Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Trauma > trauma/burn > Flashcards

trauma/burn Flashcards

1
Q

in obese patients cricothyroid membrane may be hard to find. what can be used available to locate the treachea

A

ultrasound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is the most frequent cause of asphyxia after trauma

A

airway obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

in airway obstruction two tings should be applied simultaneously

A

immobilization of the cervical spine

administration of oxygen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

avoid blind passage of what in a patient with airway obstruction

A

nasopharyngeal airway
or
nasogastric tube

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

age contraindication to cricothyroidotomy?

what damage could it cause

A

age younger than 12

permanent laryngeal damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

during airway management why is tracheostomy not desirable during initial management

A

it takes longer to perform than cricothyroidotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

other than adequate oxygenation and ventilation patients require these two things before airway manipulation

A

deep anesthesia
and
profound muscle relaxation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

coughing, bucking, will increase intracranial intravascular intraocular pressure which can result in

A

herniation of brain
extrusion of eye contents
dislodgment of hemostatic clot from injured vessel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

preferred anesthetic sequence to achieve intubation goals include

A

preoxygenation and opioid loading followed by large doses of intravenous anesthetic and muscle relaxant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Systemic hypotension, ICP elevation, decreased CPP, may occur whether cerebral autoregulation is present or absent in patients with head injuries

A

Systemic hypotension, ICP elevation, decreased CPP, may occur whether cerebral autoregulation is present or absent in patients with head injuries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what three parts of the body are vulnerable to missile and explosion injuries

A

face
head
neck

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is the standard of care for neck stabilization

A

Manual inline stabilization (MILS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

in the subacute phase of C-spine injury when time constraints, full stomach, and patient cooperation do not exist, what is the preferred method to secure an airway

A

FOB awake intubation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

the Canadian C-Spine Rule vs nexus in diagnosing C spine injury in responsive patients.

A

canadian rule is more reliable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What issue is the leading cause of mortality after blood product therapy

A

TRALI- 38%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Treatment of TRALI include

A

supportive
mechanical ventilation
ECMO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

these two things are not useful in TRALI

A

steroids and diuresis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

clinical course of trali

A

3-5 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

TRALI occurs with in how many hours of transfusion

A

6 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

TRALI symptoms include

A

Pulmonary edema

subsequent hypoxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

all blood products are associated with TRALI however- these two have been most frequently implicated

A

FFP and apheresis platelets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

treatment of DIC involves

A

elimination of its causes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

the present of elevated circulating FDP (fibrin degradation products) above ___ is suggestive of DIC

A

40mg/ml

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Fibrin level below ___ is suggestive of DIC as well

A

100mg/dl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

a diagnostic scoring system consisting of these 4 items rules in our rules out DIC

A

platelet count
PT oR INR
fibrinogen level
FDP measurements

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Hypothermia affects platelet morphology, function, and sequestration; retards enzyme activity; and decreases coagulation factor function by about ___% for each ____C drop in temperature, slowing the initiation and propagation of platelet plugs and fibrin clot as well as enhancing fibrinolytic activity.

A

10%

1C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

A core body temperature below ___C is often associated with acidosis, hypotension, and coagulopathy, which in turn may lead to an increased risk of severe bleeding, need for transfusion, and mortality.

A

A core body temperature below 35°C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

name different injuries that you will see increased heat loss with ?

A

spinal cord injury
extensive soft tissue injury
burn injuries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

T/F patient who consumed ethanol preoperatively will have increased heat loss

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what type of surgery will patients have increased heat loss

A

body cavity surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

most trauma victims receiving forced dry air at 43degrees C can prevent a temperature drop. But why does it not treat severe hypothermia?

A

low specific heat of air has little heat content to transfer to the cold trauma patient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

name the four mechanisms that you will see persistent hypotension in

A

tension pneumo
hemorrhage
neurogenic shock
cardiac injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

all in all. hypotension is most likely due to

A

bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

preferred fluid for resuscitation. and why does tissue edema form?

A

LR is preferred

tissue edema may result from its slight hypotonicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

why is NS not preferred for resuscitation

A

NS is associated with greater urine output and thus greater fluid requirement compared to LR
acidosis and dilution coagulopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

two cardiac causes of persistent hypotension include

what intraoperatively be used for differential diagnosis

A

blunt cardiac injury
pericardial tamponade
TEE!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

this type of shock is easily missed during initial evaluation especially in unconscious patients

A

neurogenic shock from spinal cord injury

38
Q

when the burn size exceeds 10% of TBSA succinylcholine should be avoided after 24 hours until when

A

1 year

39
Q

resistance develops to all non depolarizing muscle relaxants including cistracuronium in patients with more than 30% of TBSA starting when? and peaking when?

A

starting 1 week

peaking 5-6 weeks after injury

40
Q

describe the hypermetabolic state of a burn patient

A 
tachycardia
tachypnea 
catecholamine surge
increased 02 consumption
augmented catabolism
41
Q

during the healing process of a burn the hyper metabolic states requires an increase in these three things

A

oxygen
ventilation
nutrition

42
Q

Early extensive and repeated escharotomies with coverage by skin grafts attenuate the postburn hypermetabolic response
decreasing two things?
improving one important thing?

A

decrease insulin resistance
decrease fluid loss
improve survival

43
Q

when are escharotomies preformed

A

between the second day and the second week

44
Q

what do repeated escharotomies often require

A

management of fluid & electrolyte
coagulation abnomalities
massive transfusion

45
Q

drug of choice for burn dressing changes? problem with that choice?

A

ketamine

can produce hypotension in patients catecholamine depleted

46
Q

what do inhaled anesthetics do to CBF and CBV and ICP

A

increase CBF
CBV
ICP

47
Q

what do IV anesthetics do to CBF and CMRO2

A

decrease

48
Q

**Although there are unavoidable shortcomings to the study, it nevertheless indicates that the specific anesthetic agents chosen probably do not affect the neurologic outcome as long as the vital signs are maintained.

A

**Although there are unavoidable shortcomings to the study, it nevertheless indicates that the specific anesthetic agents chosen probably do not affect the neurologic outcome as long as the vital signs are maintained.

49
Q

for head and eye injuries we need to pay attention to avoid of hypotension to avoid cerebral ischemia. MAP and SBP goals to avoid less than?

A

mean less than 60, 70

SBP less than 90 or 100

50
Q

patients suffering from hypovolemia- what happens when you give nitrous oxide

A

its a cardiovascular depressant -
(we know nitrous oxide myocardial depressant effect is somewhat counterbalanced by its ability to increase sympathetic outflow. )

51
Q

in the hypovolemic patient- all inhalation agents may reduce global and regional blood flows and therefore should be used only in low concentrations (<1mac) what about opioid supplementation?

A

well tolerated and often indicated

52
Q

in the presence of hypotension suggesting uncompensated hypovolemia what occurs when anesthetics are added?

A

further deterioration of systemic blood pressure and sometimes cardiac standstill

53
Q

succs is the agent of choice for rapid sequence induction- what other drug and dose has almost the same onset time without the undesirable side effects associated with succs

A

Rocuronium 1.2-1.5mg/kg

54
Q

these two drugs produce less cardiovascular depression opposed to propofol

A

ketamine and etomidate

55
Q

anesthetic and adjunct drugs for general anesthesia need to be tailored to five major clinical conditions

A 
airway compromise
hypovolemia
head or open eye injuries
cardiac injury
burns
56
Q

base deficit mild hypoperfusion

A

-2 to -5

57
Q

base deficit moderate hypoperfusion

A

-6 to -9

58
Q

base deficit severe hypoperfusion

A

-10

59
Q

do2 index integrates these three important variables

A

Hgb concentration
arterial oxygen saturation
cardiac output

60
Q

do2 normal value

A

500ml/min/m

61
Q

what is routinely monitored as an indicator of organ perfusion

A

urine output

62
Q

when is urine output not a reliable monitor of perufsion

A

prolonged shock prior to surgery
osmotic diuresis- mannitol
radiopaque dye

63
Q

how is maintenance fluid calculated

A

4 mL/kg/hr for the first 10 kg
2 mL/kg/hr for the second 10 kg
1mL/kg/hr for additional weight thereafter.

64
Q

what population get glucose in their replacement volume after a burn

A

children

65
Q

normal healthy patient HCT requirement for blood replacement

A

20-24%

66
Q

HCT requirement in healthy but need extensive procedures

A

25%

67
Q

HCT requirement in patients when there is a history of preexisting cardiovascular disease

A

30%

68
Q

an increase in HCT during the first day of a burn means what

A

inadequate fluid resuscitation

69
Q

fluid administration to a burn patient in excess of the amount recommended by the parkland is termed

A

fluid creep

70
Q

what acid base imbalance is seen with CN toxicity

A

metabolic acidosis

71
Q

lactic acidosis after smoke inhalation in a patient without a major burn suggest what?

A

CN toxicity

72
Q

half life of CN

A

1hr

73
Q

CO level

<15–20

A

Headache, dizziness, and occasional confusion

74
Q

CO level

20–40

A

Nausea, vomiting, disorientation, and visual impairment

75
Q

CO level

40–60

A

Agitation, combativeness, hallucinations, coma, and shock

76
Q

CO level

>60

A

death

77
Q

CO affinity for hemoglobin to oxygen

A

200 fold greater affinity

78
Q

at what concentration is the cherry red color of the blood occurring with carboxyhemoglobin

A

concentration above 40%

79
Q

air complications medication technique

A

sevo

ketamine to preserve pharyngeal tone

80
Q

Immediately after securing the airway, ventilation with low levels of PEEP will prevent the pulmonary edema that may develop secondary to loss of laryngeal auto-PEEP in patients with significant airway obstruction before intubation

A

Immediately after securing the airway, ventilation with low levels of PEEP will prevent the pulmonary edema that may develop secondary to loss of laryngeal auto-PEEP in patients with significant airway obstruction before intubation

81
Q

Fourth-degree burns

A

involve muscle, fascia, and bone, necessitating complete excision and leaving the patient with limited function.

82
Q

burns caused by electrocution may show little external evidence but may be associated with

A

severe fractures, hematomas, visceral injury, and skeletal and cardiac muscle injury resulting in pain, myoglobinuria, and dysrhythmias or other ECG abnormalities

83
Q

A full-thickness

A

(third-degree) burn does not blanch, even with deep pressure, and is insensate. Complete destruction of the dermis requires wound excision and grafting to prevent a wound infection that may lead to local sepsis and systemic inflammation.

84
Q

Deep partial-thickness

A

second-degree) burns involve the deep dermis and require excision and grafting to ensure rapid return of function.

85
Q

A partial-thickness burn

A

A partial-thickness burn is red, blanches to touch, and is sensitive to painful stimuli and heat. Superficial partial-thickness (first-degree) burns involve the epidermis and upper dermis and heal spontaneously.

86
Q

Patients with burns over ___% of TBSA consistently develop catabolism and weight loss, which may last up to 1 year.

A

40%

87
Q

how do we set the guidelines for resuscitation of a burn patient

A

determine the size and depth of a burn

88
Q

Three risk factors determine the death rate

A

inhalation injury
burn size exceeding 40% of TBSA
age greater than 60 years

89
Q

Clinically, burn injury is manifested in two phases

A
  1. continued plasma loss from the intravascular space into burned and often into intact tissues for about the first day or two after injury
  2. hypermetabolic or hyperdynamic phase, which may last for months.
90
Q

Delayed fracture repair is associated with 4 things

A

an increased risk of DVT
pneumonia
sepsis
pulmonary and cerebral complications of fat embolism.

Trauma (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions