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6903 > trauma-spinal cord, ortho, abdominal injuries > Flashcards

trauma-spinal cord, ortho, abdominal injuries Flashcards

1
Q

Leading cause of death in spinal cord injuries?

A

aspiration pneumonia

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2
Q

6 conditions highly coordinated with spinal cord injuries/

A

paralysis, pain, position, paresthesias, ptosis, priapism

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3
Q

Is there a way to reverse the initial CNS damage in sc pts?

A

no

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4
Q

Most common avoidable complications in sc injury pts contributing to further damage?

A

ischemia d/t hypoexmia, hypotension, tissue swelling, delay in treatment

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5
Q

What should the radiologic assessment of the sc victim include?

A

lateral and AP C spine, open mouth X ray, T spine, L spine

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6
Q

What view is necessary if C7 is not visualized?

A

swimmer’s view

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7
Q

Is spontaneous movement or response to pain indicative of only spinal cord injuries?

A

no-head injuries too

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8
Q

What type of exam should be included in the sc injury pt?

A

rectal exam

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9
Q

What is pentaplegia?

A

SCI at junction of brain stem and spinal cord, phrenic nerve paralysis

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10
Q

What is respiratory quadriplegia?

A

lesions at C2-C3, sparring the upper most cranial nerves, paralysis of phrenic nerve and nerves that innervate the accessory muscles of respiration

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11
Q

What do cervical lesions below C4 mean in relation for respirations?

A

partial ftning of phrenic nerve, so some degree of voluntary resp control, VC 20-25% of what they should be

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12
Q

What do cervical lesions below C6 mean for respiratory control?

A

full diaphragmatic control, accessory muscle can be affected and expansion of rib cage from accessory muscle accounts for 60% of TV

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13
Q

What is Ondine’s curse?

A

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

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14
Q

How long does spinal shock after a spinal cord injury last?

A

1-3 weeks

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15
Q

Acute SCI Shock: extent of hypotension is related to?

A

level of SCI and is more pronounced in cervical lesions

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16
Q

Why does hypotension occur in acute SCI shock?

A

loss of vascular tone and preload

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17
Q

Why is bradycardia noted in cervical regions?

A

predominance of vagal tone in cervical region

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18
Q

Where are the cardioaccelerator fibers?

A

T1-T4

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19
Q

What are some cardiac dysrythmias associated with acute SCI?

A

brady, p wave changes, increased PR intervals, ectopic beats, CHB

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20
Q

3 HD changes associated w acute SCI?

A

bradycardia, irregular respirations, hypotension

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21
Q

What type of SCI pt should you avoid suxxs in?

A

paraplegic

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22
Q

Suxxs is safe to use in SCI what days after injury?

A

4-7 days after

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23
Q

If traction is not in place, what must be done during airway management by one person?

A

head stabilization

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24
Q

If the pt has a partial neuro deficit or none, what do you have to keep in mind about intubation?

A

awake intubation desirable to neuro assess can be done again after intubation

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25
Q

Hypotension resolves usually how many hours after SCI?

A

48 hours

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26
Q

The most profound episodes of bradycardia happen on what days after the SCI?

A

3rd-5th post injury days

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27
Q

What is important to maintain flow to the sc?

A

maintain SBP

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28
Q

SCI should have what HD monitor?

A

art line

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29
Q

Lesions above what level abolish phrenic nerve ftn and require mech vent?

A

C4

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30
Q

C3-C4 pts can be weaned from vent, but are at risk for?

A

sleep apnea esp w suppressants

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31
Q

Lesions above T1 abolish what?

A

abdominal and intercostal muscle function

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32
Q

What respiratory parameters are decreased in lesions above T1?

A

VC 35-50%, residual volume, FEV1, inspiratory reserve, unable to cough effectively

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33
Q

Pts with SCI above T1 are prone to?

A

atelectasis, pneumonia, chronic hypoxemia

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34
Q

Why do you want to avoid high inspiratory pressures in SCI pt?

A

can decrease BP d/t poor venous return

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35
Q

Should you give preop narcs and sedation in SCI pt?

A

no

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36
Q

What is neurogenic pulmonary edema?

A

seen immediately after SCI, 2ndary to CNS insult causes pulmonary alveolar exudate and fluid accumulation

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37
Q

Conditions other than SCI that can cause neurogenic pulmonary edema?

A

stroke, increased ICP, seizures, tumors, intracerebral hemorrhage

38
Q

What is unique ab the SCI pt’s temp regulation?

A

poikilothermic (ambient temp) in the area below the lesion, they cannot sweat in that area either

39
Q

Why should you pass an OGT or NGT ASAP in a SCI pt?

A

prone to gastric distention

40
Q

A unifacet c spine is what?

A

cord is off one of its facets, a problem if the head is hyperextended

41
Q

Major site for post traumatic bleeding?

A

abdomen

42
Q

2 types of blunt trauma forces?

A

compression and deceleration

43
Q

What does deceleration do?

A

shearing and stretching of elements located between fixed and mobile structures

44
Q

What are the organs most often injured by blunt trauma?

A

solid organs

45
Q

Fracture of the lumbar spine can mean what in relation to the abdomen?

A

intra abdominal injury

46
Q

Abdomen is divided in to what four parts?

A

thoracic, peritoneal, retroperitoneal, pelvic spaces

47
Q

What does the intrathoracic abdomen include?

A

beneath the rib cage: diaphragm, liver, spleen, stomach

48
Q

During exhalation, the diaphragm ascends to?

A

third thoracic vertebra

49
Q

High abdominal injury often associated w what type of trauma?

A

blunt or penetrating to the lower chest

50
Q

The true abdomen is made of?

A

stomach, bladder when full, omentum, gravid uterus, sm/lg bowel

51
Q

At the end of inhalation, the liver and spleen go where?

A

pushed inferiorly by the diaphragm into the true abdomen

52
Q

Retroperitoneum includes what?

A

great vessels, kidneys, pancreas, ureters, 2nd/3rd portions of duodenum, some segments of colon

53
Q

Pelvic fractures often result in?

A

significant retroperitoneal hemmorrhage

54
Q

7 indications for exp lap?

A

unexplained hypotension or shock, uncontrolled hemorrhage, signs of peritonitis, GSW to abdomen, ruptured diaphragm, pneumoperitoneum on admission, evisceration of bowel or omentum

55
Q

5 clinical findings suggestive of liver injury?

A

fractures of right lower ribs, elevated right hemidiaphragm, right pleural effusion, PTX, RUQ tenderness

56
Q

This organ is frequently injured following penetrating trauma to the left thorax or abdomen?

A

spleen

57
Q

Clinical findings of spleen injury?

A

hypotension from hemorrhage, left lower rib fractures, LUQ tenderness or left shoulder pain

58
Q

This organ is usually injured as a result of an anteroposterior compression mechanism that crushes it against the spine?

A

pancreas

59
Q

Signs of pancreatic injury?

A

ileus, elevated amylase, burning epigastric and back pain, tenderness

60
Q

This organ is commonly injured during decel injuries with extensive bleeding into the retroperitoneal space?

A

kidneys

61
Q

Signs of kidney injury?

A

hematuria, fractures of lower ribs, flank pain and tenderness

62
Q

Blood in the mouth or NG is indicative of?

A

stomach injury

63
Q

Rapid onset of epigastric pain is indicative of?

A

stomach injury

64
Q

Duodenal injury may present as?

A

referred pain to the back

65
Q

Small bowel injury may only present as?

A

vague generalized pain

66
Q

Colon injury symptoms are related to?

A

spillage of bowel contents rather than blood loss

67
Q

In abdominal vascular injuries you want IVs where?

A

upper extremities

68
Q

Where do you not want to place a line in an abdominal trauma case?

A

saphenous vein, femoral venous bc of the possibility of IVC injury and the need for clamping

69
Q

Leading cause of nonobstetric death in women 14-44 years?

A

trauma

70
Q

Fetal mortality approaches what % in cases of maternal shock?

A

80

71
Q

If cardiac arrest occurs in the first half of gestation, CPR is for?

A

the mother

72
Q

After 24 weeks gestation, research suggests that what may improve the mother’s survival?

A

delivery

73
Q

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?

A

4 minutes; 5 minutes

74
Q

Early signs of VAE?

A

hypotension, changes in ETCO2

75
Q

VAE can result from?

A

pulmonary vascular or hepatobiliary injury

76
Q

You can minimize VAE risk by?

A

maintaining adequate fluid vol

77
Q

Frequent eval of what 3 things in trauma surgery pt?

A

base deficit, UO, hematocrit

78
Q

4 surgical interventions for abdominal surgery??

A

limit fluid according to needs to reduce bowel edema, avoid N20, optimize NMDR, limit blood loss, NG/OG to compress bowel

79
Q

3 labs you can monitor to help w blood loss during abdominal case?

A

coags, Ca, hct

80
Q

Keep CPP >?

A

70

81
Q

Be vigilant for what pulm complication during abdominal surgery?

A

PTX

82
Q

Is a femur fracture potential for large blood loss?

A

yes

83
Q

Where is the correct position for the padded peritoneal post?

A

between uninjured limb

84
Q

The unaffected limb that is elevated is at risk for?

A

hypoperfusion

85
Q

Fat emboli usually occurs within how many hours of trauma?

A

72

86
Q

S/s fat emboli?

A

change in mentation, petechiae, fat in urine or sputum, fat in TGLs, increased lipase, anemia, thrombocytopenia, stiff lungs with decreased VC late in course

87
Q

Tx for fat emboli?

A

supportive, increase FiO2, intubation, PEEP, steroids, heparin

88
Q

A closed reduction is emergent when?

A

it involves a joint dislocation

89
Q

Does a closed reduction require muscle relaxation?

A

YES!!

90
Q

How long of procedures are closed reductions?

A

short

6903 (12 decks)

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