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apa2 > Trauma Rupp > Flashcards

Trauma Rupp Flashcards

1
Q

three areas of highest recall?

A

Cardiovascular,
OB,
Trauma

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2
Q

5 criteria for potential cervical spine injury

A
  1. neck pain
  2. severe distracting pain
  3. any neurological signs and symptoms
  4. intoxication
  5. loss of consciousness at the scene
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3
Q

what is the best way to intubate a patient with a cervical spine injury?

A

Manual inline stabilization (MILS), Can be used with glide scope

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4
Q

What gas do you want to avoid in trauma patients?

A

N2O

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5
Q

What can N2O do in trauma patients?

A

Accumulate in closed spaces. Avoid in trauma patients with a pneumothorax, pneumocephalus, or pnuemoperitoneum.

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6
Q

What can succs do if administered 24 hours after a burn, spinal cord or crush injury?

A

increase potassium

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7
Q

what injuries can succs increase potassium level?

A

burn, spinal cord, or crush injury

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8
Q

what ph imbalance can postops have after massive transfusion?

A

metabolic alkalosis

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9
Q

what can happen if transfusion rate exceeds 1 unit every 5 minutes?

A

You can see cardiac depression caused by hypocalcemia

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10
Q

in an anesthetized patient-hemolytic reactions are recognized by

A 
increased temp,
tachycardia,
hypotension,
hemoglobinuria,
and oozing at the field
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11
Q

hypothermia in trauma can cause

A

worsen acid/base balance,
coagulopathies-plt sequestration and red blood cell deformities,
risking myocardial function

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12
Q

common cause of bleeding after massive transfusions is

A

dilutional thrombocytopenia

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13
Q

half life of crystalloids

A

20-30 minutes

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14
Q

half life of colloids

A

3-6 hours

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15
Q

Which is less likely to cause hyperkalemic acidosis? LR or NS?

A

lactated ringers

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16
Q

why is LR less compatible with blood transfusions?

A

calcium in the LR

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17
Q

Why are dextrose solutions contraindicated in trauma?

A

r/t it may exacerbate ischemic brain damage

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18
Q

LR is slightly ______ and with large volumes can _____ cerebral edema

A

hypotonic,

aggravate

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19
Q

What type of solutions are effective in restoring intravascular volumes?

A

colloids

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20
Q

Different types of colloids?

A

albumin,
dextran,
hetastarch,
dextran and hetastarch can cause coagulopathy

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21
Q

What blood type can be released immediately to the moribund patient without type and cross?

A

Type O negative

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22
Q

Factor ___ can decrease by ___% after two days in storage. ______ thrombocytopenia quickly develops when a patient is massively transfused.

A

VIII,
50%,
Diluational

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23
Q

With anesthetics, alveolar concentration is up in shock patients r/t

A

a decrease in CO and increased ventilation,

smaller intravascular volume so the intravenous anesthetics are exaggerated

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24
Q

Hypovolemic trauma patient induction patients

A

ketamine,

etomidate

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25
Q

what can cause hematuria?

A

injury to kidneys or lower urinary tract

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26
Q

what percentage of all trauma patients does cervical injury occur?

A

2%

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27
Q

Shock=

A

circulatory failure leading to inadequate vital organ perfusion and oxygen delivery

28
Q

Trauma patients think

A

ABC’s— theses patients are always at risk for aspirations

29
Q

Consider what in any trauma patient with an altered consciousness

A

a brain injury

30
Q

Signs of brain injury include

A

restlessness,
convulsions,
cranial nerve dysfunction (non reactive pupils)

31
Q

Scale used to assess brain injury?

A

Glasgow Coma Scale

32
Q

Cushing’s triad symptoms

A

hypertension,
bradycard,
respiratory disturbances
(triad are late signs and preceded by brain herniation)

33
Q

What type of meds induce pupillary dilation? important to know with brain injuries

A

anticholinergics meds (robinol, spiriva, atrovent)

34
Q

Avoid what meds in. brain injury to preserve exam?

A

sedatives or analgesics

35
Q

Cardiac tamponade-Beck’s Triad

A

neck vein distension,
hypotension,
muffled heart tones

36
Q

distended neck veins may signal pericardial tamponade and _____ can kill

A

diprivan

37
Q

pulsus paradoxus=

A

> 10mmHg decline on BP during spontaneous ventilation

38
Q

What should you watch for if a pericardialcentesis is done

A

watch for electrocardiographic changes when needle goes to far into myocardial tissue

39
Q

What can happen when they open the abdomen with ex lap in abdominal trauma?

A

HYPOTENSION-> need large IV and blood… fluid resuscitation

40
Q

Abdomen trauma usually involves…

A 
vascular,
hepatic,
splenic,
renal,
pelvis, 
(Remember hyperkalemia with massive transfusions)
41
Q

A femur fracture can mean how many units of blood loss?

A

3

42
Q

pelvic fractures can lead to _____ shock and ____ embolism risks with fractures

A

hypovolemic,

fat

43
Q

fat embolism labs

A

elevation of serum lipase,
fat in urine,
thrombocytopenia

44
Q

extremity reattachement if spinal or regional….

A

increases blood flow,

watch hypotension with decreases blood flow

45
Q

extremity reattachment if general….

A

keep warm,

avoid shivering on emergence to help perfusion

46
Q

facial fractures name degree

A

Lefort fractures 1-3

47
Q

how is intracranial hypertension controlled?

A

by fluid restrictions,
diuretics (mannitol),
hypocapnia (paCO2 26-30mmHg)

48
Q

what can treat htn and tachycardia during intubation?

A

lidocaine and or fentanyl

49
Q

what three things can control intracranial hypertension?

A

fluid restrictions,
diuretics (mannitol),
hypocapnia (paCO2 26-30mmHg)

50
Q

what anesthetic agent can increase intracranial pressure and want to avoid in ICP?

A

Ketamine

51
Q

_____ hypothermia can assist saving brain tissue in a head injury

A

Mild

52
Q

Cervical spine injury affecting the phrenic nerve

A

c3-c5

53
Q

cardiac accelerators spinal cord

A

T1-T4

54
Q

symptoms of spinal shock with high cord injury

A 
loss of sympathetic tone,
hypotension,
warm to the touch,
bradycardia,
areflexia,
GI atony
55
Q

Autonomic hyperreflexia is NOT associated in first ___ hours and ________ OK at this point

A

48,

succinylcholine

56
Q

what is autonomic hyperreflexia?

A

a reaction of the autonomic (involuntary) nervous system to overstimulation.

57
Q

Symptoms of autonomic hyperreflexia?

A

high blood pressure, change in heart rate, skin color changes (paleness, redness, blue-grey skin color), and excessive sweating.

58
Q

Pneumothorax can be _____ or _____

A

simple or tension

59
Q

a simple pneumothorax is

A

air in the parietal and visceral pleura. Lung collapse causes vent/perf mismatch and hypoxia

60
Q

Treatment of simple pneumo

A

chest tube 4th or 5th intercostal space

61
Q

tension pneumo is

A

air in pleural space trapped and increases with inspiration and not escape with expiration-see the tracheal shift

62
Q

what can turn a simple pneumo into a tension?

A

positive pressure (bagging or ventilator)

63
Q

treatment of tension pneumo

A

14 gauge needle at second intercostal space at midclavicular line then a chest tube like for a simple pneumo

64
Q

Endotracheal tube for hemothorax and why

A

double lumen tube to isolate bleeding lung from healthy lung

65
Q

Acute Respiratory Distress Syndrome causes

A 
Delayed lung response to trauma.
sepsis,
thoracic injury,
aspiration,
head injury,
fat emboli,
massive transfusion,
Mortality 50%
66
Q

How can ARDS manifest in OR and what to do

A

alarms on anesthesia machines, need a better ventilator with higher gas flows r/t their poor lung compliance.
Need high airway pressures.

apa2 (3 decks)

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