Term
| The trauma patient is always assumed to have a_________. (hint: this term is related to intubation). |
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Definition
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Term
| What are 3 things you need to make sure of while intubating your trauma patient? |
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Definition
- RSIV w/ cricoid pressure (full stomach)
- immobilize the neck (inline mobiliztion)
- OG or NG after intubation
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Term
| The type of induction agent used can be an important choice for the anesthetist. More important than the specific agent however is the _______. |
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Definition
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Term
| The induction drug of choice in the ER is what? |
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Definition
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Term
| T or F: Small doses of narcotics should be used in the trauma patient. |
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Definition
| True. The trauma patient may be hypovolemic. Decreases in BP can be dramatic and refractory to pressors if the patient is hypovolemic and high doses of narcotics are used. |
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Term
| Trauma patients, specifically open globe injuries, severe head injuries, and patients with large vessel disruption, require a controlled, smooth induction because why? |
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Definition
| coughing, bucking, or intubation can cause spilling or intraoccular contents, brain herniation and hemorrhage from disrupted vessels. |
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Term
| You could technically use nitrous if you wanted to for the trauma patient. What's a damn good reason you might not want to though? |
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Definition
| They might have a pneumo that you don't know about-->and it'll for sure progress to a tension pneumo if you give them nitrous which diffuses like a mofo. |
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Term
| Gayle lists 6 monitors that you want for the trauma patient (Only 1 isn't really a total standard of care in every OR) what are they? |
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Definition
- pulse ox
- ekg (5 lead)
- BP cuff
- Temp
- ETCO2
- BIS
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Term
| Why is BIS a good idea for a trauma patient? |
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Definition
Trauma=increased risk for recall
- hypovolemia and/or limited cardiac reserve limits use of amnestic agents
- Patient safety vs. awareness protection (can be a tricky thing to manage and a BIS may help you do this)
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Term
| Give me a list of special equipment you may need to have in the room for your trauma patient. |
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Definition
- may need central line
- A-lines are STRONGLY recommended
- warmers
- rapid infuser/warmers
- specialty monitoring
- lab draw equipment
- crash meds
- arrest cart/external defibrillator
- internal defibrillator paddles
- autotransfusion equipment
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Term
| The main role of central lines (specifically a cordis) is for rapid fluid resuscitation. It can also be used to gauge the progress of fluid resuscitation via CVP measurements. What are a couple of things to remember when using central lines? |
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Definition
- If you have a cordis and need to use it for rapid fluid resuscitation DO NOT PUT A TRIPLE LUMEN IN IT!
• If you are using it to monitor your volume status, make sure you don’t take a measurement while you are infusing fluids!
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Term
| If you see subcutaneous air in your patient, what three areas of the upper airway may be injured? |
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Definition
- larynx
- trachea
- main bronchus
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Term
| Rib fractures are common in the trauma patient. Therefore, you should be looking for these symptoms which may indicated a pneumothorax: |
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Definition
• Severe V:Q mismatch→Decreased pO2 (hypoxia)
• Decreased breath sounds over affected area
• Hyperresonant lung sounds on percussion
• Seen on CXR as a collapsed lung
(according to other sources, you may also see subcutaneous emphysema with pneumo. What's listed above is just what Gayle said in her lecture.) |
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Term
| You miss the signs and symptoms of pneumothorax in your trauma patient and unwisely elect to use nitrous oxide. This quickly causes your pneumo to progress to a________. List the condition and its associated symptoms. |
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Definition
Tension pneumothorax.
• Distended neck veins
• Decreased SaO2 (worsening hypoxemia)
• Decreased pulmonary compliance (increased peak airway pressures)
• Tracheal deviation to unaffected side (good lung)
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Term
| How do you treat a tension pneumo? |
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Definition
• 100% FiO2 (note: this should be employed as well for a simple pneumothorax that has a chance to reabsorb because it will increase the rate of absorption of the pneumo. Because nitrogen is the primary gas in the pleural space, the gradient for nitrogen absorption into the blood is the main factor in determining the rate of reabsorption of a pneumo. Breathing 100% oxygen, which lowers the partial pressure of nitrogen in the blood, thereby increases the gradient for nitrogen absorption from the pleural space.)
• Insert 14-gauge (3-6 cm long) angiocath into the 2nd intercostal space, midclavicular line.
• Definitive treatment includes chest tube placement. (4th or 5th intercostal space in the anterior axillary or midaxillary line, directed apically).
This wasn't in her lecture-->she just mentioned it. |
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Term
| Flail chest compromises the integrity of the thorax. What happens to the flail segment during inspiration? Expiration? |
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Definition
| o Flail segment sinks in during inspiration and protrudes during expiration (paradoxical movement) |
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Term
| Paradoxical motion in flail chest greatly increases the work of breathing, however, the main cause of the hypoxemia is underlying lung contusion or even hemothorax. What might you have to do for the patient with hemothorax due to flail chest? |
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Definition
| Severe bleeding in one lung may require the use of a double lumen tube to isolate a lung and keep it from bleeding into the good lung. |
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Term
| You know Beck's triad...so list the symptoms bitch! And give me the associated clinical condition...bitch!! |
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Definition
- hypotension
- distended neck veins
- muffled heart sounds
Cardiac Tamponade! |
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Term
| What other clinical symptom, besides Beck's Triad, might you see with cardiac tamponade? |
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Definition
| Pulsus paradoxus may be another sign (a decrease of >10mmHg in BP occurring with inspiration in a spontaneously breathing patient) |
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Term
| Use this drug for inducing the cardiac tamponade patient... |
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Definition
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Term
This specific chest injury is associated with the following characteristics:
• Occurs just distal to the left subclavian artery.
• Widened mediastinum (>8cm on CXR)
• Associated with 1st rib fracture (maybe with scapular injury as well)
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Definition
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Term
| How would you know if your trauma patient had a myocardial contusion? What should you worry about happening? |
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Definition
• Diagnosed by EKG as ST changes consistent with ischemia
• Cardiac enzyme elevation (CK, MB or troponin)
• Abnormal echocardiogram
Your patient is at an increased risk for arrhythmias! |
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Term
| _______of patients with intraabdominal injuries do not have pain or signs of peritoneal irritation (muscle guarding, percussion tenderness, or ileus) on first examination. |
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Definition
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Term
| Large quantities of blood (acute hemoperitoneum) may be present in the abdomen (eg, hepatic or splenic injury) with minimal signs. The abdomen is an enclosed space and therefore may self-tamponade. So, if you're going to do an emergent exploratory laparotomy what should you do before incision? |
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Definition
| Push fluids and/or blood products before they open the belly. |
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Term
| Massive abdominal hemorrhage may require packing of bleeding areas and/or clamping of the abdominal aorta until bleeding sites are identified and the resuscitation can catch up with the blood loss. Prolonged aortic clamping leads to what other problems? |
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Definition
| Ischemic injury to the liver, kidneys, intestines, and, in some instances, a compartment syndrome of the lower extremities; the latter can produce rhabdomyolysis and acute renal failure. |
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Term
| What happens when surgeons try to close an abdominal incision with lots of edematous, poofy guts inside? |
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Definition
| Belly closure may cause compartment syndrome within the abdominal contents and splanchnic ischemia. They may do closure in stages. It may be difficult to ventilate the patient after these closures. |
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