Trauma & Critical Care Flashcards
Catecholamine response to injury is maximal at ___ (timeframe)
24-48 hours
Catecholamine response: see what other increased elements?
incr ADH; Incr ACtH (which incr cortisol and aldosterone)
Neck Zones; what else shares this way of classifying things?
I: below cricoid; II: cricoid to angle of jaw (most amenable to OR exploration); III: jaw to skull—
Remember 1 to 3; low to high (as with LeForte fx and embryology of PTH glands
1 cause of preventable blunt trauma death
missed intra-abdominal injury
DPL: preform ____ if + pelvic fx; __cc/kg infusion for peds. Positive if: ___cc frank blood, ____, ____, ___, ___, ____
supraumbilical; 10cc/kg infusion for peds; positive if: 10cc frank blood, food particles, bile, bacteria, >100,000 rbc/mm, 500 WBC/mm
Indications for thoracotomy for HTN (x 4)
instability; >1500cc out initially, >200 cc/hr x 4 hrs, incompletely drained hemothorax despite 2 good tubes
cardiac tamponade: hypotension due to _____. Tapped blood does or does not clot?
decreased diastolic filling; tapped blood does NOT clot
petechiae, hypoxia, confusion/agitation; sudan urine stain for fat
fat emboli
Diaphragm rupture from blunt trauma: On L or R? (ratio_; dx by waht imaing; rx?
8:1 on Left; dx by NGT in chest on CXR; rx= laparotomy
Diaphragm rupture delayed presentation, approach?
consider approaching via chest since there will be adhesions
Lose these s/p splenectomy: ___, _____, ____ and decreased ____
lose tuftsin, properidin, fibronectin (non-specific opsonins); decreased IgM production
Splenectomy help ___% of patients with hereditary spherocytosis; helps ___% with ITP
100% (helps anemia, jaundice remit); 80%
Low platelets, hemolytic anemia, neuro changes…. dx? Rx?
TTP; do NOT do splenectomy; rx= plasmapheresis
pulmonary compliance: change in ____ for a given change in ____
change in volume for a given change in pressure (want high compliance)
Compliance incr or decr in ARDS? why?
decr in ARDS, pulmonary edema (takes greater pressure to get same volume)
Aging reduces these pulmonary factors….
FEV1 and FVC
O2 delivery
C.O. x O2 content= C.O. x Hgb x 13 x O2 sat
O2 use
C.O. x (CaO2- CvO2)
Initial rx for air embolus, then?
position to trendelenburg with L side down; can then attempt air aspiration via central line in RA
PEEP, does what to pulmonary factors?
increased FRc, incr compliance, keeps alveoli open, rare PTx unless very high (Every year)
FRC
air in lungs after normal exhalation
inspiratory capacity
air breathed in from FRC
vital capacity
greatest volume that can be exhaled
Hgb: O2 dissociation with ____, ___, ___, ___; right or left shift? Provide or keep O2?
increase temp, co2, H+, 2,3 DPG (high altitude, babies)= “right shift” to provide o2
EDRF= _____; made from _____ in ____ cells. Causes _____ via ____; increased in ____
nitric oxide, made from arginine in endothelial cells; vasodilatation via cGMP, increase in sepsis
hydroflouric acid burns; rx with ______
topical calcium
_____ falsely elevates the o2 sat. How? Rx?
carbon monoxide; it reduces available Hb; giving 100% o2 reduces T1/2 of CO from 5 hrs to 1 hr
Slivadene: risk of ____; good activity against _____; poor _____
risk of neutropenia; good activity agasinst candid; poor eschar penetration
_______: panful; acidosis due to carbonic anhydrase inhibition (less H2co3 ->H20 + CO2)
sulfamylon
silver nitrate associated with ____ and ___ leading to ____-
hyponatremia and hypochloremia due to leeching of NaCl
1 infection in burn patients
PNA
Burn patients; how is their cardiac output initially then after?
initial drop in cardiac output; then are hyperdynamic
______ (cancer) that develops in chronic wound from burn? what is disease?
SCCA; marfolin’s ulcer
