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CNOR > Trauma Surgery > Flashcards

Trauma Surgery Flashcards

1
Q

When preparing for a trauma patient the perioperative nurse should include what three things in the trauma plan

A

Equipment, instruments and supplies that are
likely to be used

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2
Q

Decision scheme

A

An algorithm that guides EMS personnel through the following for decision points:
-Physiologic parameters
-Anatomic parameters
-Mechanism of injury
-Other special considerations

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3
Q

Which diagnostic procedure has the ability to be most specific when identifying a traumatic injury?

A

Computed tomography (CT) scan 
-can be used diagnostically or as a screening tool 

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4
Q

Trauma triage order- 1st

A

Cervical spine
C-spine immobilization top priority - immediately above airway

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5
Q

Trauma triage order- 2nd

A

Airway obstruction
-Anticipate tracheostomy for facial injury, or upper airway edema
-rapid sequence intubation
Pre-oxygenation
Paralysis with induction
Placement with proof
(Skip second pre-oxygenation after paralysis)

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6
Q

Trauma triage order- 3rd

A

Hemorrhage
-Surgery is not hemodynamically stabilizing to a trauma patient
-Unless the purpose is to stop the bleeding

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7
Q

What two things interrupt the clotting cascade?

A

Hypothermia
Acidosis

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8
Q

Causes of acidosis

A

-Hemorrhage
-Vasodilatation
-Myocardial depression
-Hyperkalemia
-Shift of oxyhemoglobin disassociation curve to the right (hemoglobin loses affinity for oxygen molecule)
-Confusion, stupor

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9
Q

Metabolic acidosis treatment options

A

-Identify cause of bleeding: mechanical versus non-mechanical
-Warm patient to reverse coagulopathies
-Blood, FFP, and platelet replacement
-Bicarb should not be used to treat severe metabolic acidosis unless the ventilation is adequate to remove increased CO2 that is formed

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10
Q

Trauma triage order- 4th

A

Cardiac tamponade
-Fluid around heart prevents cardiac adequate output
-S/s: Jugular vein distention, narrowing pulse pressure (ex:97/85)

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11
Q

Treatment for cardiac tamponade

A

-Emergent treatment
-Pericardiocentesis: spinal needle and 60 ML syringe
-Prepare for a chest tube, sternotomy or thoracotomy according to direction

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12
Q

Trauma triage order- 5th

A

Pneumothorax (tension)
-All mediastinal physiology is shifted
-Closed chest injury to the lung (usually broken rib punctures lung)
-Needle the chest (midclavicular, third intercostal space)

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13
Q

Pneumothorax, sucking chest wound is from

A

From penetrating wound (stab, bullet)
-Chest tube

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14
Q

Trauma triage order: 6th

A

Increased ICP
-Cushing’s syndrome or triad (increased BP and drop in HR)
-Hyperventilate
-Evacuate fluid/blood: prepare for burr hole

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15
Q

Neuro assessment tool

A

Glasgow coma scale
-Evaluates eye-opening, verbal response, motor response
-High score= oriented, awake 15/15

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16
Q

Trauma triage order- 7th

A

Burns
-Fluid deficit biggest issue
Days 1&2: fluid shifts cause hypovolemia (intravascular to interstitial shift), hyperkalemia
Day 3: fluid shifts back to vascular causing hemodilution (interstitial to intravascular shift), hypokalemia
-Debridement of burnt tissue 72 hours later

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17
Q

Trauma triage order- 8th

A

Spinal cord injury
-Stabilize the fracture
-loss of vascular tone from injury down
-vasodilation and peripheral pooling
-Neurogenic shock

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18
Q

Treatment for neurogenic shock

A

-place in Trendelenburg
-Vasopressors
-Fluid replacement

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19
Q

Trauma triage order- 9th

A

Extremity injury
-Monitor for compartment syndrome (blood flow occluded to part of body)
Check for cap refill, and pulses of injured extremity under drapes
-Fasciotomy of swelling impedes blood flow

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20
Q

Actions upon receiving word of mass casualty

A

-notify hospital departments
-Call in off duty staff
-Set up command center and triage

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21
Q

Red tag

A

Immediate status, go to surgery first
-life-threatening illness or injury
-Lifesaving intervention required

22
Q

Yellow tag

A

Delayed status
-Serious but not life-threatening illness or injury
-Delaying treatment will not affect outcome
-Second to treat

23
Q

Green tag

A

Minimal status
-Minor illness or injury
-Walking wounded
-Third to treat

24
Q

Black tag

A

Expectant status
-Not expected to survive
-Will receive comfort care
-May be upgraded to red if new resources permit treatment

25
Q

Estimated blood loss on 4x4

A

10 ml

26
Q

Estimated blood loss on ray-tech

A

10-20 ml

27
Q

Estimated blood loss on lap sponges

A

100 ml

28
Q

Risk of blood transfusions: transfusion associated immunomodulation (TRIM)

A

Patient immunosuppressed for about one year

29
Q

Risk of blood transfusions: transfusion related acute lung injury (TRALI)

A

Donors blood allergic to patients blood

30
Q

Who is universal blood donor?

A

O-

31
Q

Who is universal blood recipient?

A

AB+

32
Q

Why can’t patients who are Rh negative receive Rh positive blood?

A

Can receive once, then develop antibodies
Women get Rogen within 72 hours of any end of pregnancy

33
Q

Autologous transfusions

A

-patient’s own blood
-Preoperative donation
-Eliminates risk blood-borne pathogens

34
Q

Blood salvage

A

A.k.a. Cellsaver
Autotransfusion- quickest form of blood replacement in the case of an emergency

35
Q

Contraindications for autotransfusion

A

-Dirty bowel
-Clouding agents
-Amniotic fluid
-Bone cement
-Malignancy

36
Q

Normovolemic hemodilution

A
  • 1-2 units of blood removed preoperatively
    -Volume replacement with crystalloids (3 ml for every 1 ml blood)
    -Surgical bleeding happens with diluted blood
    -Units reinfused with intact clotting factors
    -4 hour window from start to finish
37
Q

Acute hemolytic reaction

A

-Reaction to antigen or antibody
-Symptoms: lumbar pain, tightness in chest, fever, chills, hemoglobinuria, shock
-Difficult to assess in surgery
-Sudden onset of uncontrolled surgical bleeding that is unexplained
-Bleeding from non-surgical sites

38
Q

Non-hemolytic transfusion reaction (febrile reaction)

A

-reaction to antigen, WBCs, or platelets
-No bleeding signs and symptoms
-Fever, chills, headache, back pain

39
Q

Transfusion associated circulatory overload (TACO)

A

-non-cardiac pulmonary edema
-Gave too much blood
-Reaction to antigen
-Hives, cough, fever, chills, cyanosis, shock

40
Q

Massive transfusion

A

10 units of packed cells or more in 24 hours
Three units in one hour

41
Q

Massive transfusion adverse effects

A

-ARDS (acute respiratory distress syndrome): Microaggregates lodge in the pulmonary bed (use a microaggregate filter)
-Coagulopathy: replace clotting factor after four units (FFP and platelets)
-Hypothermia: use a warming device on blood
-Hypocalcemia: citrate from blood bank bags binds patient’s circulating calcium

42
Q

Platelets

A

-pooled from 5 to 10 donors
-stored at room temperature
-needs frequent gentle agitation

43
Q

Platelet pheresis

A

Single donor

44
Q

Fresh frozen plasma

A

Plasma (volume) and clotting factors
-Used to replenish missing coagulating factors
-Reverse the effect of Coumadin in a hurry

45
Q

What is the reversal for heparin?

A

Protamine

46
Q

Cryoprecipitate

A

Contains clotting factors
-Fibrinogen, factors VIII and XIII
-von Willebrand’s factor (for someone with Von Willebrand’s disease)
-Used to prevent or control bleeding

47
Q

Blunt trauma

A

From forces (acceleration, deceleration, shearing, compression)
-no break in skin integrity
-ex: MVA, high contact sports, assault, falls

48
Q

Penetrating trauma

A

Foreign object passes through skin tissue
-Resulting injury to tissues/organs
-most often: liver, intestines, vessels
-ex: stabbing, GSW, impaled
-Leave object in place, may be preventing hemorrhage, remove in OR

49
Q

Primary blast trauma

A

Shockwave on body
-Lungs, stomach, intestines, tympanic membrane, large blood vessels

50
Q

Secondary blast trauma

A

Debris, sharpnel penetration, impact

51
Q

Tertiary blast trauma

A

Wind from blast
Moving the injured and debris

52
Q

Quaternary blast trauma

A

Complications from original blast injuries

CNOR (14 decks)

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