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40 Cards in this Set
- Front
- Back
- 3rd side (hint)
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What are the four characteristic hormonal changes in response to trauma?
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1. Inc Cortisol
2. Inc Glucagon 3. inc Catecholamines 4. Dec Insulin |
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What are the six endocrine organs involved in the stress response?
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1. Hypothalamus
2. ant pituitary(adenohypophysis) 3. post pituitary(neurohypophysis) 4. adrenal cortex 5. adrenal medulla 6. pancreas |
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What fluid should be used in initial resusitation with massive blood loss?
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Crystalloids (NSS or LR)
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What fluid should be avoided initially with trauma fluid resuscitation?
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Dextrose containing fluids-- unless documented hypoglycemia. (May exacerbate ischemic brain damage)
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Definition of cardiogenic shock?
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advanced CHF, in which cardiac output is insufficient to maintain adequate perfusion of vital organs
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What are three causes of cardiogenic shock?
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Myocardial Infarction
CHF Pericardial tamponade |
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What hemodynamic findings with cardiogenic shock?
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Inc PAOP (>15mmhg)
Low CI Inc SVR |
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What hemodynamics n hypovolemic shock?
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Low PAOP (<5-10)
Normal CI Normal or Inc SVR |
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With hypovolemic shock, what anesthesia drugs should be avoided?
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--Histamine-releasing MR such as atracurium and mivacuium.
--Narcotics such as morphine & codeine --Induction agents used cautiously |
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What is the cause of subcutaneous emphysema with facial fractures?
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Laryngeal or tracheal trauma (can cause a false passage for air to travel from a pneumothorax to below the skin)
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What is the potential risk with increasing subcutaneous emphysema?
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Respiratory collapse
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What is a "walk and drop" traumatic injury?
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This is a classic sign of an epidural hematoma, resulting from an arterial bleed between the skull and dura assoc with a skull fracture
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What is the risk with an epidural hematoma? Is surgery necessary?
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Yes, to prevent uncal herniation and death
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When is a nasotracheal intubation or nasogastric tube contraindicated?
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basilar facial fractures
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what are the signs of a basilar skull fracture?
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Clear CSF rhinorrhea, otorrhea or LeFprt III skull fx
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What are the five criteria that increases the risk for potential instability of C-spine?
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1. neck pain
2. severe distracting pain 3. any neurological signs or symptoms 4. intoxication 5. loss of consciousness at the scene |
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How is the C-spine stabilized best during layngoscopy and intubation?
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Manual In-line stabilization (MILS) by an assistant
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when should packed red blood cells be used to treat hypovolemic shock in the trauma pt?
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then life threatening blood loss cannot be adequately replaced with other fluids.
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what blood type is transfused in the moribund pt requiring immediate transfusion?
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O neg
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What clotting factor deficiencies develop with massive transfusions?
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Factor VIII, (dec by 50% after 2 days of storage)
Thrombocytopenia also quickly develops due to massive transfusion |
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Why does burn cause loss of fluid and protein into the interstitial tissue?
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Increases the capillary permeability (esp in first 6-8 hrs)
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How does fluid shift in the first 24 hrs in the burn pt?
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Massive fluid shifts from the intravascular to the interstitial space within the first 24hrs. (
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What happens to red blood cells and hematocrit early (24hr) in the burn pt?
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RBC are destroyed, but HCT increases sue to the loss of plasma volume
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When does capillary integrity return and colloids remain in the intravascular compartment with burns?
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24-48 hrs after the burn
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When does fluid shift back into the intravascular space in the burn pt?
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after the first 48hrs.
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What is the fluid of choice with burn pts?
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Crystalloids (usually with LR)
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What are the six signs of hypermetabolic activity in the burn pt?
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1. Hyperthermia
2. inc Catabolism 3. Inc. O2 consumption 4. Tachypnea 5. Tachycardia 6. Elevated catecholamine levels |
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How is fluid administration titrated during fluid resuscitation in the burn pt?
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Careful monitoring of HCT guides fluid administration.
--An increase in HCT during the first day suggests inadequate fluid resuscitaiton because hemolysis and sequestration are expected to cause a decrease in HCT. |
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How do burn pts lose heat?
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1. Hypermetabolism
2. evaporative loss 3. exposure (conserve heat with warm OR, warm IV fluids, and a heated humidifier) |
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What are the pharmacokinetics changes in a burn patient?
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Volume of distribution changes increases providing more free drug available:
--1. dec in extracellular volume --2. dec in protein binding |
A decrease in protein binding provides more free drug available creating a larger vol of dist. The decrease in extracellular volumes
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what is the pharmacodynamic effect of decreased protein bound drug and larger vol of distribution?
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Increased effecacy from highly protein bound drugs.
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What happens with Alph1-acid glycoprotein levels with burns and what drugs does this affect?
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Alpha1-acid glycoproteins increase following burns, and drugs that bind easily such as lidocaine, meperidine and propranolol exhibit a decrease in vol of distribution, providing decreased free drug for effect.
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What happens to drug metabolism 24-48 hrs after resuscitation post-burn?
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hypermetabolic state occurs with an inc CO causes an increase in metabolism and excretion via the kidneys.
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What muscle relaxant should not be given to the burn patient?
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Succinylcholine should not be used from 24 hrs post burn until the patient has healed
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Why are pts with 3rd degree burns resistant to Nondepolarizing muscle relaxants?
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The number of cholinergic receptors is greatly increased (extrajunctional proliferation of acetylcholine receptors)
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A pt burned 3 weeks ago is given succinylcholine on induction-- what might you see on EKG?
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Peaked T waves and widen QRS due to hyperkalemia
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How is hyperkalemia treated after a burn pt received succinylcholine?
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1. Insulin- glucose
2. calcium cholride 3. hyperventilation 4. furosemide 5. Kayexcelate 6. Beta adrenergic agonists. |
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How do you calculate the area of burns with the rule of nines?
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Head and both upper extremities each rep 9%TBSA.
Ant. trunk, post trunk, both lower extremities, each rep 18% TBSA. perineum is 1% |
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Why does edema occur in both burned and nonburned areas?
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Decrease in plasma colloid osmotic pressure causes generalized edema.
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How should a 17% carboxyhemoglobin with inhalation injury in pt in no acute distress?
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17% is midly toxic, Treatment is 100% oxygen to displace carbon monoxide from hemoglobin.
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