TRAUMA (NAGELHOUT CH. 40) EXAM
QUESTIONS AND ANSWERS 100%
CORRECT
ABCDE of trauma care - ANSWER-airway
breathing
circulation
disability (neuro status)
environment/exposure (undress patient to fully assess)
blunt trauma (Newton's 1st law) - ANSWER-Abrupt deceleration creates negative
gravitational forces.
The the outside "shell" of the human body decelerates abruptly, the internal organs,
which in a sense are separate from the exterior of the body, continue forward at the
original velocity and are torn from their attachments by way of rotary and shearing
forces.
These forces often cause disruption of connective tissue, blood vessels, and nerves.
MVC trauma and the c-spine - ANSWER-suspect c-spine injury until proven otherwise
-blunt trauma rarely occurs in isolated body systems
in 40% of blunt thoracic injuries, patient suffer from - ANSWER-pneumothorax
what anesthetic should be avoided in patients with thoracic trauma - ANSWER-nitrous
oxide (in case of a pnuemothorax because they are not always detected by CXR)
tension pneumothorax - ANSWER--lung is punctured creating a one-way valve that
traps air between the layers of pleura
-with each breath, more air is trapped in this space, increasing the intrapleural pressure
to the point that it exceeds all other intrathoracic pressures
-the enlarging pleural cavity then collapses the lung and shifts structures of the
mediastinum (trachea, great vessels, heart) into the opposite hemithorax
-this will rapidly increase during positive pressure ventilation, especially if nitrous oxide
is used
symptoms of pneumothorax - ANSWER-hypotension, SQ emphysema of the neck and
chest, unilateral decrease in breath sounds, diminished chest wall motion,
hyperresonance to percussion of one hemithorax, distended neck veins, or tracheal shift
reduction in CO, cardiovascular collapse
, emergent decompression of pneumo - ANSWER-large bore IV catheter in the second
intercostal space, attach to IV tubing and place in bottle of sterile water until a chest
tube can be placed
pericardial tamponade restricts - ANSWER-filling during diastole, low CO
-need pericardiocentesis
anesthetic for induction when there is cardiac tamponade - ANSWER-ketamine
massive hemothorax treatment - ANSWER--bleeding from heart and great vessels
fluid resuscitation before chest tube
cardiac rutpture - ANSWER-symptoms of tamponade: hypotension, muffled heart tones,
distended neck veins
damage control resuscitation in trauma - ANSWER--body re-warming
-restriction of crystalloids
-permissive hypotension
-balanced blood products
-massive transfusion protocol
-early correction of coagulopathies
-reversal of metabolic acidosis
-antifibrinolytics (TXA)
abdominal trauma diagnosis - ANSWER-FAST - focused assessment with sonography
for trauma, CT, MRI, angiography
anesthesia consideration for abdominal trauma surgery - ANSWER-large IV above
diaphragm in case there is massive bleeding from the liver or other organs
Trauma anesthesia: airway - ANSWER--expect the worst
-follow ASA difficult airway algorithm
-assume c-spine instability
-RSI due to delayed gastric emptying and full stomach
traumatic aortic rupture- - ANSWER--fluid resuscitation
-large bore IV access
-A-line
-BP control (above 100)
management of trachea disruption or major bronchi disruption - ANSWER--secure
airway with ETT or trach for surgical correction
a majority of airway injuries are found.... - ANSWER-below the carina
-only seen with CT or bronchoscopy
QUESTIONS AND ANSWERS 100%
CORRECT
ABCDE of trauma care - ANSWER-airway
breathing
circulation
disability (neuro status)
environment/exposure (undress patient to fully assess)
blunt trauma (Newton's 1st law) - ANSWER-Abrupt deceleration creates negative
gravitational forces.
The the outside "shell" of the human body decelerates abruptly, the internal organs,
which in a sense are separate from the exterior of the body, continue forward at the
original velocity and are torn from their attachments by way of rotary and shearing
forces.
These forces often cause disruption of connective tissue, blood vessels, and nerves.
MVC trauma and the c-spine - ANSWER-suspect c-spine injury until proven otherwise
-blunt trauma rarely occurs in isolated body systems
in 40% of blunt thoracic injuries, patient suffer from - ANSWER-pneumothorax
what anesthetic should be avoided in patients with thoracic trauma - ANSWER-nitrous
oxide (in case of a pnuemothorax because they are not always detected by CXR)
tension pneumothorax - ANSWER--lung is punctured creating a one-way valve that
traps air between the layers of pleura
-with each breath, more air is trapped in this space, increasing the intrapleural pressure
to the point that it exceeds all other intrathoracic pressures
-the enlarging pleural cavity then collapses the lung and shifts structures of the
mediastinum (trachea, great vessels, heart) into the opposite hemithorax
-this will rapidly increase during positive pressure ventilation, especially if nitrous oxide
is used
symptoms of pneumothorax - ANSWER-hypotension, SQ emphysema of the neck and
chest, unilateral decrease in breath sounds, diminished chest wall motion,
hyperresonance to percussion of one hemithorax, distended neck veins, or tracheal shift
reduction in CO, cardiovascular collapse
, emergent decompression of pneumo - ANSWER-large bore IV catheter in the second
intercostal space, attach to IV tubing and place in bottle of sterile water until a chest
tube can be placed
pericardial tamponade restricts - ANSWER-filling during diastole, low CO
-need pericardiocentesis
anesthetic for induction when there is cardiac tamponade - ANSWER-ketamine
massive hemothorax treatment - ANSWER--bleeding from heart and great vessels
fluid resuscitation before chest tube
cardiac rutpture - ANSWER-symptoms of tamponade: hypotension, muffled heart tones,
distended neck veins
damage control resuscitation in trauma - ANSWER--body re-warming
-restriction of crystalloids
-permissive hypotension
-balanced blood products
-massive transfusion protocol
-early correction of coagulopathies
-reversal of metabolic acidosis
-antifibrinolytics (TXA)
abdominal trauma diagnosis - ANSWER-FAST - focused assessment with sonography
for trauma, CT, MRI, angiography
anesthesia consideration for abdominal trauma surgery - ANSWER-large IV above
diaphragm in case there is massive bleeding from the liver or other organs
Trauma anesthesia: airway - ANSWER--expect the worst
-follow ASA difficult airway algorithm
-assume c-spine instability
-RSI due to delayed gastric emptying and full stomach
traumatic aortic rupture- - ANSWER--fluid resuscitation
-large bore IV access
-A-line
-BP control (above 100)
management of trachea disruption or major bronchi disruption - ANSWER--secure
airway with ETT or trach for surgical correction
a majority of airway injuries are found.... - ANSWER-below the carina
-only seen with CT or bronchoscopy
