ATLS Practice Complete Solution

ATLS Practice Complete Solution Definitive control of the airway is achieved by ____________ - Endotracheal intubation How do you treat hypothermia in the ED? - crystalloid fluids at 102.2 degrees F and warmed treatment area What does definitive hemorrhage control refer to? (3) - 1) Possible surgery 2) Stabilizing of pelvis 3) Angioembolization What are rates of fluid administration measured by? - Size and length of catheter Minimum flow rate of oxygen reservoir mask - 11 L/min MCC of shock in trauma pt - Hypovolemia due to hemorrhage Describe the 3 for 1 rule - Replace each mL of blood loss with 3 ml of crystalloid solution What metabolic state can result from continued hemorrhage or decreased perfusion? - Metabolic acidosis In what survey, primary or secondary, are these identified? 1) Simple PTX 2) Pulmonary contusion 3) Traumatic aortic disruption - Secondary Via thorough PE, CXR, pulse ox, ECG and ABG What imaging study is preferred for penetrating abdominal trauma? - CT What can FAST rapidly diagnose? - Abdominal hemorrhage When is a laparotomy indicated? - Fascial penetration with intraperitoneal bleeding or peritonitis What does the Monro Kellie doctrine describe? - The relationship between IC volume and pressure Normal resting ICP - 10 mm Hg How do you reduce elevated ICP? - Mannitol in a 20% solution How do you temporarily control pelvic hemorrhage and instability? - Internal traction and external counter-pressure How do you initially manage major arterial injury? - Direct pressure and fluid resuscitation Full thickness burn - Third degree burn What is used to estimate the size and depth of burns? - Rule of 9's Head= 9% Each arm=9% Front Trunk= 18% Back Trunk= 18% Upper leg= 9% Lower leg= 9% What type of burns appear wet and blistered? - Partial thickness burns (second degree) How do you treat CO exposed pt? - 100% oxygen flow through non re-breather mask What is a reliable measure of circulating blood volumes in burn patients? - Hourly urine output *Goal= 0.5-1.0 ml/kg body weight* Hospital admission criteria for burn pt (8) - 1) Partial-thickness burns greater than 10% total BSA (TBSA) 2) Full-thickness burns greater than 2% TBSA 3) Burns involving the face, hands, genitalia, perineum, or major joints 4) Circumferential extremity burns 5) All high-voltage electrical burns, including lightning injury--Admission of low-voltage electrical burns is selective 6) Chemical burns 7) Inhalation injury 8) Burn injuries in patients with preexisting medical disorders that could complicate management, prolong recovery, or affect mortality (eg, diabetes, immunosuppression) Parkland Formula for Fluid Resuscitation in Burn pt - 3-4 mL Ringer lactate X weight (kg) X %TBSA burned (second-degree and third degree); *half administered over the first 8 hours* (from time of injury),* remaining half administered over the next 16 hours* What injuries may necessitate inter-hospital transfer? (3) - 1) Head or spinal cord trauma 2) Pulmonary contusions 3) Severe burns *consider time between injury and definitive care as well as resources available at local facilities* A 34 year old man is injured in a motor vehicle collision. Physical examination is normal except for diffuse abdominal tenderness. He is conscious and vital signs obtained enroute to the hospital are respirations 20 per ,minute, pulse rate is 120 per minute blood pressure 100/60; How should this patient be managed in the field? A. Intravenous fluid at a "keep open" rate B. Intravenous fluid at 20 ml/kg bolus C. Fentanyl 100 mcg intravenous D. Insert an oropharyngeal airway and assist ventilations - A. Intravenous fluid at a "keep open" rate What is Sellick's maneuver? A. A method allowing the rescuer to hold a mask on the face with both hands B. A system used to calculate minute volume C. Another name for Mallampati D. Posteriorly directed pressure applied to the cricoid cartilage - D. Posteriorly directed pressure applied to the cricoid cartilage A 16 year old girl is rescued from a burning house. She has 25% partial thickness burns, and the burned areas are hot to the touch. What is the appropriate treatment? A. Apply ice to burned areas until cool to touch B. Apply clean water to burned areas for up to 1-2 minutes C. Apply iced water to burned areas until cool to touch D. Do not apply anything to burned areas other than clean sheets - B. Apply clean water to burned areas for up to 1-2 minutes What treatment is NOT indicated in the routine management of the patient with a head injury?