Trauma Surgery Flashcards
Where is the proper placement of IV access in
trauma patients with injuries to the superior or
inferior vena cava?
proximal to the vena caval disruptions
Nagelhout JJ, Zaglaniczny KL. Nurse Anesthesia. 4th ed.
Philadelphia, PA: WB Saunders Company; 2010: 881.
What is the most common cause of hypotension in
the trauma patient?
Hypovolemia. The most common causes of hypovolemia are
due to disruption from major vessels of the pelvis, chest and the
abdomen.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 919-921.
How is laryngoscopy performed in all trauma patients
that have confirmed or suspected c-spine injuries?
Laryngoscopy should be performed with the head in a neutral
position with in-line stabilization applied.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 971.
What are the three stages of shock?
- Compensated shock or nonprogressive shock 2. Progressive
shock 3. Irreversible shock
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 920.
What is the most common cause of coagulopathy in
the trauma patient?
dilutional thrombocytopenia
Longnecker DE, Newman MF, Brown DL, Zapol WM.
Anesthesiology. 2nd ed. New York: McGraw-Hill; 2012: 1352.
What is a common complication seen following longbone
fractures?
Hypoxic respiratory failure. This results from microembolization
of marrow fat into the venous circulation.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 927.
What is a common complication seen with patients
presenting for major trauma surgery?
Hypothermia. Open mesentery increases heat loss. Shock and
anesthesia also reduce heat production.
Longnecker DE, Newman MF, Brown DL, Zapol WM.
Anesthesiology. 2nd ed. New York: McGraw-Hill; 2012: 1359.
What induction agent is contraindicated in a trauma
patient with a possible head injury?
Ketamine increases ICP and should not be used in this patient
population.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 924.
Is nitrous oxide safe to use in acute trauma case
patients?
Nitrous oxide should be avoided in the acute trauma patient.
Nitrous oxide diffuses into closed spaces making it
contraindicated in patients with bowel injury, pneumothorax,
and patients with closed-head injuries. These conditions are
difficult to rule out in the acute setting and should be avoided.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 924.
A trauma patient presents with distended neck veins,
unilateral decreased breath sounds, hypotension
despite vigorous fluid resuscitation, subcutaneous
emphysema of the chest, diminished chest-wall
motion, and hyperresonance to percussion of one
hemithorax. What is the most probable diagnosis?
Tension pneumothorax. A tension pneumothorax is a life
threatening condition that creates a one-way valve of air flow
into the pleural cavity. Intrapleural pressure is increased with
every breath as more air is trapped within this space. Positivepressure
ventilation increases the size of a pneumothorax
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 916.
A trauma patient presents with a possible cribriform
plate injury. Is a nasal intubation an acceptible
technique for securing the airway?
No. The endotracheal tube can enter the brain vault during
intubation, therefore nasal intubation is contraindicated.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 971-972.
A patient with severe traumatic injuries is suspected
of also having ischemic brain damage. Which fluid
would be the least appropriate for fluid resuscitation?
In instances of possible ischemic brain damage, solutions
containing dextrose should be avoided as they could
exacerbate the ischemia. The only exception to this rule is if
hypoglycemia is documented.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 921.
An awake, but intoxicated patient suffered a midfacial
fracture as a result of a head-on motor vehicle
accident. What intubation technique would be
contraindicated after induction of this patient?
Nasal intubation is contraindicated in this case because of the
history of a mid-face fracture. It is also contraindicated in
patients with basilar skull fractures.
Longnecker DE, Newman MF, Brown DL, Zapol WM.
Anesthesiology. 2nd ed. New York: McGraw-Hill; 2012: 570.
A patient who has suffered major trauma exhibits
changes in his phonation during the interview. You
know that this may indicate an increased risk for:
A patient that exhibits changes in phonation may be suffering
from damage to the trachea and vocal structures. The
mechanism of injury may place the patient at risk for
neurological damage during airway instrumentation, resulting in
the need for a difficult airway plan to avoid damage to the
cervical spine. Changes in voice may also indicate recurrent
laryngeal nerve damage which can increase the risk of
aspiration.
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 736.
