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What does the primary survey of a trauma patient consist of?
Airway
Breathing
Circulation
Disability
Exposure
What are the two phases of trauma resuscitation added to CPR?
1. Control of bleeding
2. repair of injury
What are the 5 criteria that increases the risk for potential cervical spine injury?
1. Neck pain
2. severe distracting pain
3. neurological signs and symptoms
4. intoxication
5. loss of consciousness at scene of injury
What is the preferred method of estabilishing an airway?
Jaw thrust, this avoids neck hyperextension
When is nasal intubation avoided in trauma?
1. uncooperative patient
2. suscpected midface or basilar skull fractures
What are signs of closed laryngeal trauma? 5 criteria
1. neck crepitus
2. hematoma
3. dysphagia
4. hemptysis
5. poor phonation
How is breathing assessed in primary survey?
Look, listen, and feel
How is circulation assessed in primary survey?
Assess pulse rate, pulse pressure, blood pressure, and signs of peripheral perfusion
IF the pt is hemorrhaging what is the order of volume resusication?
1. stop the bleeding
2. replace intravascular volume
what is the usual cause of circulatory shock in trauma?
hypovolemia
What is the order of blood infusion preference in trauma?
1. fully x-matched whole blood (45-60min)
2. type-specific (5-10 min)
3. O-neg PRBC for life-threating blood loss
What type of IV fluid should be avoided in traumas? y?
1. Dextrose containg fluids because hyperglycemia may exacerbate ischemic brain damage
In a patient with a suspected brain injury what is the prefered IV fluid? y?
Hypertonic solutions 3% or 7.5%
1. are associated with less cerebral edema
2. be cautious of hypernatremia;
3. may cause transient vasodilation and hypotension
What are the side effects of hypothermia?
acid-base woresining
coagulopathy
myocardial dysfunciton
left shift of oxy-hemoglobin curve
What are the primary indicators used to guide intravenous fluid resussication?
BP
HR
Pulse pressure
When can pneumatic antishock garments be used?
for wounds from the abdomen and below
How should metabolic acidosis by treated in trauma? how not?
1. Acid-base imbalance should improve with hydration, which increases organ perfusion
2. Sodium Bicarbonate injections may augment acidosis due to HCO3 dissociating into CO2 and Water
When should vasopressors be used in trauma?
HOTN that does not respond to fluid administration, coexisting cardiogenic shock, cardiac arrest
What assessment tool is used to evaluate the level of disability or neurological insult?
AVPU

Alert
Verbal response
Painful stimuli response
Unresponsive
What is the secondary survey? when is it performed?
Begins after ABCs are stabilizsed
Head-Toe assessment
Head- injuries to scalp, eyes, and ears
Neuro-glasgow coma scale
Chest- auscultate and visulal inspection
Abdomen- visual inspection, auscultation, palpation
Extremities- examine for fractures, dislocations, and check peripheral pulses
Foley
Basic Lab analysis
FAST scan
What is in a basic laboratory analysis for trauma?
Toxicology screening, CBC (or H&H), Lytes, BUN, creatine, glucose
What is the FAST Scan?
Rapid bedside ultrasound used during secondary survey of trauma patient. Examines 4 areas for free fluid:
1. Perihepatic/hepatorenal space
2. Perisplenic space
3. Pelvis
4. Pericardium
What can be done for patients with suspected head trauma to decrease ICP?
hyperventilate
What are the common induction agents for trauma anesthesia?
Ketamine and Etomidate
-may still produce cardiodepressant properties during shock states
What does maintenance of GA consist of for trauma surgeries?
1. MR
2. GA titrated as tolerable (MAP 50-60)
3.
Combo of what anesthetic agents help to produce amnesia during trauma sx?
Volatile agent < 0.5 MAC
Ketamine 25mg q 15min
Midazolam (1mg intermittenly)
Scopolomaine (0.3mg)
How do u expect shock to affect the rise of alveolar concentration of inhalation anesthetics?
Shock causes lower CO and increased ventilation

There will be a faster rise in alveolar concentration
What is the best concept to remember when giving drugs during a trauma sx?
Small incremental doses of whichever agents used is the safest anesthetic management
What are signs of basilar skull fractures?
1. Raccoon eyes (bruising on eyelids)
2. Battle's sign (bruising over mastoid process)
3. CSF from ear or nose
What is cushing triad?
1. bradycardia
2. HOTN
3. irregular respiratory pattern

Late sign of head injury, precedes herniation
How can increased ICP be controlled?
1. Fluid restriction (absence of hypovolemia)
2. Mannitol 0.5g/kg
3. PaCO2 28-32
4. Slight head elevation to improve venous drainage
Should steroids be given to brain injury patient? spinal cord injury?
Brain injury- no
Spinal cord injury- yes, improves neurological outcomes, decreases inflammation
What is the goal to maintain CPP at for brain injury?
CPP above 60mmHg
MAP @ level of brain - (CVP or ICP, whichever is greater)
What is spinal shock?
1. Result of high spinal cord injury
2. Signs are r/t loss of sympatetic tone below lesion:
-HOTN
-bradycardia
-areflexia
-gastrointestinal atony
A patient has venous distention in legs following a fall off a ladder, what may be suspected?
Spinal cord injury, venous distention in the legs
When is it safe to give Sch to a patient with a spinal cord injury?
Safe within the first 48 hours following the injury
What are manifestations of a tension pneumothorax
1. Ipsilateral collapse with diminished lung sounds, hyperresonance to percusion

2. Meidastinum and Tracheal deviation to contralateral side
How can a tension pneumothorax be converted to an open pneumothorax?
Insertion of 14g (3-6cm) over the needle catheter into the 2nd ICP at MCL

CT placed 4-5th ICS at MAL
How to distinguish between hemothorax and pneumothorax?
Hemothorax- dullness to percussion over silent lung fields

Pneumothorax- hyperresonance over silent lung fields
Where do most bronchial ruptures occur?
Within 2.5cm of the carina
What is the anesthetic management plan for a patient with a cardiac tamponade?
Maximize contractility, chronotropism, and preload
What are signs of a cardiac tamponade?
Beck's Triad (HOTN, Jugular venous distention, and muffled heart sounds)

Pulsus Pardoxus (>10mmHg decrease in BP during spontaneous inspiration)
What is the most common organ injured in abdominal trauma?
Liver
When should a pt have a emergency laparotomy?
When they are pulseless or hemodynamic unstable

Are stable but have signs of peritonitis
What is the definition of hemodynamically unstable?
Unable to maintain a SBP > 80-90mmHg with 1-2L of fluid resuscitation
A patient is brought into the ER after a MVA. The FAST screening shows and inlarged liver. What is the concern during sx?
The encapsulated organ (or abdomen) has tamponaded and when opened opened there will be profound HOTN due to blood loss
Treat with rapid infused IV fluids and blood
What is the "golden hour"?
This the first 60 minutes from the time a patient develops hemorrhagic shock to the time that resusictation begins
How can the cerebral vasodilating effects of volatile anesthetics be attenuated?
Mild hyperventilation, no lower than 25mmHg PaCO2
WHere is the recommended placements of IV catheters for abdominal or pelvic injuries?
one above and one below the diaphragm
What are the phases of trauma-induced shock?
1. Compensated (nonprogressive shock)
2. Progressive shock
3. Irreversible shock
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