trauma-spinal cord, ortho, abdominal injuries Flashcards
Leading cause of death in spinal cord injuries?
aspiration pneumonia
6 conditions highly coordinated with spinal cord injuries/
paralysis, pain, position, paresthesias, ptosis, priapism
Is there a way to reverse the initial CNS damage in sc pts?
no
Most common avoidable complications in sc injury pts contributing to further damage?
ischemia d/t hypoexmia, hypotension, tissue swelling, delay in treatment
What should the radiologic assessment of the sc victim include?
lateral and AP C spine, open mouth X ray, T spine, L spine
What view is necessary if C7 is not visualized?
swimmer’s view
Is spontaneous movement or response to pain indicative of only spinal cord injuries?
no-head injuries too
What type of exam should be included in the sc injury pt?
rectal exam
What is pentaplegia?
SCI at junction of brain stem and spinal cord, phrenic nerve paralysis
What is respiratory quadriplegia?
lesions at C2-C3, sparring the upper most cranial nerves, paralysis of phrenic nerve and nerves that innervate the accessory muscles of respiration
What do cervical lesions below C4 mean in relation for respirations?
partial ftning of phrenic nerve, so some degree of voluntary resp control, VC 20-25% of what they should be
What do cervical lesions below C6 mean for respiratory control?
full diaphragmatic control, accessory muscle can be affected and expansion of rib cage from accessory muscle accounts for 60% of TV
What is Ondine’s curse?
spontaneous ventilation only occurs with voluntary effort so breathing ceases when sleeping, it occurs after surgical or traumatic injury to the spinal cord at level C2-C4
How long does spinal shock after a spinal cord injury last?
1-3 weeks
Acute SCI Shock: extent of hypotension is related to?
level of SCI and is more pronounced in cervical lesions
Why does hypotension occur in acute SCI shock?
loss of vascular tone and preload
Why is bradycardia noted in cervical regions?
predominance of vagal tone in cervical region
Where are the cardioaccelerator fibers?
T1-T4
What are some cardiac dysrythmias associated with acute SCI?
brady, p wave changes, increased PR intervals, ectopic beats, CHB
3 HD changes associated w acute SCI?
bradycardia, irregular respirations, hypotension
What type of SCI pt should you avoid suxxs in?
paraplegic
Suxxs is safe to use in SCI what days after injury?
4-7 days after
If traction is not in place, what must be done during airway management by one person?
head stabilization
If the pt has a partial neuro deficit or none, what do you have to keep in mind about intubation?
awake intubation desirable to neuro assess can be done again after intubation
Hypotension resolves usually how many hours after SCI?
48 hours
The most profound episodes of bradycardia happen on what days after the SCI?
3rd-5th post injury days
What is important to maintain flow to the sc?
maintain SBP
SCI should have what HD monitor?
art line
Lesions above what level abolish phrenic nerve ftn and require mech vent?
C4
C3-C4 pts can be weaned from vent, but are at risk for?
sleep apnea esp w suppressants
Lesions above T1 abolish what?
abdominal and intercostal muscle function
What respiratory parameters are decreased in lesions above T1?
VC 35-50%, residual volume, FEV1, inspiratory reserve, unable to cough effectively
Pts with SCI above T1 are prone to?
atelectasis, pneumonia, chronic hypoxemia
Why do you want to avoid high inspiratory pressures in SCI pt?
can decrease BP d/t poor venous return
Should you give preop narcs and sedation in SCI pt?
no
What is neurogenic pulmonary edema?
seen immediately after SCI, 2ndary to CNS insult causes pulmonary alveolar exudate and fluid accumulation
Conditions other than SCI that can cause neurogenic pulmonary edema?
stroke, increased ICP, seizures, tumors, intracerebral hemorrhage
What is unique ab the SCI pt’s temp regulation?
poikilothermic (ambient temp) in the area below the lesion, they cannot sweat in that area either
Why should you pass an OGT or NGT ASAP in a SCI pt?
prone to gastric distention
A unifacet c spine is what?
cord is off one of its facets, a problem if the head is hyperextended
Major site for post traumatic bleeding?
abdomen
2 types of blunt trauma forces?
compression and deceleration
What does deceleration do?
shearing and stretching of elements located between fixed and mobile structures
What are the organs most often injured by blunt trauma?
solid organs
Fracture of the lumbar spine can mean what in relation to the abdomen?
intra abdominal injury
Abdomen is divided in to what four parts?
thoracic, peritoneal, retroperitoneal, pelvic spaces
What does the intrathoracic abdomen include?
beneath the rib cage: diaphragm, liver, spleen, stomach
During exhalation, the diaphragm ascends to?
third thoracic vertebra
High abdominal injury often associated w what type of trauma?
blunt or penetrating to the lower chest
The true abdomen is made of?
stomach, bladder when full, omentum, gravid uterus, sm/lg bowel
At the end of inhalation, the liver and spleen go where?
pushed inferiorly by the diaphragm into the true abdomen
Retroperitoneum includes what?
great vessels, kidneys, pancreas, ureters, 2nd/3rd portions of duodenum, some segments of colon
Pelvic fractures often result in?
significant retroperitoneal hemmorrhage
7 indications for exp lap?
unexplained hypotension or shock, uncontrolled hemorrhage, signs of peritonitis, GSW to abdomen, ruptured diaphragm, pneumoperitoneum on admission, evisceration of bowel or omentum
5 clinical findings suggestive of liver injury?
fractures of right lower ribs, elevated right hemidiaphragm, right pleural effusion, PTX, RUQ tenderness
This organ is frequently injured following penetrating trauma to the left thorax or abdomen?
spleen
Clinical findings of spleen injury?
hypotension from hemorrhage, left lower rib fractures, LUQ tenderness or left shoulder pain
This organ is usually injured as a result of an anteroposterior compression mechanism that crushes it against the spine?
pancreas
Signs of pancreatic injury?
ileus, elevated amylase, burning epigastric and back pain, tenderness
This organ is commonly injured during decel injuries with extensive bleeding into the retroperitoneal space?
kidneys
Signs of kidney injury?
hematuria, fractures of lower ribs, flank pain and tenderness
Blood in the mouth or NG is indicative of?
stomach injury
Rapid onset of epigastric pain is indicative of?
stomach injury
Duodenal injury may present as?
referred pain to the back
Small bowel injury may only present as?
vague generalized pain
Colon injury symptoms are related to?
spillage of bowel contents rather than blood loss
In abdominal vascular injuries you want IVs where?
upper extremities
Where do you not want to place a line in an abdominal trauma case?
saphenous vein, femoral venous bc of the possibility of IVC injury and the need for clamping
Leading cause of nonobstetric death in women 14-44 years?
trauma
Fetal mortality approaches what % in cases of maternal shock?
80
If cardiac arrest occurs in the first half of gestation, CPR is for?
the mother
After 24 weeks gestation, research suggests that what may improve the mother’s survival?
delivery
Delivery of the baby by C section should be started w/in how many minutes of CPR and baby should be delivered at what minute?
4 minutes; 5 minutes
Early signs of VAE?
hypotension, changes in ETCO2
VAE can result from?
pulmonary vascular or hepatobiliary injury
You can minimize VAE risk by?
maintaining adequate fluid vol
Frequent eval of what 3 things in trauma surgery pt?
base deficit, UO, hematocrit
4 surgical interventions for abdominal surgery??
limit fluid according to needs to reduce bowel edema, avoid N20, optimize NMDR, limit blood loss, NG/OG to compress bowel
3 labs you can monitor to help w blood loss during abdominal case?
coags, Ca, hct
Keep CPP >?
70
Be vigilant for what pulm complication during abdominal surgery?
PTX
Is a femur fracture potential for large blood loss?
yes
Where is the correct position for the padded peritoneal post?
between uninjured limb
The unaffected limb that is elevated is at risk for?
hypoperfusion
Fat emboli usually occurs within how many hours of trauma?
72
S/s fat emboli?
change in mentation, petechiae, fat in urine or sputum, fat in TGLs, increased lipase, anemia, thrombocytopenia, stiff lungs with decreased VC late in course
Tx for fat emboli?
supportive, increase FiO2, intubation, PEEP, steroids, heparin
A closed reduction is emergent when?
it involves a joint dislocation
Does a closed reduction require muscle relaxation?
YES!!
How long of procedures are closed reductions?
short
