Flashcards in The Surgical Review- Trauma/Critical Care Deck (108)
what are the positive DPL criteria?
1. >10mL gross blood
2. Blunt trauma >100,000 RBCs, penetrating >10,000 RBCs
3. >500 WBCs
4. + Gram stain bacteria, food products
What are the 6T's and 6H's of PEA?
T"s: Trauma, Tension PTX, tamponade, toxins (drugs/overdose), thrombosis- coronary, thrombosis - pulmonary
H's: Hypovolemia, hypothermia, hypoxia, hyper/hypokalemia, hydrogen ion (acidosis), hypo/hyperglycemia
what is battle sign and what is it indicative of??
ecchymosis behind the hears, showing basilar skull fracture, can also see raccoon eyes (ecchymosis around eyes)
what are the hard signs of vascular injury? 6
1. Pulsatile bleeding
2. Expanding hematoma
3. Palpable thrill
4. Audible bruit
5. Regional ischemia
6. Diminished or absent pulses (ABI
a pressure greater than ___ is assoc with compartment syndrome?
what is the only indication for early use of pressers in the hypotensive trauma patient?
neurogenic shock-> dopamine used for hypotension and bradycardia
what is cushing triad and when do you see it?
3. Respiratory depression
- seen in elevated ICP 2/2 head trauma
what is a normal ICP?
15mmHg (pathologic intracranial hypertension usually occurs at 20mmHg)
Cerebral Perfusion Pressure =
MAP - ICP, should be kept above 60mmHg in patients w elevated ICP
what are the criteria for brain death? 8
1. response to painful stimuli
2. Seizure activity
3. Papillary light reflex
4. Corneal reflex
5. Gag reflex
6. Oculocephalogyric reflex (dolls eyes)
7. Vestibulo-ocular reflex
8. resp effort during apnea test
what is an apnea test?
the patient is pre oxygenated before ventilator is stopped and hypercarbia is permitted
- paco2 should rise at least 20mmHg or exceed 60mmHg before the absence of rest effort is considered confirmatory
what is a drawback to volume-cycled ventilation?
airway pressures may escalate to harmful levels i.e. barotrauma in poorly compliant lungs (stiff), can lead to alveolar rupture and pneumothorax
Central venous pressure is a measurement of what?
right sided heart function and overall volume status, can suggest cariogenic shock
when is CVP best measured?
at the end of expiration, because mechanical ventilation increases CVP during the inspiratory phase, and opposite is due in physiologic respiration (decreases w inspiration)
how do you calculate the SVR (systemic vascular resistance)?
= (MAP - CVP)/CO
what lab abnormalities occur in prerenal azotemia?
serum urea nitrogen levels rise out of proportion to the creatinine level (>20:1)
how do u calculate FENa?
[urine Na x plasma Cr] / [ plasma Na x urine Cr]
what is virchow triad?
what are the two types of heparin induced thrombocytopenia?
type I: acute, Type II: 5-8 days later
when is stress ulcer ppx indicated?
2. Severe burns
3. Head injury
4. Prolonged ventilator dependence (>48hrs)
what bladder pressure warrants emergent decompression in abdominal compartment syndrome?
>35mmHg warrants emergent,
25-35 - eventually require decompression
15-24 - close observation
workup for suspected adrenal insufficiency?
1. Random cortisol level, if
what is one side effect of IV etomidate?
adrenal insufficiency (even a single dose can cause it)
how do you calculate the free water deficit?
= 0.6 x weight [1 - (140/serum Na)]
- remember to correct for hyperglycemia, thus add 1.6mmol Na/L for each 100mg/dL of glucose over 100
what is the free water deficit?
used to estimate the volume (L) of water required to correct dehydration during the initial stages of fluid-replacement therapy
what are the clinical classifications of TBI based on GCS?
Mild (13-15), moderate (9-12), severe (8 or less)
what component of the GCS is the most important predictor of neurologic severity and recovery?
what are epidural hematoma?
- lens shaped + mass effect
- seen after direct lateral impact to the temporal region with skull fx and laceration to the middle meningeal artery
when is immediate evacuation indicated in epidural hematoma?
1. altered mental status
2. lesion >1cm in diameter
3. midline shift on CT