ATLS Chapters 4-6
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| How should you position the patient before placing a subclavian or IJ line? | show 🗑
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| show | Intraosseous infusion should be limited to emergency resuscitation and shoudl be discontinued as soon as other venous access is obtained.
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| Where do you want to make an incision for a saphenous vein cutdown and how long should your incision be? | show 🗑
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| show | This may NOT be a pneumothorax, for intubated patients always suspect a right main-stem before attempting needle decompression.
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| show | Into the 2nd intercostal space in the midclavicular line of the affected hemithorax.
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| For an open pneumothorax, (sucking chest wound) air passes preferentially through the chest wall defect (least resistance) if the diameter of the defect is at least ___ the diameter of the trachea. | show 🗑
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| show | 2 or more ribs fractured in 2 or more places
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| show | Percussion - hyperresonant with pnuemo, dull with hemothorax.
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| show | No, they might have a massive internal hemorrhage and be hypovolemic.
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| By definition, how much blood is in the chest cavity to call it a "massive hemothorax"? | show 🗑
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| show | #38 French - inserted at the 4th or 5th intercostal space, just anterior to the midaxillary line.
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| What is Kussmaul's sign? | show 🗑
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| How well do CPR compressions work on someone with a penetrating chest injury and hypovolemia? | show 🗑
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| show | NO - Only PEA with PENETRATING thoracic injuries should get an ED thoracotomy.
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| show | Evacuate pericardial blood, direcly control hemorrhage, cardiac massage, cross-clamp the descending aorta to slow blood loss below the diaphragm and increase perfusion to the heart and brain.
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| show | CHEST TUBE - positive pressure ventilation can turn a simple pneumo into a tension pneumo, so put in a chest tube first.
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| Should you evacuate a simple hemothorax if it is not causing any respiratory problems? | show 🗑
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| show | tracheobronchial - Use bronchoscopy to confirm, you may need more than one chest tube before definitive operative management.
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| show | Widened mediastinum, obliteration of aortic knob, deviation of trachea to the right, depression of left mainstem bronchus, deviation of esophagus (NG tube) to right, widened paratracheal stripe, fx'd 1st/2nd ribs or scapula.
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| show | an ESOPHAGEAL RUPTURE - a forceful blow causes expulsion of gastric contents into the esophagus, producing a linear tear in the lower esophagus allowing leakage into the mediastinum.
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| Fractures for the lower ribs (10-12) should increase suspicion for _____ injury. | show 🗑
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| Why are upper torso, facial, and arm plethora with petechiae associated with crush injuries to the chest? | show 🗑
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| How does ATLS suggest you should review a chest radiograph? | show 🗑
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| show | Puncture the skin 1-2 cm inferior to the left xiphohondral junction at a 45 degree angle to the skin towards the heart, aiming toward the top of the left scapula.
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| show | ECG Changes - extreme ST-changes, widened QRS, PVCs, etc... Withdrawl needle until ECG returns to baseline.
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| show | Lock the stopcock and leave the catheter in place in case it needs to be reevacuated. If possible, use the Seldinger technique to pass a 14 gauge flexible catheter over the guidewire. This is NOT a definitive treatment.
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| For patients with facial fractures or basillar skull fractures, gastric tubes should be inserted ____ before doing a DPL. | show 🗑
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| show | inability to void, unstable pelvic fracture, blood at urethral meatus, scrotal hematoma, perineal ecchymoses, or high-riding prostate.
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| DPL is considered to be __% sensitive for detecting intraperitoneal bleeding. | show 🗑
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| What are the four places you should look first when doing a FAST scan? | show 🗑
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| DPL is indicated when a patient with multiple blunt injuries is hemodynamically unstable, especially when they have _____. | show 🗑
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| What is the only ABSOLUTE contraindication to DPL? | show 🗑
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| show | Morbid obesity, advanced cirrhosis, preexisting coagulopathy, and previous abdominal operations (adhesions).
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| show | PELVIC FRACTURES (don't want to enter pelvic hematoma) and ADVANCED PREGNANCY (don't want to damage enlarged uterus).
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| When doing a DPL, what INITIAL findings (not from lab) would mandate a laparotomy? | show 🗑
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| show | Adult - 1,000 mL warm isotonic crystalloid. Kid - 10 mL/kg
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| You've just put a bunch of fluid in the belly and aspirated more fluid for your DPL. No gross GI contents or anything alarming are present, what QUANTATIVE things would make the DPL positive? | show 🗑
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| Your trauma patient needs an urgent laparotomy, can you take them to the CT scanner first to evaluate injuries? | show 🗑
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| show | Unstable, GSW, peritoneal irritation, fascial penetration
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| What percentage of stab wounds to the anterior abdomen do NOT penetrate the peritoneum? | show 🗑
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| Does an early normal serum amylase level exclude major pancreatic trauma? | show 🗑
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| show | No - not if they remain hemodynamically stable (Of all patients who are initially thought to havea ISOLATED solid organ injury, <5% will have hollow viscus injury as well).
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| Which is LESS likely to have a life-threating hemorrhage - an open book or closed book pelvic fracture? | show 🗑
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| show | AP = Open Book, LATERAL = Closed Book
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| Which are more common, open or closed book pelvic fracturs? | show 🗑
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| show | Angiography
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| show | DECOMPRESS BLADDER, DECOMPRESS STOMACH
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| show | 30%
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| A blown pupil in a patient with a traumatic injury is caused by compression of which nerve? | show 🗑
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| What is a "normal" ICP in the resting state? | show 🗑
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| The Monro-Kellie Doctrine describes compensatory mechanisms inside the calvarium to stabilize pressure - what are the 2 main/first ones? | show 🗑
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| show | Minor = 13-15, Moderate = 8-12
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| When calculating GCS and there is right/left assymetry in the motor response - which one do you use? | show 🗑
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| show | PERIORBITAL ECCHYMOSIS (raccoon eyes), RETROAURICULAR ECCHYMOSIS (Battle sign), and otorrhea/rhinorrhea.
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| show | EVERYTHING - Know it COLD!
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| What things might require a person with MINOR brain injury get admitted? | show 🗑
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| show | CT scan - Everything but the 30 min amnesia makes them HIGH risk for neurosurgical intervention (as would a basillar skull fx).
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| What 2 things do you need to do first for everyone with a MODERATE brain injury (according to ATLS algorithm)? | show 🗑
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| show | Dilate (to increase blood flow) - so you might want to HYPERventilate people with brain injuries.
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| Ideally, you want to wait to perform a GCS on a person with SEVERE brain injury until what? | show 🗑
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| show | 100 If a patient has a systolic over 100 with evidence of intracranial mass (blown pupil, unequal motor exam) THEN a CT would take first priority.
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| show | 5mm
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| show | 0.25-1.0 g/kg via rapid bolus
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| A cast cutter should be removed to remove a trauma victim's helmet if there is evidence of a c-spine injury or if _____. | show 🗑
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