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ATLS Exam Guide 10th^ edition Advanced Trauma Life Support Notes – American College
of Surgeons
True |or |false? |Although |the |mechanism |of |injury |may |be |similar |to |those |for |the |younger |population, | data |shows |increased |mortality |with |similar |severity |of |injury |in |older |adults. |- |answersTrue In |the |elderly |population, |what |is |decreased |physiological |reserve? |- |answersaging |is |characterized |by | impaired |adaptive |and |homeostatic |mechanisms |that |caused |an |increased |susceptibility |to |the |stress | of |injury. |Insults |tolerated |by |the |younger |population |can |lead |to |devastating |results |in |elderly | patients. Pre-existing |conditions |that |affect |morbidity |and |mortality |include: |- |answerscirrhosis, |coagulopathy, | COPD, |ischemic |heart |disease, |DM What |is |the |most |common |mechanism |of |injury |in |the |elderly? |- |answersFall. |Nonfatal |falls |are | common |in |women |and |fractures |are |common |in |women |who |fall. |Falls |are |the |most |common |cause | of |TBI. In |the |elderly |population, |what |are |risk |factors |for |falls? |- |answersadvanced |age, |physical |impairment, |history |of |previous |fall, |medication |use, |dementia, |unsteady |gait, |and |visual, |cognitive |impairment Most |of |elderly |traffic |fatalities |occur |in |the |daytime |and |on |weekends |and |typically |involve |other | vehicles. |Why? |- |answersOlder |people |drive |on |more |familiar |roads |and |at |lower |speeds |and |tend |to | drive |during |the |day. |Older |people |have |slower |reaction |time, |a |larger |blind |spot, |limited |cervical | mobility, |decreased |hearing, |and |cognitive |impairment. True |or |False? |Mortality |associated |with |small |to |moderate |sized |burns |in |older |adults |remains |high |- | answersTrue Spilled |hot |liquids |on |the |leg, |which |in |younger |patients |may |re-epithelialize |due |to |an |adequate | number |of |hair |follicles, |will |result |in |a |full |thickness |burn |in |older |patients. |- |answersthis |is |true Airway-patients |may |have |dentures |that |may |loosen |or |obstruct |the |airway. |If |dentures |are |not | obstructing |the |airway, |leave |them |in |place |for |what? |- |answersbag |mask |ventilation, |as |it |improves | mask |fitting. When |preforming |rapid |sequence |intubation, |the |dose |of |benzos, |barbiturates, |and |other |sedatives | should |be |reduced |to |what |percentage |to |minimize |the |risk |of |cardiovascular |depression? |- | answers20-40% Functional |changes |in |cardiac |system |include |declining |function, |decreased |sensitivity |to | catecholamines, |atherosclerosis |of |coronary |vessels, |increased |afterload, |fixed |heart |rate |(beta | blockers) |- |answersthis |results |in |lack |of |classic |response |to |hypovolemia, |risk |for |cardiac |ischemia, | elevated |BP |at |baseline, |and |increased |risk |of |dysrythmias.
Functional |changes |in |pulmonary |system |include |decreased |elastic |recoil, |reduced |residual |capacity, | decreased |gas |exchange |and |decreased |cough |reflex |- |answersthus |they |are |at |increased |risk |for | respiratory |failure, |increased |risk |for |pneumonia, |and |poor |tolerance |to |rib |fractures Functional |changes |in |renal |system |include |loss |of |renal |mass, |decreased |GFR, |and |decreased | sensitivity |to |ADH |and |aldosterone |- |answersresulting |in |drug |dosing |for |renal |insufficiency, |decreased |ability |to |concentrate |urine, |increased |risk |for |AKI |and |urine |flow |may |be |normal |with |hypovolemia Functional |changes |to |MSK |include |loss |of |lean |body |mass, |osteoporosis, |changes |in |joints |and | cartilage, |c |spine |degenerative |changes |and |loss |of |skin |elastin |and |subcutaneous |fat |- | answersresulting |in |increased |risk |for |fractures, |decreased |mobility, |difficulty |for |oral |intubation, |risk | of |skin |injury, |increased |risk |for |hypothermia, |challenges |in |rehabiliation Functional |changes |in |Endocrine |system |include |decreased |production |and |response |to |thyroxin |and | decreased |dehydroepiandrosterone |(DHEA) |- |answersresulting |in |occult |hypothyroidism, |relative | hypercortisone |states |and |increased |risk |of |infection True |or |false: |Arthritis |can |complicate |the |airway |and |cervical |spine. |Patients |can |have |multilevel | degenerative |changes |affecting |disk |spaces |and |posterior |elements |associated |with |severe |central | canal |stenosis, |cord |compression, |and |myelomalacia |- |answerstrue In |elderly |population, |due |to |their |changes |in |pulmonary |system, |placing |a |gauze |between |gums |and | cheek |to |achieve |seal |when |using |bag |valve |mask |ventilation |is |okay. |In |addition, |because |aging | causes |a |suppressed |heart |rate |response |to |hypoxia...... |- |answersrespiratory |failure |may |present | insidiously |in |older |adults. Age |related |changes |in |the |cardiovascular |system |place |the |elderly |trauma |patient |at |significant |risk | for |being |inaccurately |categorized |as |hemodynamically |stable. |- |answersElderly |patients |have |a |fixed | heart |rate |and |fixed |cardiac |output, |thus, |their |response |to |hypovolemia |will |involve |increasing |their | systemic |vascular |resistance. |Furthermore, |since |older |patients |have |HTN, |an |acceptable |BP |may |truly |reflect |a |hypotensive |state. |A |systolic |BP |of | 110 |is |to |be |utilized |as |the |threshold |for |identifying | hypotension |in |patients | 65 |and |older. Do |no |equate |blood |pressure |with |shock |in |older |patients |- |answersBP |in |older |patients |may |look | normal |due |to |the |medications |they |are |on. |Use |lactate |and |base |deficit |to |evaluate |for |evidence |of | shock what | 2 |factors |place |elderly |patients |at |risk |for |intracranial |hemorrhage? |- |answersaging |causes |dura | to |become |more |adherent |to |the |skull |increasing |risk |of |injury |and |older |patients |are |on | anticoagulant |and |antiplatelet |medications. Loss |of |subcutaneous |fat, |nutritional |deficiencies, |chronic |medical |conditions |place |elderly |patients |as | risk |for |hypothermia |and |complications |for |immobility. |- |answersRapid |evaluation |and |when |possible | early |liberation |from |spine |boards |and |cervical |collars |will |minimize |complications. True |or |False: |Fall |prevention |is |the |mainstay |of |reducing |the |mortality |associated |with |pelvic | fractures. |- |answerstrue
placenta |receives |20% |of |the |patient's |cardiac |output |during |the |3rd |trimester. |In |supine |position, | vena |cava |compression |can |decrease |cardiac |output |by |30% |because |of |decreased |venous |return | from |lower |extremities. During |pregnancy |the |heart |rate |increases |to |a |maximum |of |10-15 |beats |per |minute |over |baseline |by | the |third |trimester. |- |answersthis |heart |rate |must |be |considered |when |interpreting |a |tachycardic | response |to |hypovolemia. Blood |pressure |falls |5-15 |mm |Hg |in |systolic |and |diastolic |pressures |during |second |trimester, |although | it |returns |to |near |normal |levels |at |term. |- |answerssome |women |experience |hypotension |when |placed |in |the |supine |position |due |to |the |compression |of |teh |inferior |vena |cava. hypertension |in |the |pregnant |if |accompanied |by |proteinuria |may |represent |what? |- |answerspre- eclampsia. EKG |findings |in |pregnant |patient |- |answersFlatted |or |inverted |T |waves |in |leads |III |and |AVF |and |the | precordial |leads |may |be |normal. |Ectopic |beats |are |increased |during |pregnancy. Minute |ventilation |increases |primarily |due |to |an |increase |in |tidal |volume. |Hypocapnia |(30 |mm |Hg) |is | common |in |late |pregnancy |- |answersMonitor |ventilation |in |late |pregnancy |with |arterial |blood |gas | values. |A |PaCO2 |of |35-40 |mm |Hg |may |indicate |impending |respiratory |failure |during |pregnancy. | Pregnant |patients |should |be |hypocapneic. Anatomical |alterations |in |the |thoracic |cavity |seem |to |account |for |the |decreased |residual |volume | associated |with |diphragmatic |elevation |and |chest |x |ray |reveals |increased |lung |marking |and | prominence |of |the |pulmonary |vessels. |- |answersoxygen |consumption |increases |during |pregnancy |and | its |important |when |resuscitating |injured |pregnant |patients |to |maintain |adequate |oxygenation |above | 95% In |patients |with |advanced |pregnancy, |those |that |require |a |chest |tube |placement, |where |should |the | test |tube |be |placed? |- |answersit |should |be |positioned |higher |to |avoid |intra-abdominal |placement | given |the |elevation |of |the |diaphragm. Urinary |system: |what |happens |to |the |GFR, |serum |creatinine |and |urea |nitrogen |levels? |- |answersGFR | and |renal |blood |increases |during |pregnancy, |whereas |levels |of |the |serum |creatinine |and |urea | nitrogen |fall |to |one |half |of |the |normal |pre |pregnancy |levels. |Glycosuria |is |common |in |pregnancy. When |interpreting |x |ray |films |of |the |pelvis |in |a |pregnant |patient, |the |symphysis |pubis |widens |4-8 |mm |and |the |sacroiliac |joint |spaces |increase |by |the |7th |month |- |answerskeep |this |in |mind Eclampsia |- |answersMaintain |a |high |index |of |suspicion |for |eclampsia |when |seizures |are |accompanied | by |HTN, |proteinuria, |hyperreflexia, |and |peripheral |edema |in |pregnant |trauma |patients. |This |can | mimic |head |injury. External |contusions |and |abrasions |of |the |abdominal |wall |are |signs |of |blunt |uterine |trauma. |- | answerstrue. |Fetal |injuries |can |occur |when |the |abdominal |wall |strikes |an |object, |such |as |the | dashboard |or |steering |wheel, |or |when |a |pregnant |patient |is |struck |by |a |blunt |instrument. Using |a |shoulder |restraints |in |conjunction |with |a |lap |belt |reduces |the |likelihood |of |direct |and |indirect |fetal |injury, |presumably |because |the |shoulder |belt |dissipates |deceleration |forces |over |a |great |surface
|area |and |helps |prevent |the |mother |from |flexing |forward |over |the |gravid |uterus. |- |answersthe | deployment |of |air |bags |in |vehicles |does |not |appear |to |increase |pregnancy |specific |risks. |Using |lap |belt |alone |allows |for |forward |flexion |and |uterine |compression |with |possible |uterine |rupture |or |placental | abruption. |Lap |belt |worn |too |high |over |uterus |may |produce |uterine |rupture. Penetrating |injury |to |pregnant |women |- |answersAs |uterus |grows |larger, |other |viscera |are |protected | from |penetrating |injury. |Dense |uterine |musculature |in |early |pregnancy |can |absorb |significant |amount | of |energy |from |penetrating |objects |decreasing |their |velocity |and |lowering |risk |of |injury |to |other | viscera. |However, |fetal |outcome |is |generally |poor |with |penetrating |injury |to |uterus. carefully |observe |pregnant |patients |with |even |minor |injuries |since |occasionally |minor |injuries |are | associated |with |placental |abruption |and |fetal |loss. |- |answersTrue. |AND |to |optimize |outcomes |for | mother |and |baby, |clinicians |must |assess |and |resuscitate |the |mother |first |and |then |assess |the |fetus | before |conducting |second |survey |of |the |mother. Failure |to |displace |the |uterus |to |the |left |side |in |a |hypotensive |pregnant |patient |- |answerslogroll |all | patients |appearing |clinically |pregnant |(second |and |third |trimester) |to |the |left |15-30 |degrees |and | elevate |the |right |side |4-6 |inches |and |support |with |a |bolstering |device |to |maintain |spinal |motion | restriction |and |decompression |of |the |vena |cava. Due |to |increases |intravascular |volume, |pregnant |patients |can |lose |a |significant |amount |of |blood | before |tachycardia, |hypotension, |and |other |signs |of |hypovolemia |occur. |Thus, |what |do |stable |vital | signs |in |a |pregnant |patient |indicate |about |the |fetus? |- |answersThe |fetus |may |be |in |distress |and |the | placenta |deprived |of |vital |perfusion |while |the |mother's |condition |and |vital |signs |appear |stable. | Administer |crystalloid |fluid |resuscitation |and |blood |to |support |the |physiological |hypervolemia |of | pregnancy. |vasopressers |should |be |an |absolute |last |resort |in |restoring |maternal |blood |pressure |as | they |further |reduce |uterine |blood |flow, |resulting |in |fetal |hypoxia. What |does |a |normal |fibrinogen |level |indicate |in |a |pregnant |patient? |- |answersFibrinogen |level |may | double |in |late |pregnancy |and |a |normal |level |may |indicate |early |disseminated |intravascular | coagulation Most |common |cause |of |fetal |death? |- |answersmaternal |shock |and |maternal |death. |Placental | abruption |is |second. |Placental |abruption |is |suggested |by |vaginal |bleeding, |uterine |tenderness, | frequent |uterine |contractions, |uterine |tetany, |and |uterine |irritability |(uterus |contracts |when |touched). |In |30% |of |cases |of |abruption, |bleeding |may |not |occur. |Uterine |ultrasound |may |be |helpful |in | diagnosis, |but |is |NOT |definitive. Signs |of |uterine |rupture |- |answersabdominal |tenderness, |guarding, |rigidity, |or |rebound |tenderness. | Signs |of |peritonitis |are |hard |to |tell |due |to |expansion |and |attenuation |of |the |abdominal |wall | musculature. |Other |findings |include |abdominal |fetal |lie |(oblique |or |transverse |lie), |easy |palpation |of | the |fetal |parts |because |of |their |extrauterine |location |and |inability |to |readily |palpate |the |uterine | fundus |when |there |is |fundal |rupture. |Xray |evidence |of |rupture |include |extended |fetal |extremities, | abnormal |fetal |position, |and |free |intraperitoneal |air. Perform |continuous |fetal |monitoring |with |a |tocodynamometer |beyond |20-24 |weeks |of |gestation. |- | answersPatients |with |no |risk |factors |for |fetal |loss |should |have |continuous |monitoring |for | 6 |hours, | whereas, |patients |with |risk |factors |for |fetal |loss |or |placental |abruption |should |be |monitored |for | 24 |
Factors |that |increase |the |risk |of |upper |airway |obstruction |are: |- |answersincreasing |burn |size |and | depth, |burns |to |the |head |and |face, |inhalation |injury, |associated |trauma, |and |burns |inside |the |mouth. | Airway |can |become |obstructed |form |direct |injury |such |as |inhalation |injury, |but |also |from |massive | edema |resulting |from |burn |injury. How |do |you |decontaminate |burn |areas? |- |answersCompletely |remove |the |patient's |clothing |to |stop | burning |process, |but |do |not |peel |off |adherent |clothing. |Synthetic |fabrics |can |ignite, |burn |rapidly |at | high |temps |and |melt |into |hot |residue |that |continues |to |burn |the |patient. |brush |any |dry |chemical | powder |from |wound. |rinse |with |copious |amounts |of |warm |saline |irrigation |or |rinsing |in |a |warm | shower. |once |the |burning |process |has |been |stopped, |cover |the |patient |with |warm, |clean, |dry |linens | to |prevent |hypothermia. hoarseness, |stridor, |accessory |respiratory |muscle |use, |sternal |retraction |are |signs |of |what? |- | answersairway |obstruction. |Clinical |manifestations |of |inhalation |injury |may |be |subtle |and |may |not | show |up |within |the |first | 24 |hours. |do |not |wait |for |the |xray |to |show |evidence |of |pulmonary |injury |or | changes |in |blood |gas |because |airway |edema |can |preclude |intubation |and |a |surgical |airway |will |be | required. A |carboxyhemoglobin |level |greater |than |what |percentage |indicates |a |patient |was |involved |in |a |fire | and |has |inhalation |injury? |- |answers10% Indications |for |early |intubation |in |burn |patients: |- |answersfull |thickness |circumferential |neck |burns, | signs |of |airway |obstruction, |extent |of |the |burn |> |40%, |burns |inside |the |mouth, |difficulty |clearing | secretions |or |swallowing, |decreased |level |of |consciousness, Patient |with |inhalation |injury |are |at |risk |for |bronchial |obstruction |from |secretions |and |debris |and | they |may |require |bronchoscopy. |- |answersMake |sure |to |place |an |adequately |sized |airway |tube Direct |thermal |injury |to |the |lower |airway |is |very |rare |and |essentially |occurs |only |after |exposure |to | superheated |steam |or |ignition |of |inhaled |inflammable |gases. |Breathing |concerns |arise |from |what | 3 | general |causes: |- |answershypoxia, |carbon |monoxide |poisoning, |and |smoke |inhalation |injury. Always |assume |CO |exposure |in |patients |who |were |burned |in |enclosed |areas. |Patients |with |CO |levels | less |than |20% |may |not |show |any |symptoms |- |answersHA |and |nausea |(20-30%), |confusion |(30-40%), | coma |(40-60%) |and |death |(>60%). |Cherry |red |skin |color |in |patients |may |only |be |seen |in |moribund | patients. | Measurements |of |arterial |PaO2 |do |not |reliably |predict |CO |poisoning |b/c |a |partial |pressure |of |only | 1 | mm |Hg |results |in |an |HbCO |level |of |40% |or |greater. |Pulse |ox |cannot |be |relied |on |to |rule |out |carbon | monoxide |poisoning |b/c |we |cant |distinguish |oxyhemoglobin |from |carboxyhemoglobin. |A |discrepancy | between |pulse |ox |and |arterial |blood |gas |may |be |explained |by |presence |of |carboxyhemoglobin. Cyanide |inhalation |poisoning |can |occur |in |confined |spaces |and |sign |of |potential |toxicity |is |persistent | profound |unexplained |metabolic |acidosis. |- |answersTHERE |IS |NO |ROLE |for |hyperbaric |oxygen |therapy | in |the |primary |resuscitation |of |a |patient |with |critical |burn |injury.
American |Burn |Association |states | 2 |requirements |for |diagnosis |of |smoke |inhalation |injury: |- |answers1. |exposure |to |combustible |agent |
- |signs |of |exposure |to |smoke |in |the |lower |airway, |below |the |vocal |cords, |seen |on |bronchoscopy. | A |chest |Xray |and |arterial |blood |gases |should |be |ordered |to |evaluate |the |pulmonary |status |of |a | patient |with |smoke |inhalation |injury, |but |normal |values |on |admission |DO |NOT |exclude |an |inhalation | injury. The |treatment |of |smoke |inhalation |injury |is |supportive. |- |answersAny |patient |with |smoke |inhalation | injury |and |significant |burns |greater |than |20% |TBSA |should |be |intubated. |IF |the |patient's | hemodynamic |condition |permits |and |spinal |injury |has |been |excluded, |elevate |the |patient's |head |and | chest | 30 |degrees |to |help |reduce |neck |and |chest |wall |edema. True |or |false: |Clinicians |should |provide |burn |resuscitation |fluids |for |deep |partial |and |full |thickness | burns |larger |than |20% |TBSA |- |answersTrue. |urine |output |monitoring |is |0.5mL/kg/hr |in |adults |and | should |be |maintained |at |30-50cc/hr |to |minimize |over |resuscitation in |a |burn |patient, |cardiac |dysrhytmias |may |be |the |first |sign |of |hypoxia |and |electrolyte |or |acid |base | abnormalities. |- |answerstherefore |an |ECG |should |be |performed |for |cardiac |rhythm |disturbances. | Persistent |acidemia |in |patients |with |burn |injuries |may |be |due |to |under |resuscitation |or |infusion |of | large |volumes |of |saline. Tachycardia |is |a |poor |indication |for |resuscitation |in |the |burn |patient. |- |answersAdjust |the |fluid |rate | up |or |down |based |on |the |urine |output |and |recognize |that |factors |such |as |inhalation |injury, |age |of | patient, |renal |failure, |diuretics, |and |alcohol |can |affect |the |volume |of |resuscitation |and |urine |output. True |of |false: |Burn |patients |should |get |tetanus. |- |answerstrue Partial |thickness |burns |- |answersare |characterized |as |either |superficial |partial |thickness |(moist, | painfully |hypersensitive, |, |potentially |blistered, |homogenously |pink, |and |blanch |to |touch) |or |deep | partial |thickness |( |drier, |less |painful, |potentially |blistered, |red |or |mottled |in |appearance, |and |do |not | blanch |to |touch) Full |thickness |burns |- |answersappear |leathery |and |skin |may |be |white |or |translucent |or |waxy |white. | surface |area |is |painless |to |light |touch |or |pinprick |and |generally |dry Compartment |syndrome |in |burn |patients: |- |answersCompartment |syndrome |can |result |from |an | increase |in |pressure |inside |the |compartment |that |interferes |with |perfusion |to |the |structures |within | that |compartment. |In |burns, |this |condition |results |from |a |combination |of |decreased |skin |elasticity | and |increased |edema |in |the |soft |tissue. |A |pressure |> | 30 |mm |Hg |within |the |compartment |can |lead |to | muscle |necrosis |and |once |the |pulse |is |gone |it |may |be |TOO |LATE |to |save |the |muscle. |so |recognize |the |signs |early: pain |greater |than |expected |and |out |of |proportion |to |the |injury pain |on |passive |stretch |of |the |affected |muscle
In |frostbite |injury, |warming |large |areas |can |result |in |reperfusion |syndrome, |with |acidosis, |hyperK |and | local |swelling. |- |answerstherefore |monitor |the |patient's |cardiac |status |and |peripheral |perfusion |during |rewarming. Sympathetic |blockade |agents |and |vasodilating |agents |have |shown |to |be |effective |in |altering |the | progression |of |acute |cold |injury |- |answersfalse hypothermia |is |a |core |temp |below |36C |or |96.8F |- |answershypothermia |can |worsen |coagulopathy |and | affect |organ |function. Rhabdomyolysis |can |lead |to |metabolic |acidosis, |hyperK, |hypoC, |and |DIC. |- |answersMyoglobin |induced |renal |failure |can |be |prevented |with |intravascular |fluid |expansion, |alkalinization |of |the |urine |by |IV | administration |of |Bicarbonate |and |osmotic |diuresis. For |MSK |trauma, |loss |of |sensation |in |a |stocking |or |glove |distribution |is |an |early |sign |of.... |- | answersearly |sign |of |vascular |impairment Knee |dislocations |can |reduce |spontaneously |and |may |not |present |with |any |gross |external |or | radiographic |anomalies |until |a |physical |exam |of |is |joint |is |perfromed. |- |answersan |ankle |brachial | index |of |less |than |0.9 |indicates |abnormal |arterial |flow |secondary |to |injury |or |peripheral |vascular | disease Blanched |skin |associated |with |fractures |and |dislocations |can |lead |to |soft |tissue |necrosis. |The |purpose | of |promptly |reducing |this |injury |is |to |prevent |pressure |necrosis |of |the |lateral |left |ankle |soft |tissue |- | answersthe |only |reason |to |forgo |an |xray |exam |before |treating |a |dislocation |or |fracture |is |the | presence |of |vascular |compromise |or |impending |skin |breakdown, |often |seen |with |fracture |dislocations |of |the |ankle Treat |all |patients |with |open |fractures |as |soon |as |possible |with |iv |antibiotics |- |answerscephalosporins | are |necessary |for |all |open |fractures operative |revascularization |to |an |avascular |extremity |is |important |to |treat |emergently. |- | answersmuscle |necrosis |begins |where |there |is |a |lack |of |blood |flow |for | 6 |hours. |is |there |is |an | associated |fracture |deformity, |correct |it |by |gently |pulling |the |limb |out |to |length, |realigning |the | fracture |and |splinting |the |injured |extremity. |This |maneuver |can |restore |the |blood |flow High |risk |activities |that |can |cause |compartment |syndrome |include: |- |answersexcessive |exercise burns severe |crush |injury |to |muscle localized |prolonged |external |pressure |to |an |extremity increased |capillary |permeability |secondary |to |reperfusion |of |ischemic |muscle. Compartment |syndrome |is |a |clinical |diagnosis |and |pressure |measurements |are |only |an |adjunct |to |aid | in |its |diagnosis. |a |pressure |greater |than | 30 |can |cause |anoxia. |- |answersthe |absence |of |a |palpable | distal |pulse |is |an |uncommon |or |late |finding |and |is |not |necessary |to |diagnose |compartment |syndrome. |
Capillary |refill |times |are |also |unreliable weakness |or |paralysis |of |the |involved |muscle |is |a |late |sign |and |indicates |nerve |or |muscle |damage the |lower |the |systemic |pressure, |the |lower |the |compartment |pressure |that |causes |compartment | syndrome risk |of |tetanus: |- |answerswounds |that |are |more |than | 6 |hours |old contused |or |abraded more |than |1cm |in |depth from |high |velocity |missiles due |to |burns |or |cold significantly |contaminated ischemic |tissue |or |denervated |wounds True |or |false? |on |page |162. |To |exclude |occult |dislocation |and |concomitant |injury, |x |ray |films |must | include |the |joints |above |and |below |the |suspected |fracture |site |- |answerstrue. |unless |life |threatening, | splinting |of |extremity |injuries |should |be |done |during |the |secondary |survey. do |not |apply |traction |to |patients |with |an |ipsilateral |tibia |shaft |fracture. |- |answerstrue Laryngeal |Trauma |presents |as |hoarseness, |subcutaneous |emphysema, |and |palpable |fracture |- | answerstrue. |sounds |of |airway |obstruction |and |include |snoring, |gurgling, |stridor, |hoarseness, | cyanosis, |agitation LEMON |assessment |for |difficult |airway |- |answersLook, |evaluate |3-3-2 |rule, |mallampati, |obstruction, | neck |mobility Do |not |give |a |nasopharyngeal |airway |to |someone |suspected |of |having |a |cribriform |plate |fracture. |- | answersalso |do |not |give |nasotracheal |intubation |to |patients |with |basillar |skull |fracture A |tube |placed |in |the |trachea |with |the |cuff |inflated |below |the |vocal |cords |and |the |tube |connected |to | oxygen |enriched |assisted |ventilation |and |airway |secured |in |place. |- |answersdefinitive |airway patients |use |the |gum |elastic |bougie |when |vocal |cords |cannot |be |visualized |on |direct |laryngoscopy. |- | answersusing |the |GEB |has |allowed |for |rapid |intubation |of |nearly |80% |of |prehospital |patients |in |whom |laryngoscopy |was |difficult. |A |GEB |inserted |into |the |esophagus |will |pass |its |full |length |without | resistance Reliable |ways |to |detect |proper |intubation |- |answersproper |placement |of |the |tube |is |suggested |but | not |confirmed:
- |hearing |equal |breath |sounds |bilaterally
Less |than |15% |blood |loss. |no |change |in |HR, |BP, |pulse |pressure, |RR, |urine |output. |- |answersthis |is | class | 1 |hemorrhage |and |requires |monitoring |with |base |deficit |of |0- |- 15-30% |blood |loss. |increase |in |heart |rate. |decrease |in |pulse |pressure. |BP, |RR, |urine |output |do |not | change |- |answersclass |II |hemorrhagic |shock. |possible |need |for |blood |products, |but |mostly |crystalloid | fluid |and |base |deficit |of |-2 |to |-6. |anxiety, |fear 31-40% |blood |loss. |heart |rate |increase, |respiratory |rate |increase, |blood |pressure |decrease, |pulse | pressure |decrease, |urine |output |and |GCS |decrease |- |answersclass |III |and |this |is |the |least |amount |of | blood |loss |that |consistently |causes |a |drop |in |systolic |blood |pressure. |blood |products |needed |and |base |deficit |is |-6 |to |-
|40% |blood |loss. |heart |rate |increase, |RR |increase, |BP |decrease, |pulse |pressure |decrease, |urine | output |and |GCS |decrease |- |answersMTP |and |base |deficit |is |-10 |or |less A |chest |xray |must |be |obtained |after |attempts |at |inserting |a |subclavian |or |IJ |to |document |position |of | line |and |evaluate |for |pneumo |or |hemothorax. |- |answersdo |not |use |sodium |bicarb |to |treat |metabolic | acidosis |from |hypovolemic |shock Hypothermia |can |be |prevented |and |reversed |by |storing |crystalloids |in |a |warmer |or |infusing |them | through |intravenous |fluid |warmers. |- |answersblood |products |cannot |be |store |in |a |warmer, |but |they | can |be |heated |by |passage |through |intravenous |fluid |warmers. |Fluids |should |be |warmed |to |39C |or | 102.2F |before |infusing |them. Massive |fluid |resuscitation |with |the |resultant |dilution |of |platelets |and |clotting |factors |(severe | hemorrhage |and |injury |results |in |consumption |of |coagulation |factors |and |early |coagulopathy) | contributes |to |coagulopathy |in |injured |patients. |- |answersThe |response |of |elderly |patients, |athletes, | pregnant |patients, |patients |on |medications, |hypothermic |patients, |and |patients |with |pacemakers |or | implantable |devices |may |have |different |set |of |vitals |in |response |to |shock. Older |patients |are |unable |to |increase |their |HR |when |stressed |by |blood |volume |loss. |A |systolic |BP |of | 100 |may |represent |shock |in |an |elderly |patient. |Due |to |medications, |HR |may |not |increase |in |the | elderly |population |when |in |shock. |- |answersBlood |volumes |may |increase |15-20% |in |athletes, |cardiac | output |can |increase | 6 |fold |and |the |rest |HR |can |be |50. |Trained |athletes |have |a |remarkable |ability |to | compensate |for |blood |loss |and |they |may |not |manifest |the |usual |way |to |hypovolemia, |even |with | significant |blood |loss. Patients |suffering |from |hypothermia |and |hemorrhagic |shock |do |not |respond |as |expected |to |the | administration |of |blood |products |and |fluid |resuscitation. |IN |hypothermia, |coagulopathy |may |develop | and |worsen. |- |answersWhen |a |patient |fails |to |respond |to |fluid |therapy |one |or |more |of |these |causes | may |be: |tension |pneumothorax, |cardiac |tamponade, |undiagnosed |bleeding, |unrecognized |fluid |loss, | acute |gastric |distention, |MI, |diabetic |acidosis, |neurogenic |shock Tracheobronchial |injury |will |present |with |hemoptysis, |cervical |subcutaenous |emphysema, |tension | pneumothorax, |and/or |cyanosis. |- |answersA |bronchoscopy |can |confirm |the |diagnosis, |but |these | patients |require |immediate |surgical |consultation. |intubation |of |these |patients |may |be |difficult, |so | they |may |need |fiber |optic |assisted |ET
what |are |these |signs |and |symptoms |describing? |chest |pain, |air |hunger, |tachypnea, |respiratory | distress, |tachycardia, |hypotension, |tracheal |deviation |away |from |side |of |injury, |unilateral |absence |of | breath |sounds, |neck |vein |distention, |cyanosis |(late |manifestation), |hyperresonance |on |percussion |- | answerstension |pneumothorax. |initially, |you |can |do |a |needle |decompression |or |finger |thoracostomy. | place |tube |in |afterwards pain, |difficulty |breathing, |tachypnea, |decreased |breath |sounds |on |affected |side, |and |noisy |movement | of |air |through |chest |wall |injury |- |answersthese |are |signs |and |symptoms |of |an |open |pneumothorax. | sterile |occlusive |dressing |large |enough |to |overlap |the |wound's |edges |and |tap |it |securely |on | 3 |sides Causes |of |Pulseless |Electrical |Activity |- |answershypovolemia, |hypokalemia, |hyperkalemia, | hypoglycemia, |hypothermia, |toxins, |cardiac |tamponade, |tension |pneumothorax, |thrombosis Massive |hemothorax |is |suggested |when |a |patient |is |in |shock |and |has |decreased |breath |sounds |or | dullness |to |percussion |on |one |side |of |the |chest |with |collapsed |neck |veins |- |answerschest |tube |at |the | fifth |intercostal |space |at |the |midaxillary |line |and |you |get |a |return |of |1500mL |or |1/3 |or |more |of |the | patient's |blood |in |the |chest, |that |indicated |the |need |for |urgent |thoracotomy. |persistent |need |for | blood |is |an |indication |for |a |thoracotomy. |color |of |the |blood |is |a |poor |indicator |of |the |necessity |for | thoracotomy. muffled |heart |sounds, |hypotension, |and |distended |necks |veins |may |not |always |be |present |in |cardiac | tamponade. |Kussmaul's |sign |(rise |in |venous |pressure |with |inspiration |when |breathing |spontaneously) | is |a |true |paradoxical |venous |pressure |abnormality |that |is |associated |with |tamponade |- |answersThe | presence |of |hyperresonance |on |percussion |indicated |tension |pneumothorax |whereas |presence |of | bilateral |breath |sounds |is |cardiac |tamponade. |FAST |can |identify |cardiac |tamponade. |if |FAST |is | unavailable, |use |echo |or |pericardial |window. |definitive |treatment |is |surgery |so |thoracotomy |or | sternotomy. potentially |life |threatening |injuries |that |should |be |identified |on |secondary |survey |- |answerssimple | pneumothorax, |hemothorax, |flail |chest, |pulmonary |contusion, |blunt |cardiac |injury, |traumatic |aortic | disruption, |traumatic |diaphragmatic |injury, |esophageal |rupture pulmonary |contusion |can |occur |with |rib |fractures |and |flail |chest |(two |or |more |adjacent |ribs |fractured |in |two |or |more |places). |- |answersinitial |treatment |includes |humidified |oxygen, |adequate |ventilation, | and |cautious |fluid |resuscitation. |definitive |treatment |includes |pain |control, |adequate |oxygenation Blunt |cardiac |injury |can |present |with |hypotension, |dysrhythmias, |EKG |changes, |premature |ventricular | contractions, |unexplained |sinus |tachycardia, |AFib, |bundle |branch |block, |elevated |central |venous | pressure |without |any |obvious |cause |may |indicate |right |ventricular |dysfunction |secondary |to | contusion. |- |answerscardiac |troponins |can |be |diagnostic |in |an |MI |but |have |little |role |in |diagnosing | blunt |cardiac |injury. |patients |with |a |blunt |injury |to |the |heart |diagnosed |by |conduction |abnormalities | are |at |increased |risk |for |sudden |dysrhythmias |and |need |to |be |monitored |for | 24 |hours. Traumatic |aortic |disruption- |most |survive |if |they |have |an |incomplete |laceration |near |the |ligmentum | arteriosum. |commonly |caused |by |vehicle |collision |or |fall |from |a |great |height. |have |a |high |index |of | suspicion |if |history |has |decelerating |force. |- |answersLook |for |widened |mediastinum |on |chest |xray, | obliteration |of |the |aortic |knob, |deviation |of |the |trachea |to |the |right, |depression |of |the |L |mainstem | bronchus, |elevation |of |R |mainstem |bronchus, |deviation |of |the |esophagus |to |the |right, |left |
repeatable does |not |assess |retroperitoneal |structures. | obesity |can |degrade |images |obtained |by |FAST indications |for |a |laparotomy: |- |answersBlunt |abdominal |trauma |with |hypotension, |positive |FAST hypotension |with |an |abdominal |wound |that |penetrates |anterior |fascia gunshot |wounds |that |traverse |the |peritoneal |cavity evisceration | bleeding |from |stomach, |rectum, |or |GU |tract peritonitis | free |air |of |hemidiaphragm contrast |CT |showing |rupture |GI |tract, |bladder |injury Aspiration |of |gastrointestinal |contents, |vegetable |fibers, |or |bile |through |the |lavage |mandate | laparotomy. |Aspiration |of |10cc |or |more |of |blood |in |hemodynamically |abnormal |patients |requires | laparotomy. Diaphragm |injuries |- |answerselevation |or |blurring |of |the |hemidiaphragm, |hemothorax, |an |abnormal | gas |shadow |that |obscures |the |hemidiaphragm, |or |a |gastric |tube |in |the |chest Duodenal |injuries- |a |bloody |gastric |aspirate |or |retroperitoneal |air |on |abdominal |CT |or |radiograph | should |raise |suspicion |- |answersclassically |seen |in |unrestrained |drives |involved |in |frontal-impact |MVC | and |patients |who |sustain |direct |blows |to |the |abdomen |from |bicycle |handlebars. Any |early |normal |serum |amylase |level |or |an |elevated |amylase |level |does |not |conclude |pancreas | injury |- |answers uncal |herination |- |answersipsilateral |pupillary |dilation |associated |w/contralateral |hemiparesis |and |loss |of |pupillary |response |to |light ICP |- |answersnormal |is |10. |> | 22 |has |poor |outcomes. |increased |ICP |decreases |cerebral |perfusion | pressure. |monroe |kellie |doctrine |states |that |total |volume |of |intracranial |contents |must |remain | constant |because |cranium |is |a |rigid |container |incapable |of |expanding. CPP= |MAP |-ICP |- |answersa |MAP |of |50-150 |is |autoregulated |to |maintain |a |constant |cerebral |blood | flow. | GCS |of | 8 |or |less= |severe |brain |injury GCS |of |9-12= |moderate GCS |of |13-15= |mild
Indications |for |CT |scanning |- |answersGCS |< | 15 |at | 2 |hours |after |injury | suspected |open |or |depressed |skull |fracture any |sign |of |basilar |skull |fracture emesis |more |than | 2 |episodes age |> | 65 anticoagulant |use LOC |> | 5 |minutes amnesia |before |impact Goals |of |treatment |of |brain |injury |- |answerssystolic |BP |> | 100 temp |36- Glucose |80- Hgb |> | 7 PaCO2 |35- ICP |5- pulse |ox |> | 95 NA |135- TBI |treatment |- |answersIV |fluids |& |hypertonic |saline |(do |not |give |hypotonic |fluids |or |glucose | containing |fluids |because |this |can |harm |the |injured |brain) Avoid |hyponatremia reversal |of |anticoagulants Hyperventilation |to |keep |PaCO2 |at |35-temporizing |measure Mannitol-do |not |give |to |patients |with |hypotension reversal |agents: |- |answersaspirin/plavix: |platelets warfarin: |FFP, |vitamin |K, |Prothrombin |Complex Heparin |or |LMWH: |Protamine |Sulfate
distracting |injury unable |to |provide |history spinal |tenderness |midline Signs |of |blood |loss |in |a |child |- |answersprogressive |weakening |of |peripheral |pulses, |narrowing |pulse | pressure |less |than |20, |skin |mottling |(clammy |skin), |cool |extremities |compared |with |torso |skin, | decrease |in |level |of |consciousness |with |dulled |response |to |pain. | often |times |tachycardia |may |be |the |only |sign |of |shock |in |a |kid hypotension |in |child |- |answerssystolic |BP |for |kid |is | 90 |+ |twice |the |child's |age |in |years. |hypotension | represents |a |state |of |decompensated |shock |and |can |indicated |blood |loss |of |> |45%.
