Trauma II Flashcards
TBI Goals
Traumatic brain injury
Prevent 2° brain damage resulting from intracranial bleeding, edema, ↑ICP, hypoxia, & shock
TBI Classifications
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
What ideal CPP should be maintained in patients w/ severe TBI?
CPP 60-70mmHg
CPP Formula
MAP - ICP
What inhalational anesthetics should be avoided in TBI anesthetic management?
Nitrous oxide → pneumoencephalogram
SCI
Spinal cord injury
Most often occurs at lower cervical spine level C4-7
SCI Deficits
Sensory
Motor
Sensory & motor
What 3 factors do SCI patient outcomes depend on?
- Acute injury severity
- Exacerbation prevention during rescue, transport, & hospitalization
- Avoid hypoxia & hypotension*
Early SCI Treatment Focus
Adequate perfusion to prevent 2° injury
What complication develops in 85% SCI patients w/ complete injury above T5?
Autonomic hyperreflexia
SCI Goal MAPs
> 85mmHg
Neurogenic Shock
Unopposed PSNS tone
Loss cardioaccelerator fibers → bradycardia
C-Spine Evaluation
Requires all 7 cervical vertebrae to clear
Patients need to be awake - no sedation, ETOH, drug intoxication, or CNS impairment
SCI Intubation
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
What fractures are at high risk for DVT?
Long bone fractures
Fix or reduce w/in 1st 24hrs ↓pneumonia, ARDS, or fat emboli risk