Trauma

Question 1

What are the 3 areas of highest recall?

Answer 1

• CV
• OB
• Trauma

Question 2

5 criteria for C-Spine injury

Answer 2

• Neck Pain
• Severe distracting pain
• Neuro signs
• Intoxication
• LOC at scene

Question 3

What is the best way to intubate C-spine injury?

Answer 3

• Manual inline stabilization

- Glidescope

Question 4

Why should N2O be avoided in trauma situations?

Answer 4

-It accumulates in closed spaces

Question 5

N2O should not be used in what types of injuries?

Answer 5

• Pneumocephalus
• Pneumoperitoneum
• Pneumothorax

Question 6

Succs can increase what if administered after what 3 things?

Answer 6

• Potassium

- Burn, spinal cord or crush injury

Question 7

After massive transfusions patients can develop what?

Answer 7

• Metabolic alkalosis

- Hyperkalemia

Question 8

If transfusions exceeds 1 unit every 5 minutes, what can be seen?

Answer 8

-Cardiac depression due to hypocalcemia (calcium binds to citrate preservatives)

Question 9

Hemolytic reactions are recognized by what symptoms?

Answer 9

• Increased temp
• Tachycardia
• Hypotension
• Hemoglobinuremia
• Oozing

Question 10

Hypothermia problems

Answer 10

• Worsen acid base balance
• Coagulopathies
• Increase MI risk

Question 11

What is a common cause of bleeding after massive transfusion.

Answer 11

-Dilutional thrombocytopenia**

Question 12

Half life of crystalloid? Colloids?

Answer 12

• Crystalloid = 20-30 mins

- Colloids = 3-6 hours

Question 13

Lactated ringers is less likely to cause what when compared to NS?

Answer 13

-Hyperkalemic acidosis

Question 14

Calcium in LR makes it less compatible with what?

Answer 14

-Blood transfusions

Question 15

What type of solutions are contraindicated in trauma due to exacerbation of brain damage?

Answer 15

-Dextrose solutionns

Question 16

LR is slightly _____ and with large volumes can aggravate __________

Answer 16

• Hypotonic

- Ceberal edema

Question 17

Colloids are effective in rapidly restoring ___________

Answer 17

-Intravascular volumes

Question 18

What 2 colloids can cause coagulopathy?

Answer 18

-Dextran and hetastarch

Question 19

What type of blood can be released to the moribund trauma patient requiring immediate blood transfusion that has not been typed and crossed.

Answer 19

-Type O negative

Question 20

What factor decrease by 50% after 2 days in storage? And this decrease causes what?

Answer 20

• Factor VIII

- Dilutional thrombocytopenia

Question 21

Why does a hypovolemic patient need less IV anesthetic? Volatile agent?

Answer 21

• Smaller intravascular volume

- Decreased CO and increased ventilation

Question 22

Best induction agents for hypovolemic trauma patients?

Answer 22

• Ketamine

- Etomidate

Question 23

C-spine injury occurs in ___ of all trauma patients

Answer 23

-2%

Question 24

What is the definition of shock?

Answer 24

-Circulatory failure = inadequate organ perfusion and oxygenation

Question 25

What is cushing's triad?

Answer 25

- Hypertension - Bradycardia - Respiratory disturbances

Question 26

When is cushing's triad seen?

Answer 26

-Late signs preceded by brain herniation

Question 27

What type of meds would be avoided with suspected neuro exam?

Answer 27

- Sedatives | - Analgesia

Question 28

What type of meds produce pupillary dilation?

Answer 28

-Anticholinergics | robinol, sprivia, atrovent

Question 29

What triad is present with cardiac tamponade? and what are the symptoms?

Answer 29

- Beck's triad - Neck vein distension - Hypotension - Muffled heart tones

Question 30

Distended neck veins may signal _________, what med must be avoided?

Answer 30

- Pericardial tamponade | - Diprovan

Question 31

What is pulsus paradoxus?

Answer 31

-Decrease in at least 10mmHg of BP upon inhalation

Question 32

During a pericardialcentesis what should be monitored and for what?

Answer 32

- ECG | - Needle too far into myocardial tissue

Question 33

What is to be expected with abdominal trauma upon opening of the abdomen?

Answer 33

-Hypotension

Question 34

Pelvic fx can lead to what?

Answer 34

Hypovolemic shock

Question 35

How much blood loss can occur with femur fx?

Answer 35

-3 units

Question 36

What 3 things are seen with a fat embolism

Answer 36

- Elevated serum lipase - Fat in urine - Thrombocytopenia

Question 37

What should be avoided with extremity reattachment and GA?

Answer 37

-Shivering (reduces reperfusion)

Question 38

How is intracranial hypertension controlled?

Answer 38

- Fluid restrictions - Diuretics - Hypocapnia

Question 39

Hypertension or tachycardia and be treated during intubation with what drugs?

Answer 39

- Lidocaine | - Fentanyl

Question 40

What anesthetic agent increases intracranial pressure?

Answer 40

-Ketamine

Question 41

Mild hypothermia can assist in saving what?

Answer 41

-Brain tissue with a head injury

Question 42

Injury to which section of the spinal column can cause apnea?

Answer 42

-C3,4,5

Question 43

In relation to sensory block, where would the autonomic level be? Motor?

Answer 43

``` Autonomic = 2 above sensory Motor = 2 below sensory ```

Question 44

What is autonomic hyperreflexia?

Answer 44

-Reaction of the autonomic nervous system to overstimulation.

Question 45

Autonomic hyperreflexia signs.

Answer 45

- High BP - Change in HR - Skin color changes - Sweating

Question 46

How can a simple pneumo turn in to a tension pneumo?

Answer 46

-Positive pressure (bagging or vent)

Question 47

how would you treat a tension pneumo?

Answer 47

- 14 gauage needle @ 2nd intercostal space at midclavicular line. - Then chest tube

Question 48

How to treat hemothorax?

Answer 48

-Double lumen tube to isolate bleeding lung from healthy lung

Question 49

What is needed with ARDS?

Answer 49

- High gas flows | - High airway presures