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85 Cards in this Set
- Front
- Back
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Trauma is the ___leading cause of death at any age
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3rd
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Trauma no. 1 cause of death between ages
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1-45
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Describe trimodal pattern of trauma deaths
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Golden hour (1st hour)=50% death due to CNS, heart, great vessel injury;1early-4 hrshemmo. 5-6wks infec/multi:
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PT History approach
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AMPLE: Allergies, Meds, Previous hx, surg, last meal, events leading
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Primary survey approach
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ABCDE: Airway(Cspine), Breathing, circulation, Disability (neuro status), Expose (2ndary survey)
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Describe/Name Trauma scoring systems
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Physiolocal (GCS); Anatomic: Abreviated Injury Scale (AIS); Combined: A severeity charac. of trauma (ASCOT)
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GCS
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Glascow Coma Scale for head injury based on eye opening, verbal response, best motor response
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ISS is determined by
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Injury severeity score determine by summing the squares of 3 most injured areas
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Maximal injury automatically assined an ISS of
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16
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what percent of trauma incid. are related to alcohol or illicit drugs?
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50
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preoperative agitation may be due to
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hypercarbia or hypoxia
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what should u give before blood?
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crystalloids
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what full stomach precautions should be taken?
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bictrat; H2 bloc(blocks act. of his on parietal cells, decreas prod. of aci /Reglan (blocks dopamie receptors)
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Apprehension=
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hypoxia unless proven otherwise
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most common site of spinal fx is
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C2
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subluxation of _______is most common injury
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C5-C6
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What does MILS stand for?
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Manual Inline Axial Traction (MILS)
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Most appropriate tech for urgent airway control
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oral intubation (pit falls with nasal, awake foi)
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Does C spine mvm't decrease more with MILS or phila collar?
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mor0e. Mils (3.63) philla collar (9.4
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safest mech for securing airway
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DL/MILS
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5 risk factors for CSI
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midlline neck tender, focal neurological diff, ETOH, altered level of consiousness,distract pain/inj
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if pt ihas one or more of intox, has midline neck, distracting pain or injury,focal neor def, althered cons. wht is % of CSI
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2%
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if pt doesn't have 5 risk factors what is chance has CSI?
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.03%
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Cricoid pressure increases___but lowers____
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increases upperesophageal but lowers lower esoph.
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Esophagus begins at the
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lower border of the cricoid cartilage
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1KG=
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9.81N
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Two muscles of Upper Espohageal Sphincter (UES)
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inferior sphinctor and cricopharyngeos
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compare pressure of UES under anesthesia to normal pt and TOF
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under anesth. (except w/ketamine) UESP decreases to 10-15mmHg from 40mmHg. at TOF <.8
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How many newtons are needed to apply 40mmHg to 10cm2?
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30newtons
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what does cricoid pressure do to LESP/barrier pressure?
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lowers it
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GERD is dependent on
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barrier pressure (LESP-GastricP)
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Recommended CP for awake pt is and increases to____at LOC
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10-20 N; 30-40N
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most aspiration happens during
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tracheal extubation then DL
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Optimal DO2 occurs at
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10-12 mg/dL
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In intial fluid replacement ____are first choice
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isotonic (2-5X) blood loss
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Are colloids better than crystalloids in initial fluid replacement?
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debatable
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most sign correlations between severity and duration of coagulopathy
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speed and adequacy of fluid replacement
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what does rapid hemodiluation with crystalloids do to coagulation?
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enhances it
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Do crystalloids have a greater dilulation on coagulation factors or AT-III?
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AT-III
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what do colloids do to von willenbrand factors and factor VIII?
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dose-dependent decrease
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what do colloids do to platelet function?
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decreases them
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what do platelets do to clot fragility?
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increases
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Effect of albumin on coagulation?
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none
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effects of dextran on coagulation?
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increased bleeding time, increased fibrinolysis
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Effects of Hespan/Hetastarch on coagulation
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impairs postop coag in CABG pts, impairs CPB as priming agent; at 10-20% dilution dec.platelt act; 20%fibrin.form
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which colloid is implicated in accute renal failure?
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dextran
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adverse hemostatic effects from fluids?
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increased perfusion pressure/dislocation of clots;dilutional effects on clotting fact;dec. blood visco.
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DO2=
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CO*CaO2
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__% of EBV may be lost bfore change in vital signs
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30%
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Post transfusion survival of fresch, 14 days old, and 28 days RBC
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gone: fresh=110 days; 14 days=108 days; 28days=83 days;
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Universal plasma and RBC
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plasma=AB; RBC=O
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Safest blood if no type and screen?
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O, RH- for women under 50
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what percent of pop has RBC antibody?
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.3%
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Anti D antibodies to O+only from
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previous transfusion/pregnancy
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In type specific, cross-matched blood antigens are found
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antigen neg. blood must be procured
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What type of antibodies are present in Type O blood?
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anitbodies A and B
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potential danger of switching from O to pts native blood
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hemolytic rxn;glines= don't switch if 8-10 units giv,send 4antibodies titers pres; lec.= stay w/ O if started with )
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Does metabolic alkalosis or acidosis lead to progressive coag?
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acidosis
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causes of metabolic acidosis?
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active hemmorage, shock
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one blood volume=how many units?
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10 units
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def of massive transfusion
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1 blood volume in 24hrs,50% of pts EBV in 3 hrs,acute admin of of 4 units w/anticipation of ongoing usag
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what is the earliest coagulation disturbance seen in rapidly transfused pts?
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hypofibrinogenemia
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fibrinogen of <___mg/dl is associated w/coagulopathy
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100
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fibrinogen of <100mg/dl (coagulopathy) occurs with how many units of transfused blood?
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10-15 units
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If u have <100mg/dl of fibrinogen, what is prolonged despite clotting factors?
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PT/PTT
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Goal of fibrinogen content?
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>100-150mg/dl
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to fluids to replace fibrinogen
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cryoprecipitate and FFP
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compare fibrinogen results of cryo and ffp
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cryo pool (8-10 pk) raises 50mg/dl or 10-20mg/ml; FFP only 2-4mg/ml
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Each unit of FFP increases clotting factors by how much? what % do we need for homeostasis?
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FFP unit increases by 7%; need 30% for homeostais
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PT/PTT>1.5 normal after how many units of PRBC? do we give ffp or cryo?
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8-10 units RBC delivered=20-30% coag factors so do consider ffp or cryo
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After how many units of PRBC do we give FFP? Aim for PT/PTT to be ___times norma
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consider at 8-10 units; 1.3 times normal
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Sig. thrombocytopenia(lack of platelets) may occur after how much delivered PRBC
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15-20 units
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each unit raises platelet count
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5000-10000
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During storage, what increases in plasma?
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K+
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pH of banked blood after 5 wks
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6.5
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why isn't acidosis persistent after giving blood?
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citrate converted to bicarb
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most common metabolic complication of rapid infusion
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citrate toxicity/hypocalceimia
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effects of hypocalcemia
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hypotension, cardiac arrest, coagulopathy
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citrate toxicity for PRBC can lead to
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hypocalcemia and hypomagnesemia
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manifestations of hypomagnesia
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dysrhythmias,hypotension, prolonged QT interval (Torsades de Points)
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complications of hypothermia from massive infusion of PRBC
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increased hemo/oxy affin, decreased pltlt fxn/ coag. status,dysrthymias, dec. hepatic metab of citrate,wound
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Does hypothermia alter clotting factors? what does it affect?
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no; fibrinolysis stimulated, adversely affects platelets,
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how does hypothermia affect platelets?
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morphology, function(decreased prod of thromboxane 2); sequestered (splenic and hepatic)
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Best induction drug for trauma pt? why? why not others?
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STP best at lower dose (1-2mg/kg); propofol=CV depressent; ketamine=dec. in myocard and causes hypoten
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Use Sux for RSI unless
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after 24 hrs for burn pt.
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