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

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

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

gastric emptying time==>all increased

are the following increased or decreased in pregnancy?

pCO2

Hematocrit==>Decreased

What is the primary survey?

**-->ABCDEs

In a trauma situation, what should be treated first-->Greatest threat to life

anytime you come into a trauma pt what should you do? (2 things)-->Airway with c–spine protection

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

what size needle is used for needle decompression-->14/16 gauge

2nd intercostal space mid clavicular line

aim down the pt

What should you ask for from your ancillary staff upon start of a 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?

Carotid: Femoral: Dorsalis pedis:-->

Carotid: 60 Femoral: 70 Dorsalis pedis: 80

if you are the only physician available in a trauma scenario, what are you going to likely do?-->transfer him out

Describe the GCS and scoring

***-->Eye Response:

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

Inappropriate words. +3

Incomprehensible sounds. +2

No verbal response. +1

Motor Response:

Obeys commands. +6

Localizes pain. +5

Withdrawal from pain. +4

Flexion to pain (Decorticate). +3

Extension to pain (Decerebrate). +2

No motor response. +1