What ICP is abnormal?==>>20mmHg >40 is severe sustained increased ICP leads to decreased brain function and poor outcome
CBF is maintained at a mean BP of what?==>50–150 what is the Monro–Kellie Doctrine of head injury?==>total volume of the intracranial compartment must stay constant
Lucid interval, bi convex (lenticular) skull fracture that may be rapidly fatal... what is the classic artery affected?==>middle meningeal, this is an Epidural what vessel is responsible for a brain bleed that crosses suture lines and is concave...==>Bridging veins (brain laceration), subdural hematoma When is rapid surgical evacuation of a subdural recommended?==>>5mm shift of midline loss of gray/white matter differentiation indicates what==>diffuse axonal damage, this has poor outcomes give a Mild, Moderate, or severe GCS (the ranges)==>Mild 15–13, Moderate 12–9, Severe < 8 if patient has a GCS of 12 or below, when should you get a repeat CT? ==>6 hours, or if they have notable deterioration Indications for CT a pt with head injury?==>GCS still <15 two hours after injury
Neuro deficit, open skull fracture, sign of basal skull fracture, vomiting >2 episodes, extremes of age, retrograde amnesia
pt is conscious, cooperative, able to concentrate on C–spine, no neck/spine tenderness. if still no pain or tenderness with voluntary movement what should you do?==>no further evaluation or xray needed, can clear the c–spine and remove collar
if a pt has altered LOC or has sx, what should be obtained?==>CT, radiographic visualization of entire spine
what 3 views do you need for c–spine xray==>Cross table lateral, AP , Odontoid (open mouth)
if you find an isolated c–spine fracture, what should you look for? ==>ANOTHER noncontiguous vertebral column fracture, it happens 10% of the time
what % of pts with spinal cord injuries will worsen at the hospital==>5%
Dorsal column carries what info? same side or opposite side? ***==>position, vibration, fine touch, ipsilateral side
two fracture sites that are commonly missed sites that can cause shock?
How much blood can go there?(*? *)==>5L in pelvis, 1.5L in femur how soon after arrival should a patient with major open MSCK wounds be given abx?==>within the first hour when getting xrays, what must you get a picture of in in addition to the site of injury==>joint above and below
2 most common places for compartment syndrome==>tibia and forearm, can be caused by severe crush injury, burn, casts, tissue pressures >35–40 mm Hg
Myoglobinuria can result from what kind of injury? What should you do? ==>Crush injury, Hydrate
know that the cervical spine in old people has lots of OA....==>so it makes them tough to intubate
most common cause of death/disability in kids?==>injury
kids less than 10, seen at C2/3, seen worse in felxion...
what is the 442 rule?==>for Maintenance fluid 4mL/kg for first 10 kg, 2mL/kg for second 10kg 1mL/kg for every kg beyond 20 kg ETT depth is how long in kids?==>3x the ETT size Bolus for kids fluid: 20 mL/kg, blood dosage?==> blood: 10 mL/kg What is the Parkland formula==>2– 4/mL x weight in kg x % body surface area, first half over the first 8 hours second half over the next 16 used in burns
are the following increased or decreased in pregnancy? minute ventilation HR/CO Blood Volume GFR
3 ways kids are harder to intubate==>smaller jaw, larger tongue, anterior larynx
if a child is laying on a backboard, what must you consider==>put a pad under the back... the large head of the child will cause them to be in flexion if on a back board. Having the pad will neutralize the c–spine
gastric emptying time==>all increased are the following increased or decreased in pregnancy?
pCO2
Hematocrit==>Decreased
trauma?-->EKG,Pulse Ox,IV,BP,Draw Labs what is considered large bore IV? ?->14/16 gauge how much fluid should initially be given in the trauma pt?--> (2L as fast as possible over 10 min if you are able to obtain a pulse at the following areas, what is the SBP? What is the primary survey?
Carotid: Femoral: Dorsalis pedis:-->
**-->ABCDEs
Carotid: 60 Femoral: 70 Dorsalis pedis: 80
In a trauma situation, what should be treated first-->Greatest threat to life
if you are the only physician available in a trauma scenario, what are you going to likely do?-->transfer him out
anytime you come into a trauma pt what should you do? (2 things)->Airway with c–spine protection
Describe the GCS and scoring
***-->Eye Response: Universal precautions:hat mask w shieldgowngloves (double glove, single gloving viral transmission is 67%) What are the 2 areas that are part of xray in resuscitation adjunct?-->Chest and pelvis house the most blood note: use FAST for abdomen
Eyes open spontaneously. +4 Eye opening to verbal command. +3 Eye opening to pain. +2 No eye opening. +1
Verbal Response: Oriented. +5 Confused. +4
what size needle is used for needle decompression-->14/16 gauge 2nd intercostal space mid clavicular line
Inappropriate words. +3 Incomprehensible sounds. +2 No verbal response. +1
aim down the pt Motor Response: What should you ask for from your ancillary staff upon start of a
Obeys commands. +6 Localizes pain. +5
Withdrawal from pain. +4
Extension to pain (Decerebrate). +2
Flexion to pain (Decorticate). +3
No motor response. +1
