Trauma Anesthesia Flashcards
Becks Triad
Pericardial TAMPONADE
- HYPOTENSION
- JVD
- Distant “muffled heart sounds”
Trauma lethal Triad
- Hypothermia
- Acidosis
- Coagulopathy
Trauma Airway Management
RSI 5 primary components
RSI is a procedure conducted to rapidly control a patient’s airway while reducing the likelihood of gastric aspiration. RSI consists of five primary components: (1)preoxygenation, (2) cricoid pressure, (3) induction/muscle relaxation, (4) apneic ventilation, and (5) direct laryngoscopy
RSI Preoxygenation
should be performed before intubation to limit the possibility of hypoxia during airway management. Preoxygenation is accomplished using high-flow(10–15 L) oxygen via a nonrebreather facemask, bag-valve facemask, or anesthesia circuit
Cricoid pressure is maintained throughout the RSI and is not released until__________________.
ETT placement has been confirmed
The appropriate pressure to apply to the cricoid ring
30 newtons (∼3 kg or 10 lb of pressure) adequately occludes the esophagus
RSI Preoxygenation in patients who are unable to perform vital capacity breaths or follow commands when obtunded
Provide controlled positive pressure mask ventilation throughout induction.
The term controlled indicates that positive inspiratory pressure breaths will be monitored and kept below 20cm H2O to avoid gastric distention.
___________pressure is applied during the RSI and is intended to prevent both gastric insufflation during bag-valve-mask ventilation and passive reflux of gastric content.
Cricoid
_________ is often used as the primary induction agent in hemodynamically unstable trauma patients because of its ability to minimize significant hypotension.
Etomidate
Succinylcholine administration may cause ___________ in patients with neurologic deficits from spinal cord injury (SCI) or massive crush injuries but usually not until 24 to 48hours after injury.
lethal hyperkalemia
True or False: Succinylcholine (1.5 mg/kg) provides favorable and rapid muscle relaxation to facilitate incubation. It is generally the preferred agent for RSI for any patient with no specific contraindication to its use.
true
Massive transfusion Protocol
The most common causes of SCI in the United States are
MVCs (31.5%), falls (25.3%), and gunshot wounds(10.4%
The outcome after an acute SCI depends on three factors.
1) the severity of the acute injury; (2 avoiding exacerbation of the injury during rescue, transport, and hospitalization; and (3) preventing hypoxia and systemic hypotension, which can further compromise neural function
njuries at the C1 or C2 level result in
Complete respiratory paralysis. Death follows within a few minutes if airway support with assisted ventilation is not commenced rapidly.
____ is the most common site of spinal injury
C7
__________________ may precipitate cardiac arrest in patients with massive muscle injury or denervation that is seen in patients with SCIs, severe crush injuries, or burns
Succinylcholine
True or False A conservative approach to caring for patients with SCI is to use a non-depolarizing neuromuscular blocker such as rocuronium or avoid paralysis altogether during airway management.
True
Autonomic dysreflexia may be experienced from _________ to _________
several weeks to 6 months post-SCI
What is autonomic dysreflexia?
Autonomic dysreflexia is a potentially fatal clinical condition, is found in patients who suffer an SCI above T6 a
Autonomic dysreflexia is characterized by
Sudden activation of sympathetic response as a result of noxious stimuli. It could be triggered as a result of surgery or from colorectal or bladder distention.
Autonomic dysreflexia Presents with
Severe hypertension and other life-threatening consequences, including seizures, pulmonary edema, myocardial infarction, acute renal injury, and intracranial hemorrhage
Management of Autonomic Dysrefexia
Determining and correcting the noxious stimuli. Because bladder distention and fecal impaction are the most common triggers, bladder catheterization, exclusion of a urinary tract infection, and rectal disimpaction should be performed.
The speed of IV fluid administration is directly related to the radial diameter of the catheter as described by _____________ law’s
Poiseuille’s Law
