Trauma-II (Lynch) Flashcards
1
Q
Objectives
A
- rescuscitation options for trauma
- analgesia plan for trauma patient
- consider factors influence timing of procedues
- understand concepts of damage control
2
Q
Where is fluid lost from during trauma
A
- intravascular space
- lose
- red cells
- water
- protein
- smallest fluid compartment
- doesn’t take much to see signs of shock
- lose
3
Q
IV volume deficits
A
- replace like with like
- lose volume quickly => replace volume quickly
- be careful, rapid admin may worsen bleeding
- dislodging soft clots
- be careful, rapid admin may worsen bleeding
- lose blood => replace blood
- lose volume quickly => replace volume quickly
4
Q
Resuscitation in severely injured patients
A
- SIRS (systemic inflammatory response syndrome)
- severe trauma=sepsis like syndrome
- Coagulopathy possible
- ongoing hemorrhage leads to further fluid loss
- sythetic fluids may make worse
- transfusions may be better
5
Q
Resuscitation with isotonic crystalloids
A
- Shock dose based on normal blood volume
- dogs: 90 ml/kg
- cats: 60 ml/kg
- 5 kg cat this would be less than a coke can
- Give proportion of shock dose, then re-assess
- improv perfusion parameters
- improv tachycardia
- improv mm color
- improv blood pressure
- lower lactate levels
- improv mentation
- improv perfusion parameters
6
Q
Concerns with large volume resuscitation
A
- Lethal triad of trauma
- dilution of clotting factors
- acidemia (Cl gets rid of bicarb)
- hypothermia
7
Q
Alternative to large vol resuscitation
A
- Low volume resuscitation
- hypertonic saline
- synthetic colloids
- Hypotensive (delayed) resuscitation
- Hemostatic resuscitation
- blood products
8
Q
Low volume resuscitation
A
- Hypertonic saline (7.2%)
- more rapid volume expansion
- must follow with isotonic crystalloids
- depletes other fluid compartments
- don’t give too rapidly
- Synthetic colloids
- hydroxyethylstarches
- more rapidly volume expansion
- theoretical more sustained expansion than isotonic crystalloid
- dose dependent coagulopathy
- may not be good for trauma
- AKI risk in people
- limited availability
9
Q
Hypotensive (delayed resuscitation
A
- from military experience
- only appropriate if confirmed surgical lesion
- surgical hemostasis achieved before volume resuscitation
- rarely justifiable in vet med
*has to have a real bleed, not a coagulopathy
*tying off a bleeder
*done quickly (do or die)
10
Q
Hemostatic resuscitation
A
- transfusions
- fresh whole blood best
- red cells
- platelets
- plasma
- most hospitals have blood components, not donors
- Ratios of blood can help
- if several transfusions required
- 1:1:1 of packed red cells: platelets: plasma
11
Q
Massive transfusion
A
- large volume blood products
- whole blood volume in 24 hours
- half blood volume in 3 hours
12
Q
hemostatic resuscitation
benefits
A
- Advantages
- most physiological approach
- Plasma/whole blood can correct coagulopathy
- red cells improve oxygen carrying capacity
- Disadvantages
- Expensive
- not always available
- citrate containing transfusions may worsen coagulopathy
13
Q
Autotransfusion
A
- large volume shed blood from cavitary bleeds
- infection risk-lack of sterility
- give antimicrobial
- deficient in clotting factors
- cheap and readily available
14
Q
Oxygen supplementation
A
- not harmful short term
- minimally stressful and min invasive methods
- oxygen mask
- oxygen cage
- nasal lines
- intubation/ventilation
- most oxygen carried bound to hemoglobin
- limited help in anemic/hemorrhaging patients
- pleural space dz
- benefits from oxygen AND thoracocentesis
15
Q
Analgesia
A
- Multimodal approach helpful
- assess locomotor ability before analgesia admin