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ZANDER CNOR > Trauma Surgery > Flashcards

Trauma Surgery Flashcards

1
Q

What is the first thing we prioritize with traumas?

A

cervical spine immediately above airway

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2
Q

How do we prioritize cervical spine with trauma?

A

c-spine immobilization

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3
Q

What is the second thing we prioritize with traumas?

A

airway obstruction

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4
Q

What should we anticipate with airway obstruction

A

anticipate tracheostomy for facial injury or upper airway edema

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5
Q

what do you need to perform an emergency trach?

A

trach tray

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6
Q

what kind of intubation do we want to do with trauma patients?

A

rapid sequence intubation

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7
Q

Why would we do rapid sequence intubation with airway obstruction?

A

because we are assuming they have a full stomach

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8
Q

What is the sequence of rapid sequence intubation?

A
  1. pre-oxygenation
  2. paralysis with induction
  3. placement with proof
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9
Q

What is a maneuver we might do to help with rapid sequence intubation?

A

cricoid pressure or sellik manneuver; push cricoid cartilage back to occlude the esophagus

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10
Q

What is the third thing we prioritize with traumas?

A

hemorrhage

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11
Q

Surgery is not what?

A

hemodynamically stabilizing to a trauma patient

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12
Q

Surgery is not hemodynamically stabilizing unless what?

A

unless the purpose is to stop the bleeding

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13
Q

What might you do if a patient is experiencing hemorrhage during surgery in order to prevent too much destabilization?

A

might do a staged procedure. Large procedure divided into smaller surgeries

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14
Q

Hemorrhage leads to what?

A

acidosis

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15
Q

What can uncorrected hemorrhage shock in trauma patients lead to?

A

profound metabolic acidosis

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16
Q

Profound metabolic acidosis leads to what 2 things?

A

1.interferes with blood clotting mechanisms
2. promotes coagulopathy and blood loss

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17
Q

Why is acidosis so bad for you? (5 things)?

A
  1. vasodilation
  2. myocardial depression
  3. hyperkalemia
  4. shift of oxyhemoglobin dissociation curve to the right - hemoglobin has lost affinity for oxygen molecule
  5. confusion, stupor
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18
Q

We want to identify what to help treat metabolic acidosis?

A

identify the cause of bleeding

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19
Q

Cause of bleeding can be what 2 things?

A

mechanical vs. non-mechanical bleeding

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20
Q

To reverse coagulopathies associated with metabolic acidosis what can we do?

A

warm patient

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21
Q

What kind of replacement do we want to do with metabolic acidosis?

A

blood, FFP, and platelet replacement

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22
Q

What should not be used to treat severe metabolic acidosis?

A

bicarb

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23
Q

If you do give bicarb for severe metabolic acidosis, what is it conditional of?

A

the ventilation needs to be adequate to remove the increased CO2 that is formed.

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24
Q

What is the fourth thing we prioritize with traumas?

A

cardiac tamponade

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25
Q

What is cardiac tamponade?

A

blood and fluid is accumulating around the heart in the pericardial sack.

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26
Q

What does cardiac tamponade prevents?

A

it prevents the ventricles from expanding, so the heart can’t have adequate cardiac output

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27
Q

What are 2 clinical signs of cardiac tamponade?

A
  1. jugular vein distention
  2. narrowing pulse pressures
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28
Q

What are the 2 actions we would take for emergent treatment of cardiac tamponade?

A
  1. pericardiocentesis
  2. prepare for a chest tube, sternotomy or thoracotomy according to direction
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29
Q

What do you need for a pericardiocentesis?

A

spinal needle and 60 cc syringe

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30
Q

How does a pericardiocentesis work?

A

insert spinal needle under the xiphoid process aiming for the left shoulder. Pull back on plunger on syringe and the fluid will begin to evacuate

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31
Q

What is the fifth thing we prioritize with traumas?

A

pneumothorax

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32
Q

What is the most severe pneumothorax?

A

tension pneumothorax

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33
Q

What kind of physiology is shifted in pneumothorax?

A

mediastinal physiology

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34
Q

Are pneumo’s life threatening?

A

yes

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35
Q

What kind of injury is pneumothorax?

A

closed chest injury to the lung usually caused by blunt force trauma

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36
Q

What is happening with pneumothorax from a physiology perspective?

A

Every time the patient inhales air is trapped in the pleural space, they can’t exhale. The lung becomes more and more compressed

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37
Q

What are we going to do to do to help a pneumothorax?

A

needle the chest.

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38
Q

What are the steps for a needle to the chest for a pneumothorax?

A
  1. Locate Midclavicular line 3rd rib down - angle of Louis. You follow that and go one below.
  2. You get a big fat angio catheter
  3. Punch in 3rd intercostal space midclavicular line
  4. pull stylet out
  5. get a chest tube setup
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39
Q

What is a sucking chest wound with pneumothorax?

A

penetrating injury (bubbles, gurgles)

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40
Q

What kind of involvement is there with sucking chest wound with pneumothroax?

A

vascular involvement

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41
Q

Besides fixing the vascular with a sucking chest wound, what are we going to place? why?

A

a chest tube to prevent a tension pneumothorax

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42
Q

What are 3 things we are going to do to help with placement of a chest tube?

A
  1. set up
  2. secure
  3. transport
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43
Q

What is the sixth thing we prioritize with traumas?

A

increased ICP

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44
Q

How do we know a patient has increased ICP?

A

cushing’s triad

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45
Q

What is cushing’s triad characterized as?

A
  1. increase in BP
  2. drop in HR
  3. neuro respiratory pattern (gasping neuro breathing)
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46
Q

What can you do to help drop the ICP?

A

hyperventilate them; drops their ICP - safety net

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47
Q

How does hyperventilating a patient decrease ICP?

A

clamp down the peripheral vascular system to help decrease cerebral blood flow

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48
Q

Because we can’t hyperventilate a patient too long, what are we looking to do in surgery?

A

evacuate fluid/blood

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49
Q

Prepare for what in surgery to help deal with ICP?

A

prepare for burr hole

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50
Q

What are 3 criteria you measured on for glasgow coma scale?

A

eye opening, verbal response, best motor response

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51
Q

What is the best score you can get on glasgow coma scale?

A

15

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52
Q

What does a dead person get on glasgow coma scale?

A

3 points

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53
Q

Spontaneous eye opening gets you a what on GCS?

A

4

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54
Q

Eye opening to speech gets you a what on the GCS?

A

3

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55
Q

Eye opening to pain gets you a what on GCS?

A

2

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56
Q

No eye opening gets you a what on GCS?

A

1

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57
Q

Oriented verbal response gets you a what on GCS?

A

5

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58
Q

Confused conversation for verbal response gets you a what on GCS?

A

4

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59
Q

inappropriate words for verbal response gets you a what on GCS?

A

3

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60
Q

incomprehensible words for verbal response gets you a what on GCS?

A

2

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61
Q

No words for verbal response gets you a what on GCS?

A

1

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62
Q

Obeying commands for motor responses gets you a what on GCS?

A

6

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63
Q

Localising pain for motor responses gets you a what on GCS?

A

5

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64
Q

Normal flexion for motor responses gets you a what on GCS?

A

4

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65
Q

abnormal flexion for best motor responses gets you a what?

A

3

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66
Q

extend for motor responses gets you a what on GCS?

A

2

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67
Q

no motor responses gets you a what on GCS?

A

1

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68
Q

What is the 7th thing we triage for in trauma surgery?

A

massive burns

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69
Q

What is the biggest issue with burns?

A

fluid deficit

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70
Q

What happens with fluid shifts on days 1 and 2 for burns?

A

fluid shifts cause hypovolemia

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71
Q

Where does the fluid shift in and out of for burns? day 1 and 2

A

intravascular to intersitial shift

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72
Q

What kind of electrolyte change is there on days 1 and 2 for burn patients?

A

hyperkalemia

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73
Q

Day 3 of having a massive burn is characterized by what kind of fluid shift?

A

fluid shifts back to vascular causing hemodilution

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74
Q

Day 3 of having a massive burn causes the fluid to shift from what to what?

A

interstitial to intravascular

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75
Q

What kind of electrolyte change is there on days 3 for burn patients?

A

hypokalemia

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76
Q

What kind of temperature changes do you see with burn patients? what interventions do we take?

A

hypothermia; so make the room warm and humid

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77
Q

Excision of tissue within how many hours of a burn?

78
Q

What kind of surgery is an excision of burn?

A

bloody, so prepare for transfusion

79
Q

Any burns that we are not working on need to be what to prevent insensible loss?

80
Q

Additional what commonly accompanies what with burns?

A

additional trauma

81
Q

What is the 8th thing we do in the order of triage?

A

spinal cord injury

82
Q

What do we want to do with spinal cord injuries?

A

stabilize the fracture

83
Q

how do we transport a spinal cord patient?

84
Q

What kind of effort is it to remove cervical collar?

A

team effort

85
Q

It is within a nursing scope of practice to remove a backboard from patient and remove a c collar if we have a what?

A

an order to remove it if their spine is clear

86
Q

What is there a loss of with spinal cord injuries?

A

loss of vascular tone from area of injury down

87
Q

Due to the loss of vascular tone with spinal cord injuries what happens?

A

vasodilation and peripheral pooling

88
Q

What is something you can do to help with vasodilation and peripheral pooling with loss of vascular tone?

A

drop the head of bed 5-10 degrees

89
Q

What are 3 interventions for neurogenic shock (not perfusing for a neuro reason)?

A
  1. place in trendelenbur
  2. vasopressors
  3. fluid replacement
90
Q

What is number 9 in triage order?

A

extremity injury

91
Q

Rapair an extremity injury with what 2 things?

A

supplies and equipment

92
Q

Monitor extremity injury for what?

A

compartment syndrome

93
Q

What is compartment syndrome?

A

hematoma and swelling of injury is occluding blood vessels, in which you then lose pulses

94
Q

Do we address extremity injuries sooner if we have compartment syndrome?

95
Q

How do we monitor for compartment syndrome?

A

check for cap refill and pulses of injured extremities under drapes

96
Q

What do you perform if swelling impedes blood flow with extremity injury?

A

fasciotomy

97
Q

Disaster drills are held at least how often?

A

twice a year

98
Q

One of the disaster drills needs to be a what? the other one?

A

fire drill; the other one can be a power outage, active shooter, mass casualty

99
Q

What is the very first thing you do when there is an internal or external disaster

A

COMMUNICATION; so
1. notify hospital departments
2. call in off duty staff
3. set up command center and triage

100
Q

Which patients go to surgery first in mass casualty?

A

red tag patients

101
Q

What are 3 characteristics of red tag patients?

A
  1. life threatening illness or injury
  2. lifesaving intervention required
  3. first to treat
102
Q

What are 3 characteristics of yellow tag patients or delay?

A
  1. serious but not life-threatening illness or injury
  2. delaying treatment will not affect outcome
  3. second to treat
103
Q

What is status of yellow tag?

104
Q

What is status of red tag?

105
Q

What are 3 characteristics of green tag patients?

A
  1. minor illness or injury
    2 walking wounded
  2. third to treat
106
Q

What is status of green tag?

107
Q

What is status of black tag?

108
Q

What are 3 characteristics of black tag patients?

A
  1. not expected to survive
  2. will receive comfort care
  3. may be upgraded to red if new resources permit treatment
109
Q

When administering blood what is the first priority?

A

blood conversation

110
Q

What are tolerated more now than in the past?

A

low hematocrits are now tolerated more now than in the past

111
Q

4x4 dry sponges hold about how much blood?

A

10 mL of blood

112
Q

dry ray techs hold about how much blood?

A

10-20 mL of blood

113
Q

dry lap sponges hold about how much blood?

A

100 mL of blood

114
Q

Pediatric cases should have what weighed for what?

A

sponges and gauze weighed for blood loss

115
Q

What is there a risk of transmission with blood transfusions?

A

transmission of hep B, hep C, and HIV

116
Q

What is there an increased risk of with banked blood?

A

risk of SSI (decreased oxygenation to the wound, because the red blood cells become cold and therefore cannot fit through the capillary bed normally.)

117
Q

The patient becomes immuno what after a transfusion? what is this known as?

A

immunosuppressed; otherwise known as TRIM - transfusion associated immunomodulation

118
Q

The more transfusions a patient gets the more what?

A

the more immunosuppressed they get

119
Q

What can happen to the lungs with blood transfusions?

A

transfusion-related acute lung injury

120
Q

FUN FACT: blood transfusions are the highest risk for SSI than any other factor

121
Q

If donor has antibodies, what can that cause post a transfusion?

A

incompatibility reaction

122
Q

We do not use what kind of patients to donate ffp?

A

women who have had children

123
Q

A type and screen is usually within how many minutes?

A

15 minutes

124
Q

What does a type and screen look for?

A

ABO and Rh factors only

125
Q

Type and crossmatch takes how long?

A

45 minutes

126
Q

What does a type and crossmatch test for?

A

several common antibody reactions between donor and recipient

127
Q

How does a type and crossmatch work?

A

takes 1 cc of pt blood per unit requested to do the cross-match

128
Q

Pt’s who are Rh+ can receive Rh what blood?

A

both Rh+ and Rh- blood

129
Q

Pt’s who are Rh- cannot receive Rh what blood?

130
Q

Rh- patients can be exposed to what only 1 time?

A

exposed to Rh factor one time without anything bad happening

131
Q

What are Rh- moms given within 72 hours of end of any pregnancy?

132
Q

What 2 times are moms given Rho gham?

A
  1. 20 weeks gestation
    2.within 72 hours of end of any pregnancy
133
Q

Does Type O have any antigens?

134
Q

Does Type A have any antigens?

A

A antigens

135
Q

Does Type B have any antigens?

A

B antigens

136
Q

Does type AB have any antigens?

A

yes A and B antigens

137
Q

What is universal donor?

A

O negative

138
Q

What is universal recipient?

139
Q

Autologous transfusions are defined by what 2 characteristics?

A
  1. patients own blood
  2. preoperative donation
140
Q

What do autologous transfusions eliminate the risk of?

A

eliminates risk of blood borne pathogens

141
Q

What is unique about autologous transfusion patients and SSI?

A

they are more prone to SSI because of the refrigeration of the blood

142
Q

Directed donor transfusions are characterized by what?

A

friends and family can donate for a patient

143
Q

Directed donor transfusions still go through what?

A

all the steps of public donation

144
Q

There is no statistically significant decrease in what for directed donor transfusions?

145
Q

Autotransfusion is what?

A

the quickest form of blood replacement in the case of an emergency

146
Q

What are 5 contraindications for blood salvage?

A
  1. dirty bowel
  2. clotting agents
  3. amniotic fluid
  4. bone cement
  5. malignancy
147
Q

Jehovah’s witness can accept what? If what?

A

can accept autotransfusion if they consider it an extension of their own circulatory system; if it disconnects from them and is stored elsewhere they can be excommunicated for that

148
Q

What is normovolemic hemodilution?

A

1-2 units of blood removed preoperatively

149
Q

With normovolemic hemodilution, what are we doing as we are taking blood from the patient?

A

volume replacement with crystalloids; 3 mL for every 1 mL they take off the patient

150
Q

Surgical bleeding in normovolemic hemodilution happens with what>

A

diluted blood

151
Q

You only have how long from taking the blood out of the patient to putting it back in them?

152
Q

units of blood in normovolemic hemodilution reinfused with what?

A

intact clotting factors

153
Q

Acute hemolytic reaction is a reaction to what?

A

antigen or antibody

154
Q

What are symptoms of acute hemolytic reaction?

A
  1. lumbar pain
  2. tightness in chest
  3. fever
  4. chills
  5. hemoglobinuria - dark urine
  6. shock
155
Q

Why is acute hemolytic reaction difficult to assess in surgery? (2 things)?

A
  1. sudden onset of uncontrolled surgical bleeding that is unexplained
  2. bleeding from non-surgical sites
156
Q

Non-hemolytic reaction is also known as what?

A

febrile reaction

157
Q

what is non-hemolytic or febrile reaction reaction to what?

A

reaction to antigen, WBC’s or Platelets

158
Q

What are s/sx of non-hemolytic or febrile reaction?

A
  1. fever
  2. chills
  3. headache
  4. back pain
159
Q

Transfusion associated circulatory overload (TACO) is just what?

A

fluid volume overload with massive transfusions

160
Q

What is the main s/sx of TACO?

A

noncardiac pulmonary edema

161
Q

What are s/sx of noncardiac pulmonary edema associated with TACO?

A

hives, cough, fever, chills, cyanosis, shock

162
Q

Noncardiac pulmonary edema is a reaction to what?

163
Q

Delayed hemolytic reaction is a more what?

A

mild reaction to antigens or antibodies

164
Q

What are 2 s/sx of delayed hemolytic reaction?

A
  1. jaundice
  2. anemia
165
Q

Uncross matched blood is otherwise known as what?

A

emergency release blood

166
Q

We only give uncross match blood in what situations?

A

life-threatening bleeding situations

167
Q

What do we want to draw early in uncross matched blood?

A

draw type and cross from patient early

168
Q

Use blood from who for uncross matched blood?

A

O negative donor

169
Q

What are 4 complications of massive transfusions?

A
  1. ARDS
  2. Coagulopathy
  3. hypothermia
  4. hypocalcemia
170
Q

What is the definition of massive transfusion?

A

10 units or more

171
Q

What in massive transfusions cases ARDS?

A

microaggregates lodge in the pulmonary bed

172
Q

Use a what for ARDS?

A

a micro aggregate filter on the blood tubing

173
Q

After every 4 units of packed cells during massive transfusion, pt. should be getting what?

A

platelets and FFP at minimum

174
Q

Banked blood is what that can cause hypothermia, so use what?

A

banked blood is refrigerated, so use warming devices

175
Q

Blood banked bags are lined with what?

A

citrite, which binds with patient’s circulating ionized calcium causing hypocalcemia

176
Q

Packed Red Blood Cells are what?

A

RBC’s in saline

177
Q

Packed RBC’s should only be given with what?

A

normal saline

178
Q

P RBC’s must be what? if not what happens?

A

must be ABO compatible, and if anything is mislabeled send it back to the blood bank

179
Q

Use what with Packed RBC’s?

A

blood warmer

180
Q

Platelets are pooled from how many donors?

A

5-10 donors

181
Q

Platelets are stored at what?

A

room temperature

182
Q

Platelets need what?

A

frequent gentle agitation

183
Q

What is platelet pharasis?

A

all from one donor; which is better for patients who are getting multiple transfusions so they desensitize more slowly

184
Q

FFP (Fresh Frozen Plasma) is what only?

A

plasma and clotting factors only

185
Q

FFP is used to what?

A

replenish missing coagulation factors (extrinsic clotting factors - VII)

186
Q

FFP reverses what in a hurry?

A

reverses the effects of coumadin (warfarin) in a hurry

187
Q

Cryoprecipitate contains what?

A

contains clotting factors (fibrinogen, Factors VIII and XIII and Von Willenbrand’s factor - intrinsic to the patient PTT)

188
Q

What is the reversal for heparin?

189
Q

What do you use to reverse coumadin (warfarin) and elequis?

A

FFP or vitamin K if you have time

190
Q

Cryoprecipitate is used to what?

A

prevent or control bleeding

ZANDER CNOR (15 decks)

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