Trauma Anesthesia

Question 1

Becks Triad

Answer 1

Pericardial TAMPONADE

1. HYPOTENSION
2. JVD
3. Distant “muffled heart sounds”

Question 2

Trauma lethal Triad

Answer 2

1. Hypothermia
2. Acidosis
3. Coagulopathy

Question 3

Trauma Airway Management

Answer 3

Question 4

RSI 5 primary components

Answer 4

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

Question 5

RSI Preoxygenation

Answer 5

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

Question 6

Cricoid pressure is maintained throughout the RSI and is not released until__________________.

Answer 6

ETT placement has been confirmed

Question 6

The appropriate pressure to apply to the cricoid ring

Answer 6

30 newtons (∼3 kg or 10 lb of pressure) adequately occludes the esophagus

Question 6

RSI Preoxygenation in patients who are unable to perform vital capacity breaths or follow commands when obtunded

Answer 6

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.

Question 6

___________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.

Answer 6

Cricoid

Question 6

_________ is often used as the primary induction agent in hemodynamically unstable trauma patients because of its ability to minimize significant hypotension.

Answer 6

Etomidate

Question 7

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.

Answer 7

lethal hyperkalemia

Question 7

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.

Answer 7

true

Question 7

Massive transfusion Protocol

Answer 7

Question 8

The most common causes of SCI in the United States are

Answer 8

MVCs (31.5%), falls (25.3%), and gunshot wounds(10.4%

Question 9

The outcome after an acute SCI depends on three factors.

Answer 9

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

Question 10

njuries at the C1 or C2 level result in

Answer 10

Complete respiratory paralysis. Death follows within a few minutes if airway support with assisted ventilation is not commenced rapidly.

Question 11

____ is the most common site of spinal injury

Answer 11

C7

Question 12

__________________ may precipitate cardiac arrest in patients with massive muscle injury or denervation that is seen in patients with SCIs, severe crush injuries, or burns

Answer 12

Succinylcholine

Question 13

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.

Answer 13

True

Question 14

Autonomic dysreflexia may be experienced from _________ to _________

Answer 14

several weeks to 6 months post-SCI

Question 15

What is autonomic dysreflexia?

Answer 15

Autonomic dysreflexia is a potentially fatal clinical condition, is found in patients who suffer an SCI above T6 a

Question 16

Autonomic dysreflexia is characterized by

Answer 16

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.

Question 17

Autonomic dysreflexia Presents with

Answer 17

Severe hypertension and other life-threatening consequences, including seizures, pulmonary edema, myocardial infarction, acute renal injury, and intracranial hemorrhage

Question 18

Management of Autonomic Dysrefexia

Answer 18

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.

Question 19

The speed of IV fluid administration is directly related to the radial diameter of the catheter as described by _____________ law’s

Answer 19

Poiseuille’s Law