Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Advanced Principles 2 > Trauma part 1 > Flashcards

Trauma part 1 Flashcards

1
Q

Trauma is the leading cause of death between

A

1-45 years of age in the US

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Receiving care at _______ reduces mortality from unintentional injury by ________

A

level 1 trauma center; 25%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

WHO estimates trauma is the leading cause of death world wide between

A

15-44 years of age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

The initial evaluation of a trauma patient includes

A

Rapid overview- initial impression, ABCs
Primary survey
secondary survey

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Describe the rapid overview.

A

takes a few seconds is patient stable or unstable
ABC’s
inability to oxygenate–> brain injury & death within 5-10 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Inability to oxygenate leads to*****

A

brain injury & death within 5-10 minutes**

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

The primary survey involves

A

rapid evaluation for functions crucial to survival and includes ABCDE (airway patency, breathing, circulation, disability, and exposure)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

The secondary survey involves

A

detailed and systemic evaluation of each anatomic region & continued resuscitation if needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Describe ABCDE in detail:

A

airway patency- obstruction
breathing- high flow oxygen, trachea midline, flail chest (3 or more fractured segments of ribs), tension pneumothorax due to air leaking from the lung, or chest wall into the pleural space, massive hemothorax >1500 cc blood
circulation- skin temp, color, 2 large bore IVs
disability (neuro) mentation- GCS
exposure- take it off

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe the components of the glasgow coma score

A

eye-opening response
verbal response
motor response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Describe how to assign an eye-opening response.

A 
4= spontaneous
3= to speech
2= to pain
1= none
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Describe how to assign verbal response

A 
5= oriented to name
4= confused
3= inappropriate words
2= incomprehensible sounds
1= none
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Describe how to assign motor response

A 
6= follows commands
5= localizes to painful stimuli
4= withdraws from painful stimuli
3= abnormal flexion (decorticate posturing)
2= abnormal extension (decerebrate posturing)
1= none
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Describe the step of exposure.

A

final step of primary survey and includes complete exposure of the patient
removal of clothing and turning to examine
includes a brief head-to-toe search for visible injuries or deformities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

The secondary survey begins after

A

critical life saving actions have begun:

  • intubation
  • chest tube placement
  • fluid resuscitation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

The focus for the secondary survey is:

A

history of injury**
allergies, medications, last oral intake*
focused medical & surgical history*****

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

In terms of the airway evaluation, most trauma patients require:

A

assisted or controlled ventilation
self-inflating bag with a non-rebreathing valve is sufficient after intubation and for transport
100% oxygen is necessary until ABG is complete

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

When performing an airway evaluation, assume

A

patient absolutely requires an airway & cannot be re-awakened electively**

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

The airway evaluation involves:

A

the diagnosis of trauma to the airway & surrounding tissue
anticipates the respiratory consequences
contemplates airway management maneuvers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Airway obstruction considerations include:

A 
airway edema/direct airway injury
cervical deformity
cervical hematoma
foreign bodies
dyspnea, hoarseness, stridor, dysphonia
subcutaneous emphysema & crepitation
hemoptysis/active oral bleeding/copious secretions
tracheal deviation
jugular vein distention
hemodynamic condition
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

If someone is bleeding, the airway device of choice is

A

not fiberoptic b/c the camera will be obscured

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Nasal intubations are prone to

A

increased blood in the airway & nasal trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

If considering a nasal intubation, ensure that

A

there is no basilar skull fracture
-assess for Battle’s sign, racoon eye, CSF leak, bruising around ears
also cannot nasally intubate with Lafort 3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Considerations for AW management include:

A 
oxygen administration
chin lift & jaw thrust
full stomach
clearing of oropharyngeal airway
oral & nasal airway*** (smaller tube= increased resistance)
immobilization of cervical spine
tracheal intubation if ventilation is inadequate
consider AW adjuncts to secure AW
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

If a trauma patient arrives intubated,

A

always check ETT placement via breath sounds & capnometry

remember if hypotensive may not see a lot of CO2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Airway management techniques for the trauma patient include:

A

DL, bougie, video laryngoscopy, awake fiberoptic, RSI vs. MRSI, cricoid pressure??- can sometimes impede visualization & ventilation, manual in line cervical stabilization, surgical cricothyrotomy/trach

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Indication for ETT intubation includes:

A

cardiac or respiratory arrest
respiratory insufficiency/deteriorating condition
airway protection
need for deep sedation or analgesia (pain control)
GCS <8
delivery of 100% FiO2 in presence of carbon monoxide poisoning
facilitate work-up in an uncooperative or intoxicated patient
transient hyperventilation required

28
Q

Describe considerations with a tracheotomy over a cricothyroidotomy.

A

takes longer to perform

requires neck extension which may cause extended neck trauma if cervical injury is present

29
Q

Describe considerations with a cricothyroidotomy over a tracheotomy.

A

is contraindicated in those younger than 12 years old

laryngeal damage precludes the ability to perform a cricothyroidotomy

30
Q

A surgical cricothyroidotomy can be used for

A

up to 72 hours then must be converted to a tracheotomy

31
Q

A cricothyrotomy will be considered when there is

A 
massive facial trauma/hemorrhage
supraglottic foreign body obstruction
angioneurotic edema
inhalational thermal injury
epiglottitis/croup
32
Q

______ is a consideration for ALL trauma patients and impacts AW intervention

A

full stomach*

-time not available to allow pharmacologic intervention to decrease gastric contents and acidity

33
Q

Safe technique for securing the airway for trauma patients includes:

A 
RSI with cricoid pressure & manual in-line stabilization (cricoid pressure no longer a class I recommendation)
awake intubation with topical anesthesia (consider loss of protective reflexes) and sedation
LMA use is contraindicated as a definitive airway
34
Q

________ use is contraindicated* as a definitive airway

A

LMA

35
Q

Describe the induction agents that may potentially be used and their dosages.

A

etomidate: 0.2-0.3 mg/kg IV
ketamine 2-4 mg/kg IV
ketamine 4-10 mg/kg IM
propofol 2 mg/kg IV

36
Q

Describe the neuromuscular blocking drugs.

A

succinylcholine 1-1.5 mg/kg IV
-30 sec onset, fasciculate, 5-12 min. duration
rocuronium 1.2 mg/kg IV
-30-60 sec onset, may need gentle mask vent (MRSI), 60-90 min. duration

37
Q

There is a high suspicion for cervical injury if victim has experienced:

A

a fall
MVA
diving accident

38
Q

Cervical spine injuries & AW management include:

A

semi-rigid collar, sandbags, and backboard provide best stabilization
manual inline stabilization best for AW management
stabilization is maintained until cervical injury is ruled out
orotracheal intubation is most desirable

39
Q

Ruling out need for cervical stabilization includes:

A

XR of cervical spine that is clean &

pt cannot be obtunded or under the influence of drugs or alcohol and must be able to say they are not having pain

40
Q

With head, open eye, & major vessel injuries, ensure that

A

adequate oxygenation and ventilation occur

deep anesthesia & profound relaxation prior to airway manipulation & intubation

41
Q

Without sufficient depth of anesthesia, patients with head, open eye, or major vessel injuries:

A

hypertension
coughing/bucking
increased ICP, IOP, & intravascular pressure

42
Q

Describe considerations with maxillofacial injuries & AW managmenet:

A

bloody & debris in the oropharyngeal cavity may predispose the patient to- complete or partial AW obstruction
aspiration of teeth or foreign bodies
serious AW compromise may present within a few hours of penetrating facial trauma
consider limitation of mandibular movement and trismus
AW management technique is based on the presenting condition

43
Q

Cervical airway injuries may result from

A

blunt or penetration trauma

44
Q

With cervical airway injuries, intubation of the trachea should be with a

A

fiberoptic scope or AW should be established surgically

45
Q

Damage from a penetrating injury to the cervical spine depends on 3 interactive factors:

A

type of wounding instrument
velocity at time of impact
characteristics of tissue thru which it passes

46
Q

Clinical signs of penetrating injury include

A

escape of air, hemoptysis, and coughing

47
Q

Blunt injury may result from

A

direct impact, deceleration, shearing, and rotary forces- laryngotracheal damage

48
Q

Clinical signs of blunt injury include

A

hoarseness, muffled voice, dyspnea, stridor, dysphagia, cervical pain & tenderness, flattening of the thyroid cartilage

49
Q

Factors that alter respiration and interfere with breathing and pulmonary gas exchange after trauma include:

A 
tension pneumothorax
flail chest
open pneumothorax
hemothorax
pulmonary contusion
diaphragmatic rupture
chest wall splinting
50
Q

A hemothorax is

A

presence of blood in pleural cavity

51
Q

Hallmark symptoms of a hemothorax include

A

hypotension, hypoxemia, tachycardia, increased CV

52
Q

Anesthetic considerations for a patient with a hemothorax include

A

may need 1 lung ventilation

intubate first with a regular tube

53
Q

The treatment for a hemothorax includes

A

eliminate and correct problem

-will likely need a chest tube

54
Q

A pneumothorax is a

A

disruption of the parietal or visceral pleura- presence of gas within the pleural space

55
Q

Pneumothorax types include

A

simple
communicating
tension- requires needle decompression

56
Q

Treatment for a pneumothorax is a

A

chest tube if pneumothorax >20% lung collapse

57
Q

A tension pneumothorax occurs with

A

rib fractures and barotrauma due to mechanical ventilation

58
Q

Hallmark symptoms of a tension pneumothorax include

A

hypotension, hypoxemia, tachycardia, increased CVP, tracheal deviation, diminished BS on the affected side

59
Q

Decompression of a tension pneumothorax occurs by

A

16G or bigger needle between 2nd and 3rd rib on midclavicular line

60
Q

Flail chest results from

A

comminuted fractures of at least 3 ribs
rib fractures associated with costrochondral separation
sternal fracture

61
Q

A flail chest may result in

A

respiratory insufficiency and hypoxemia over several hours with deterioration of CXR and ABG

62
Q

The treatment for flail chest is

A

consider pain management (intercostal blocks, give oxygen, CPAP or Bipap) over mechanical ventilation

63
Q

Hemorrhage is the most common cause of

A

traumatic hypotension and shock in trauma patients

64
Q

Circulatory failure leads to

A

inadequate vital organ perfusion and oxygen delivery

65
Q

Resuscitation in the circulatory shock state refers to the

A

restoration of normal circulating blood volume, normal vascular tone, and normal tissue perfusion

Advanced Principles 2 (42 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions