Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Advanced Principles 2 > Trauma part 2 > Flashcards

Trauma part 2 Flashcards

1
Q

Initial response to shock is mediated by

A

the neuroendocrine system

  • hypotension leads to vasoconstriction & catecholamine release
  • heart, kidney, and brain blood flow is preserved while other regional beds are constricted
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Hypotension in the state of shock leads to

A

vasoconstriction and catecholamine release

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

___________ blood flow is preserved while other regional beds are constricted.

A

Heart, kidney, & brain blood flow

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

Traumatic injuries lead to a release in

A

hormones that set the stage for microcirculatory response

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

Ischemic cells response to hemorrhage by taking up

A

interstitial fluid & depleting intravascular volume & producing lactate & free radicals

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

Inadequate organ perfusion interferes with

A

aerobic metabolism–> producing lactic acid & metabolic acidosis

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

_______ accumulate in the circulation while perfusion is diminished

A

lactate & free radicals

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

Lactate & free radicals can cause:

A

direct damage to cell

a toxic load that will be washed into circulation once re-established

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

Ischemic cells also produce inflammatory factors

A

(leukotrienes, interleukins, etc.)

  • systemic inflammatory process
  • becomes a disease process unto itself
  • lays the foundation for multiple organ failure and nigh mortality rates
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

_______ temporarily maintain perfusion to vital organs

A

catecholamine release, regional vasoconstriction (adrenal/neuroendocrine)

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

The cellular response to shock includes:

A

uptake interstitial fluid–> swell
swelling may cause obstruction of capillaries–> no perfusion
this may inhibit reversal of ischemia
ischemic cells produce lactate, free radicals, and inflammatory mediators

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

In response to pain & hemorrhage, the following hormones are released:

A 
renin/angiotensin
vasopressin
ADH
growth hormone
glucagon
cortisol 
epi/norepi
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Describe the CNS response to shock.

A

responsible for maintaining blood flow to heart, kidney, & brain at expense of other tissues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Describe the kidney/adrenal glands response to shock.

A

maintains GF during hypotension by selective vasoconstriction and concentration of blood flow in medulla and deep cortical areas

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

Describe the heart’s response to shock.

A

preserved via an increase in nutrient blood flow and cardiac function until later stages

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Describe the lung’s response to shock

A

the destination of inflammatory byproducts–> accumulate in capillary beds and results in ARDS. sentinel organ for the development of MOSF

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

Describe the Gut/intestinal response to shock.

A

one of the earliest organs affected by hypo-perfusion and may be trigger for MOSF

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

Resuscitation includes early treatment of

A

acute traumatic coagulopathy

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

Acute traumatic coagulopathy begins in the early presence of reduced clot strength

A

hypotension & tissue injury–> inflammatory response—> endothelial activation of protein C
-hyperfibrinolysis due to APC formation

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

Base deficit reflects the

A 
severity of shock
oxygen debt
changes in O2 delivery
adequacy of fluid resuscitation 
likelihood of multi-organ failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Admission base deficit of _____ correlates with increased mortality

A

5-8 mmol/L

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

Describe the base deficit difference in mild, moderate, and severe shock.

A

mild: 2-5 mmol/L
moderate: 6-14 mmol/L
severe: greater than 14 mmol/L

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

Blood lactate level is

A

less specific than base deficit but nonetheless improtant

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

Elevated lactate levels correlate to

A

hypoperfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Normal plasma lactate level is
0.5-1.5 mmol/L and its half life is 3 hours
26
Plasma lactate levels above
5 mmol/L indicate significant lactic acidosis
27
Failure to clear lactate within
24 hours after reversal of shock is predictor of increased mortality
28
Symptoms of shock include
``` pallor diaphoresis agitation or obtundation hypotension tachycardia prolonged capillary refill diminished urine output narrowed pulse pressure ```
29
Assessment of systemic perfusion includes
``` vital signs urine output systemic acid-base status lactate clearance cardiac output mixed-venous oxygenation gastric tonometry tissue specific oxygenation stroke volume variation acoustic blood flow ```
30
Urine output in assessment of systemic perfusion may be
inaccurate due to diuretic therapy, intoxication, & renal injury
31
Systemic acid base status is
confounded by respiratory status
32
Cardiac output measurement requires
PA catheter/non invasive technology
33
Gastric tonometry needs
time to equilibrate, subject to artifact
34
Stroke volume variation is
an emerging technology, uses art line
35
Mixed- venous oxygenation is
an accurate marker, difficult to obtain
36
Goals for early resuscitation include
``` maintain SBP at 80-100 mmHg maintain hct at 25-30% maintain PTT and PT within normal range maintain platelet count >50,000 maintain normal serum ionized calcium maintain core temp >35 degrees C maintain function of pulse ox prevent increase in serum lactate prevent worsening acidosis adequate anesthesia/analgesia ```
37
Site for emergency intravenous access in order of desirability includes:
large bore IV's- AC vein other large bore IV sites subclavian vein- easiest to place and does not require neck manipulation in circumstance of cervical neck injury femoral vein- infection risk, belly full of blood indicates possible vascular damage so could end up dumping more blood into the stomach internal jugular vein intraosseous
38
Risks of aggressive volume replacement during early resuscitation includes
``` increased blood pressure decreased blood viscosity decreased hematocrit decreased clotting factor concentration greater transfusion requirement disruption of electrolyte balance direct immune suppression premature reperfusion ```
39
Resuscitation goals for anesthesia include:
``` oxygenate & ventilate restore organ perfusion restore homeostasis/repay "oxygen debt" treat coagulopathy restore the circulating volume continuous monitoring of the response ```
40
Resuscitation goals for surgery include:
STOP the bleeding
41
Goals for late resuscitation include:
maintain systolic blood pressure >100 mmHg maintain hematocrit above individual transfusion threshold normalize coagulation status normalize electrolyte balance normalize body temperature restore urine output maximize cardiac output by invasive/noninvasive monitoring reverse systemic acidosis document decrease in lactate to normal range
42
End point for resuscitation lab levels include
serum lactate level <2 mmol/L base deficit <3 gastric intramucosal pH >7.33
43
The four stops in management of shock include:
1. control the source of the hemorrhage 2. begin fluid resuscitation: isotonic crystalloids, hypertonic saline, colloids, PRBCs, & plasma 3. Possibly use Rapid infusing system (1500 cc/min.) 4. reasonable blood pressure (early resusc. 80-100 vs. late >100)
44
Describe the use of isotonic crystalloids:
monitor electrolytes & lactate will direct fluid therapy plasmalyte is a good option
45
Describe the use of hypertonic saline:
traumatic brain injury HS is used as an osmotic agent in the management of increased ICP
46
Describe the use of colloids:
rapid plasma volume expansion
47
Describe the use of FFP:
2 units of FFP with every 4 units of PRBC when massive transfusion is anticipated or ongoing
48
Describe the use of PRBCs:
provided to adequate oxygen carrying capacity- mainstay of hemorrhagic shock blood loss replacement: -1:1 with RBC 3:1 with crystalloid Rh negative blood is preferable if crossmatch is not complete (ABO & Rh) especially if woman of childbearing age
49
Damage control with hemostatic resuscitation includes
administration of set protocol of blood & hemostatic products to mimic whole blood massive transfusion protocol limited crystalloid
50
Goal directed therapy with hemostatic resuscitation includes:
utilizes "point of care" visoelastic (TEG) monitoring to direct therapy
51
Tranexamic acid is a
antifibrinolytic | -benefit when instituted within 1 hour of admission
52
Additional hemostatic agents include
recombinant activated human coagulation factor VII | it's expensive so not commonly kept on hand
53
Describe the lethal triad***
acidosis hypothermia coagulopathy
54
Principle goal of early management of the hemorrhaging trauma patient is
to avoid the development of the lethal triad
55
________ are major factors in the induction of coaguloapthy
acidosis & hypothermia
56
Resuscitation with fluids & PRBC without hemostasis properties can
dilute already dysfunctional platelets
57
Fluid inflation system is an
active mechanical pump that enables fluid administration rates up to 1500 mL/min.
58
The fluid inflation system is compatible with
crystalloid, colloid, PRBCs, washed salvaged blood & plasma
59
Additional facts regarding the fluid inflation system include:
reservoir allows for mixing of products in preparation for rapid blood loss fluids infused at a controlled temperature (38-40 C) able to pump simultaneously through multiple intravenous lines accurate recording of fluid volume administration portable enough to travel with patient between units
60
Hypothermia causes worsening of
``` acid base disorders coagulopathy myocardial function shifts oxygen-hgb curve to left decreases the metabolism of lactate, citrate, and some anesthetic drugs ```
61
Hypothermia results in
vasoconstriction*******; can ultimately make BP appear higher than volume status really is... BP may drop as patient warms
62
Hypothermia leads to
abnormal potassium and calcium homeostasis impairs platelet and clotting function left shift of oxygen dissociation curve- decreased tissue oxygenation
63
Combined disorders of platelet & clotting factors
massive transfusion causes dilution of factors and platelets | hypothermia slows coagulation and causes sequestering of platelets
64
At 29 degrees C _____ increase 50%
PT & PTT
65
At 29 degrees C _____ decrease 40%
platelets
66
Activation of the clotting cascade causes
consumption of clotting factors
67
Blood loss causes a loss of
clotting factors
68
_______ further dilutes clotting factors
Hemodilution
69
Severely injured trauma patients become
hypercoagulable
70
Treatment of coagulopathy includes
avoidance or reversal of the lethal triad judicious resuscitation... avoid hemodilution treat coagulopathies
71
Trauma disrupts the equilibrium between
hemostatic and fibrinolytic processes
72
Changes are complex and can either result in
hypercoagulable or hypocoagulable states
73
Avoidance or reversal of the lethal triad includes
control hemorrhage avoid/correct hypothermia actively re-warm

Advanced Principles 2 (42 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions