Trauma Anesthesia (Exam II) Flashcards
What is the “Lethal Triad” associated with hemorrhage?
- Hypothermia
- Metabolic Acidosis
- Coagulopathy
Resuscitation using ________ increases blood loss, transfusion requirements, and mortality.
Crystalloids
What is Class I Hypovolemic Shock?
15% blood loss, normal vitals
What is Class II Hypovolemic Shock?
- 15 - 30% blood loss
- ↑ HR
- Normal sBP
What is Class III Hypovolemic Shock?
- 30 - 40% blood loss
- ↓ BP
- ↓ mentation
- HR > 120
- Delayed capillary refill
What is Class IV Hypovolemic Shock?
- > 40% blood loss
- ↓BP w/ narrowed pulse pressure
- Absent UO
- Significantly altered mentation
Components of the GCS.
12 - 15: sick but okay
8 - 12: needs help
< 8: bad
Components of damage control resuscitation.
What are the two things we are concerned about with crystalloid over-resuscitation?
- Abdominal Compartment Syndrome
- Hemodilution
What is the order of crystalloid preference for trauma patients?
- Plasmalyte
- LR
- NS
What are the early and late effects of shock on the renal system?
- Early: GFR maintained
- Late: ATN, inability to concentrate urine
What is one of the earliest organs effected by shock? Why?
Intestines due to blood being shunted away to more vital organs
Which organ metabolizes citrate?
Liver
What is the classic trauma dose of TXA?
2g IV bolus
What is the pediatric dose of TXA?
15mg/kg bolus
2mg/kg/hr over 8 hours
What two things in trauma patients result in decreased citrate metabolism?
- Hypothermia
- Liver injury
Compare whole blood to a PRBC:FFP:PLT:Cryo combination.
What is REBOA?
Resuscitative Endovascular Balloon Occlusion of the Aorta.
What are contraindications to REBOA?
Pericardial Tamponade & Aortic Dissection
Does REBOA work?
Compare mild, moderate, and severe TBI.
Epidural hematomas are most often caused by injury to the….
middle meningeal artery
What is the classic “sign” associated with epidural hematoma?
What other signs are there?
LOC → consciousness → LOC (Lucid Interval)
- Mydriasis
- ↓ HR
“Lucid Interval” is commonly associated with…..
Epidural Hematomas
Subdural hematomas are typically due to a tear in the….
Sagittal venous sinus
What s/s are common with a subdural hematoma?
- Headache
- Progressive drowsiness
- Visual issues
- Gait issues
What PaCO₂ is typically needed to induce brain relaxation?
PaCO₂ of 30 - 35 mmHg
Can intermittently hyperventilate to 25 if necessary.
Differentiate complete and incomplete spinal cord injuries.
What are the 5 “P’s” of acute compartment syndrome?
- Pallor
- Paralysis
- Paresthesia
- Pain
- Pulselessness
What long bone fracture is compartment syndrome most common with?
Tibia
What is the triad associated with pericardial tamponade?
Beck’s Triad
- Hypotension
- Muffled Heart tones
- Distended neck veins
A sBP goal of _____ if bleeding is non-compressible.
90 mmHg
Where are the 4 areas of the body where non-compressible bleeding can occur?
- Abdomen
- Chest
- Brain
What 3 areas of the body are semi-compressible or difficult to compress?
What is the ET-Tube size formula for pediatric patients older than two years?
(Age + 16) ÷ 4
What is the formula for determining what depth an ETT should be placed at in a pediatric patient (cm)?
(Age ÷ 2) + 12
