TCAR module 5- abdominal injuries fully solved questions with 100% accurate solutions(Latest Update)

4 potential sites of energy transfer in a crash

if a patient has a positive seat belt sign, they are likely to have at least 3 abdominal injuries due to the transfer of energy

seat belt sign

high probability of peritoneal injury

grey turner sign

flank bruising

concerning for retroperitoneal bleeding

obese drivers are 20-80% more likely to die as a result of a collison

fixed points...

hollow structures...

solid structures...

in response to energy application

tear

pop

crack

encapsulated organs...

spleen, liver, kidneys

kehr's sign-

pain from diaphragmatic irritation that is referred to the left shoulder. this classic pain is most commonly the result of blood under the left hemi-diaphragm leaking from a bleeding spleen

which two solid organs are most likely to be damaged in blunt abdominal injury?

spleen or liver

besides the kidneys, which organs or structures are completely retroperitoneal?

the aorta

vena cava

spine

why are serum lipase and amylase enzymes elevated after a pancreatic injury?

because a damaged pancreas will leak digestive fluid (amylase and lipase) into the tissues which will be absorbed into the blood stream

used to help diagnose pancreatic injuries- these injuries arent always as obvious on CT scanning

PE exam:

delayed onset burning epigastric pain

nausea

trauma patients with retroperitoneal bleeding are usually managed...

non operatively

space is limited in the retroperitoneum, minor or moderate bleeding will usually tamponade itself, making non op management the most common treatment option

patients with a shattered kidney or great vessel tear can experience extensive blood loss that will require invasive intervention

signs of bowel perforation

fever, rebound tenderness, and an elevated WBC count

PE findings of a liver injury

RUQ pain, high ALT and AST levels

If "free air" is identified on a trauma patient's abdomen, where it the patient likely to go next

the operating room. why?

free air indicates perforation of one of the hollow, air-filled abdominal structure: the bowel, the stomach, or rarely, the esophagus

such injuries can only be adequately visualized and repaired in surgery

we cant reverse acidosis and coagulopathy until we correct....

hypothermia

intra-abdominal hemorrhage primarily causes problems at what three points on the tissue oxygenation cascade?

hgb availability, then cardiac output due to the decrease in circulating volume, and the ventilation due to the extra pressure on the diaphragm

the primary goal of damage control surgery is to....

restore normal pH

control hemorrhage

establish normothermia

perform anatomica repairs

control hemorrhage

the patient with an intestinal injury is at high risk for which of the following post-op complications

interstitial fluids shifts

abdominal abscesses

sepsis

peritonitis

bowel edema

Body water distribution

2/3 of our body water is found in the cells* (intracellular)

1/3 is extracellular

of that extracellular fluid, 3/4 is interstitial and only 1/4 is intravascular

what happens if you administer hypotonic fluid? it is evenly distributed throughout the body

when would this be indicated?

D5 0.45% NS- we administer this for cellular dehydration: such as patients who have hyperglycemia, hypernatremia, GI losses, environmental dehydration

isotonic crystalloid

LR, plasmalyte, NS

this fluid stays in the extracellular space and distributes evenly (interstitial and extracellular) does not go into intracellular space

hypotonic solutions (D5W, D50.45%NS) distribute evenly throughout all body fluid compartments. thus, two thirds (666ml) quickly move into the cells, and one third (333ml) distribute evenly throughout the extracellular space. three quarters of that amount (250ml) goes between the cells in the interstitium. only 83ml remain in the intravascular space

in adults, hypotonic IV solutions are used as maintenance fluids because isotonic solutions...

quickly leave the extracellular space

do not enter the cells

contain too much sodium

draw water into the circulation

do not enter the cells

every 1mL of blood lost must be replaced with ____ml of an isotonic solution to restore the same vascular volume

3-4

large volume isotonic fluid infusions contribute to...

interstitial edema

normal saline Na and Cl contents

Na 154mEq

Cl 154mEq... our normal serum level is ~100!

pH of 5.5

osmo of 308

there is nothing "normal" about normal saline

volume resuscitation with large amounts of NS leads to....hyperchloremic acidosis which is associated with an increased incidence of AKI

LR Na and Cl levels

Na 130mEq

Cl 109mEq

l

hyponatremic as compared to serum.. it is contraindicated in brain trauma patients

it also contains some K and Ca. and lactate! this is a buffer (like bicarbonate, acetate, and gluconate) brings the pH up to 6.5

plasmalyte, normosol R

referred to as a balanced or physiologic solution

pH of 7.4

normal levels of Na, Cl, K, and Mg

hypertonic solution indication?

what happens if you administer 250mL of 7% saline into the intravascular space?

- TBI patients. treats cerebral edema, pulls fluids out of swollen brain tissue

- fluid is going be drawn from the intracellular and interstitial comparments expanding intravascular volume by as much as two liters. this can quickly fluid overload a patient

administering 20% albumin will increase intravascular volume by about ___ times the amount infused

four

when 100mL of 20% albumin are infused, this hypertonic colloid will draw water from the intracellular and interstitial compartments, expanding vascular volume by about 400mL

initial steps toward normalizing a trauma patient's physiology involve optimizing... __ , ___, ___

pH level, body temp, and cellular oxygenation

patients can not optimally release oxygen to the cells until body temperature and pH are normalized. fluid balance and sodium level are not intitial goals. correcting fluid deficits and restoring adequate perfusion is the best approach to normalizing UO

trauma fluid management paradigms with near universal acceptance include...

aggressively controlling hemorrhage

minimizing IV crystalloids

quickly starting blood transfusions

giving the yellow stuff right away

tube feedings can contribute to dehydration when....

high colorie/high protein (hypertonic solutions) are used

many bloodborne infections begin in a patient's own intestines

benefit of trickle feeding

wont meet a patients nutritional needs, but it can reduce bacterial translocation, minimize mucosal atrophy, and keep the intenstines healthy, happy, and doing their job

abdominal compartment syndrome

a state in which increasing pressure in the abdominal compartment decreases tissue perfusion and leads to organ dysfunction

decreased gut perfusion --> inflammatory response --> bowel edema --> increased pressure --> tissue ischemia --> increased mucosal permeability --> toxic mediator translocation --> cell death

whats the leading cause of mesenteric injuries in the trauma patient?

seatbelts, particularly when only a lap belt is used

adverse effects of intra-abdominal hypertension

whats the pressure in the vena cava?

2-8mmHg, same as central venous pressure

if abdominal pressure exceeds this, venous return to the heart will be impeded

why... the vena cava is the vessel that returns blood to the heart. if abdominal pressure exceeds vena cava pressure, the vena cava will be compressed

intr-abdominal pressures

normal: 0-5

physiological compromise 10-15

irreversible tissue injury 20-30

patients with mesenteric vessel injuries usually...

develop feeding intolerance days after injury

which assessment findings suggest abdominal compartment syndrome?

ventilator high pressure alarm (diaphragm excursion and ventilation are impeded due to bowel edema and abdominal distention)

abdominal distention and tenderness

dwindling urine output

tachycardia and hypotension

leaving the abdomen open after a laparotomy eliminates the risk of abdominal compartment syndrome development? true or false

false

the incidence is lower in patients with an open abdomen, but the risk is not eliminated.

sepsis risk factors that are very preventable with basic intervention

oral care

catheter care

wound care

skin care

hand-washing

careful IV access

IV dressing changes

visitor surveillance

suctioning

elevate HOB

early mobility

etc...

sepsis

toxic and inflammatory mediators produce

widespread endothelial damage -->

leading to vasodilation --> capillary leakage/increased permeability --> interstitial edema --> microcirculation clotting --> coagulopathies --> cellular metabolic dysfunction --> multiple organ failure

early sepsis identifiers

which vital sign best distinguishes hypovolemia from sepsis?

pulse pressure

why?

PP = SBP - DBP

hypovolemic patient has increasing DBP due to vasoconstriction compensation, which will cause a narrowing pulse pressure

the septic patient has a dropping DBP due to vasodilation, resulting in pulse pressure widening

where does early sepsis start on the tissue oxygen cascade?

tissue oxygen utilization problem

oxygen is being delivered to the periphery, but it is not making that last mm through the capillaries to the cells

or the cells simply cant use it

sepsis is a complex and incompletely understood condition that causes widespread damage to the ______ layer of the blood vessels

endothelial

the hypovolemic patient has a ___ pulse pressure

the septic patient has a ____ pulse pressure

narrow

wide

organ donation- primarily regulated by state governments or the federal government?

federal government

there are minor state-to-state differences, but it is chiefly regulated at the federal level in the US

once brain death (death by neurological criteria) has been declared..

the patient is legally considered dead