ATLS Review

A 22yo M is hypotensive and tachycardia after a shotgun wound to the L shoulder. His BP is initially 80/40. After 2L of fluids his BP increases to 122/84. HR is 100bpm and his RR is 28. Breath sounds are decreased in the left hemithorax, and a closed tube thoracotomy is performed with a small amount of blood return and no air leak. What is the next step? - Reexamine the chest A construction worker falls 2 stories and suffers bilateral calcanea fractures. He now is having back pain. What would confirm diagnosis? - Complete spine x-ray series What is the principle of balanced resuscitation? - permissive hypotension and early plasma infusion In managing a head-injured patient, what is the most important initial step? - Secure the airway A previously healthy 70kg man suffered ~2L of acute blood loss. Which appropriately applies to this patient? - His systolic BP will be decreased with a narrowed pulse pressure NOT his pulse pressure will be widened, urinary output at lower level of normal, tachy but no BP change, or maintained systolic BP with elevated diastolic BP The physiologic hypovolemia of pregnancy has clinical significance in the management of severely injured, gravid woman by: - increasing the volume of blood to produce maternal hypotension The best assessment of fluid resuscitation of the burn patient is - adequate urinary output The diagnosis of shock MUST include: - evidence of inadequate organ perfusion A 7yo M is brought to the ED by his parents several minutes after falling through a window. He is bleeding from a 6cm wound on the medial right thigh. Immediate management of the wound should include? - Direct pressure on the wound **For the patient with severe traumatic brain injury, around HYPOCARBIA (dec CO2) should be avoided in order to prevent what? - cerebral vasoconstriction with diminished perfusion. **A 25yo M is brought in to a facility with a general surgeon after being in an MVA, CT shows aortic injury and spe=lenic lac with abdominal fluid, BP is 70mm Hg after CT. What is the next step? - exploratory laparotomy Which one of the following statements regarding abdominal trauma in the pregnant patient is true? - leakage of amniotic fluid is indication for hospital admission What is the first maneuver to improve oxygenation after chest injury? - administer supplemental O2 25yo M in an MVC is admitted to the ED. Pupils react sluggishly and he opens his eyes to painful stimuli. He does not follow commands, but he does moan periodically. His R arm is performed and does not respond to pain, however his L hand reaches purposefully toward the pain. Both legs are stiffened. What is his GCS? - 9 20yo F is 32w gestation and stabbed in the R upper chest. In the ED her BP is 80/60. She is gasping for breath, anxious, and yelling for help. BS are diminished in the right chest. Next step? - perform needle compression in the right chest Which one of the following findings in an adult is most likely to require immediate management during the primary survey? - RR of 44 The most important, immediate step in the management of open PTX is? - placement of an occlusive dressing on the wound What is a contraindication for tDap? - history of neurological reaction or severe hypersensitivity to the product 56yo M is thrown in against a steering wheel during MVC. On arrival to the ED he is diaphoretic and having chest pain. BP is 60/40 and his RR is 40. Which of the following best differentiates cardiac tamponade from tension PTX? - breath sounds