Trauma Anesthesia Flashcards
What kind of acidosis does massive resuscitation with normal saline cause?
non-gap hyperchloremic metabolic acidosis
*chloride load results in bicarbonate spilling by the kidney to maintain electroneutrality*
How does the hypothalamus respond to hypovolemia in trauma?
increased release of vasopressin
increased release of ACTH, increasing cortisol and glucagon levels
At what temperature is hypothermia thought to cause of substantial funcitonal coagulopathy?
33 oC
What is Beck’s triad?
Found in < 10% of patients with cardiac tamponade:
1) muffled heart sounds
2) distended neck veins
3) hypotension
What is Kussmaul’s sign?
distention of neck veins on inspiration
*sometimes seen in cardiac tamponade*
What are the hemodynamic goals with cardiac tamponade?
fast (HR), full (preload), and tight (afterload)
What are the induction options for tamponade?
1) pericardiocentesis with local anesthesia
2) mask induction for maintenance of spontaneous ventilation
3) ketamine induction and intubation without muscle relaxant
4) ketamine induciton with muscle relaxant and minimal positive-pressure ventilation to limit intrathoracic pressures
Where should needle thoracostomy be performed for tension pneumothorax?
just superior to the 3rd rib in the midclavicular line
How is a stable vertebral artery disection (rarely seen with minor trauma) commonly treated?
anticoagulation
What are the common scenarios for abdominal compartment syndrome?
blunt abdominal trauma
pancreatitis
sepsis
bowel obstruction
reperfusion injury
How can intra-abdominal pressures be accurately estimated?
bladder pressure
What are the concerns for intubation in burn victims?
Upper airway edema and obstruction are common so the threshold for intubation is low.
Awake fiberoptic intubation preferable given likelihood of difficult ventilation and intubation
How does carbon monoxide poisoning affect oxygen binding and delivery?
Carboxyhemoglobin has a higher affinity for O2 so the oxygen-hemoglobin disociation curve is shifted left and O2 delivery is impaired.
How is pulse oximetry affected by carbon monoxide poisoning?
Carboxyhemoglobin can be mistaken for oxyhemoglobin on pulse oximetry, overestimating SaO2
*cherry red blood and SaO2 92% is classic boards scenario*
What is the treatment for carbon monoxide poisoning?
100% supplemental O2 via non-rebreather
