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?==>50150
what is the MonroKellie 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 1513, Moderate
129, 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 Cspine, 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 cspine 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 cspine

xray==>Cross table lateral, AP ,
Odontoid (open mouth)

if you find an isolated cspine 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 >3540 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 cspine

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 cspine 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