Factor 7 is a glycoprotein dependent on what?

Factor 7 binds to _____1______ (exposed when there is injury to the tissue)

Factor 7 also plays a key roll in Factor _____2_____ activation.

1) Tissue Factor

2) Factor X

The studies for factor VII are mixed:

But- it seems to be more beneficial in one type of trauma vs. another. 

What type of Trauma  does factor VII seem to be beneficial in?

In Gayle's Lecture there were 2 main things that rendered factor VII ineffective (other than using it too damn late).

What are these 2 things?

Severe Acidosis (pH 7.2 or lower)

Or Hypothermia (temp, 35 degrees C)

Let's say I give factor 7.

What pathway am I working on? (predominantly)

What lab would indicate that maybe my coagulopathy was getting better?

1) Extrinsic Pathway

2)  a decrease in PT

1)What is the dose for Factor VII?

2) Supplied in 3 different size vials- what are  they?

3) Does it need to be reconstituted?

4) What is the relative cost? 

5) Can/Should it be used as a last ditch effort?

1) 70-90 mcg/ kg

2) 1.2 mg, 2.4 mg, 4.8 mg

3) Yes

4) 81 cents per microgram

5) Should not be used as last ditch effort

1)What type of trauma is open chest massage mostly used in? 

2) What is the most common arrhythmia in Trauma?

3) When are hypothermic pts pronounced? 

 4) Most common arrhythmia in hypothermia?

1) Penetrating Trauma

2) PEA

3) Pronounced when they are WARM and dead- but not until warm first. 

4) VT/ VF

Pregnant moms in trauma are more susceptible to these things because the uterus extends above the pelvis at 12 weeks:

When do I need to worry about aortocaval compression?

What can I do about it?

Pregnancy >20 weeks.

Left Uterine Displacement position (I would assume that maybe might need to clear C-spine first- but then situation dictates I suppose)

I have a mom that is bleeding like a stuffed pig but her vitals are groovy.

Why worry?

1) Because maternal blood volume increases by 40%- shock will occure w/o significant changes in vitals.

What is uterine circulation dependent on? 

If Mommy gets tachycardic, and hypotensive-

fetal survival drops to what percentage?

Prego Mommy comes in all jacked up. 

1) Per ATLS what is the primary goal?

2) Should fetal heart tones be monitored?

1) Stabilize baby's momma

2) Yes

Pregnant mom scenario continued:

Signs of trouble in the fetus include?:

What happens if I have bleeding into the myometrium?

1) Tachycardia

2) Bradycardia

3) Absence of normal Decelerations

4) late decelerations

Bleeding into myometrium is extremely irritating and can induce labor.

Pregnant woman isn't doing well and is getting open cardiac massage. 

1) Can/ should an emergent C- Section be done? 

2) What might happen if we did do a C-section?

1) Can be done if fetus is viable > 24 weeks

> 500 gms in weight

2) Delivery of the infant may improve mom's chances by improving cardiac filling.

1) Child's head is proportionately larger- Larger occiput can cause excessive flexion of C-spine

2) Skeleton is softer therefore can sustain an impact but not necessarily break bones.

Trauma-

1) In children- BP is maintained until how much blood loss has occured?

2) I have a kid who was cool clammy skin and tachycardia- what am I concerned about?

1) > 30% blood loss

2) These are the first signs of shock in children- they can crash very quickly from here.

Trauma-

IV access can be a problem.  Per ATLS what order should we attempt to gain IV access?

1) peripheral

2) IO

3) Femoral

4) Saphenous Cutdown

5) Central Line

Trauma and the Elderly:  True or False:

1) Multiple disease constellations

2) Don't have adequate CV response to Trauma and blood loss.

3) Take medications

4) Prone to hypothermia

5) Prone to Subdural Hematomas d/t brain atrophy

6) Prone to cervical and spinal injuries

7) Prone to bone fractures

8) Prone to shock d/t subcutaneous bleeding

9) Poor immune responses

1) What are MAST trousers used for and or good for?

2) What type of damage is increased with the use of MAST trousers and what is the implication?

1) Good for pelvic Stabilization

May provide increased venous return, and prevent a pt from bleeding out d/t a crush injury.

2) Increased risk for tissue damage which can lead to rhabdomyolysis

When Deflating:

1) deflation= intravascular influx of lactic acid

2) Must provide adequate volume support

3) Deflate 1 compartement at a time beginning with pelvic compartment