Trauma Rupp Flashcards
three areas of highest recall?
Cardiovascular,
OB,
Trauma
5 criteria for potential cervical spine injury
- neck pain
- severe distracting pain
- any neurological signs and symptoms
- intoxication
- loss of consciousness at the scene
what is the best way to intubate a patient with a cervical spine injury?
Manual inline stabilization (MILS), Can be used with glide scope
What gas do you want to avoid in trauma patients?
N2O
What can N2O do in trauma patients?
Accumulate in closed spaces. Avoid in trauma patients with a pneumothorax, pneumocephalus, or pnuemoperitoneum.
What can succs do if administered 24 hours after a burn, spinal cord or crush injury?
increase potassium
what injuries can succs increase potassium level?
burn, spinal cord, or crush injury
what ph imbalance can postops have after massive transfusion?
metabolic alkalosis
what can happen if transfusion rate exceeds 1 unit every 5 minutes?
You can see cardiac depression caused by hypocalcemia
in an anesthetized patient-hemolytic reactions are recognized by
increased temp, tachycardia, hypotension, hemoglobinuria, and oozing at the field
hypothermia in trauma can cause
worsen acid/base balance,
coagulopathies-plt sequestration and red blood cell deformities,
risking myocardial function
common cause of bleeding after massive transfusions is
dilutional thrombocytopenia
half life of crystalloids
20-30 minutes
half life of colloids
3-6 hours
Which is less likely to cause hyperkalemic acidosis? LR or NS?
lactated ringers
why is LR less compatible with blood transfusions?
calcium in the LR
Why are dextrose solutions contraindicated in trauma?
r/t it may exacerbate ischemic brain damage
LR is slightly ______ and with large volumes can _____ cerebral edema
hypotonic,
aggravate
What type of solutions are effective in restoring intravascular volumes?
colloids
Different types of colloids?
albumin,
dextran,
hetastarch,
dextran and hetastarch can cause coagulopathy
What blood type can be released immediately to the moribund patient without type and cross?
Type O negative
Factor ___ can decrease by ___% after two days in storage. ______ thrombocytopenia quickly develops when a patient is massively transfused.
VIII,
50%,
Diluational
With anesthetics, alveolar concentration is up in shock patients r/t
a decrease in CO and increased ventilation,
smaller intravascular volume so the intravenous anesthetics are exaggerated
Hypovolemic trauma patient induction patients
ketamine,
etomidate
what can cause hematuria?
injury to kidneys or lower urinary tract
what percentage of all trauma patients does cervical injury occur?
2%
Shock=
circulatory failure leading to inadequate vital organ perfusion and oxygen delivery
Trauma patients think
ABC’s— theses patients are always at risk for aspirations
Consider what in any trauma patient with an altered consciousness
a brain injury
Signs of brain injury include
restlessness,
convulsions,
cranial nerve dysfunction (non reactive pupils)
Scale used to assess brain injury?
Glasgow Coma Scale
Cushing’s triad symptoms
hypertension,
bradycard,
respiratory disturbances
(triad are late signs and preceded by brain herniation)
What type of meds induce pupillary dilation? important to know with brain injuries
anticholinergics meds (robinol, spiriva, atrovent)
Avoid what meds in. brain injury to preserve exam?
sedatives or analgesics
Cardiac tamponade-Beck’s Triad
neck vein distension,
hypotension,
muffled heart tones
distended neck veins may signal pericardial tamponade and _____ can kill
diprivan
pulsus paradoxus=
> 10mmHg decline on BP during spontaneous ventilation
What should you watch for if a pericardialcentesis is done
watch for electrocardiographic changes when needle goes to far into myocardial tissue
What can happen when they open the abdomen with ex lap in abdominal trauma?
HYPOTENSION-> need large IV and blood… fluid resuscitation
Abdomen trauma usually involves…
vascular, hepatic, splenic, renal, pelvis, (Remember hyperkalemia with massive transfusions)
A femur fracture can mean how many units of blood loss?
3
pelvic fractures can lead to _____ shock and ____ embolism risks with fractures
hypovolemic,
fat
fat embolism labs
elevation of serum lipase,
fat in urine,
thrombocytopenia
extremity reattachement if spinal or regional….
increases blood flow,
watch hypotension with decreases blood flow
extremity reattachment if general….
keep warm,
avoid shivering on emergence to help perfusion
facial fractures name degree
Lefort fractures 1-3
how is intracranial hypertension controlled?
by fluid restrictions,
diuretics (mannitol),
hypocapnia (paCO2 26-30mmHg)
what can treat htn and tachycardia during intubation?
lidocaine and or fentanyl
what three things can control intracranial hypertension?
fluid restrictions,
diuretics (mannitol),
hypocapnia (paCO2 26-30mmHg)
what anesthetic agent can increase intracranial pressure and want to avoid in ICP?
Ketamine
_____ hypothermia can assist saving brain tissue in a head injury
Mild
Cervical spine injury affecting the phrenic nerve
c3-c5
cardiac accelerators spinal cord
T1-T4
symptoms of spinal shock with high cord injury
loss of sympathetic tone, hypotension, warm to the touch, bradycardia, areflexia, GI atony
Autonomic hyperreflexia is NOT associated in first ___ hours and ________ OK at this point
48,
succinylcholine
what is autonomic hyperreflexia?
a reaction of the autonomic (involuntary) nervous system to overstimulation.
Symptoms of autonomic hyperreflexia?
high blood pressure, change in heart rate, skin color changes (paleness, redness, blue-grey skin color), and excessive sweating.
Pneumothorax can be _____ or _____
simple or tension
a simple pneumothorax is
air in the parietal and visceral pleura. Lung collapse causes vent/perf mismatch and hypoxia
Treatment of simple pneumo
chest tube 4th or 5th intercostal space
tension pneumo is
air in pleural space trapped and increases with inspiration and not escape with expiration-see the tracheal shift
what can turn a simple pneumo into a tension?
positive pressure (bagging or ventilator)
treatment of tension pneumo
14 gauge needle at second intercostal space at midclavicular line then a chest tube like for a simple pneumo
Endotracheal tube for hemothorax and why
double lumen tube to isolate bleeding lung from healthy lung
Acute Respiratory Distress Syndrome causes
Delayed lung response to trauma. sepsis, thoracic injury, aspiration, head injury, fat emboli, massive transfusion, Mortality 50%
How can ARDS manifest in OR and what to do
alarms on anesthesia machines, need a better ventilator with higher gas flows r/t their poor lung compliance.
Need high airway pressures.
