Trauma lecture

Question 1

5 criteria for c spine injury

Answer 1

neck pain
severe distraction pain
any neuro sign and symptom
intoxication
loss of consciousness

Question 2

how to intubate c spine injury

Answer 2

MILS
manual inline stabilization

Question 3

Which agent to avoid

Answer 3

n2o- accumulates in closed spaces
avoid with ptx, pneumocephalus, pneumoperitoneum

Question 4

succ and trauma

Answer 4

succ can increase k if administered 24 hours after a burn, spinal cord, crush injury

Question 5

massive transfusions cause what to blood

Answer 5

met alkalosis
hypocalcemia
hyperkalemia

Question 6

hemolytic reaction in the anesthetized patient

Answer 6

increased temp, tachy, hotn, hgburia, oozing at feild

Question 7

Why is there bleeding after massive transfusion?

Answer 7

dilutional thrombocytopenia

Question 8

half life of crystalloids, colloids

Answer 8

crystal- 30 minutes
colloids- 3-6 hours

Question 9

why to avoid dextrose in trauma

Answer 9

may exacerbate brain damage
hypotonic, goes into cells?

Question 10

factor 8 can decrease by 50% by when in storage?

Answer 10

2 days

Question 11

hypvolemic patient and anesthetics

Answer 11

need less, lower CO, more ventilaiton, and less iv volume

Question 12

hypovolemic trauma induction meds

Answer 12

ketamine
etomidate

Question 13

signs of brain injuries

Answer 13

AMS
GCS
restlessness, convlusions, cranial nerve damage (pupils reactive??)

Question 14

Cushings triad

Answer 14

LATE signs preceded by brain damage
bradycardia, htn, irregular respiration

Question 15

which meds may induce pupilary dilation

Answer 15

anticholinergics- robinol, spiriva, atrovent

Question 16

becks triad

Answer 16

suggests cardiac tamponade
neck vein distention, hotn, muffled heart sounds
propofol can kill

Question 17

cardiac tamponade signs

Answer 17

becks triad- neck vein, hotn, muffled
pulsus paradoxus

Question 18

femur fracture can mean how many units of lost blood

Answer 18

3 units

Question 19

how would you be able to tell fat embolism from labs

Answer 19

elevation of serum lipase
fat in urine
thrombocytopenia

Question 20

how to treat intracranial htn

Answer 20

mannitol
fluid restrictions
hypocapnia 26-30
avoid an increase in intracranial pressure- ketamine
mild hypothermia can assist

Question 21

high spinal cord injury symptoms

Answer 21

loss of sympathetic tone- hotn, warm, brady, gi atony

Question 22

autonomic hyperreflexia

Answer 22

Reaction of the autonomic system to overstimulation- htn, tachy, skin color change, sweating
not associated in first 48 hours, succ is okay at this point

Question 23

where to place chest tube for ptx

Answer 23

2/3 medial
4/5 intercostal lateral

Question 24

simple vs tension ptx

Answer 24

simple- space in the parietal and visceral pleura
tension- air in pleural space invreases with inspiration and doesnt escape- tracheal shift
simple can turn into tension with bagging

Question 25

tension ptx treatment

Answer 25

14gauge 2ics midclavicular

Question 26

causes of ards

Answer 26

sepsis
fat embolism
massive transfusion
aspiration
thoracic injury
head injury

Question 27

how would u notice ards in the or

Answer 27

needing higher gas flows rt poor lung compliance
requiring high airway pressures

Question 28

highest incidence of recall

Answer 28

cardiovascular
ob
trauma

Question 29

brain injuries and anesthesia

Answer 29

no sedatives, analgesics if expected neuro exam

Question 30

tamponade and etco2

Answer 30

DROP rt lower co

Question 31

What is a hemolytic vs allergic vs febrile reaction?

Answer 31

Hemolytic- most devastating, hotn, tachy, oozing, sotp transfusion and maintain uo 100ml/ht with ivf, mannitol, lasic
Allergic- not IgE, itching, most not serious and can continue transfusion, stop if laryngeal edema/ dyspnea
Febrile- most common, can be prevented w leukoreduced blood, fever, chills, malaise, give tylenol