Trauma lecture Flashcards
5 criteria for c spine injury
neck pain
severe distraction pain
any neuro sign and symptom
intoxication
loss of consciousness
how to intubate c spine injury
MILS
manual inline stabilization
Which agent to avoid
n2o- accumulates in closed spaces
avoid with ptx, pneumocephalus, pneumoperitoneum
succ and trauma
succ can increase k if administered 24 hours after a burn, spinal cord, crush injury
massive transfusions cause what to blood
met alkalosis
hypocalcemia
hyperkalemia
hemolytic reaction in the anesthetized patient
increased temp, tachy, hotn, hgburia, oozing at feild
Why is there bleeding after massive transfusion?
dilutional thrombocytopenia
half life of crystalloids, colloids
crystal- 30 minutes
colloids- 3-6 hours
why to avoid dextrose in trauma
may exacerbate brain damage
hypotonic, goes into cells?
factor 8 can decrease by 50% by when in storage?
2 days
hypvolemic patient and anesthetics
need less, lower CO, more ventilaiton, and less iv volume
hypovolemic trauma induction meds
ketamine
etomidate
signs of brain injuries
AMS
GCS
restlessness, convlusions, cranial nerve damage (pupils reactive??)
Cushings triad
LATE signs preceded by brain damage
bradycardia, htn, irregular respiration
which meds may induce pupilary dilation
anticholinergics- robinol, spiriva, atrovent
becks triad
suggests cardiac tamponade
neck vein distention, hotn, muffled heart sounds
propofol can kill
cardiac tamponade signs
becks triad- neck vein, hotn, muffled
pulsus paradoxus
femur fracture can mean how many units of lost blood
3 units
how would you be able to tell fat embolism from labs
elevation of serum lipase
fat in urine
thrombocytopenia
how to treat intracranial htn
mannitol
fluid restrictions
hypocapnia 26-30
avoid an increase in intracranial pressure- ketamine
mild hypothermia can assist
high spinal cord injury symptoms
loss of sympathetic tone- hotn, warm, brady, gi atony
autonomic hyperreflexia
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
where to place chest tube for ptx
2/3 medial
4/5 intercostal lateral
simple vs tension ptx
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
tension ptx treatment
14gauge 2ics midclavicular
causes of ards
sepsis
fat embolism
massive transfusion
aspiration
thoracic injury
head injury
how would u notice ards in the or
needing higher gas flows rt poor lung compliance
requiring high airway pressures
highest incidence of recall
cardiovascular
ob
trauma
brain injuries and anesthesia
no sedatives, analgesics if expected neuro exam
tamponade and etco2
DROP rt lower co
What is a hemolytic vs allergic vs febrile reaction?
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
