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Special Pop Exam 2 > Week 7: Trauma (Part 2) > Flashcards

Week 7: Trauma (Part 2) Flashcards

24-42

1
Q

Circulation:
Shock Classes

A
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2
Q

table 48-1
guidelines for management of traumatic shock

A
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3
Q

ACLS for
penetrating/blunt trauma
with no pulse

A
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4
Q

Primary Survey: Disability

A
  • Neuro Status
  • rapid assessment is necessary on arrival to ER
  • GCS
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5
Q

If the GCS <8

A

ETT

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6
Q

Which GCS score is reassuring and indicates the optimal level of consciousness?
Which score signifies a deep coma?

A

maximum score of 15
minimum score of 3

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7
Q

T/F:
Avoid Nitrous in trauma pts.

A

True

likely have injuries which would be worsened by nitrous

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8
Q

How to score GCS

A
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9
Q

How does AVPU correlate with GCS?

A

A = 15
V = 12-13
P = 5-6
U = 3

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10
Q

TERRIBLE for an injured brain

A

Hypoxia and Hypotension

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11
Q

MAP and SpO2 goals for TBI

A

MAP > 80mmHg
SpO2 > 92%

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12
Q

CPP Mgmt in TBI

A
  • Goal: maximize CPP
  • Mannitol/Furosemide to decrease ICP
  • Head Elevation
  • Isotonic/Hypertonic fluid resuscitation-may be prudent to avoid LR
  • NO COLLOIDS
  • TEMPORARY hyperventilation (prolonged worsens cerebral ischemia)
  • Sedation (to decrease CMRO2)
  • Imaging if hemodynamically stable, OR for simultaneous management/decompression
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13
Q

Can we give colloids in TBI?

A

NO

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14
Q

Management of Spinal Cord Injury

A
  • Focused neuro assessment
  • May be limited by distracting injuries, depressed mental status, sedation, etc
  • Immobilization until clinical or imaging clearance
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14
Q

The spine is like the brain in that…

A

hypotension and hypoxia are bad

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15
Q

Spinal shock

A
  • hypotension from vasodilation & bradycardia from unopposed vagal tone
  • May require inotropes/vasopressors
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16
Q

SCI
Catecholamine surge

A

may cause pulmonary edema

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17
Q

SCIs at ___ level or above likely impair respiration

A

C4

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18
Q

Are SCI pts at risk for aspiration? why?

A

Yes
Loss of gastric sphincter tone May increase risk of aspiration

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19
Q

Can we give steroids to SCI pts?

A

Steroids controversial- generally avoided

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20
Q

Surgery for SCI timeframe

A

Surgical intervention when able
<72 hours ideally

21
Q

T/F:
Rip the patients clothes off but give them warm blankets them bc we’re not perverts.

A

True

completely undress & expose so no injuries are missed. They should then be re-covered with warm blankets to limit the risk of hypothermia.

22
Q

Adjuncts to the Primary Survey:
ECG

A

eval dysrhythmias, STEMIs, PEA, and cardiac tamponade

23
Q

Foleys are good for fluid status monitoring but these C/I’s exist:

A

blood at the meatus
perineal ecchymosis
high-riding prostate

24
Q

Benefits of NGT/OGTs in trauma

A

decompress the stomach, reducing the risk of aspiration and limiting pressure on the thorax that a distended stomach can create

25
Q

Use an OGT instead of an NGT in these cases

A

avoid nasal insertion in the presence of facial trauma or concern for a basilar skull fracture.

26
Q

Why get a A chest X-ray ?

A

pneumothorax, hemothorax, or suspicion of an aortic injury

27
Q

Why get a pelvic X-ray?

A
  • evaluate for pelvic fractures
  • If an open book fracture is found, a pelvic binder is indicated to limit pelvic bleeding
28
Q

FAST Examination
“Focused Assessment with Sonography in Trauma”

A

identify free fluid in the abdomen suggestive of intra-abdominal bleeding or pericardial tamponade

29
Q

The Secondary Survey

A

indicated in ALL trauma patients who have had their primary surveys completed.

30
Q

purpose of the secondary survey

A
  • detailed history
  • perform a head-to-toe physical exam
  • reassess all vitals
  • pertinent lab and imaging studies to identify injuries and metabolic abnormalities.
31
Q

T/F:
The Primary Survey adresses injuries you may be managing later.

A

False
secondary survery

32
Q

Anesthetic Mgmt Goals

A
  • Airway
  • hemodynamic instability: hemorrhagic hypovolemic shock & its sequelae (coagulopathy, hemodilution, hypothermia, and electrolyte and acid-base derangements)
  • other etiologies of shock after trauma.
  • Lung-protective ventilation.
  • normothermia.
  • adequate cerebral blood flow, oxygenation, and ventilation
  • Prevention of unpleasant experiences during painful intervention
33
Q

Preop Evaluation

A
  • Thorough?
  • Focused?
  • None?
34
Q

If you’re able to do a focused preop eval, what do u include?

A
  • Allergies
  • Problems with Anesthesia
  • Medical Problems
  • Heart Problems?
35
Q

Anesthetic induction and maintenance agents with minimal _____ effects are selected

A

hemodynamic

36
Q

doses are …. to avoid exacerbation of hypotension

A

reduced and carefully titrated

37
Q

T/F:
No induction may be necessary in comatose patients

A

True

38
Q

rapid sequence induction and intubation
(RSII)

A
  • either etomidate or ketamine is typical
  • propofol is avoided or reduced dose if hypotensive
39
Q

Roc & Succ doses for RSII

A

Succinylcholine 1.5 mg/kg
rocuronium 1.2 mg/kg

40
Q

Airway algorithm

A
41
Q

rapidly inserted instead of or in addition to a CVC

A
  • Large-bore peripheral IV
  • 16 G or larger
42
Q

Yes, appropriate IV access is important, but…

A

Placement should not unduly delay emergency surgical intervention

43
Q

most hemodynamically unstable trauma patients undergoing general anesthesia will get …. in addition to standard ASA monitors

A

A-line and CVC

44
Q

T/F:
IO access can be used for blood, fluids, and medications.

A

True

45
Q

T/F:
IO access is rapid and reliable if unable to secure a good IV.

A

True

46
Q

Which increases IV catheter flow more? Length or radius?

A

radius

Pousielle’s Law

47
Q

comparitive flow rates between catheters

A
48
Q

Using volatile agents

A
  • commonly selected, often at reduced doses
  • Increased concentration as hemodynamics allow
  • < .5 MAC if TBI suspected
  • Nitrous avoided
49
Q

Adjuncts for amnesia

A
  • Benzo’s
  • Ketamine
  • Scopalamine
  • Opioid (Carefully titrated)

Special Pop Exam 2 (3 decks)

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