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Flashcards in EXAM 2 Deck (45)
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1

Which of the following is TRUE regarding blunt chest trauma?

Other injuries seen in blunt chest trauma may include tracheal tears, pneumothorax, hemothorax, pulmonary contusion, esophageal injuries and rib/sternal fractures.

2

An 80 kg male is brought into the trauma center with an open forearm fracture and burns over 40% of his body he sustained in a chemical plant explosion. Based only on his burn injuries, which of the following is TRUE regarding fluid replacement in this patient?

6400 -12800 ml of IVF should be administered in the first 24 hours; half should be administered in the first 8 hours, 25 % in the next, and 25% in the final 8 hours

3

Which of the following TWO statements are TRUE about medications that may be used in the pregnant trauma patient?

terbulataline may cause ventricular ectopy if used with ephedrine or atropine

4

A 22 year old sailor has been life-flighted to a Level I trauma Center after being rescued following a fall from the flight deck of an aircraft carrier flight deck into the water (about 80 feet) while the ship was in port. He has a small isolated epidural hematoma. Shortly after arriving to the trauma center, he becomes progrssively and severely hypotensive. Considering the mechanism of his injury, the isolated injury and the progressive hypotension, what is the likely source of bleeding?

ruptured spleen

5

Signs of adequate volume resuscitation in the pediatric population include a normal BP, pulse pressure >20, pulse rate and skin color near normal, improved level of consciousness, and adequate urine output. Which of the following are normal vital signs for a 4 year old?

HR 100, BP 100/70, RR 24

6

Which of the following is FALSE regarding airway management in the patient with traumatic brain injury?

in-line stabilization does not affect the view of airway anatomy upon direct laryngoscopy

7


Which of the following TWO statements are TRUE about the anesthetic considerations of the pediatric trauma patient?

-An increased dose of succinylcholine is required because of the large volume of distribution

-estmating blood loss in children is challenging and intraopertaive monitoring of Hgb is essential

8

A 25 year old male is emergently brought to the operating room actively hemorrhaging after sustaining multiple gunshot wounds. He is intubated and has 2 large bore IVs in place. His initial vital signs and arterial blood gas analyisis in the OR are:

BP 80/35 and HR 120

pH 7.20, pCO2 42, HCO3 14, BE -

Which of the following is the most appropriate initial fluid to administer to this patient?

un-cross-matched red blood cells

9

The signs and syptoms of transfusion-related acute lung injury include hypoxia, fever, dyspnea, an possibly fluid in the endotracheal tube. These signs and syptoms begin almost immedately upon starting an transfusion and peak within 2 hours. (T or F)

False

10

All of the following are risk factors for secondary brain injury following a traumatic brain injury EXCEPT:

paCO2 of 33

11

A 32 year old male arrives in the trauma OR for emergency exploratory laparotomy s/p MVC with blunt trauma to the chest and abdomen. Pt is being ventilated with 100% O2 via an ETT BP is 85/45, HR=110, SPO2=93%. He appears to be 72 inches and 100 kg.

Soon after incision, the blood pressure is 75/44, HR=130, Hgb is 6. Minimal crystalloid has been given. A mild amount of blood (estimated at 10ml/min) is being aspirated from the surgical site. You are assured that PRBC's, FFP, and platelets will arrive within 5 minutes. Someone suggests giving a 2-3 liter fluid bolus. The CRNA says that he/she wants to wait for the blood and just give a moderate amount crystalloid infusion. You know that:

The CRNA is making a wise choice because administration of large volumes of crystalloid will result in coagulopathy and acidoisis without a significant increase in delivery of oxygen to the tissues.

12

You receive a trauma patient S/P motor vehicle crash (unrestrained driver) with multiple extremity fractures and a facial fracture. The patient is screaming in pain and is on a back-board with a C-collar in place. In planning your induction/intubation, choose the BEST plan of action.

Rapid sequence induction with cricoid pressure with propofol 2mg/kg, and succinylcholine 1 mg/kg and intubation with a Glidescope while maintaining in-line stabilization

13

The temperatures in Emergency Departments and Operating Rooms create a 25-30 degree Farhenheit temperature gradient between the environment and a trauma patient. Which of following TWO statements are TRUE regarding rewarming the patient?

-Rewarming should begin in the field and continue in the Emergency Department, the Operating Room and into the postoperative period.

-The administration of warm IV fluids and blood is a critical step in preventing hypothermia in the trauma patient.

14

Falls are a common mechanism of injury in the elderly and often result in hip fractures. (T or F)

True

15

Which of the following TWO are TRUE regarding anaphylaxis?

-The differential diagnosis of the cardiovascular symptoms of an anaphylactic reaction include an anesthetic overdose, hemorrhage, gas embolism and rapid IV administration of Vancomycin.

-Pharmacologic treatment of anaphlaxis may include epinephrine, hydrocortisone, ranitidine and diphenhydramine

16


A pulse that is only palpable at the level of the femoral artery correlates with a systolic blood pressure of approximately 70 mmHG. (T or F)

False

17

Which of the following statements about arterial blood gas analysis is TRUE?

Normally, the "gap" between routinely measured cations and ions is filled by weak acids such as albumin, phosphates, sulfates and lactates.

18

Blood loss from pelvis fractures can be several liters. The best initial measure to control bleeding from a pelvic fracture is:

Reduction of the pelvis with a circumferential sheet

19

The treatment strategy for the treatment of anaphylaxis should occur in the following order:

call for help, epinephrine (dose based on severity of anaphylaxis), treat bronchospasm, treat cardiac arrythmias, treat hypotension, and 24 hour postoperative monitoring or recurrence. (T or F)

True

20

All of the following are true about the physiologic responses to shock EXCEPT:

Although immune complexes collect in pulmonary capillaries, the lung architecture is resistent to destruction and the lung plays little role in the development of multiple organ system failure

21

Due to the age-related pharmacologic changes of drugs, epidural and spinal dose requirements are decreased AND the duration of spinal and epidual anesthesia is increased. (T or F)

False

22

With regard to pain management, which of the following is TRUE?

The most accurate and reliable evidence of pain is from the patient.

23

A healthy 28 year old female has multiple deep skull lacerations on her face and has sustained a LeFort II fracture following an assault. LeFort II fractures fracture have a pyramidal shape and extend from the nasal bridge at or below the nasofrontal suture through the frontal processes of the maxilla, inferolaterally through the lacrimal bones and inferior orbital floor and rim through or near the inferior orbital foramen, and inferiorly through the anterior wall of the maxillary sinus; it then travels under the zygoma, across the pterygomaxillary fissure, and through the pterygoid plates.

This type of injury requires early surgery to decrease the incidence of meningitis. (T or F)

True

24

Which of the following electrolyte abnormalities is most common during massive transfusion therapy?

hypocalcemia

25

Because intraopertaive fetal monitoring has been shown to improve outcome, it should be done on all trauma patients unless it is not practical due to the site of the surgical procedure (abdominal). (T or F)

False

26

Which of the following types of shock may be caused by a tension pneumothorax, cardiac tamponade, or pulmonary embolism?

obstructive

27

Which of the following is correct?

Falls in the elderly are often associated with events such as transient ischemic attacks or myocardial ischemia.

28

Arterial blood gas analysis provides information about all of the following EXCEPT:

cardiac function

29

According to the “4-2-1 Rule,” hourly maintenance fluid requirement of a 22-kg 5-year-old boy is (mL):

62

30

Because aging alters serum proteins (albumin and A-1-acid glycoprotein) in different way, which protein binds a drug becomes important. (T or F)

True