Trauma & Anesthesia - Quiz 7 Flashcards
What are the 3 areas w/ the Highest incidences of Recall?
CV
OB
Trauma
What are factors that can potentially indicate Cervical Spine Injury?
Neck Pain
Severe Distracting Pain
Neuro Signs & Symptoms
Intoxication
Unconscious @ the Scene
What is the best way to Intubate a patient w/ a Cervical Spine Injury?
Manual Inline Stabilization (MILS) using a Glidescope
Why should N2O be avoided in Trauma Patients?
Expands Closed Spaces
Trauma patients might have Pneumothorax, Pneumocephalus, or Pneumoperitonium
What can happen if Sux is given to patients who sufferred from a Burn, Spinal Cord, or Crush Injury in the past 24 hrs?
Hyperkalemia
How do Massive Blood Transfusions affect Systemic pH?
Metabolic Alkalosis
What are the potential Cardiovascular Effects of receiving > 1 unit PRBC per 5 minutes?
Cardiac Depression d/t Hypocalcemia
What are the signs & symptoms of a Hemolytic Reaction in an Anesthetized patient?
↑Temp
Tachycardia
Hypotension
Hemoglobinuria
Oozing
What are the Hematologic effects of Hypothermia?
Coagulopathy
Platelet Sequestration
Deformed RBCs
Myocardial Malfunction
What is the main cause of Bleeding after a Massive Transfusion?
Dilutional Thrombocytopenia
What is the Half-Life of Crystalloids?
20 - 30 minutes
What is the Half-Life of Colloids?
3 - 6 Hours
Which Crystalloid is more likely to cause Hyperkalemic Acidosis?
Normal Saline > LR
Why should LR never be hung w/ Blood?
The Calcium in LR is less compatible w/ Blood Transfusions
Which fluids are contraindicated in Trauma patients?
Fluids containing Dextrose - can worsen Ischemic Brain Damage
What is the affect of Lactated Ringers on Cerebral Edema?
LR’s Hypotonicity + Large Volume = Worsens Cerebral Edema
What are the different Colloids used to rapidly restore Intravascular Volume?
Albumin
Dextran - causes coagulopathy
Hetastarch - causes coagulopathy
Which Blood Type can be given w/o a prior Type & Screen in Emergency Situations?
O Negative
With Stored Blood, what happens to Factor VIII after two days of storage?
Reduced Factor VIII by 50%
Hypovolemia patients require ______ anesthetics d/t a Decrease in Cardiac Output & Increased Ventilation
Hypovolemia patients require LESS anesthetics d/t a Decrease in Cardiac Output & Increased Ventilation
What are the preferred Induction agents for a Hypovolemic Trauma Patient?
Ketamine & Etomidate
What might the sign of Hematuria indicate in the Trauma Patient?
Kidney or Lower Urinary Tract Injury
What are patients w/ Cervical Spine Injuries at risk for?
Aspiration
&
Circulatory Failure –> Poor Organ Perfusion –> SHOCK
What are signs of a Brain Injury in the Trauma Patient?
AMS
Low GCS
Restlessness
Convulsions
Cranial Nerve Dysfunction
Non-Reactive Pupils
What is Cushing’s Triad?
HTN
Bradycardia
Irregular Respirations
These are LATE signs before Herniation
What medications induce Pupillary Dilation?
Anticholinergics:
Robinul
Spiriva
Atrovent
What meds should be avoided if a patient is to have a Neuro Exam?
Avoid Sedatives & Analgesics
What are the symptoms commonly associated w/ Cardiac Tamponade?
Beck’s Triad
Jugular Distension
Hypotension
Muffled Heart Sounds
What is Pulsus Paradoxus?
A 10 mmHg drop in BP during Spont. Ventilation
Why should Propofol be avoided in pts w/ Cardiac Tamponade?
Can severely drop BP and lead to death
What should be monitored very closesly during a Pericardialcentesis?
EKG for ectopy
How do Massive Transfusions affect the Potassium Level?
Hyperkalemia
What is a concern associated w/ Pelvic and Long Bone Fractures?
Fat Embolism
Hypovolemia
Blood Loss
What are the signs indicating a Fat Embolism?
↑Lipase
Fat in Urine
Thrombocytopenia
What is the main goal for the pt undergoing Extremity Reattachment?
Normothermia
Avoid shivering to help Reperfusion
Which Lefort Fracture is this?
Lefort 2
Which Lefort Fracture is this?
Lefort 3
Fracture of Skull Base thru the Eye Sockets
Increased risk of Intubating into the Brain
Which Lefort fracture is this?
Lefort 1
How can Intracranial Hypertension be controlled?
Fluid Restriction
Diuretics - Mannitol
Hypocapnia
(PaCO2 26 - 30 mmHg)
What can help save Brain Tissue in a Head Injury?
Mild Hypothermia
Injury to which Spinal Cord segments cause Apnea?
C3-C5
“3,4,5 keeps you alive”
A High Spinal Cord Injury can cause Spinal Shock & Loss of Sympathetic Tone. What are the symptoms?
Hypotension
Bradycardia
Warm Touch
Areflexia
GI Atony
What are the symptoms of Autonomic Hyperreflexia?
HTN
HR Changes
Skin Color Changes
Diaphoresis
What is a Simple Pneumothorax?
Air in Parietal & Visceral Pleural causing Lung Collapse & V/Q Mismatch
Positve Pressure can convert Simple to Tension PTX
What is a Tension Pneumothorax?
Air trapped in Pleural Space & increases w/ Insipration causing Tracheal Shift
How is a Simple Pneumothorax treated?
Chest Tube @ 4th or 5th ICS
How is a Tension Pneumothorax treated?
14 ga. Needle @ 2nd ICS & Midclavicular, then Chest Tube
What should be done for a Hemothorax?
Isolate Bleeding Lung from Healthy Lung w/ Double Lumen Tube
What are the causes of the Delayed Lung Reponse known as ARDS?
Sepsis
Trauma
Aspiration
Head Injury
Fat Emboli
Massive Transfusion
