Term
| Differentiate between the 3 types of blast injuries: primary, secondary, and tertiary |
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Definition
Primary: injury due to change in pressure/pressure wave, affects air filled spaces
Secondary: objects in the pressure wave are thrown and cause injury, burns
Tertiary: body is actually thrown |
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Term
| True or False: bullets have a nearly perfect projectile and when penetrating the human body follow a straight path |
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Definition
| False: bullets do not have a perfect projectile and create damage by tumbling and yawing |
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Term
| Describe the energy transfer that occurs with bullet penetration |
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Definition
| The original energy carried with the bullet will expand out to tissues and create extensive damage |
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Term
| A top (maybe most) important priority for the CRNA when faced with a trauma patient in the OR is.......? |
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Definition
| RSI - assume a full stomach |
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Term
| If a patient was hypotensive in the ER what can be assumed? |
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Definition
| Internal injury has likely occured - ominous |
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Term
| The patient can sign consent if what three factors are present? |
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Definition
| Pt is A + O x3, has no neuro injury, and has no ETOH or narcotics on board |
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Term
| The patient cannot sign the consent, family is unavailable....who else can sign the consent (name 3 individuals) |
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Definition
| the surgeon, anesthesiologist, yourself (if surgeon puts note in chart identifying procedure as emergency) |
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Term
| How are cervical spine injuries cleared? |
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Definition
1. via radiology
2. physically - pt denies pain/numbness/tingling, etc. |
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Term
| A bony cervical fracture is not evident on the Xray - what else can cause an unstable neck? |
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Definition
| ligament injury in the neck area |
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Term
| What are basic airway management strategies for the patient with actual or suspected cervical spine injury? |
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Definition
NO head tilt - use jaw thrust
Oral airway is ok if no gag reflex
Nasal airway should not be placed in LeFort 2 or 3 |
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Term
| The patient has a facial fracture. You pull on the teeth and the upper teeth move. Is it likely that you can place a nasal tube? |
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Definition
| Yes - if only the upper teeth move, the patient probably has a LeFort I fracture |
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Term
| What are physical clues to avoid nasal tubes/intubation? |
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Definition
| CSF from the nose (or just clear fluid from nose that has not been ruled out), blood behind the tympanic membrane, periorbital edema, racoon eyes (hematoma), battle signs (ecchymosis behind ears) |
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Term
| If you are very careful and use excellent technique, you do not need to worry about disruption of the cervical spine when intubating |
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Definition
| False - this should always be a concern as all intubation techniques can cause cervical spine movement |
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Term
| Can you nasally intubate an awake, spontanteously breathing, cooperative patient? |
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Definition
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Term
| If a spinal injury does exist what is your technique of choice to secure the airway? What does it require? |
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Definition
Awake fiberoptic intubation, requires cooperative patient with adequate laryngeal-pharyngeal blockade
(note: many practitioners are beginning to use glidescope as blood can obscure fiberoptic scope view) |
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Term
| What is a limitation to use of glidescope in the trauma patient? |
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Definition
| Not likely to be able to ventilate without hyperextending the neck - patient requires full induction with heavy sedation |
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Term
| What are 2 contraindications to surgical airways? |
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Definition
| Tracheal injury, <12 years old |
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Term
| Why is cricothryroidotomy contraindicated in children <12 years of age |
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Definition
| Not in Gayle's notes, but I am surmising that it is because the cricothyroid membrane is a very tiny slit that is hard to find in younger children - any other thoughts? |
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Term
| You decide to do an awake intubation and anesthetize the airway with lidocaine. Your patient weights 90kg. What is your maximum dose? You are using 2% lido - what is your maximum volume? |
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Definition
| Max lido dose w/o epi: 4mg/kg so max dose is 360mg. Max volume: 18ml |
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