612 Trauma Prodigy Qs
What is the formula for shock index (SI)? A. Heart rate X systolic blood pressure B. Heart rate - systolic blood pressure C. Heart rate/systolic blood pressure D. Heart rate/(systolic blood pressure - diastolic blood pressure)
C. Shock index (SI) is obtained by dividing the heart rate (HR) by the systolic blood pressure (SBP). There is some evidence that it may be a better indicator of mortality than individual vital signs.
Trauma is associated with a progressive renal loss of potassium primarily due to the effects of A. cell lysis B. decreased renal perfusion C. elevated corticosteroid levels D. elevated vasopressin levels
D.Although other factors such as nasogastric suctioning may contribute, trauma is associated with a progressive loss of potassium primarily due to the effects of vasopressin.
What is the greatest determinant of the mortality rate in a patient with a burn injury? A. Serum albumin levels on admission B. The greatest depth of any portion of the burn C. The surface area of the burn D. The presence of an inhalation injury
D.The presence of an inhalation injury with a burn will double the mortality rate and is the single greatest determinant of the risk of death from a burn.
All of the following are symptoms of acute spinal cord injury except: A. Rigid paralysis below the level of the injury B. Loss of temperature regulation below the level of the injury. C. Loss of spinal cord reflexes below the level of the injury D. Loss of cutaneous sensation below the level of the injury
A. Below the level of injury, the patient will exhibit flaccid paralysis, total absence of sensation, and loss of temperature regulation and spinal cord reflexes.
A patient with a history of spinal cord injury is undergoing a cesarean section. Which anesthetic modality would be the most effective at preventing autonomic hyperreflexia? A. Epidural anesthesia B. Spinal anesthesia C. General endotracheal anesthesia D. General anesthesia with an LMA
B. The use of neuraxial anesthesia has been reported to prevent autonomic hyperreflexia in response to labor contractions. Epidural anesthesia is less effective than spinal anesthesia in this scenario as it can spare sacral segments that can be involved in autonomic hyperreflexia.
The initial treatment for a chemical burn is irrigation of the affected area with (select two) A. water B. saline C. 7.5% sodium bicarbonate solution D. betadine
A +B. Chemical burns are caused by disruption of the cellular components of the skin by the chemical irritant. The initial treatment is irrigation with water or saline irrigation because the chemical will continue to damage tissue until it is removed.
What are the most important parameters to normalize in patients with brain injury? (select two) A. Intracranial pressure B. Cerebral perfusion pressure C. Central venous pressure D. Heart rate
A+B Interventions aimed at normalizing the ICP, CPP, and oxygen delivery to the patient have the greatest therapeutic significance in patients with brain injury.
During the first phase of the injury of a major trauma patient, a core body temperature below 35 degrees Celsius is often associated with: (select two) A. hypotension B. coagulopathy C. alkalosis D. hypoxia
A+B. A core body temperature below 35 degrees Celsius is often associated with acidosis, hypotension, and coagulopathy during the early phase of injury for the major trauma patient.
Select two potential treatments for commotio cordis. A. CPR B. Defibrillation C. Nitroglycerin D. Aspirin
A+B. Commotio cordis is presented by the appearance of ventricular tachycardia or cardiac arrest following a sudden blow to the chest in young people. The immediate treatments include CPR for cardiac arrest and defibrillation for ventricular tachycardia.
Which secondary events have the highest associated mortality rate in patients with head injury? (select two) A. Hypoxia B. Hypotension C. Hemorrhage D. Cardiac arrhythmias
A+B. Hypotension and hypoxia are the most significant events contributing to the mortality of a patient with a head injury.
According to the Advanced Trauma Life Support Classification of Hemorrhagic Shock, Class III hemorrhagic shock criteria includes (select two) A. Blood loss between 1500 and 2000 mL B. Urine output > 30 mL/hr C. Pulse rate >120/min D. Respiratory rate between 14 and 20
A+C. ATLS Classification of Class III Hemorrhagic Shock includes the following parameters: (Blood loss 1500-2000 mL; Pulse rate >120 per min; blood pressure decreased; pulse pressure decreased; respiratory rate 30-40 per min; UOP 5-15 mL per hour; mental status: anxious and confused.
Select two agents that may be administered to shift potassium into the cells in patients with hyperkalemia. A. Regular insulin B. Methylene blue C. D50W D. Sodium chloride
A+C. Treatments used to shift potassium into the cells in patients with hyperkalemia include IV regular insulin, IV glucose, or nebulized salbutamol. Hyperchloremia from large volume NS bolusing pushes potassium out of cells.
Select two conditions required to justify the use of recombinant Factor VIIa. A. Severe acidosis (<7.25) is corrected B. Hypercalcemia is corrected C. Severe hypothermia is corrected D. Serum albumin levels are normal
A+C. Use of recombinant Factor VIIa is only recommended when acidosis has been corrected to at least a pH of 7.25, hypothermia has been corrected to a temperature of at least 33 degrees Celsius, and platelet and fibrinogen levels are adequate.
Spinal shock is consistent with which of the following? A. Warm, pink extremities B. Exaggerated hyperkalemic response to succinylcholine within 3 hours of injury C. Shock symptoms typically resolve within 6 hours D. Hypertension
A. Because spinal shock disrupts the compensatory vasoconstrictive response, patients with spinal shock will exhibit warm, pink extremities, whereas patients with hemorrhagic shock will exhibit cool, clammy extremities. Some practitioners will utilize succinylcholine during the first 24 hours as upregulation of extrajunctional receptors probably has not had time to occur yet. In patients who survive, spinal shock can last 1-3 weeks.
Which of the following hemodynamic patterns is consistent with hypovolemic shock? A. Increased HR, low CO, low SVR B. Increased HR, low CO, high SVR C. Increased HR, high CO, low SVR D. Decreased HR, high CO, low SVR
B. Typically, the patient in hypovolemic shock presents with an increased heart rate, low cardiac output, and a high systemic vascular resistance.
Carbon monoxide binds to hemoglobin much more strongly than oxygen. Which of the following statements regarding carbon monoxide poisoning is false? A. It shifts the oxyhemoglobin curve to the right B. Carbon monoxide acts as a direct myocardial toxin C. Hyperbaric oxygen therapy is useful in treating carbon monoxide poisoning D. Carbon monoxide poisoning results in metabolic acidosis
A. Carbon monoxide has an affinity for hemoglobin that is 250-300 times greater than that of oxygen, impairs mitochondrial function, uncouples oxidative phosphorylation and reduces ATP production resulting in metabolic acidosis, and shifts the oxyhemoglobin dissociation curve to the left, impairing the unloading of oxygen to the tissues. In addition, it acts as a direct myocardial toxin and can prevent survival in resuscitation efforts during cardiac arrest. Hyperbaric oxygen is indicated for patients with carboxyhemoglobin levels >30 percent at admission if it does not compromise the treatment of life-threatening issues.
What is the most appropriate fluid for volume resuscitation during the first 24 hours following a burn injury? A. Crystalloids B. Hetastarch C. Albumin D. Dextran
A. During the first 24 hours following a burn injury, crystalloids are preferred for fluid resuscitation. In a burn that affects more than 30% of the body surface area, replacement of plasma protein may be accomplished using 5% albumin in LR on the following day.
If hyperkalemia is detected intraoperatively, which agents may facilitate the treatment of elevated potassium? A. Regular insulin, sodium bicarbonate, and Dextrose 50 percent B. NPH Insulin, sodium bicarbonate, and Dextrose 50 percent C. Calcium chloride, sodium bicarbonate, and Dextrose 50 percent D. Regular insulin, sodium bicarbonate, and calcium chloride
A. If an elevation of K+ is discovered intraoperatively, the recommended treatment is the administration of 10U of regular insulin IV, 50 mLs of 50% Dextrose, and 50 mLs of sodium bicarbonate 8.4%.
A patient with severe traumatic injuries is suspected of also having ischemic brain damage. Which fluid would be the least appropriate for fluid resuscitation? A. D5 1/2 NS B. Lactated Ringer's solution C. 3% saline D. Normal saline
A. In instances of possible ischemic brain damage, solutions containing dextrose should be avoided as they could exacerbate the ischemia. The only exception to this rule is if hypoglycemia is documented.
You are preparing to induce a patient for craniotomy for the treatment of epilepsy that will involve the use of electrocorticography (ECoG). You are using sevoflurane at 1.2 MAC and the ECoG will begin in about 30 minutes. What alteration in your anesthetic would be appropriate at this point? A. Reducing the inhalation agent to 0.5 MAC and administering high-dose fentanyl B. Switching to a total intravenous anesthetic with propofol C. Discontinuing the use of narcotics and increasing the volatile agent to 1.5 MAC D. Discontinuing the sevoflurane and administering midazolam 1 mg/kg
A. Inhalation agents can interfere with ECoG. Thirty minutes before the ECoG begins, you should try to reduce the MAC to 0.5, discontinue a propofol infusion if one is being used, and employ high-dose narcotics, nitrous oxide, and scopolamine to help prevent awareness. Midazolam would interfere with the ECoG monitoring.
What fluid would be the most appropriate for use in the treatment of hemorrhagic shock in a patient with traumatic brain injury? A. Normal saline B. Hetastarch C. D5 Lactated Ringer's D. Albumin
A. Isotonic crystalloids are preferred when performing volume resuscitation in patients with traumatic brain injury. Normal saline is probably the best option because it can be mixed with packed red blood cells. The caution in using large volumes of saline is the predisposition to developing hyperchloremic acidosis. Any solution containing glucose should be avoided.
You are evaluating a patient who has been admitted to the ER for treatment of severe burn injuries from a house fire. Which of the following would be your most immediate concern in this patient? A. Inhalation injury B. Hypovolemia C. Hypertension D. Intracranial hypertension
A. Patients who suffer burns within closed spaces such as a house fire should be considered to have an inhalation injury as well.
A patient in the intensive care unit with which disorder would most likely require parenteral caloric supplementation within 24 to 48 hours of admission? A. severe burns B. lupus erythematosus C. congestive heart failure D. renal failure
A. Severe burns.
What aspect of care should take precedence in the initial management of the patient with potential spinal trauma? A. Airway B. Pain C. Type and cross D. Imaging studies of the spinal column
A. The first management of the spinal trauma patient is the emphasis on the airway, breathing, and circulation. Endotracheal intubation may be particularly challenging in the patient with spinal cord injury, especially if the lesion is on the cervical spine.
What factors comprise what is known as the lethal triad of hemorrhage in the trauma patient? A. Hypothermia, acidosis, and coagulopathy B. Hypothermia, spinal shock, and disseminated intravascular coagulation C. Disseminated intravascular coagulation, cerebral edema, and acidosis D. Metabolic alkalosis, hyperthermia, and overuse of colloids
A. The lethal triad that produces a vicious cycle of hemorrhage in the trauma patient is hypothermia, acidosis, and dilutional coagulopathy.
What is the most common cause of traumatic hypotension? A. Hemorrhage B. Congestive heart failure C. Myocardial infarction D. Tension pneumothorax
A. The most common cause of traumatic hypotension and shock is hemorrhage. Hemorrhage is second to head injury for the most common cause of mortality after trauma.
You have just intubated a 70 Kg patient suffering from severe burns of the face and head and entire anterior torso. You start an intravenous line and begin administering fluids. You know that the initial fluid resuscitation volume to be infused over the first 24 hours is about A. 5,000 mL B. 10,000 mL C. 12,500 mL D. 15,000 mL
A. The most commonly used strategy for fluid resuscitation is to take the percent of body surface area burned, multiply it by 2-4 times the weight in kilograms, and administer that volume during the first 24 hours following the burn. This patient has suffered a 27% burn (18% for the anterior trunk and 9% for the face and head). This creates a range of fluid administration between 3780 and 7560 mLs, making 5,000 mLs the best answer.
Which of the following interventions would NOT be appropriate for the treatment of intracranial hypertension in a trauma patient during the first 24 hours following head injury? A. Maintaining a normal to high serum glucose level B. Maintain a MAP of 75 mmHg C. Reverse Trendelenburg position D. Placement of a lumbar CSF drain
A. The primary interventions to improve cerebral perfusion pressure (CPP) in a trauma patient with intracranial hypertension are to maintain a mean arterial pressure of at least 70-75 mmHg to ensure a CPP of at least 60 mmHg and promote oxygenation and adequate glucose levels without hyperglycemia. Measures to reduce intracranial pressure may include reverse Trendelenburg position, short-acting sedatives such as propofol, midazolam or fentanyl, CSF drainage via a ventriculostomy, and neuromuscular blockade.
The ratio of units of packed red blood cells to fresh frozen plasma to platelets recommended by the US military for massive transfusion is A. 1:1:1 B. 2:1:1 C. 3:1:1 D. 3:2:1
A. The ratio of units of packed red blood cells to fresh frozen plasma to platelets recommended by the US military for massive transfusion is 1:1:1. This ratio has reports of improved survival in massive transfusions.
A patient with a suspected cervical spine injury is transported to the emergency department by ambulance. On arrival, an LMA is in place. The patient exhibits no spontaneous respirations and is unconscious, but you are able to bag-ventilate the patient with ease. You should: A. replace the LMA with an endotracheal tube B. connect the LMA to a ventilator C. prepare for a cricothyrotomy D. continue ventilating via ambu bag until a cervical injury is confirmed by CT
A: An LMA or Combitube is suitable for placement by paramedics for transport, but it should be replaced with a definitive endotracheal airway as soon as possible.
Which conditions are not a problem during the acute management of a traumatic spinal cord injury? (select two) A. Hypotension B. Autonomic hyperreflexia C. Spinal shock D. Acute respiratory distress syndrome
B +D. Spinal shock (a loss of sympathetic tone in the vessels below the level of the spinal lesion) and hypotension are both conditions that may have to be addressed immediately in a patient with a traumatic spinal cord injury. Autonomic hyperreflexia is associated with lesions above T5 but does not develop in the acute period of injury. Acute respiratory distress syndrome can be a complication in patients with traumatic injuries, but is a delayed pulmonary complication.
You are called to intubate a patient presenting to the emergency department with a spinal cord transection at C3. You would expect which of the following on first assessment: A. Hypertension B. Bradycardia C. Increased urine output D. Increased preload
B: A patient with a spinal cord lesion at C3 would typically exhibit severe hypotension from dilation of the capacitance vessels due to loss of sympathetic tone and bradycardia from a lack of sympathetic input from the cardioacceleratory fibers of T1-T4. Due to the drop in preload, the patient would likely exhibit signs of fluid volume deficit which would translate into a decreased urine output.
You are preparing to anesthetize a patient for emergency trauma surgery. What intervention would exert the most protective influence on postoperative renal status in this patient? A. Administration of mannitol B. Administration of fenoldopam C. Maintaining the intravascular volume D. Administration of dopamine
C. Maintenance of intravascular volume exerts the most protective influence on postoperative renal status in the patient presenting for emergency trauma surgery.
What is the recommended dose of fresh frozen plasma for severely traumatized, bleeding, and coagulopathic patients? A. 5 mL/kg B. 10-15 mL/kg C. 20-25 mL/kg D. 30 mL/kg
B. Although additional FFP may be required, the recommended dose of thawed FFP to be administered immediately after the arrival of severely traumatized, hemorrhaging, coagulopathic individual is 10-15 mL/kg.
A trauma patient exhibits distended neck veins, hypotension despite vigorous fluid resuscitation, and subcutaneous emphysema over the neck and chest. These symptoms are consistent with A. Fat embolus from a long-bone fracture B. Tension pneumothorax C. Tracheal injury D. Hepatic laceration
B. Distended neck veins, unilateral decreased breath sounds, hypotension despite vigorous fluid resuscitation, subcutaneous emphysema of the chest, diminished chest-wall motion, and hyperresonance to percussion of one hemithorax are consistent with a diagnosis of tension pneumothorax.
In addition to clinical evaluation, what diagnostic tool is recommended to rule out C-spine injury in major trauma patients? A. MRI B. CT Scan C. X-ray D. Ultrasound
B. In addition to clinical evaluation, routine CT is recommended to rule out C-spine injury in the major trauma patient. MRI remains the gold standard to exclude C-spine injury, but it picks up subtle injuries that are clinically insignificant, it is expensive, requires patient transport, and can't be performed immediately.
A patient with severe burns over his entire body is undergoing anesthesia for surgical debridement. In this instance, which of the following is appropriate concerning ECG monitoring? A. The leads and ECG pads should be placed normally regardless of the area burned B. Needle electrodes should be used C. ECG monitoring can be discontinued D. The ECG leads should be securely taped to the patients skin
B. In patients undergoing surgical debridement for burns, placement of the ECG leads can be challenging. In situations where the adhesive pads cannot be placed due to the damage they would cause to the burned tissue, the leads should be stapled to the patients skin or needle electrodes should be used.
What is an appropriate minimum urinary output for a 70 kg patient who has suffered a high-voltage electrical burn? A. 35 mL/hour B. 70 mL/hour C. 150 mL/hour D. 200 mL/hour
B. In patients with high-voltage electrical burns, the minimum urinary output to maintain is 1-1.5 mL/kg/hour. In this patient, the minimum would be between 70 and 105 mL/hour. In ordinary burns in adults, the minimum urinary output is 0.5 mL/kg/hour. In pediatric patients less than 30 Kg, the minimum is 1 mL/kg/hour.
A 37 year-old, healthy male suffered a high-voltage electrical burn and fell from a ladder while repairing an electrical line. He is undergoing surgery for repair of a fracture. He also has burns to most of his torso and arms. What is the minimum urinary output you would attempt to maintain in this patient intraoperatively? A. 0.5 mL/kg/hour B. 1 mL/kg/hour C. 2 mL/kg/hour D. 5 mL/kg/hour
B. In patients with high-voltage electrical burns, the minimum urinary output you should strive to maintain is 1-1.5 mL/kg/hour. In ordinary burns in adults, the minimum urinary output is 0.5 mL/kg/hour. In pediatric patients less than 30 Kg, the minimum is 1 mL/kg/hour.
A burn patient has suspected inhalation injury. The gold standard for assessing the severity of an inhalation injury is A. direct laryngoscopy B. fiberoptic bronchoscopy C. chest xray D. Neck CT
B. Inhalation injury can cause significant damage to the upper airway in addition to the heat and toxins that can adversely affect the lungs themselves. Direct laryngoscopy can be used to assess the airway down to the cords, but fiberoptic bronchoscopy is the gold standard for determining the severity of an inhalation injury.
In the trauma patient, platelet transfusion is recommended when the platelet count falls below: A. 40,000 per microliter B. 50,000 per microliter C. 70,000 per microliter D. 90,000 per microliter
B. Platelet transfusion is recommended when the platelet count falls less than 50,000. Those with head injury and massive hemorrhaging may need administration of platelets at higher levels (75-100,000 per microliter).
Which burn degree classification is characterized by deep partial-thickness damage that involves the deep dermis? A. First B. Second C. Third D. Fourth
B. Second-degree burn classification is characterized by deep partial-thickness burns involving the deep dermis. It typically requires excision and may even require grafting to ensure rapid return of function.
Which of the following is NOT a component of the Glasgow Coma Scale? A. Eye response B. Blood pressure C. Motor response D. Verbal response
B. The Glasgow Coma Scale (GCS) evaluates the best verbal response, eye response, and motor response with a minimum score of 3 and a maximum score of 15. A GCS score less than 9 indicates severe brain injury.
The diaphragm is innervated by fibers originating from which nerve roots? A. C2, C3, and C4 B. C3, C4, and C5 C. C4, C5, and C6 D. C6, C7, C8, and T1
B. The diaphragm is innervated by fibers originating from the C3, C4, and C5 nerve roots. C3, 4, and 5-Keep the diaphragm alive!
The loss of sympathetic tone and concomitant administration of corticosteroids in patients with spinal cord injury can predispose the patient to A. hypoglycemia B. peptic ulceration C. subarachnoid hemorrhage D. hypocalcemia
B. The loss of sympathetic tone can predispose patients to peptic ulceration, especially when combined with the administration of corticosteroids. Orogastric or nasogastric tubes are often employed to decompress the stomach which has the combined effect of easing restrictions on diaphragmatic movement caused by gastric distention and reducing the risk for aspiration of gastric contents.
Electrical burns can place patients at risk for renal damage due to A. hypotension B. myoglobin release C. vasoconstriction of renal vessels D. calcium release from damaged bone tissue
B: Electrical burns vary in severity based on the voltage and duration of contact with the source. Electrical burns will cause damage at a point of entry and exit. These wounds may appear superficial and conceal internal damage to nerves, vessels, muscle and bone. Significant damage to muscle tissue can cause the massive release of myoglobin which can place these patients at risk for renal damage.
At what compartment pressure is fasciotomy of an affected extremity indicated? A. 10 cm H2O or higher B. 20 cm H2O or higher C. 30 cm H2O or higher D. 40 cm H2O or greater
C. A compartment pressure exceeding 30 cm H20 in the affected extremity is an indication for immediate fasciotomy. Compartment pressure is measured by inserting a needle and fluid-filled extension tube connected to a transducer into the various compartments of the affected extremity.
A trauma patient exhibits tracheal deviation, significant hypotension, hypoxia, tachycardia, and diminished breath sounds on one side of the chest. You suspect a tension pneumothorax. The most appropriate intervention is A. send the patient for a chest xray B. obtain an MRI of the chest C. perform a needle decompression D. intubate the patient
C. A tension pneumothorax is a potentially lethal situation and should be addressed immediately. The chest can be decompressed by inserting a 14-gauge angiocath into the 2nd or 3rd anterior interspace over the affected side or through the 4th or 5th interspace if approached laterally. A rush of air will be noticed when the needle enters the thorax.
The critical level for the development of autonomic hyperreflexia due to a spinal cord lesion is A. C4 B. T1 C. T6 D. L1
C. Autonomic hyperreflexia is seen in approximately 85% of all patients with a spinal cord lesion at or above T6. Lesions at or below T10 do not consistently produce symptoms of autonomic hyperreflexia.
Autonomic hyperreflexia A. occurs concomitantly with the onset of spinal shock B. is associated with unopposed parasympathetic discharge C. represents the return of spinal reflexes D. occurs in response to stimulation above the level of cord transection
C. Autonomic hyperreflexia may appear after spinal shock has resolved and represents the return of spinal cord reflexes. It is a massive sympathetic discharge that occurs in response to a cutaneous or visceral stimulation below the level of transection. In normal patients, the sympathetic activity that results from this stimulation is overridden by inhibitory impulses from higher central nervous system centers. In the patient with spinal cord injury, the sympathetic outflow is isolated from the inhibitory feedback loop and the sympathetic discharge is unopposed.
Spinal shock is a condition that can last A. 1-3 hours B. 1-3 days C. 1-3 weeks D. 1-3 years
C. In patients who survive, spinal shock can last 1-3 weeks (some sources cite up to 6 weeks).
You are preparing to emergently intubate a patient with a traumatic brain injury. What associated injury must you assume this patient also has? A. Penetrating lung injury B. Intra-abdominal bleeding C. Cervical spine injury D. Intraocular injury
C. It must be assumed that a patient with traumatic brain injury also has a cervical spine injury. Forty percent of patients with TBI will also have another associated life-threatening injury.
Which of the following drugs would be the least appropriate for the intravenous induction of a trauma patient with a head injury? A. Etomidate B. Propofol C. Ketamine D. Thiopental
C. Ketamine increases ICP and should not be used in this patient population.
What is the most frequent and dangerous complication of fluid creep from massive fluid resuscitation in burn patients? A. Systemic hypertension B. Interstitial nephritis C. Intra-abdominal hypertension D. Intracranial hypertension
C. The most dangerous and frequent complications of massive fluid resuscitation for a burn patient are intra-abdominal hypertension and abdominal compartment syndrome. They can have deleterious effects on end-organ function throughout the body, not just the organs within the abdominal compartment. Intra-abdominal hypertension is defined as an intra-abdominal pressure of at least 12 mm Hg and abdominal compartment syndrome is said to exist with an intra-abdominal pressure greater than 20 mm Hg accompanied by signs of organ dysfunction.
Which of the following methods are most appropriate for securing the airway in a patient undergoing evaluation for cervical spine injury? A. Videolaryngoscopy B. Direct laryngoscopy with a Macintosh blade C. Flexible fiberoptic laryngoscopy D. Intubation through a supraglottic airway
C. Videolaryngoscopy and intubation through a supraglottic airway produce as much neck movement as direct laryngoscopy with a Macintosh blade. Flexible fiberoptic laryngoscopy, use of a lightwave, or translaryngeal-guided intubation produce the least amount of neck movement.
What estimated percent of body surface area is affected when the entire head and trunk are burned? A. about 25 B. about 35 C. about 45 D. about 60
C: In adults, each arm represents 9%, each leg represents 18%, the entire trunk is 36%, and the head is 10%. In this case, the patient has burns to 46% (or about 45% )of the body.
Which of the following statements regarding spinal shock is incorrect? A. The initial hemodynamic findings of spinal shock may persist for 1-3 weeks B. The extent of hypotension is related to the spinal cord level at which the lesion is located C. The profound hypotension seen with spinal shock is primarily due to diminished afterload D. Cardiac dysrhythmias are commonly associated with spinal shock
C: The profound hypotension seen with spinal shock is related to the level at which the lesion is located (cervical injuries produce more severe hypotension than do lumbar injuries) and is due primarily to a drop in preload caused by dilation of the capacitance vessels. A wide range of cardiac dysrhythmias ranging from PVCs to complete heart block are seen with spinal shock and the hemodynamic changes associated with spinal shock may last for up to 1-3 weeks after the injury occurs.
Which of the following agents would be least appropriate for use in an acute trauma patient? A. Thiopental B. Desflurane C. Rocuronium D. Nitrous oxide
D. Nitrous oxide should be avoided in the acute trauma patient. Nitrous oxide diffuses into closed spaces making it contraindicated in patients with bowel injury, pneumothorax, and patients with closed-head injuries. These conditions are difficult to rule out in the acute setting and should be avoided.
Prior to inducing anesthesia for a patient who has suffered major trauma, changes in the patient's phonation during the interview may indicate an increased risk for A. gastric perforation B. pneumothorax C. autonomic hyperreflexia on induction D. neurological damage during intubation
D. A patient that exhibits changes in phonation may be suffering from damage to the trachea and vocal structures. The mechanism of injury may place the patient at risk for neurological damage during airway instrumentation, resulting in the need for a difficult airway plan to avoid damage to the cervical spine. Changes in voice may also indicate recurrent laryngeal nerve damage which can increase the risk of aspiration.
You are preparing to emergently intubate a patient who suffered a spinal cord injury two weeks ago. You know that in this patient, A. there is no significant upregulation of nicotinic receptors at the neuromuscular junction B. ketamine is contraindicated C. there is an increased incidence of adverse reaction to etomidate D. succinylcholine should be avoided
D. Because the new nicotinic receptors surrounding the neuromuscular junction have not yet had a chance to develop, succinylcholine is safe during the first 24 hours following injury. After that, there is a risk for dangerous hyperkalemia with the administration of succinylcholine.
A burn patient exhibits signs of inhalation injury and possible carbon monoxide poisoning. All of the following regarding carbon monoxide are true except: A. It has a greater affinity for hemoglobin than oxygen B. It can result in metabolic acidosis C. It impairs mitochondrial function D. It shifts the oxyhemoglobin dissociation curve to the right
D. Carbon monoxide has an affinity for hemoglobin that is 200 times greater than that of oxygen, impairs mitchondrial function, uncouples oxidative phosphorylation and reduces ATP production resulting in metabolic acidosis, and shifts the oxyhemoglobin dissociation curve to the left, impairing the unloading of oxygen to the tissues. In addition, it acts as a direct myocardial toxin and can prevent survival in resuscitation efforts during cardiac arrest.
The primary cerebral perfusion pressure goal for a brain trauma patient is (mm Hg): A. 5-15 B. 20-25 C. 30-40 D. 50-70
D. Current therapeutic recommendations advise maintaining the CPP at levels between 50-70 mm Hg.
Which of the following statements concerning the anesthetic management of a severely burned patient in the immediate resuscitation stage is true? A. Succinylcholine administration is contraindicated. B. Carbon monoxide poisoning should be treated with hydroxycobalamin. C. Fiberoptic intubation is contraindicated. D. Fluid losses are greatest in the first 12 hours after the burn
D. Fluid losses are greatest in the first 12 hours and then slow down and stabilize by 24 hours after the burn.
A patient with a smoke inhalation injury arrives in the emergency department. At what blood carboxyhemoglobin level is hyperbaric oxygen indicated? A. 5 percent B. 10 percent C. 20 percent D. > 30 percent
D. Hyperbaric oxygen is indicated for patients with carboxyhemoglobin levels >30 percent at admission if it does not compromise the treatment of life-threatening issues.
A patient with a blunt aortic injury from a motor vehicle accident exhibits increased pulmonary vascularity and a normal heart size on chest x-ray. What injury-induced pathologies would most likely produce this? A. Pericardial tamponade B. Thoracic aorta tear C. Vena cava tear D. Ventricular septal defect
D. Increased pulmonary vascularity and a normal heart size on chest x-ray in a patient with blunt chest trauma could be indicative of a ventral septal defect caused by trauma.
Which of the following stimuli would be most likely to precipitate autonomic hyperreflexia in a patient with a T7 lesion? A. Intubation B. Intravenous induction C. Cutaneous stimulation of the scalp D. Bladder catheterization
D: Autonomic hyperreflexia results from stimulation below the level of the transection. Bladder catheterization, defecation, childbirth, distention of the bladder or rectum, and cutaneous stimulation can precipitate autonomic hyperreflexia in susceptible patients. Autonomic hyperreflexia is a massive sympathetic discharge that occurs in response to a cutaneous or visceral stimulation below the level of transection. In normal patients, the sympathetic activity that results from this stimulation is overridden by inhibitory impulses from higher central nervous system centers. In the spinal cord injured patient, the sympathetic outflow is isolated from the inhibitory feedback loop and the sympathetic discharge is unopposed.
Which patient would be most likely to exhibit warm, pink extremities? A. A patient who is hypotensive due to a malignant arrhythmia B. A patient in hemorrhagic shock C. A patient in cardiogenic shock caused by an acute myocardial infarction D. A patient in spinal shock
D: Because spinal shock disrupts the compensatory vasoconstrictive response, patients with spinal shock will exhibit warm, pink extremities whereas patients with hemorrhagic or cardiogenic will exhibit cool, clammy extremities.
Succinylcholine is contraindicated A. at the onset of a significant burn injury B. in the first 6 hours of a significant burn injury C. in the first 12 hours of a significant burn injury D. more than 24 hours after a significant burn injury
Significant burns are associated with upregulation of acetylcholine receptors throughout the muscle membranes. As a result, the administration of succinylcholine could result in a dangerous hyperkalemia. The upregulation may take a few days to occur, so succinylcholine should be avoided more than 24 hours after a burn injury.
What are the four types of burns? (select four) A. Thermal B. Scalding C. Chemical D. Electrical E. Epidermal F. Vasoreactive G. Inhalation H. Steam
The four types of burns are: chemical, electrical, thermal, and inhalation.