Trauma & Perioperative Care

Question 1

What is “Damage Control Recussitation” regarding trauma?

Answer 1

Goal SBP 80-90; hemostasis. Improved outcomes prior to OR.

Question 2

What is best massive transfusion protocol ratio for trauam?

Answer 2

1:1:1

Question 3

Mechanism of action of Tranexamic Acid (TXA)?

Answer 3

Anti-fibrinolytic. Stops breakdown of clot. Improves mortality in trauma.

Question 4

Idarucizumab is reversal agent for what?

Answer 4

Dabigatran (Pradaxa). Idarucizumab is “Praxbind”.

Question 5

Reversal agent for Xa-inhibitors?

Answer 5

Andaxet Alfa (Andexxa). 2nd line is 4-PCC.

Question 6

How to manage misplaced chest tube in parenchyma?

Answer 6

place new tube in pleural space prior to removing old tube.

Question 7

Drugs causing malignant hyperthermia?

Answer 7

inhaled anesthetics (except N2O), and succinylcholine

Question 8

Sx (Malignant hypertermia)?

Answer 8

• w/in 90 minutes of drugs.
• Temp > 101.8.
• PaCo2 / EtCo2 > 60.
• Muscle rigidity.
• CK > 10,000.
• Tachycardia.

Question 9

Tx (Malignant hyperthermia)?

Answer 9

• Increase minute ventilation.
• Dantrolene. Repeat until sx better.
• IVF.
• MH hotline.
• Genetic testing for patient & family.

Question 10

In traumatic, extubated patients after abdominal surgery who become hypoxemic, how to treat?

Answer 10

NIPPV reduces reintubation rates