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ATLS - Ch 1
Assessment & Management
| Question | Answer |
|---|---|
| Give three signs for transport to trauma center | 1-GCS < 14 2-RR < 10 or > 29 3-SBP < 90 |
| Give twelve MVA criteria for transport to trauma center | 1-Ejection 2-Death 3-Run over or thrown 4-Unrestrained > 40 mph 5-Deformity > 20 in 6-Intrusion > 12 in 7-Extrication > 20 min 8-Fall > 20 ft 9-Rollover 10-Hit > 5 mph 11-Motorcycle > 20 mph 12-Separation |
| Give nine situations prompting transport to trauma center | 1-Flail 2-Fx 2+ proximal long bones 3-Amputation > wrist or ankle, crushed, mangled, degloved 4-Penetration to head, neck, chest, extremities prox to knee or elbow 5-Open or depressed skull 6-Paralysis 7-Pelvic fx 8-Trauma & burns 9-Isolated major burns |
| After evaluating airway, | Protect the cervcial spine |
| When is definitive airway management indicated? (3) | 1-Tracheal/laryngeal fractures 2-GCS < 8 3-Nonpurposeful motor responses |
| How do you confirm ETT placement? (5) | 1-Auscultation bilateral breath sounds 2-Watching chest rise & fall 3-End-tidal CO2 detector 4-Visualizing ETT through cords 5-CXR |
| What is No. 1 cause of preventable post-traumatic death? | Hemorrhage |
| Give three examples of occult hemorrhage | 1-Thoracic/abdominal cavity 2-Surrounding femur fracture 3-Pelvic fx c retroperitoneal hemorrhage |
| What is an unlikely cause of occult hemorrhage? | Neurogenic shock secondary to spinal cord injury |
| ___ patients may not demonstrate ____ as an early sign of significant blood loss. | Elderly, pediatric, athletic....tachycardia |
| How should rapid external hemorrhage be controlled during the primary survey? | direct manual compression |
| GCS measures ____ ____ and ____. | Eye opening, BEST Motor Response, and Verbal Response |
| Give four contributions to low GCS | 1-Hemorrhage 2-Hypoglycemia 3-Meds & Drugs 4-C-spine injury |
| Which type of hematoma leads to rapid ____ sometimes after a ____ interval? | alteration in mental status lucid epidural, not subdural |
| What factors determine maximum rate of fluid administration? | 1-Internal diameter of IV catheter and 2-inversely, the length of IV catheter, not the size of the vein |
| Which IV fluid is preferred and how is it prepared? | Ringers lactate warmed |
| What can IV NS cause? | hyperchloremic acidosis, especially with impaired renal function |
| Give blood priority: | MTSp UTSp ONeg |
| Give three considerations in PEA | 1-Cardiac tamponade 2-Tension Pneumothorax 3-Massive hemorrhage c hypovolemia |
| When should urethral injury be suspected? (6) | 1-Blood at penile urethral meatus 2-Perineal ecchymosis 3-Nonpalpable prostate (high-riding) 4-Ecchymotic scrotum 5-Blood in scrotum 6-Pelvic fracutre |
| When should a Foley not be inserted? | When urethral injury suspected |
| Best way to diagnose urethral injury | Retrograde urethrogram |
| Give four complications of NG tube insertion | 1-Insertion into brain via fx cribriform plate 2-Pulmonary aspiration of oropharyngeal or gastric contents 3-Bradycardia 4-Vomiting |
| What does pulse oximetry measure? | Percent of hemoglobin saturated with oxygen |
| Give four ways to evaluate cervical vasculature | 1-U/S 2-Contrast CT 3-MRI/MRA 4-Angiography |
| Give four criteria for surgical exploration of penetrating trauma to neck | 1-Expanding hematoma 2-Airway compromise 3-Arterial bleeding 4-New bruit |
| Give two examples of delayed abdominal trauma | 1-Small bowel injury 2-Pancreatic injury |
| Which findings are consistent with tension pneumothorax? (5) | 1-Distended neck veins 2-Hyperresonance to percussion 3-Decreased breath sounds 4-Tracheal deviation 5-Hypotension |
| Which findings are consistent with cardiac tamponade? (3) | 1-Hypotension 2-Distended neck veins 3-distant heart sounds |
| Which findings are consistent with aortic rupture? (7) | 1-Widened mediastinum 2-Blurring/obliteration of aortic knob 3-Rightward deviation of trachea and esophagus 4-Depression of left mainstem bronchus 5-Obliteration of space between PA and Aorta 6-Widened paratracheal stripe 7-Widened paraspinal interface |
| Three indications for DPL | 1-Unexplained hypotension 2-Abdominal pain and tenderness 3-Inability to perform reliable exam d/t neuro injury or altered mental status |
| Urethral injury is more common in ____. | Males |
| Immobilization if neuro injury suspected | 1-Semi-rigid cervical collar 2-long spine board |
| Adult maintenance urine output | 0.5 mL/kg/hour |
| Child maintenance urine output | 1.0 mL/kg/hour |
| Under 1 year of age maintenance urine output | 2.0 mL/kg/hour |
| Route of pain meds for trauma patient | IV, not oral or IM |
| Best method for opening airway in trauma patient | Chin lift or Jaw thrust |
| What should you do with an open pneumothorax? | Seal it on three sides, not four |
| Ten steps in initial assessment process 1-8 | 1-Preparation 2-Triage 3-Primary Survey 4-Resuscitation 5-Adjuncts to Primary Survey and Resuscitation 6-Consider need for Patient Transport 7-Secondary Survey (Head to Toe Evaluation and Patient History 8-Adjuncts to Secondary Survey |
| Ten steps in initial assessment process 9-10 | 9-Continued Postresuscitation Monitoring and Reevaluation 10-Definitive Care |
| Prehospital emphasis | 1-Airway maintenance 2-Control of external bleeding and shock 3-Immobilization of patient 4-Transport to closest appropriate facility 5-Minimization of scene time 6-Obtaining/reporting information, mechanism of injury |
| Give six more reasons to transfer to trauma center | 10-Crush, degloved, or mangled extremity 11-Pregnancy > 20 wks 12-Time-sensitive extremity injury 13-End-stage renal disease requiring dialysis 14-Burns w/o trauma: Triage to burn facility 15-Burns w trauma: Triage to trauma center |
| Considerations for Hospital Phase of trauma care (6) | 1-Proper airway equipment 2-Warmed IV crystalloid solutions 3-Appropriate monitoring capabilities 4-Method to summon additional help 5-Transfer agreements 6-Universal precautions |
| Appropriate patients should arrive at | appropriate hospitals. |
| Two types of triage situations | 1-Multiple casualities 2-Mass casualities |
| Characteristics and goal of Multiple Casualities | 1-Number and severity do not exceed ability 2-Life-threateningand multiple-system injuries treated first |
| Characteristics and goal of Mass Casualities | 1-Number and severity DO exceed capability 2-Greatest chance of survival and least expenditure treated first |
| Ten-second assessment (3) | 1-injuries 2-vital signs 3-injury mechanism |
| Trauma is a common cause of death in the | elderly. |
| Two things to promote survival in elderly trauma patients | 1-prompt, aggressive resuscitation 2-early recognition of preexisting conditions and medication use |
| What suggests airway is not in immediate jeopardy? | Patient able to communicate verbally. |
| Does neurologic exam alone exclude C-spine injury? | No |
| Assume a C-spine injury in patients with (3) | 1-multi-system trauma 2-altered level of consciousness 3-blunt injury above the clavicle |
| Airway patency alone does not ensure | adequate ventilation. |
| Ventilation requires adequate function of the (3) | lungs, chest wall, and diaphragm |
| Impaired ventilation during primary survey (4) | 1-tension pneumothorax 2-flail chest w pulmonary contusion 3-massive hemothorax 4-open pneumothorax |
| Impaired ventilation during secondary survey (4) | 1-simple pneumothorax 2-simple hemothorax 3-fractured ribs 4-pulmonary contusions |
| Intubation and vigorous bag-valve ventilation can make patient worse with | pneumothorax or tension pneumothorax |
| Until proven otherwise, injury related hypotension is considered | hypovolemic in origin. |
| Three elements of hypovolemia | 1-level of consciousness 2-skin color 3-pulse |
| A conscious patient may have lost | a significant amount of blood. |
| Skin in hypovolemic patient may show | 1-ashen, gray facial skin 2-white extremities |
| Easily accessible central pulses | carotid and femoral |
| Pulses in hypovolemia | thready, rapid, irregular, absent |
| What kind of hemorrhage is identified and controlled during what survey? | external primary |
| Two things not to use during primary control of hemorrhage | tourniquets and hemostats |
| When is a rapid neuro exam done? | at the end of the primary survey |
| Four things assessed during rapid neuro exam | 1-level of consciousness 2-pupillary size and reaction 3-lateralizing signs 4-spinal cord injury level |
| What correlation with CO does BP have in elderly? | little |
| What can increase blood loss in elderly? | anticoagulation therapy |
| Regarding room temperature, consider ____ rather than ____. | patient's body temp health-care providers |
| Immediate ____ should be started if tension pneumothorax is suspected. | chest decompression |
| How many, and what kind of IV catheters? | Two, large-bore |
| Prioritize volume resuscitation vs definitive control of hemorrhage | definitive control of hemorrhage |
| Shock w injury most often ____ in origin. | hypovolemic |
| What can and cannot be warmed in a microwave oven? | crystalloid fluids blood products |
| Name nine adjuncts used during primary survey | 1-electrocardiographic monitoring 2-urinary catheters 3-gastric catheters 4-ventilatory rate 5-ABG levels 6-pulse oximetry 7-blood pressure 8-x-rays 9-diagnostic studies |
| Dysrhythmias can indicate | blunt cardiac injury |
| Hypoxia, hypoperfusion and/or hypothermia can cause what dysrhythmias? (3) | 1-bradycardia 2-aberrant conduction 3-premature beats |
| Rectal exam and genital exam should be done before | inserting a urinary catheter |
| Gastric tube used to | 1-reduce stomach distension 2-decrease risk of aspiration |
| Blood in gastric aspirate may indicate (3) | 1-oropharyngeal (swallowed) blood 2-traumatic insertion 3-actual injury to upper digestive trace |
| Capnography does not confirm | proper placement of tube in trachea. |
| Pulse oximetry does not measure | the partial pressure of oxygen, nor the partial pressure of carbon dioxide |
| Blood pressure may be a poor measure of | actual tissue perfusion |
| On which arm should pulse oximetry not be placed? | the one with the blood pressure cuff on |
| Essential x-rays should be obtained EVEN | in pregnant patients |
| F A S T | Focused Assessment Sonography in Trauma |
| D P L | Diagnostic Peritoneal Lavage |
| Two limiting factors in FAST | obesity and intraluminal bowel gas |
| Three limiting factors in DPL | 1-obesity 2-previous abdominal operations 3-pregnancy |
| Potential in unresponsive or unstable patient (2) | 1-missing an injry 2-failing to appreciate significance of injury |
| Medical assessment always includes | history of mechanism of injury |
| A in AMPLE | Allergies |
| M in AMPLE | Medications currently used |
| P in AMPLE | Past illness and Pregnancy |
| L in AMPLE | Last Meal |
| E in AMPLE | Events/Environment related to injury |
| Four categories of injury | 1-Blunt trauma 2-Penetrating trauma 3-Thermal injuries 4-Hazardous environment |
| Considerations in blunt trauma from MVC (5) | 1-seat-belt use 2-steering wheel deformation 3-direction of impact 4-damage (deformation or intrusion) 5-ejection |
| Considerations in penetrating trauma (2) | 1-organs in the path 2-velocity of the missile |
| Clues to extent of injury in gunshot victims (4) | 1-velocity 2-caliber 3-presumed path of bullet 4-distance from weapon to wound |
| Burns can occur ____ or with ____ | alone blunt and penetrating trauma |
| Two considerations in a fire | 1-inhalation injury 2-carbon monoxide poisoning |
| Two considerations about exposure to hazardous environment | 1-pulmonary, cardiac, internal organ dysfunction in patient 2-hazard to healthcare providers |
| Eyes should be evaluated for (7) | 1-visual acuity 2-pupillary size 3-hemorrhage of conjunctiva and/or fundi 4-penetrating injury 5-contact lenses (remove before edema) 6-dislocation of lens 7-ocular entrapment |
| Mechanism of Injury (5) | 1-Frontal impact 2-Side impact 3-Rear impact 4-Ejection 5-Pedestrian struck by motor vehicle |
| MOI | Mechanism of Injury |
| SIP | Suspected Injury Pattern |
| SIP in Frontal Impact MVC (7) | 1-Cervical spine fracture 2-Anterior flail chest 3-Myocardial contusion 4-Pneumothorax 5-Traumatic aortic disruption 6-Fractured spleen or liver 7-Posterior fracture/dislocation of hip and/or knee |
| SIP in Side Impact MVC (8) | 1-Contralateral neck sprain 2-Cervical spine fracture 3-lateral flail chest 4-Pneumothorax 5-Traumatic aortic disruption 6-Diaphragmatic rupture 7-Fracture spleen/liver and/or kidneys, depending on side of impact 8-Fractured pelvis or acetabulum |
| SIP in Rear Impact MVC (2) | 1-Cervical spine injury 2-Soft tissue injury to neck |
| SIP in Ejection from vehicle | Meaningful pattern precluded |
| SIP in Pedestrian Struck by Vehicle (4) | 1-Head injury 2-Traumatic aortic disruption 3-Abdominal visceral injuries 4-Fractured lower extremities/pelvis |
| Patient with mid-face fracture can have | fracture of cribriform plate |
| Presumption with maxillofacial or head trauma | unstable cervical spine injury |
| Does not exclued injury to cervical spine | absence of neurological deficit |
| Exam of neck includes (3) | 1-Inspection 2-Palpation 3-Auscultation |
| Unexplained or isolated paralysis of upper extremity | suspect cervical nerve root injury and document |
| Palpation of chest cage includes (3) | 1-clavicles 2-ribs 3-sternum |
| Auscultation of breath sounds for hemothorax | posterior bases |
| Auscultation of breath sounds for pneumothorax | high on anterior chest |
| Children often sustain significant injury to the ____ without evidence of ____. | 1-intrathoracic structures 2-thoracic skeletal trauma |
| What are you looking for in vaginal exam? | 1-blood in vaginal vault 2-vaginal lacerations |
| Pelvic fractures should be suspected when you identify ecchymosis over the (4) | 1-iliac wings 2-pubis 3-labia 4-scrotum |
| Manipulation of the pelvis should be done | only once |
| Complete musculoskeletal exam includes | the back |
| Prioritize treatment vs consent | consent, then treatment, usually, but when not possible, treat, then obtain consent |
Created by:
tcrouch2000
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