ATLS EXAM CURRENTLY TESTING EXAM
VERSION WITH A PREDICTED EXAM VERSION
AND A STUDY GUIDE | ACCURATE AND
EXPERT VERIFIED FOR GUARANTEED PASS |
LATEST VERSION
pelvic fractures - ANSWER>>Pelvic fractures can be suspected by the identification
of ecchymosis over the iliac wings, pubis, labia, or
scrotum. Pain on palpation of the pelvic ring is an important finding in alert patients. In
addition, assessment of peripheral pulses can identify vascular injuries
• Placement of a pelvic binder
or sheet can limit blood loss
from pelvic fractures.
Pelvic fractures associated
with hemorrhage commonly involve disruption
of the posterior osseous ligamentous complex
(i.e., sacroiliac, sacrospinous, sacrotuberous, and
fibromuscular pelvic floor), evidenced by a sacral
fracture, a sacroiliac fracture, and/or dislocation of
the sacroiliac joint.
urine output goals - ANSWER>>Continuous monitoring of vital signs, oxygen saturation,
and urinary output is essential.
For adult patients, maintenance of *urinary output at 0.5 mL/kg/h is desirable.*
In pediatric patients who are older than 1 year, *an output of 1 mL/kg/h is typically
dequate. *
Periodic ABG analyses and end-tidal CO2 monitoring
are useful in some patients.
definitive airway - ANSWER>>A definitive airway is defined
as 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.
laryngeal injury - ANSWER>>1. Hoarseness
2. Subcutaneous emphysema
3. Palpable fracture
o2 vs co2 response - ANSWER>>. Observe the patient to determine whether
he or she is agitated (suggesting hypoxia) or
obtunded (suggesting hypercarbia).
cervical/thoracic injury breathing - ANSWER>>Injuries below the C3 level result in
maintenance of the diaphragmatic function but loss
of the intercostal and abdominal muscle contribution
to respiration. Typically these patients display a seesaw
pattern of breathing in which the abdomen is pushed
out with inspiration, while the lower ribcage is pulled
in. This presentation is referred to as "abdominal
breathing" or "diaphragmatic breathing." This pattern
of respiration is inefficient and results in rapid, shallow
breaths that lead to atelectasis and ventilation perfusion
mismatching and ultimately respiratory failure.
capnography - ANSWER>>capnography in spontaneously breathing and intubated
patients to assess whether ventilation is adequate. Capnography may also be used in
intubated patients to confirm the tube is positioned within the airway.
helmet cervical spine - ANSWER>>A patient wearing a helmet who requires airway
management must have his or her head and neck held
in a neutral position while the helmet is removed
This is a two-person procedure: One person restricts cervical spinal motion from below
while the second person expands the sides of the helmet and removes it from above.
Then, clinicians reestablish cervical spinal motion restriction from above and secure the
patient's head and neck during airway
management.
Using a cast cutter to remove the helmet while stabilizing the head and neck can
minimize
c-spine motion in patients with known c-spine injury
Approximately 10% of patients with a cervical spine
fracture have a second, noncontiguous vertebral
column fracture.
difficult airways - ANSWER>>• C-spine injury
,• Severe arthritis of the c-spine
• Significant maxillofacial or mandibular trauma
• Limited mouth opening
• Obesity
• Anatomical variations (e.g., receding chin,
overbite, and a short, muscular neck)
• Pediatric patients
indications for definitive airway - ANSWER>>• A —Inability to maintain a patent airway
by
other means, with impending or potential airway
compromise (e.g., following inhalation injury,
facial fractures, or retropharyngeal hematoma)
• B —Inability to maintain adequate oxygenation
by facemask oxygen supplementation, or the
presence of apnea
• C —Obtundation or combativeness resulting
from cerebral hypoperfusion
• D —Obtundation indicating the presence of a
head injury and requiring assisted ventilation
(Glasgow Coma Scale [GCS] score of 8 or less),
sustained seizure activity, and the need to
protect the lower airway from aspiration of
blood or vomitus
airway protection needs - ANSWER>>NEED FOR
AIRWAY PROTECTION
Severe maxillofacial
fractures
Risk for aspiration
from bleeding and/or
vomiting
Neck injury
Neck hematoma
Laryngeal or tracheal
injury
Inhalation injury from
burns and facial burns
Stridor
Voice change
Head injury
Unconscious
Combative
, Orotracheal intubation is the preferred route taken
to protect the airway. In some specific situations and
depending on the clinician's expertise, nasotracheal
intubation may be an alternative for spontaneously
breathing patients. Both techniques are safe and
effective when performed properly, although the
orotracheal route is more commonly used and results
in fewer complications in the intensive care unit (ICU)
(e.g., sinusitis and pressure necrosis). If the patient has
apnea, orotracheal intubation is indicated.
need for ventillation or oxygenation - ANSWER>>Inadequate respiratory
efforts
• Tachypnea
• Hypoxia
• Hypercarbia
• Cyanosis
• Combativeness
• Progressive change
• Accessory muscle use
• Respiratory muscle
paralysis
• Abdominal breathing
• Acute neurological
deterioration or
herniation
• Apnea from loss of
consciousness or
neuromuscular paralysis
contraindications to nasopharyngeal injury - ANSWER>>Facial, frontal sinus, basilar
skull, and cribriform
plate fractures are relative contraindications to
nasotracheal intubation. Evidence of nasal fracture,
raccoon eyes (bilateral ecchymosis in the periorbital
region), Battle's sign (postauricular ecchymosis), and
possible cerebrospinal fluid (CSF) leaks (rhinorrhea
or otorrhea) are all signs of these injuries. As with
orotracheal intubation, take precautions to restrict
cervical spinal motion.
VERSION WITH A PREDICTED EXAM VERSION
AND A STUDY GUIDE | ACCURATE AND
EXPERT VERIFIED FOR GUARANTEED PASS |
LATEST VERSION
pelvic fractures - ANSWER>>Pelvic fractures can be suspected by the identification
of ecchymosis over the iliac wings, pubis, labia, or
scrotum. Pain on palpation of the pelvic ring is an important finding in alert patients. In
addition, assessment of peripheral pulses can identify vascular injuries
• Placement of a pelvic binder
or sheet can limit blood loss
from pelvic fractures.
Pelvic fractures associated
with hemorrhage commonly involve disruption
of the posterior osseous ligamentous complex
(i.e., sacroiliac, sacrospinous, sacrotuberous, and
fibromuscular pelvic floor), evidenced by a sacral
fracture, a sacroiliac fracture, and/or dislocation of
the sacroiliac joint.
urine output goals - ANSWER>>Continuous monitoring of vital signs, oxygen saturation,
and urinary output is essential.
For adult patients, maintenance of *urinary output at 0.5 mL/kg/h is desirable.*
In pediatric patients who are older than 1 year, *an output of 1 mL/kg/h is typically
dequate. *
Periodic ABG analyses and end-tidal CO2 monitoring
are useful in some patients.
definitive airway - ANSWER>>A definitive airway is defined
as 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.
laryngeal injury - ANSWER>>1. Hoarseness
2. Subcutaneous emphysema
3. Palpable fracture
o2 vs co2 response - ANSWER>>. Observe the patient to determine whether
he or she is agitated (suggesting hypoxia) or
obtunded (suggesting hypercarbia).
cervical/thoracic injury breathing - ANSWER>>Injuries below the C3 level result in
maintenance of the diaphragmatic function but loss
of the intercostal and abdominal muscle contribution
to respiration. Typically these patients display a seesaw
pattern of breathing in which the abdomen is pushed
out with inspiration, while the lower ribcage is pulled
in. This presentation is referred to as "abdominal
breathing" or "diaphragmatic breathing." This pattern
of respiration is inefficient and results in rapid, shallow
breaths that lead to atelectasis and ventilation perfusion
mismatching and ultimately respiratory failure.
capnography - ANSWER>>capnography in spontaneously breathing and intubated
patients to assess whether ventilation is adequate. Capnography may also be used in
intubated patients to confirm the tube is positioned within the airway.
helmet cervical spine - ANSWER>>A patient wearing a helmet who requires airway
management must have his or her head and neck held
in a neutral position while the helmet is removed
This is a two-person procedure: One person restricts cervical spinal motion from below
while the second person expands the sides of the helmet and removes it from above.
Then, clinicians reestablish cervical spinal motion restriction from above and secure the
patient's head and neck during airway
management.
Using a cast cutter to remove the helmet while stabilizing the head and neck can
minimize
c-spine motion in patients with known c-spine injury
Approximately 10% of patients with a cervical spine
fracture have a second, noncontiguous vertebral
column fracture.
difficult airways - ANSWER>>• C-spine injury
,• Severe arthritis of the c-spine
• Significant maxillofacial or mandibular trauma
• Limited mouth opening
• Obesity
• Anatomical variations (e.g., receding chin,
overbite, and a short, muscular neck)
• Pediatric patients
indications for definitive airway - ANSWER>>• A —Inability to maintain a patent airway
by
other means, with impending or potential airway
compromise (e.g., following inhalation injury,
facial fractures, or retropharyngeal hematoma)
• B —Inability to maintain adequate oxygenation
by facemask oxygen supplementation, or the
presence of apnea
• C —Obtundation or combativeness resulting
from cerebral hypoperfusion
• D —Obtundation indicating the presence of a
head injury and requiring assisted ventilation
(Glasgow Coma Scale [GCS] score of 8 or less),
sustained seizure activity, and the need to
protect the lower airway from aspiration of
blood or vomitus
airway protection needs - ANSWER>>NEED FOR
AIRWAY PROTECTION
Severe maxillofacial
fractures
Risk for aspiration
from bleeding and/or
vomiting
Neck injury
Neck hematoma
Laryngeal or tracheal
injury
Inhalation injury from
burns and facial burns
Stridor
Voice change
Head injury
Unconscious
Combative
, Orotracheal intubation is the preferred route taken
to protect the airway. In some specific situations and
depending on the clinician's expertise, nasotracheal
intubation may be an alternative for spontaneously
breathing patients. Both techniques are safe and
effective when performed properly, although the
orotracheal route is more commonly used and results
in fewer complications in the intensive care unit (ICU)
(e.g., sinusitis and pressure necrosis). If the patient has
apnea, orotracheal intubation is indicated.
need for ventillation or oxygenation - ANSWER>>Inadequate respiratory
efforts
• Tachypnea
• Hypoxia
• Hypercarbia
• Cyanosis
• Combativeness
• Progressive change
• Accessory muscle use
• Respiratory muscle
paralysis
• Abdominal breathing
• Acute neurological
deterioration or
herniation
• Apnea from loss of
consciousness or
neuromuscular paralysis
contraindications to nasopharyngeal injury - ANSWER>>Facial, frontal sinus, basilar
skull, and cribriform
plate fractures are relative contraindications to
nasotracheal intubation. Evidence of nasal fracture,
raccoon eyes (bilateral ecchymosis in the periorbital
region), Battle's sign (postauricular ecchymosis), and
possible cerebrospinal fluid (CSF) leaks (rhinorrhea
or otorrhea) are all signs of these injuries. As with
orotracheal intubation, take precautions to restrict
cervical spinal motion.
