Q

Cns response to ischemia

A

Mod: anxiety
Severe: coma

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53
Q

Cvs response to ischemia

A

Mod: vasoC, increase CO
Severe: vasoD, MI, dysthymia

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54
Q

Pulmonary response to ischemia

A

Mod: increase RR
Severe: V/Q mismatch, ARDS

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55
Q

Renal response to ischemia

A

Mod: hybernation
Severe: ATN

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56
Q

GI response to ischemia

A

Mod: ileus
Severe: infarct, loss of barrier function

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57
Q

Hepatic response to ischemia

A

Mod: increase glucose release
Severe: no reflow, re perfusion injury

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58
Q

Hematologic response to ischemia

A

Mod: none
Severe: decrease cell production, impaired immune function

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59
Q

It begins as soon as Shock is identified

A

Fluid resuscitation

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60
Q

T or F: resu and primary therapy overlaps

A

True

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61
Q

Risk of aggressive fluid resuscitation

A 
BBHC GEDP
Increase bp
Decrease blood viscosity
Decrease hct
Decrease clothing factors
Greater transfusion reqr
Electrolyte imbalance
Direct immune suppression
Premature reperfusion "pop the clot"
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62
Q

Fluid resu goal of maintaining Lower than normal Bp (___mnHg) until definitive control of hemorrhage

A

90mmhg

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63
Q

Responder/ transient responder/ non responder and implication
Increased and sustained improvement of bp

A

Responder-

Not actively bleeding, unlikely to require transfusion

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64
Q

Responder/ transient responder/ non responder and implication
Increased bp Ff by recurrent hypotension

A

Transient responder-

Actively bleeding, consider early transfusion

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65
Q

Responder/ transient responder/ non responder and implication
No improvement

A

Non-responder-

Must R/o other causes, active bleeding

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66
Q

Fluid which causes dilution of blood composition

A

0.9% Saline
LR
Plasmalyte
Starch

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67
Q

Fluid which cause rapid volume expansion

A 
Starch
Hypertonic saline
RBC
Plasma 
FWB
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68
Q

Fluid which is cheap and compatible with blood

A

0.9 saline

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69
Q

Fluid which cause hyperchloremic metab acidosis

A

0.9 saline

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70
Q

Fluid in which Ca clots the blood

A

LR

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71
Q

Fluid with physiologic electrolyte mix

A

Plasmalyte

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72
Q

Fluid which cause coagulopqthy with 1st generation

A

Starch

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73
Q

Fluid which cause rapid increase of bp

A

Hypertonic saline

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74
Q

Fluid which cause increase O2 delivery

A

RBC

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75
Q

Fluid which have clotting factors

A

Plasma

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76
Q

Fluid which have O2, clotting factors and is ideal but Unavailable

A

FWB

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77
Q

Fluid which are expensive, limited resource, requires cross matching, viral transmission, TRALI

A

RBC

Plasma

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78
Q

Vicious cycle of rapid crystalloids infusion in pts with Active hemorrhage

A

Vigorous fluid resu
Hemodilution, increased bleeding
Recurrent hypotension

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79
Q

In deep shock, one can use ____ to rapidly restore coagulation

A

Bicarbonate
Cryoprecipitate
FActore VIIa

80
Q

1 blood loss vol in 24hr is equivalent to

A

10units of whole blood

81
Q

Indications for massive transfusion

A 
4 units in 1hr
50 units in 48hrs
20 units in 24hrs
50% blood loss in 3hrs
>150ml/min blood loss
82
Q

Bloody vicious cycle or lethal triad

A 
Acidosis
Hypothermia
Coagulopathy (due to large vol of crystalloids, colloid, PRBC without hemo static component)
83
Q

Warm all IV fluids and blood to avoid hypothermia. Room temp?

A

> 28C

Humidify inspired gas

84
Q

For decreased ionized calcium, how many CaCl to give?

A

Calcium chloride 20mg/kg

85
Q

Resu end points within 1st 24hr after trauma:

Mixed venous oxygen tension

86
Q

Resu end points within 1st 24hr after trauma:

Mixed venous oxygen saturation (CVP, PA)

87
Q

Resu end points within 1st 24hr after trauma:

Base deficit

88
Q

Resu end points within 1st 24hr after trauma:

Lactate

A

<2.5mmol/L

89
Q

Pulse oximetry information

A

O2 sat
HR
Plethysmographic tracing of pulse
Tissue perfusion

90
Q

Interferes with reading in pulse oximetry

A 
IV dyes
Movement
Dark fingernails
Highly pigmented skin
COHgb
metHgb
91
Q

High sat but truly with low oxyhemoglobin

A

Poisoning/inhalational injury

92
Q

Trauma pts suffers from low perfusion state thus oximetry reading not reliable. Which is a more sensitive measure?

93
Q

Efficacy of ventilation or ute elimination of CO2 can be assessed by both PETCO2 values and Capnogran analysis

A

End tidal CO2 analysis

94
Q

High CO2

Increased production

A

Hyperthermia/malignant hyperthermia
Cancer
Burn
Sepsis

95
Q

High CO2

Decreased elimination

A

Asthma
COPD
Inadequate ventilation (drugs, fatigue, sweating)

96
Q

Low CO2

Increased elimination

A

Hyperventilation

Anxiety/vent strategy

97
Q

Low CO2

Decreased production

A

Coma
Hypothermia
Anesthesia
Paralysis

98
Q 
Ventilator setting (low pressure/high pressure alarms):
Machine leak or disconnection of breathing circuit
A

Low pressure alarm

99
Q 
Ventilator setting (low pressure/high pressure alarms):
Due to patient condition such ass reduced lung compliance, secretions in ET tubes, dyssynchronous ventilation
A

High pressure alarms

100
Q

Pulse electrical activity 5H

A 
Hypovolemia
Hypothermia
Hyper/hypokalemia
H ion acidosis
Hypoxemia
101
Q

Pulseless electrical activity 5T

A 
Tension pneumothorax
Tamponade
Thrombosis (pulmonary embolism)
Thrombosis (coronary artery embolus)
Tablets (drug overdose)
102
Q

CVP level

103
Q

T or F: CVP has no predictable relationship between pressure and volume preload indices and cardiac performance variables

104
Q

T or F: CVP is used as guide to fluid therapy

105
Q

PA catheter information

A

CO
CVP
PAP
PAWP

106
Q

Urine production

A

0.5ml/kg/hr

107
Q

Surrogate measure of organ perfusion

A

Urine output

108
Q

Indicator of hemolysis, sk ms destruction and UT integrity

A

Urine output

109
Q

T or f: urine output reliability is increased in prolonged shock prior to surgery and use of osmotic dieresis

A

False. Decreased reliability

110
Q

Accurate site for temp

A

Distal esophagus
Tympanic mem
PA catheter sensor
Nasopharynx

111
Q

Intermediate accurate site of temp

A

Bladder
Rectum
Mouth
Axilla

112
Q

Inaccurate site of temp

113
Q

Conseq of patient expo

A 
Coagulation disturbance
Arrhythmias
Inappro diuresis
Delay in metab of drugs
Risk of infection
114
Q

T or F: avoid anesthetics and ms relaxants before securing the airway

115
Q

Hemorrhagic shock (increase/decrease) the MAC by approx __

A

Decrease Mac by 25%

116
Q

T or f: anesthetic drugs are direct CV depressant and inhibit compensatory hemodynamics mechanism

117
Q

Expulsion of eye contents and loss of vision

A 
LEt BuCKS
Laryngoscopy
ET intubation
Bucking
Coughing
Ketamine
Succinylcholine
118
Q

T or F: aspiration of stomach contents may cause lung injury and pneumonia

119
Q

Induction agents

A

Thiopental
Propofol
Midazolam

120
Q

Crystalloids/colloid: what to give during early phase of burn

A

Crystalloids

121
Q

Crystalloids/colloid: what to give 24hrs after burn injury

122
Q

When to avoid succinylcholine in burn injury

A

If >24hrs and for at least 18mos after injury

123
Q

Burn injury, rapid sequence induction of ____ if >24hrs after burn injury

A

Rocuronium

124
Q

IV anesthetics in early phase burn injury

A

Decrease dose requirements

125
Q

IV anesthetics in during hyper dynamic phase burn injury

A

Increase dose reqr

Consider multimodal therapy (opioid, Propofol, ketamine, benzodiazepines)

126
Q

Inhalation agents in early phase burn injury

A

Decrease MAC during early phase

127
Q

Inhalation Agnets in during hyper dynamic phase burn injury

A

Increase MAC

128
Q

T or F: beta blocker attenuated hyperdynamic phase of burn injury

129
Q

Succinylcholine increase K if __%TBSA

130
Q

Causes of persistent hypotension

A

Bleeding
Tension pneumothorax
Neurogenic shock
Cardiac injury

131
Q

LR/NS in persistent hypotension

132
Q

LR cause no acidosis but tissue edema due to..

A

Hypotonicity

133
Q

The higher the molar substitution, the ___ retention, the ___ chance of coagulopqthy

A

The higher the molar substitution, the higher retention, the higher chance of coagulopqthy

134
Q

Causes of hypothermia

A 
SAAFE
Shock
Alcohol intoxication
Abnormal Thermoregulatory mech
Fluid resu
Expo to cold
135
Q

Coagulation abnormalities causes

A 
DATHH
Dilution of coag factors
Acidosis
Tissue hypoperfusion
Hypoxia
Hypothermia
136
Q

Indication for FFP

A

> 10 units PRBC within 6hrs
1.5x the normal PTT and PT
Reversal of coag in pts in Vit.K antagonist

137
Q

Platelet indication

A

<50 x 10^9/L

Higher in pts with DIC, hyperfibrinolysis, head injury and massive bleeding

138
Q

One unit of whole blood contains platelet concentrates of

A

7.5 x 10^10/L

139
Q

Fibrinogen indications

140
Q

Replace fibrinogen conc and cryoprecipitate

A

3-4g fibrinogen

50mg/kg cryoprecipitate

141
Q

Antifibrinolytic agents and dose

A

Tranexamic acid - 10-15mg/kg then 1-5mg/kg/hr

Aminocaproic acid - 100-150mg/kg then 15mg/kg/hr

142
Q

T or F: anti fibrinolytic agents are effective in cardiac and elective surgery

143
Q

Why is antifibrinolytic agents not included in massive transfusion protocol?

A

Be do it contains all endogenous antifibrinolytic elements

144
Q

Conditions to justify the use of factor 7a

A

Controlled bleeding
Corrected severe acidosis, hypothermia and hypocalcemia
Using antifibrinolytic agents

145
Q

Caution for the use of factor 7a

A

Arterial and venous TE

146
Q

Dose for factor 7a

A

100-140 mg/kg repeat after 1-3hrs later

147
Q

Electrolyte and acid base disturbance

A

Hyperkalemia

Metab acidosis

148
Q

Early post-op considerations

A

Acute renal failure
Abdominal compartment syndrome
TE

149
Q

Creatinine and free water clearance on ARF

A

Creatinine <25ml/min

Free water >15ml/hr

150
Q

Myoglobinuria/hemoglobinuria: clear supernatant (crush syndrome)

A

Myoglobinuria

151
Q

Myoglobinuria/hemoglobinuria: rose color

A

Hemoglobinuria

152
Q

Management for ARF

A

Fluids only.

DONT Give mannitol and HCO3

153
Q

Intra abdominal hypertension with organ dysfunction

A

Abdominal compartment syndrome

154
Q

Most important factor in abdominal compartment syndrome

A

Limit crystalloids infusion

155
Q

Management for TE

A 
PPV FiO2 of 1
Intubation
Fluids and inotropes
Arterial CVP monitoring
TEE
156
Q

TE prophylaxis

A

Compressin devices
LMW heparin
Vena cava filter
Thrombolytic agents

157
Q

Superficial burn

A

First degree burn

158
Q

Partial thickness burn

A

Second degree burn (superficial and deep dermal burn)

159
Q

Full thickness burn

A

Third and fourth degree burn

160
Q

Erythema of skin
Microscopic destruction of superficial layers of epidermis
Heals spontaneously

A

First degree burn

161
Q

Burn from epidermis to upper Dermis

Heals spontaneously

A

Superficial derma burn

162
Q

Burn from epidermis to deep Dermis

Requires excision and grafting

A

Deep dermal burn

163
Q

Burn of epidermis and dermis

Excision and grafting with limitation of function and scar formation

A

Third degree burn

164
Q

Burn of ms, fascia and bone

Complete excision with limited function

A

4th degree burn

165
Q

Full thickness burn TBSA

A

> 10% TBSA

166
Q

Partial thickness TBSA

A

> 25% TBSA in adults

20% TBSA in extremes of age

167
Q

Surface area of head and neck in children is larger than 9%, and that of lower extremities are smaller, thus can’t use rules of 9, instead use…

A

Lund and Browder chart

-takes into aact the changing prop of body from infancy to adulthood

168
Q

CO increase/decrease immediately after burn injury due to …

A

Decrease CO due to circulating myocardial depressant factors

169
Q

CO increase/decrease after 24hrs resu due to …

A

Increase CO due to hypemetabolic state (tachycardia, hypertension)

170
Q

Patho physio changes in burn injury in upper airway

A

Glottis and preglottic edema = obstruction

171
Q

Patho physio changes in burn injury in lower airway

A

Decrease surfactant and mucociliary func
Mucosal necrosis and ulceration
Edema
Leads to obs, air trapping, broncho spasm, ARDS, PE

172
Q

Patho physio changes in burn injury in GI

A 
Adynamia ileus (>20%tbsa)
Curlings ulcer (stomach and duo)
173
Q

Life threatening complication of burn injury in GI

A

Curlings ulcer

174
Q

Patho physio changes in burn injury in renal

A

Decrease RBF and GFR = RAAS activation and ADH release = Na and water retention = exag K, Ca, Mg losses

175
Q

T or F: Renal changes in burn injury improves with adequate resu

176
Q

Patho physio changes in burn injury in endocrine

A

ADH, renin, aldosterone, angiotensin, glucagon and catecholamine release = inc serum glucose

177
Q

Patho physio changes in burn injury in metab and thermoreg

A

Increase metab rate
Increase skin and core temp
Ineffective water vapor barrier = loss of ion-free water

178
Q

Leading cause of hypoxia in burn injury

A

Carbon monoxide poisoning.

179
Q

Produced by incomplete combustion of C-containing cmpds (wood, coal, gasoline)

A

Carbon monoxide

180
Q

Carbon monoxide is ___x greater affinity for ____

A

200x greater affinity to Hgb than O2

181
Q

Carbon monoxide (competitive/noncompetitive; irrev/rev) reaction

A

Competitive reversible reaction

182
Q

T or F: fluid resu is essential in the early burn injury period

183
Q

Parkland formula

A

4ml/kg/% TBSA
1st 8hrs - 1/2
Nxt 8hrs - 1/4
Nxt 8hrs - 1/4

184
Q

What to give in 1st 24 hr in burn injury

A

LR

Parkland formula

185
Q

What to give in second 24hr in burn injury

A 
Glucose in water (replace water loss and maintain Na level)
Colloid soln (albumin)
186
Q

Dose of colloid soln with TBSA 30-50%

A

0.3ml/kg/%

187
Q

Dose of colloid soln with TBSA 50-70%

A

0.4ml/kg/%

188
Q

Dose of colloid soln with TBSA >70%

A

0.5ml/kg/%

189
Q

What to give in children <20kg burn injury

A

Crystalloids (2-3ml/kg/%) same hr
Crystalloids with 5% dextrose (maintenance) for 24 hrs
1st 10kg = 100ml/kg
2nd 10kg = 50ml/kg

190
Q

Fluid resu clinical ends

A

Uo 0.5-1ml/kg/hr
PR 80-140bpm
SBP 60mmHg infants; 70-90mmHg + (age x 2) children
Basale deficit <2

191
Q

If difficult mask ventilation and intubation, consider

A

Awake intubation

192
Q

Ms relaxant of choice in burn injury

A

Non depolarizing

Esp with minimal histamine release

193
Q

T or F: burn patient have RELATIVE RESISTANCE To nondepolarizing relaxants

194
Q

How many fold increase in dose requirement of ms relaxant in burn injury

195
Q

In pts with burns >30% TBSA, manifesting approx 10 day postinjury, peak is ____ and declines after ____

A

Peak -40d

Decline -60d

196
Q

T or F: succinylcholine is contraindication in burn patients

A

True, 24hrs postinjury up to 2yrs

197
Q

Reason behind an increase serum K in succinylcholine

A

Due to presence of extra junctional Ach receptors

198
Q

T or F : avoid NSAID in burn injury

Med Prep (52 decks)

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