ATLS WRITTEN EXAM REVIEW
• in TBI, Every effort should be made to reduce , while normalizing
, , and .
Answer: ICP
MAP, oxygenation, intravascular volume
• What GCS ranges for the following classes
Answer:
1. Minor
2. Moderate
3. Severe: 1. 13-15
2. 9-12
3. 3-8
• What nerve palsy may occur with basilar skull fracture?
Answer: seventh nerve.
• A GCS of is accepted definition of coma?
Answer: 8 or less
• How do you assess a GCS of someone with asymmetric responses?
Answer: Usethe best possible because this will be the best predictor of outcome
• Basilar fractures of the skull usually require what type of imaging?
Answer: thisrequires CT with bone-window setting.
• What are the typical clinical signs of basilar skull fractures?
Answer:
1. periorbitalecchymosis (raccoon eyes)
2. retroauriculor ecchymosis (battle sign)
3. CSF leak from nose or ears
4. 7th or 8th CN dysfunction (facial paralysis and hearing loss)
• What should be a primary consideration for any patient with a skull fracture,
especially a linear skull fracture?
Answer: hematoma. linear skull fracture increaseslikelihood of intracranial
hematoma by about 400x
• What mechanism is common with diffuse axonal injury and what is the likely
,outcome?
Answer: these injury often occur with high velocity or deceleration injures.They
appear as diffuse cerebral hemorrhage often between grey and white matter.These
are associated with variable but often poor outcomes.
• Epidural hematomas often occur in the area of the skull and resultfrom a
tear of the arteries.
Answer:
temporal
middle meningeal artery
• What is the classic presentation of a epidural hematoma?
Answer: a lucid intervalbetween time of injury and neurologic a deterioration.
• What are more common brain injury: epidural or subdural?
Answer:
subdural 30%
epidural 0.5%
• Subdural hematoma occur from tear of .
Answer: bridging vessels of thecerebral cortex
• Contusion occur in % ofTBI.They often occur in or lobes
of brain.They may coalesce to form in as many as 20$%.
Answer: 20-30%
frontal or temporal intracerebral hematoma.
• What is the imaging protocol for a patient with cerebral contusion?
Answer: get CTat presentation. then get another within 24 hours to assess for
coalesced hematoma.
• What factors would require a CT in minor brain injury?
Answer:
1. suspected openskull frac
2. basilar frac
3. >2 episode vomitting
4. pt older than 65
5. LOC >5 min
6. amnesia before impact of >30 min
• How long after discharge should patient with mild brain injury be observedby
friend?
, Answer: 24 hours
• What type of brain injury requires serial GCS?
Answer: ALL. minor. moderate. Major
• What imaging is done in all patient with moderate brain injury?
Answer: CT
• What factor of ABCDE must be monitored closely in moderate brain in-jury?
Answer: Airway and breathing. rapid deterioration may occur. hypoventilation and
hypercapnia may ensue requiring intubation. close monitoring in ICU is required.
• What should immediately follow the secondary survey in major/severebrain
injury?
Answer: CT.
REMEMBER: CT should never delay patient transfer
• When assessing ABCDE of severe brain injury, when does DPL or FAST come
before neuro exam?
Answer: if the systolic blood pressure cannot be brought above100, DPL or FAST is
done first as to assess source of hypotension
• Spinal cord injury has what result in blood pressure?
Answer: hypotension.This mayalso occur in terminal brain injury with medullary
failure
• What is the primary goal of treating TBI? How is this done?
Answer: preventing secondary brain injury. This is done by maintaining blood
pressure and providingadequate profusion.
• After managing ABCDEs of TBI what MUST be identified if present? How isthis
done?
Answer: mass lesion that requires surgical evacuation is critical! this is done with
CT. NOTE: obtaining a CT should not delay patient transfer to trauma center.
• Which brain lobes do the following hold
Answer:
• anterior fossa: frontal lobes
• middle fossa: temporal lobes
• posterior fossa: lower brainstem and cerebellum
• What are the 3 layers of the meninges?
• in TBI, Every effort should be made to reduce , while normalizing
, , and .
Answer: ICP
MAP, oxygenation, intravascular volume
• What GCS ranges for the following classes
Answer:
1. Minor
2. Moderate
3. Severe: 1. 13-15
2. 9-12
3. 3-8
• What nerve palsy may occur with basilar skull fracture?
Answer: seventh nerve.
• A GCS of is accepted definition of coma?
Answer: 8 or less
• How do you assess a GCS of someone with asymmetric responses?
Answer: Usethe best possible because this will be the best predictor of outcome
• Basilar fractures of the skull usually require what type of imaging?
Answer: thisrequires CT with bone-window setting.
• What are the typical clinical signs of basilar skull fractures?
Answer:
1. periorbitalecchymosis (raccoon eyes)
2. retroauriculor ecchymosis (battle sign)
3. CSF leak from nose or ears
4. 7th or 8th CN dysfunction (facial paralysis and hearing loss)
• What should be a primary consideration for any patient with a skull fracture,
especially a linear skull fracture?
Answer: hematoma. linear skull fracture increaseslikelihood of intracranial
hematoma by about 400x
• What mechanism is common with diffuse axonal injury and what is the likely
,outcome?
Answer: these injury often occur with high velocity or deceleration injures.They
appear as diffuse cerebral hemorrhage often between grey and white matter.These
are associated with variable but often poor outcomes.
• Epidural hematomas often occur in the area of the skull and resultfrom a
tear of the arteries.
Answer:
temporal
middle meningeal artery
• What is the classic presentation of a epidural hematoma?
Answer: a lucid intervalbetween time of injury and neurologic a deterioration.
• What are more common brain injury: epidural or subdural?
Answer:
subdural 30%
epidural 0.5%
• Subdural hematoma occur from tear of .
Answer: bridging vessels of thecerebral cortex
• Contusion occur in % ofTBI.They often occur in or lobes
of brain.They may coalesce to form in as many as 20$%.
Answer: 20-30%
frontal or temporal intracerebral hematoma.
• What is the imaging protocol for a patient with cerebral contusion?
Answer: get CTat presentation. then get another within 24 hours to assess for
coalesced hematoma.
• What factors would require a CT in minor brain injury?
Answer:
1. suspected openskull frac
2. basilar frac
3. >2 episode vomitting
4. pt older than 65
5. LOC >5 min
6. amnesia before impact of >30 min
• How long after discharge should patient with mild brain injury be observedby
friend?
, Answer: 24 hours
• What type of brain injury requires serial GCS?
Answer: ALL. minor. moderate. Major
• What imaging is done in all patient with moderate brain injury?
Answer: CT
• What factor of ABCDE must be monitored closely in moderate brain in-jury?
Answer: Airway and breathing. rapid deterioration may occur. hypoventilation and
hypercapnia may ensue requiring intubation. close monitoring in ICU is required.
• What should immediately follow the secondary survey in major/severebrain
injury?
Answer: CT.
REMEMBER: CT should never delay patient transfer
• When assessing ABCDE of severe brain injury, when does DPL or FAST come
before neuro exam?
Answer: if the systolic blood pressure cannot be brought above100, DPL or FAST is
done first as to assess source of hypotension
• Spinal cord injury has what result in blood pressure?
Answer: hypotension.This mayalso occur in terminal brain injury with medullary
failure
• What is the primary goal of treating TBI? How is this done?
Answer: preventing secondary brain injury. This is done by maintaining blood
pressure and providingadequate profusion.
• After managing ABCDEs of TBI what MUST be identified if present? How isthis
done?
Answer: mass lesion that requires surgical evacuation is critical! this is done with
CT. NOTE: obtaining a CT should not delay patient transfer to trauma center.
• Which brain lobes do the following hold
Answer:
• anterior fossa: frontal lobes
• middle fossa: temporal lobes
• posterior fossa: lower brainstem and cerebellum
• What are the 3 layers of the meninges?
