Trauma, Burns, Sepsis

Question 1

Hoarsenss, a change in voice, or stridor are clues to _________ and require intubation before airway obstruction occurs.

Answer 1

laryngeal edema

Question 2

An absence of a gag reflex means that the airway should be inspected for

Answer 2

foreign bodies

Question 3

The GCS takes whatinto account?

Answer 3

eye-opening, verbal response, motor response

Question 4

Insertion of chest tube does not allow the lung to fully inflate. Next steps?

Answer 4

check if tube erroneously inserted into subq tissues, if it has air leaks, or is occluded. reposition or replace the tube

Question 5

Placement of chest tube and large amount of air continues to leak over the next 6 hours. The lung is only partially inflated. What’s going on?

Answer 5

major airway injury with disruption of a bronchus or the trachea. Will require thoracotomy and partial lung resection

Question 6

T/F: While a small asymptomatic uncomplicated pneumothorax (NOT hemothorax) can be observed, it MUST be treated with a chest tube if the patient is to ahve surgery in the OR.

Answer 6

TRUE. THe positive pressure of 20-40mm Hg to the TB tree by ventilation causes a small pneumothorax to turn into a larger or tension PTX

Question 7

Even small amounts of blood in teh pericardium (<__mL) can limit venous inflow to the heart and cause hypotension.

Answer 7

<50 mL

Question 8

If a patient has lost more than 30-40% of blood, about how many mL is that? What will their HR be?

Answer 8

1.5-2L (note: this is where you resuscitate with crystalloid AND blood)
HR 120bpm

Question 9

T/F: The heart rate of a pregnant woman will decrease by ~20 bpm in the third trimester.

Answer 9

FALSE. Increase!

Question 10

Before placing a catheter in any male trauma patient, what must be performed?

Answer 10

Rectal exam to assess for prostatic injury (retrograde cystourethrogram to assess for urethral injury)

Question 11

If neurologic deficits, radiologic abnormalities (either lateral, anterior, or oblique views), or cervical spine tenderness is present, what should be suspected?

Answer 11

cervical spine injury

Question 12

What type of intubation is used in suspected cervical spine injury?

Answer 12

oropharyngeal intubation with in-line traction to maintain spinal column alignment or nasotracheal intubation

Question 13

T/F: In suspected spinal cord injury, a patient should receive steroids.

Answer 13

True. To maximize recovery of the neurologic loss due to damage caused by edema to the adjacent areas of the spinal cord.

Question 14

Priapism, loss of anal sphincter tone, loss of vasomotor tone, bradycardia, and intestinal ileus are all potential findings in patients with

Answer 14

fresh spinal cord injury

Question 15

How much blood evacuated from a tubne thoracostomy indicates a thoracotomy should be performed?

Answer 15

> 1500 mL; or >200 mL/h for 3 hours

Question 16

DPL may miss injuries to what?

Answer 16

The duodenum and the pancreas, if there is no communicatio nbetween the injuries and the peritoneal cavity

Question 17

T/F: A CTA should only be performed in stable patients with suspected abdominal injury.

Answer 17

True. Use DPL or FAST in the others

Question 18

In a suspected fractured pelvis, what is the next step?

Answer 18

Pelvic angiogram (likely significant bleeding from a branch of the internal iliac artery, which is controlled by embolization)

Question 19

Infarctio nis rarely a problem when embolizing a portion of the spleen because of rich collateral blood supply from

Answer 19

the short gastric vessels

Question 20

Any patient who has had a splenectomy should receive immunization with vaccines for

Answer 20

diplococcus, meningococcus, haemophilus, Strep pneumococcus

Question 21

Before removing an injured kidney, you need to

Answer 21

document the presence of two kidneys! Use an IVP in the resuscitation area or OR

Question 22

A hematoma in the area of the SMA indicates injury to where?

Answer 22

upper abdominal aorta, major aortic branches, or direct injury to pancreas and duodenum (retroperitoneal hematoma)

Question 23

________ is a common injury in children who hit their abdomen on bicycle handlebars. What is the treatment?

Answer 23

duodenal hematoma (seen as intramural hematoma that obstructs the duodenal lumen and can be diagnosed on UGI). If it is an isolated injury, management involves observation and no oral intake until the obstruction resolves (commonly in 5-7 days)

Question 24

Why is surgical exploration of a pelvic hematoma discouraged?

Answer 24

The peritoneum covering the pelvis is helping to tamponade hte bleeding (opening it will make bleeding worse). It is difficult ot localize a bleeding pelvic vessels because the interior of the vessel is difficult ot visualize surgically and hte large mass of hematoma obscures the structures.

Question 25

T/F: Blunt trauma to the kidney/perirenal area and to the pelvis do not require exploration.

Answer 25

True! But penetrating trauma does (to exclude major vascular injuries)

Question 26

Which type of retroperitoneal hematomas usually require abdominal exploration for management?

Answer 26

central (great vessels, pancreas, duodenum). With hemodynamic instability, preoperative angiogram is useful.

Question 27

What is Battle’s sign?

Answer 27

ecchymosis in the mastoid region (with blood behind the tympanic membrane and around the eyes, signifies basal skull fracture)

Question 28

T/F: Head trauma has been linked to both SIADH and DI.

Answer 28

true

Question 29

How does hypothermia affect bleeding?

Answer 29

Leads to coagulopathy from platelet dysfunctio nand prolongation of the PT and PTT

Question 30

Why should fluid replacement be conservative in the setting of pulmonary contusion?

Answer 30

Damaged lung is more susceptible to edema

Question 31

If a patient has received 1-2L bolus but is not responding (UOP is low), what is the next step?

Answer 31

CVP to be sure hydration is adequate

Question 32

What is normal SVR?

Answer 32

800-1400 dynes-sec/cm^5

Question 33

What are the normal pressures of the chambers of the heart?

Answer 33

RA: 0-6
RV: 20-30/0-6
Pulm artery: 12-18
LA: 4-12
LV: 100-140/5-14

Question 34

Direct pressure on a supposed fistula leading to a drop of ___ beats/min or more in HR is called Branham’s sign and supports the diagnosis of fistula.

Answer 34

10 (Duplex or angiogram can also confirm the diagnosis)

Question 35

What is high output heart failure caused by a fistula?

Answer 35

hen a large proportion of arterial blood is shunted from the left-sided circulation to the right-sided circulation via the fistula, the increase in preload can lead to increased cardiac output. Over time, the demands of an increased workload may lead to cardiac hypertrophy and eventual heart failure. Patients may present with the usual signs of high-output heart failure including tachycardia, elevated pulse pressure, hyperkinetic precordium, and jugular venous distension

Question 36

Subcutaneous emphysema in the neck suggests…

Answer 36

airway injury

Question 37

Can epithelial regeneration occur in partial-thickness burns? What degree is this?

Answer 37

Yes – 2nd degree

Question 38

Can epithelial regeneration occur in full thickness burns? What degree is htis?

Answer 38

No – 3rd degree

Question 39

What are the most common infections for burn patients?

Answer 39

Staph aureus, pseudomonas, streptococcus, and candida

Question 40

Levels of carboxyhemoglobin of more than __% in nonsmokers or more than ___% in smokers indicates CO poisoning.

Answer 40

> 5% in nonsmokers or more than 10% in smokers

if this has occurred, 100% oxygen should be administered until carboxyhemoglobin levels are normal

Question 41

What is methemoglobin?

Answer 41

Hemoglobin with the iron oxidized to the ferric (Fe3+) rather than normal reduced ferrous (Fe2+)

Question 42

T/F: Pulse oximetry can be used to measure oxygen saturation in methomoglobinemia.

Answer 42

No! Cannot differentiate between methemoglobin and hemoglobin.

Question 43

What is the treatment of methemoglobinemia?

Answer 43

supplemental oxygen is sufficient if the patient is asx; administration of IV methylene blue (1-2mg/kg)

Question 44

What are baseline caloric needs in a healthy individual?

Answer 44

30 kcal/kg/day

Question 45

T/F: The infection potential of single and triple lumen catheters is the same.

Answer 45

False! Triple > single

Question 46

What do you do if a patient on TPN has an increase in LFTs?

Answer 46

Lower the rate of infusion. Failure to plateau or return to normal in 7-14 days = another etiology; fatty liver and structural liver damage can be induced by TPN