ATLS Prep exam with verified solutions

What are the elements of the initial assessment? preparation, triage, primary survey, adjuncts to the primary survey and resuscitation, consideration for transfer, secondary survey, adjuncts to the secondary survey, continued post resuscitation monitoring, definitive care What's the difference between multiple and mass casualties? does the number and severity of patients exceed the capability of the facility and staff What is the primary survey? airway (with restriction of c-spine motion), breathing and ventilation, circulation, disability, exposure What are injuries that significantly impair ventilation in the short term? tension pneumothorax, massive hemothorax, open pneumothorax, tracheal and bronchial injuries How can a simple pneumothorax be converted to a tension pneumothorax? when a patient is intubated and positive pressure ventilation is provided before decompressing the pneumothorax What are the elements of clinical observation that yield important information about hemodynamic status? level of consciousness, skin perfusion, pulse Where are the major areas of internal hemorrhage? chest, abdomen, retroperitoneum, pelvis, long bones Other than CNS injury, what can alter a patient's level of consciousness? hypoglycemia, alcohol, narcotics, other drugs What are adjuncts used during the primary survey? EKG, pulse oximetry, CO2 monitoring, ABG, urinary catheter, gastric catheter, lactate, XR, FAST If there is blood at the urethral meatus or perineal ecchymosis...think? urethral injury, retrograde urethrogram before inserting a catheter What does AMPLE stand for? allergies, medications, past illnesses/pregnancy, last meal, events/environment related to the injury During the secondary survey, what is the sequence of the physical exam? head, maxillofacial structures, cervical spine and neck, chest, abdomen and pelvis, perineum/rectum/vagina, musculoskeletal, neurological What is the MIST acronym for EMS handoff? mechanism and time of injury, injuries found and suspected, symptoms and signs, treatment initiated Definitive airway definition? a tube placed in the trachea with the cuff inflated below the vocal cords, the tube connected to a form of oxygen-enriched assisted ventilation, and the airway secured in place with an appropriate stabilizing method What is the triad of clinical signs of laryngeal fracture? hoarseness, subcutaneous emphysema, palpable fracture Agitated suggests _______? Obtunded suggests ________? hypoxia, hypercarbia injuries below ______ result in maintenance of diaphragmatic function but loss of intercostal and abdominal muscle contribution to respiration C3 What does LEMON stand for? Look Externally Evaluate 3-3-2 Mallampati Obstruction Neck Mobility Mallampati class I Soft palate, uvula, fauces, pillars visible Mallampati class II soft palate, uvular, fauces partially visible Mallampati class III soft palate, base of uvula visible Mallampati class IV hard palate only visible Do not attempt nasopharyngeal airway with suspected or potential...? cribriform plate fracture Criteria for establishing a definitive airway inability to maintain patent airway, inability to maintain adequate oxygenation, cerebral hypoperfusion, GCS<8 What's battle's sign? postauricular ecchymosis Drug assisted intubation doses? etomidate 0.3 mg/kg, succinylcholine 1-2mg/kg Define shock. an abnormality of the circulatory system that results in inadequate organ perfusion and tissue oxygenation What are the kinds of shock? hypovolemic, cardiogenic, obstructive, neurogenic, septic formula for cardiac output HR x SV How do you determine stroke volume? preload, myocardial contractility, and afterload What are the two components of the venous system? volume of blood that would remain in the capacitance circuit if the pressure in the system were 0, volume that contributes to the mean systemic venous pressure What is the earliest measurable circulatory sign of shock? tachycardia (then cutaneous vasoconstriction) Why are vasopressors contraindicated as a first-line treatment of hemorrhagic shock? worsen tissue perfusion Examples of causes of cardiogenic shock? blunt cardiac injury, cardiac tamponade, air embolus, myocardial infarction Clinical signs of cardiac tamponade tachycardia, muffled heart sounds, dilated engorged neck veins, hypotension How can you tell cardiac tamponade from tension pneumothorax? absent breath sounds and hyperresonant percussion are present in tension pneumothorax How much blood loss in the four classes of hemorrhage? <15%, 15-30%, 31-40%, >40% (note: transient response to fluid in class II and III hemorrhage) What's the difference between class II and class III hemorrhage? class III start to see decreased BP and need for blood products What is the initial fluid therapy in adults and peds in hemorrhagic shock? two 18-guage IVs, IL for adults, 20 ml/kg for kids If crossmatched blood is unavailable, what should you use? type O pRBCs, AB plasma (Rh negative pRBCs for females of child bearing age) Why do up to 30% of severely injured patients experience coagulopathy? dilution of platelets and clotting factors, adverse effect of hypothermia on platelet aggregation Where do the majority of tracheobronchial tree injuries occur? within 1 inch of the carina What is initial management of an open pneumothorax? occlusive dressing taped on only three sides PEA H's and T's hypovolemia, hypoxia, hypo/hyperkalemia, hypoglycemia, hypothermia, hydrogen ion (acidosis) / toxins, cardiac tamponade, tension pneumothorax, thrombosis (coronary or pulmonary) Indications for thoracotomy after chest tube placement? immediate return of 1500 mL or more of blood or 200 ml/hr for 2-4 hours What is Kussmaul's sign? What is it associated with? a rise in venous pressure with inspiration, tamponade Eight potentially lethal injuries identified during the secondary survey simple pneumothorax, hemothorax, flail chest, pulmonary contusion, blunt cardiac injury, traumatic aortic disruption, traumatic diaphragmatic injury, blunt esophageal rupture Which pleura is attached to the lung? visceral pleura definition of flail chest two or more adjacent ribs fractured in two or more places What side are traumatic diaphragmatic ruptures more common on? left Which ribs sustain most of the effects of blunt trauma? 4-9 anterior abdomen definition costal margins superiorly, inguinal ligaments and pubic symphysis inferiorly, anterior axillary lines laterally thoracoabdomen definition area inferior to the nipple line anteriorly and the infrascapular line posteriorly and superior to the costal margins flank defintion area between the anterior and posterior axillary lines from the 6th intercostal space to the iliac crest back definition posterior to the posterior axillary lines from the tip of the scapulae to the iliac crests In patients who sustain blunt trauma, the organs most frequently injured are... spleen, liver, and small bowel Stab wounds most commonly involve which organs? liver > small bowel > diaphragm > colon Gun shot wounds most commonly injure? small bowel > colon > liver > abdominal vascular structures Which four regions are included in the FAST exam? pericardial sac, hepatorenal fossa, splenorenal fossa, pelvis/pouch of Douglas Indications for emergency laparotomy? hypotension, peritonitis, evisceration, positive FAST without another source of bleeding, wound that penetrates the anterior fascia, gunshot wounds that traverse the peritoneal cavity, bleeding from the stomach/rectum/GU tract following penetrating trauma, free air or rupture of hemidiaphragm, CPL with aspiration of >10mL of blood/GI contents/bile What is a chance fracture? transverse fractures through the vertebral body (commonly caused by seat belt) Where should pelvic binder be placed? at the level of the greater trochanters of the femur anterior fossa houses the _____, middle fossa _______, posterior fossa _____ frontal lobes, temporal lobes, lower brainstem and cerebellum Where does superior sagittal sinus drain? bilateral transverse and sigmoid sinuses Where are meningeal arteries located? between dura and in the internal surface of the skull (in the epidural space) Where is CSF located? between arachnoid and pia mater (subarachnoid space)