Trauma II Flashcards

1
Q

TBI Goals

A

Traumatic brain injury

Prevent 2° brain damage resulting from intracranial bleeding, edema, ↑ICP, hypoxia, & shock

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2
Q

TBI Classifications

A
Mild GCS 13-15
- Resolves w/ minimal deficits
- Observation 24hrs
Moderate GCS 9-12
- Early CT
- High deterioration potential requires early intubation & mechanical ventilation
- Manifested as intracranial lesions that require surgical evacuation
Severe GCS < 8 
- Intubate 
- Carries significant mortality rate
- Direct care at cerebral perfusion
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3
Q

What ideal CPP should be maintained in patients w/ severe TBI?

A

CPP 60-70mmHg

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4
Q

CPP Formula

A

MAP - ICP

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5
Q

What inhalational anesthetics should be avoided in TBI anesthetic management?

A

Nitrous oxide → pneumoencephalogram

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6
Q

SCI

A

Spinal cord injury

Most often occurs at lower cervical spine level C4-7

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7
Q

SCI Deficits

A

Sensory
Motor
Sensory & motor

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8
Q

What 3 factors do SCI patient outcomes depend on?

A
  1. Acute injury severity
  2. Exacerbation prevention during rescue, transport, & hospitalization
  3. Avoid hypoxia & hypotension*
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9
Q

Early SCI Treatment Focus

A

Adequate perfusion to prevent 2° injury

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10
Q

What complication develops in 85% SCI patients w/ complete injury above T5?

A

Autonomic hyperreflexia

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11
Q

SCI Goal MAPs

A

> 85mmHg

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12
Q

Neurogenic Shock

A

Unopposed PSNS tone

Loss cardioaccelerator fibers → bradycardia

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13
Q

C-Spine Evaluation

A

Requires all 7 cervical vertebrae to clear

Patients need to be awake - no sedation, ETOH, drug intoxication, or CNS impairment

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14
Q

SCI Intubation

A

Simple chin lift w/ manual in-line stabilization
Avoid extension, flexion, & rotation w/ direct laryngoscopy
Consider video laryngoscopy

Gold standard = awake fiberoptic intubation*
*Requires cooperative patient

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15
Q

What fractures are at high risk for DVT?

A

Long bone fractures

Fix or reduce w/in 1st 24hrs ↓pneumonia, ARDS, or fat emboli risk

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16
Q

Dislocated Hip Considerations

A

Femoral head avascular necrosis = EMERGENCY

Requires paralysis → GETA

17
Q

Fractured Pelvis Considerations

A

Pelvic binder
Expect high blood loss
- Type & cross 4 units
- Notify blood bank to remain at least 2 units ahead

18
Q

Crush Injury Considerations

A

Muscle damage → myoglobinurea
Administer fluids to flush myoglobin through kidneys & prevent renal tubal clogging
Consider Mannitol & Bicarbonate to treat

19
Q

Open Fracture Considerations

A

OR w/in 1st 12hrs to debride

20
Q

Compartment Syndrome Considerations

A

Check pulses distal to the fracture

Treatment = fasciotomy

21
Q

Orthopedic Trauma

Anesthetic Management

A

Emergency trauma = full stomach → general anesthesia
Controlled hypotension MAP < 20mmHg baseline to prevent bleeding or w/in 20%
Administering inotropes before bleeding controlled → excessive blood loss

22
Q

Traumatic Aortic Injury

Diagnosis

A

CXR
Angiography
CT scan
TEE

Requires surgery to repair d/t rupture risk in hours to days

23
Q

The most common injury resulting from blunt chest trauma: _____ ______

A

Flail chest

24
Q

Flail Chest

A

Comminuted fractures at least 3 ribs
Characterized by paradoxical respirations
Consider pain management - epidural placement to maintain ventilation/perfusion or regional techniques (intercostal or TAP blocks)
CPAP or BiPap support

25
Q

Beck’s Triad

A

Hypotension
Jugular venous distension
Muffled heart sounds

26
Q

Cardiac Tamponade Presentation

A

Beck’s triad
Narrow pulse pressure
Tachycardia

27
Q

Blunt Cardiac Trauma →

A

Bruising or contusion → hypotension and/or arrhythmias
Presents similar to MI (functionally indistinguishable)
Treatment - manage as ischemic cardiac injury

28
Q

Cardiac Bruising or Contusion

Treatment

A

Volume control
Vasodilators
Monitor & treat rhythm disturbances
Cardiology consult as necessary

29
Q

OB & Pregnancy

Trauma

A

High incidence spontaneous abortion, pre-term labor, or premature delivery
OB consult for immediate management & follow-up
Requires rapid & complete resuscitation 1° focus = mother
L lateral uterine displacement
Rh¯ mother admin Rhogam
U/S fetus, assess gestational age, consider viability & delivery
Spontaneous abortion requires surgical D&C

30
Q

Extubation Criteria

A

Mental status - not intoxicated, able to follow commands, non-combative, & pain adequately controlled
Airway anatomy & reflexes - appropriate cough & gag, able to protect airway from aspiration, & no excessive airway edema or instability
Respiratory mechanics - adequate tidal volume & RR, normal motor strength, FiO2 requirements < 50%
Systemic stability - adequately resuscitated, repeat surgeries not required in short-term, normovolemic w/o S/S sepsis

31
Q

Risk factors r/t developing ARDS after trauma:

A
Elderly
Pre-existing physiologic impairment or co-morbidities
Direct pulmonary or chest wall injury
Aspiration blood or stomach contents
Prolonged mechanical ventilation
Severe TBI
SCI w/ quadriplegia
Massive transfusion
Hemorrhagic shock
Occult hypoperfusion
Wound or body cavity infection
32
Q

Appropriate Ventilator Settings

A
Vt 6-8mL/kg
PEEP 10-15cmH2O
Limit peek pressures < 40cmH20
Adjust I:E ratio as necessary
Wean FiO2 to obtain PaO2 80-100 w/ SpO2 93-97%
33
Q

Postoperative Complications

A
Infection/sepsis
Thromboembolism
Abdominal compartment syndrome
ARDS
Volume status