What two mechanisms of injury make up the most traumas between the ages of 16 and 24?
motor vehicle accidents and firearms
What mechanism of injury makes up the most traumas between the ages of 35 and 44?
motor vehicle accidents
What two mechanisms of injury make up the most traumas between the ages of 75 and 85?
motor vehicle accidents and falls
Which mechanism of injury has the highest percentage of mortalities per case? (motor vehicle accidents, falls, or firearms)
From birth to age 30, trauma ______ more people than any other disease or illness.
What are three preventable causes of combat death?
- hemorrhage from extremity wounds (60%) - tension pneumothorax (33%) - airway obstruction (6%)
What is the trauma triad of death?
- hypothermia - coagulopathy - acidosis
What are the 4 ways your body can lose heat?
- evaporation - radiation - convection -conduction
Hypothermia can increase what 3 things?
- mortality - blood loss - blood transfusion
Statistically, a trauma patient with a temp of < ___ on admission will have 100% mortality.
A temp of 33-36 C causes what cardiovascular effects?
increased heart rate, blood pressure, and CO
A temp of 32-33 C causes what cardiovascular effects?
decreased heart rate, blood pressure, and CO
A temp of < 31 C causes what cardiovascular effects?
increased atrial and ventricular irritability
A temp of < 30 C causes what cardiovascular effects?
profound bradycardia and V-fib is likely
A temp of 19-20 C causes what cardiovascular effects?
asystole usually occurs
A temp of 33-35 C causes what effects on renal function?
afferent pressure increases secondary to systemic vasoconstriction
A temp of < 33 C causes what effects on renal function?
GFR decreases. impairment of distal tubular reabsorption can cause polyuria.
What are two hematological effects of hypothermia?
HCT rises: results from fluid shift to interstitial space and loss of fluid due to decreased distal tubular reabsorption. Platelets are sequestered in the spleen and liver resulting in increased bleeding times.
Regarding coagulopathy, the majority (90%) of trauma patients are ___________.
pro-thrombotic (and they need anticoagulation to prevent a DVT/PE)
Regarding coagulopathy, the minority (10%) of trauma patients are ___________.
Which lab value is a better indicator for inadequate perfusion, lactate level or base deficit?
base deficit (serum lactate works well, but need to be sent to the lab and processed. studies show that base deficit is a quick and sensitive measure of inadequate perfusion)
What are the three steps in damage control in a combat casualty?
1. abbreviated operation 2. resuscitation in the ICU 3. return to the operating room for definitive operation
What are the four goals of damage control resuscitation?
normal base deficit
rapid hemorrhage control
Level 1 trauma centers are facilities equipped to handle emergent care and offer these 5 services. (per the slides)
-emergency medicine - ICU - trauma / surgical - ancillary services - surgical services - anesthesia services
What are the indications for massive transfusion?
temp < 96
SBP < 90
Hgb < 11
base deficit > 6
INR > 1.5
What are relative indications for giving rFVIIa?
- severe bleeding
- at risk for massive transfusion
- intracranial hemorrhage with altered mental status
- double amputee
- chest tube output > 1L or > 200mL/hr
- major truncal injury with positive FAST
In massive transfusions, the ratio of __:__:__ (PRBC : plasma : PLT) are indicated.
1 : 1 : 1
Things to know when using rFVIIa. (5)
- correct acidosis first (decreased efficacy when pH < 7.2) - need adequate fibrinogen and PLTs for it to work - consider with FWB use (not totally sure what FWB means) - dose 90 - 120 mcg/kg - can use every 2 hours
With burn victims, the chance of survival drops precipitously with > ___% total body burn.
Direct inhalational thermal injury results in edema, meaning you should do what?
maintaining airway control is a priority. intubate early.