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X. MRCS: Pathophysiology > Trauma/Haemorrhage > Flashcards

Trauma/Haemorrhage Flashcards

1
Q

Cardiac output

A 
L/min
Stroke volume (ml/beat) x heart rate (b/min)
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2
Q

Preload

A

Volume of venous return to left and right sides of heart
Determined by:
Venous capacitance
Volume status
Pressure difference between mean venous pressure and mean atrial pressure

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3
Q

Stroke volume

A

Preload
Myocardial contractility
Afterload

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4
Q

Afterload

A

Peripheral vascular resistance

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5
Q

Frank-Starling Law

A

Stroke volume of heart increases in response to increased volume of blood in ventricles.
Increased volume into ventricle stretches cardiac muscle, leading to increased force of contraction.

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6
Q

Types of shock

A

Hypovolaemic
Cardiogenic
Obstructive
Distributive (Neurogenic)

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7
Q

Hypovolaemic shock

A 
Haemorrhage (traumatic, non-traumatic)
Fluid loss (Gi losses, Burns, diuresis, pancreatitis)
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8
Q

Classes of haemorrhage

A

Class I
Class II
Class III
Class IV

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9
Q

Class I

A 
Blood loss: <750ml (15%)
BP: Normal
HR: Normal
RR: Normal
GCS: Normal
Urine: >30ml/hr
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10
Q

Class II

A 
Blood loss: 750-1500 (15-30%)
BP: normal (reduced pulse pressure)
HR: 100-120
RR: 20-30
GCS: mild anxiety
Urine: 20-30ml/hr
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11
Q

Class III

A 
Blood loss: 1500-2000ml (30-40%)
BP: Systolic <100
HR: 120-140
RR: 30-40
GCS: confused
Urine: 20ml/hr
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12
Q

Class IV

A 
Blood loss: >2000ml (>40%)
BP: Systolic <70
HR: >140
RR: >40
GCS: reduced GCS
Urine: Negligible
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13
Q

Cardiogenic shock

A 
Impaired contractility (MI, Myocarditis, myocardial contusion)
Dysrhythmia (tachycardias, bradycardias)
Valvular diysfunction (severe aortic regurgitation/stenosis)
Left ventricular outflow tract obstruction (HOCM, left atrial myxoma)
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14
Q

Obstructive shock

A 
Massive PE
Atrial thrombus/myxoma
Emboli (e.g. air embolus)
Cardiac tamponade
Abdominal compartment syndrome
Tension pneumothorax
Dynamic hyperinflation (severe asthma)
Caval compression (supine hypotension syndrome in pregnancy)
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15
Q

Distributive Shock

A 
Sepsis
Anaphylaxis
Neurogenic shock
Liver failure
Adrenal insufficiency
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16
Q

Neurogenic shock

A

Complication of spinal cord injury
Hypotension, bradycardia, temperature dysregulation
Above T6
Descending sympathetic tracts disrupted. Loss of sympathetic tone and unopposed parasympathetic response

17
Q

Liver Injury Grading

A

American Association for Surgery of Trauma (AAST) Liver Injury Scale

18
Q

AAST Liver Scale: Grade I

A

Haematoma: sub capsular <10% of surface area
Laceration: capsular tear, <1cm parenchymal depth

19
Q

AAST Liver Scale: Grade II

A

Haematoma: subcapsular: 10-50% surface area
Haematoma: intraparenchymal <10cm diameter
Laceration: capsular tear. 1-3cm Parenchymal depth, <10cm length

20
Q

AAST Liver Scale: Grade III

A

Haematoma: subcapsular >50% surface area
Haeamatoma: intraprenchymal >10cm
Laceration: capsular tear. >3cm parenchymal depth
Vascular: injury with active bleeding contain within liver parenchyma

21
Q

AAST Liver Scale: Grade IV

A

Laceration: parenchymal disruption 25-75% hepatic lobe
Vascular: injury with active bleeding breaching liver parenchyma into peritoneum

22
Q

AAST Liver Scale: V

A

Laceration: parenchymal disruption >75% of hepatic lobe
Vascular: juxtahepatic venous injuries (retrohepative vena cava/central major hepatic veins)

23
Q

Splenic Injuries

A

AAST Splenic Injury Scale

Grade 1-5

24
Q

AAST Splenic Injury Scale: Grade 1

A

Capsular tear <1cm parenchymal depth

Subcapsular haematoma <10% surface area

25
Q

AAST Splenic Injury Scale: Grade 2

A

Capsular tear 1-3cm parenchymal depth

Subcapsular 10-50% surface area, or intraparenchymal <5cm

26
Q

AAST Splenic Injury Scale: Grade 3

A

Capsular tear >3cm parenchymal depth, or any tear involving trabecular vessels
Subcapsular >50% surface area, or intraparenchymal >5cm, or any expanding or ruptured haematoma.

27
Q

AAST Splenic Injury Scale: Grade 4

A

Laceration involving segmental or hilar vessels, devascularising >25% of the spleen

28
Q

AAST Splenic Injury Scale: Grade 5

A

Completely shattered spleen or hilar vascular injury, devascularising the entire spleen

29
Q

Kidney Injury

A

AAST Renal Trauma Classification

one grade up for bilateral injuries, up to grade III

30
Q

AAST Renal Trauma Classification: Grade I

A

Contusion: microscopic or gross Haematuria, urologic studies normal
Haematoma: Subcapsular, non expanding without parenchymal laceration

31
Q

AAST Renal Trauma Classification: Grade II

A

Haematoma: non expanding perirenal haematoma confirmed to renal retroperitoneum
Laceration: <1cm parenchymal depth without urinary extravagation

32
Q

AAST Renal Trauma Classification: Grade III

A

Laceration: >1cm parenchymal depth or renal cortex without collecting duct rupture or urinary extravagation

33
Q

AAST Renal Trauma Classification: Grade IV

A

Laceration: Parenchymal laceration extending through renal cortex, medulla and collecting system
Vascular: main renal artery or vein injury with contained haemorrhage

34
Q

AAST Renal Trauma Classification: Grade V

A

Laceration: completely shattered kidney
Vascular: avulsion of renal hilum devascularising kidney

X. MRCS: Pathophysiology (13 decks)

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