Week 11 - Trauma Anesthesia Flashcards
When does 50%, 30%, and 20% of death due to traumatic injury occur following injury?
50% of deaths occurs within one hour of the event (Golden hour) – airway obstruction, massive hemorrhage due to head injury or an injury to the “box”
30% occur 1 to 4 hours post injury – increased ICP from swelling or hemorrhage, continued uncontrolled hemorrhage
20% die within 1 week of injury – due to infection or sepsis
What is the key to providing care to the trauma patient?
Prioritization
- initial evaluation of pt is designed to be completed in 1 minute… is the pt:
- -dead, dying (black)
- -critically unstable (red)
- -stable but need of surgical intervention (yellow)
- -very stable may or may not need intervention (green)
What is the primary survey in trauma care?
Intended to assess the pt in one minute and alert the caregiver of critical life-threatening injuries that need to be addressed
-initially performed at the scene of the traumatic event but should be completed again upon arrival to hospital
What does the primary trauma survey assess?
- Airway (L.E.M.O.N - Look, Evaluate, Mallampati, Obstruction, Neck mobility)
- Breathing
- Circulation
- Disability or Deformity (stop major bleeding)
- Exposure (quick glance head to toe anterior and posterior of naked pt)
What is the goal of the primary trauma survey?
To identify those pts with critical injuries that need to be transported and treated immediately
i.e. airway obstruction, inadequate breathing, traumatic arrest, shock, head injury with decreased LOC
What is the secondary survey in trauma care?
Re-evaluates some things covered in the primary survey but assessed in more detail
Includes head to toe assessment with auscultation, palpation, and percussion to more specifically identify injuries and deformities in need of treatment
AMPLE: allergies, medications, past medical hx, last meal, events prior to injury
What is included in a secondary trauma survey?
- Maintain airway, breathing, and circulation
- Examines all body regions more closely
- Obtains a full set of vital signs
- Assess head/face
- Assess neck (assume c-spine instability)
- Assess thorax (palpate/percuss and auscultate
- Assess abdomen (palpate/percuss and auscultate)
- Assess extremities (deformities, deficits, pulses, splints)
- Full neuro exam
What are the different classifications of traumatic injuries?
- Gun shot wounds
- Blast injuries (explosion)
- Stab wounds
- Blunt trauma
What is the Golden Hour in trauma?
The time during which the traumatized patient in shock would probably survive if appropriately resuscitated
- time starts when the trauma occurs and includes ambulance response, ER, and OR time
- after 30 min the likelihood of surviving is only 50% and after one hour of “shock” there is only about 10% chance of survival
What is the stress response in a traumatic injury?
Injury and tissue hypo-perfusion activate the hypothalamic-pituitary-adrenal axis and the autonomic nervous system to cause the stress response – leads to increased levels of glucocorticoids and increased levels of circulating catecholamines – redistribution of blood from the periphery to heart and brain (can result in tissue damage if blood flow doesnt return to periphery in reasonable amount of time)
- normally this is controlled by anesthetic agents, analgesics, fluids, and airway management – metabolic and hemodynamic instability of trauma pt increase the need for control of the stress response via anesthesia
- goal is to establish and maintain metabolic and hemodynamic stability and control the acute stress response
What questions must be answered in the airway management of a trauma patient?
- Is there overt airway obstruction, hypopnea, or apnea requiring emergent intervention?
- Is there a possibility of delayed airway compromise?
- Is there a potential for difficult tracheal intubation or ventilation?
- Is there a Therapeutic indication for intubation?
- What are the potential risks associated with the planned airway management?
What are the stages of upper respiratory obstruction and the signs of symptoms of each stage?
Stage I (mild or potential obstruction): no stridor at rest, cough, hoarseness
Stage II (moderate): stridor on slight exertion, rib retraction w/ inspiration, nares dilation on inspiration, use of accessory muscles, indrawing of soft cervical tissue, tugging of jaw/trachea, dyspnea
Stage III (severe): stridor at rest, apprehension, restlessness, sweating, pallor, increased pulse and BP, dilated neck vessels
Stage IV (very severe): slowed respiration, hypotension, cyanosis, impaired consciousness
What is the definition of shock?
A clinical condition characterized by signs and symptoms which arise when the cardiac output is insufficient to fill the arterial system with blood under sufficient pressure to provide tissues and organs with adequate blood flow
*all forms of shock appear to be related to inadequate tissue perfusion
What are the different kinds of shock?
- Hypovolemic/Hemorrhagic Shock: due to loss of blood volume
- Cardiogenic Shock: due to loss of the ability to pump the blood volume
- Septic (vasogenic) Shock: due to a loss of the ability of blood vessels to constrict enough around the pumped blood volume to ensure tissue perfusion
- Neurogenic Shock: due to a loss of the CNS’s ability to control vascular tone
What types of shock does initial trauma treatment focus on?
Hypovolemic and Neurogenic Shock
*must remember that other shock states may also occur in trauma pts
