Trauma & Critical Care

Question 1

Catecholamine response to injury is maximal at ___ (timeframe)

Answer 1

24-48 hours

Question 2

Catecholamine response: see what other increased elements?

Answer 2

incr ADH; Incr ACtH (which incr cortisol and aldosterone)

Question 3

Neck Zones; what else shares this way of classifying things?

Answer 3

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

Question 4

1 cause of preventable blunt trauma death

Answer 4

missed intra-abdominal injury

Question 5

DPL: preform ____ if + pelvic fx; __cc/kg infusion for peds. Positive if: ___cc frank blood, ____, ____, ___, ___, ____

Answer 5

supraumbilical; 10cc/kg infusion for peds; positive if: 10cc frank blood, food particles, bile, bacteria, >100,000 rbc/mm, 500 WBC/mm

Question 6

Indications for thoracotomy for HTN (x 4)

Answer 6

instability; >1500cc out initially, >200 cc/hr x 4 hrs, incompletely drained hemothorax despite 2 good tubes

Question 7

cardiac tamponade: hypotension due to _____. Tapped blood does or does not clot?

Answer 7

decreased diastolic filling; tapped blood does NOT clot

Question 8

petechiae, hypoxia, confusion/agitation; sudan urine stain for fat

Answer 8

fat emboli

Question 9

Diaphragm rupture from blunt trauma: On L or R? (ratio_; dx by waht imaing; rx?

Answer 9

8:1 on Left; dx by NGT in chest on CXR; rx= laparotomy

Question 10

Diaphragm rupture delayed presentation, approach?

Answer 10

consider approaching via chest since there will be adhesions

Question 11

Lose these s/p splenectomy: ___, _____, ____ and decreased ____

Answer 11

lose tuftsin, properidin, fibronectin (non-specific opsonins); decreased IgM production

Question 12

Splenectomy help ___% of patients with hereditary spherocytosis; helps ___% with ITP

Answer 12

100% (helps anemia, jaundice remit); 80%

Question 13

Low platelets, hemolytic anemia, neuro changes…. dx? Rx?

Answer 13

TTP; do NOT do splenectomy; rx= plasmapheresis

Question 14

pulmonary compliance: change in ____ for a given change in ____

Answer 14

change in volume for a given change in pressure (want high compliance)

Question 15

Compliance incr or decr in ARDS? why?

Answer 15

decr in ARDS, pulmonary edema (takes greater pressure to get same volume)

Question 16

Aging reduces these pulmonary factors….

Answer 16

FEV1 and FVC

Question 17

O2 delivery

Answer 17

C.O. x O2 content= C.O. x Hgb x 13 x O2 sat

Question 18

O2 use

Answer 18

C.O. x (CaO2- CvO2)

Question 19

Initial rx for air embolus, then?

Answer 19

position to trendelenburg with L side down; can then attempt air aspiration via central line in RA

Question 20

PEEP, does what to pulmonary factors?

Answer 20

increased FRc, incr compliance, keeps alveoli open, rare PTx unless very high (Every year)

Question 21

FRC

Answer 21

air in lungs after normal exhalation

Question 22

inspiratory capacity

Answer 22

air breathed in from FRC

Question 23

vital capacity

Answer 23

greatest volume that can be exhaled

Question 24

Hgb: O2 dissociation with ____, ___, ___, ___; right or left shift? Provide or keep O2?

Answer 24

increase temp, co2, H+, 2,3 DPG (high altitude, babies)= “right shift” to provide o2

Question 25

EDRF= _____; made from _____ in ____ cells. Causes _____ via ____; increased in ____

Answer 25

nitric oxide, made from arginine in endothelial cells; vasodilatation via cGMP, increase in sepsis

Question 26

hydroflouric acid burns; rx with ______

Answer 26

topical calcium

Question 27

_____ falsely elevates the o2 sat. How? Rx?

Answer 27

carbon monoxide; it reduces available Hb; giving 100% o2 reduces T1/2 of CO from 5 hrs to 1 hr

Question 28

Slivadene: risk of ____; good activity against _____; poor _____

Answer 28

risk of neutropenia; good activity agasinst candid; poor eschar penetration

Question 29

_______: panful; acidosis due to carbonic anhydrase inhibition (less H2co3 ->H20 + CO2)

Answer 29

sulfamylon

Question 30

silver nitrate associated with ____ and ___ leading to ____-

Answer 30

hyponatremia and hypochloremia due to leeching of NaCl

Question 31

1 infection in burn patients

Answer 31

PNA

Question 32

Burn patients; how is their cardiac output initially then after?

Answer 32

initial drop in cardiac output; then are hyperdynamic

Question 33

______ (cancer) that develops in chronic wound from burn? what is disease?

Answer 33

SCCA; marfolin’s ulcer