ITLS 2024
Scene Size-up - answer Observations made and actions taken at a trauma scene
before actually approaching the patient. Initial step in the ITLS Primary Survey. Starts at
dispatch.
Steps of scene size-up - answer1. Standard precautions (PPE)
2. Scene safety
3. Initial triage (# of patients)
4. Need for more help/equipment
5. MOI
OPIM - answer Other potentially infectious material
High-energy event - answerMOI in which it is likely that there was a large release of
uncut rolled kinetic energy
Kinetic Energy formula - answerKinetic energy = 1/2 (M x V squared)
MOI Frontal impact potential injuries - answer- Cervical spine fracture
- Flail chest
- Myocardial contusion
- Pneumothorax
- Aortic disruption
- Spleen or liver laceration
- Posterior hip dislocation
- Knee dislocation
MOI Lateral impact (T-bone) potential injuries - answer- Contralateral neck sprain
- Cervical-spine fracture
- Lateral flail chest
- Aortic disruption
- Diaphragmatic rupture
- Laceration of spleen, liver, kidney
- Pelvic fracture
MOI Rear impact potential injuries - answer- Cervical-spine injury
MOI Ejection potential injuries - answerExposure to all mechanisms and mortality
increased
MOI Ped vs car potential injuries - answer- Head injury
,- Aortic disruption
- Abdominal visceral injuries
- Fracture lower extremities and pelvic
Rapid trauma survey - answerBrief head to toe exam to identify life-threatening injuries
Focused exam - answerUsed when there is localized MOI or isolated injury. Exam
limited to area of injury
MVC types - answer1. Frontal-impact (head-on collision)
2. Lateral-impact (T-bone collision)
3. Rear-impact collision
4. Rollover
5. Rotational
The three separate collision events - answer1. Machine collision
2. Body collision
3. Organ collision
Rollover collision high risk injury - answerAxial-loading injuries
Rotational collision consideration - answerIt is a combination of a frontal and lateral
impact MOI.
Firearm terminology - answerCaliber (internal diameter of the barrel)
Rifling (spiral groove in the interior surface of the barrow
Ammunition (case, primer, power, and bullet)
Bullet construction (Soft/hollow nose, jacket type)
Missile size (large the bullet = more resistance -> larger the permanent tract)
Missile deformity (soft nose flatten on impact = larger surface area of damage)
Semijacket (expands and adds to surface area)
Tumbling (causes a wider path of destruction)
Yaw (missile oscillate vertically and horizontally (wobble) about its axis = larger surface
area)
Blast injury factors - answerPrimary (initial air blast. Almost always effects air-filled body
structures)
Secondary (patient being struck by material propelled by the blast)
Tertiary (body being thrown, resulting in an impact with ground/object)
Quaternary (thermal burns, inhalation of toxic dust/fumes)
Quinary (Hyperinflammatory state from contaminant in the blast such as chemical,
biological or radiological materials)
Primary Survey - answerBrief exam to find immediately life-threatening condition.
Consist of scene size-up, initial assessment and either the rapid trauma survey or the
focused exam
,Initial assessment - answerPrioritize the patient and indemnify immediately life-
threatening conditions
1. General impressions
2. Life threatening bleeding (CABC)
3. LOC
4. Airway (c-spine control prn)
5. Breathing
6. Circulation (bleeding control)
Rapid Trauma Survey - answerBrief head to toe to identify life-threatening injuries
1. Head. And neck
2. Chest. (Symmetry, breath sounds, heart tones, trauma)
3. Abdomen
4. Pelvis
5. Lower / Upper extremities
6. Mother and sensory
7. Posterior
**If critical patient transfer to ambulate to complete exam**
Focused exam - answerUsed when focused or localized MOI / injury
1. Evaluate need for spinal
2. Vital sings
3. If ALOC (pupils - GCS)
Ongoing exam - answerAbbreviated exam to determine changes in patient condition.
Completed every 5 mins for critical patient and 15 minutes for stable patients. Should be
performed every time the patient is moved, an intervention performed, patient condition
worsens. May take the place of secondary survey if time restraints is a factor.
Secondary Survey - answerComprehensive head-to-toe exam to find additional injuries
that may have been missed.
Progression of Important Larynx structures (moving inferior) - answerHyoid, thyroid
cartilage, crico thyroid membrane, cricoid cartilage
ELM/BURP - answerBackwards upwards rightward pressure of the thyroid cartilage
Sellick Maneuver - answerCricoid pressure as high as 100cm H2O posteriorly, closing
off the esophagus. Routine use is no longer recommended.
, Landmarking cricoid membrane - answerA: Find the most prominent part of the thyroid
cartilage. Slide index finger down until you feel a second notch (this is the cricoid
cartilage). The Cricoid membrane is between these two landmarks.
B: Find eternal notch. Move upward until you feel the first prominent cartilage "bump"
which is the cricoid cartilage. Just superiorly to this is the cricoid membrane. This
method is useful for difficult airways (i.e thick necks ect)
Location where the cuff of ETT should lie - answerNear the sternal notch
Landmarking the sternal notch - answerPalpated at the junction of the clavicles with the
upper edge of the sternum
Three important numbers for ETT landmarking - answer15 cm from the teeth = vocal
cords
20 cm = sternal notch
25cm = carina
Alternative method: 3x ETT size (8.0mm ETT x3 = no more than 24cm at teeth)
Note: flexion/extension can move ETT between 2.0-2.5cm up or down
Anatomical dead space - answerThe trachea and bronchi
Carbon dioxides effects on cerebral vessels - answerVasodilation
Three essential tasks to maintain a patent airway - answer1. Observation (pulse
oximetry and capnography)
2. Suction
3. Airway adjuncts
Patients who tolerate a OPA should be considered candidates for this procedure -
answerETT. They are not able to protect their lower airway and are considered high risk
for aspiration
PALM - answerPharmacological assisted laryngeal airway
MMAP - answerMnemonic to predict a difficult airway
Mallampati
Measurement (3-3-1): 3 fingers from chin (mentum) to hyoid, 3 fingers in open mouth,
1cm of space between the lower teeth and the upper teeth when the jaw in protruded
forward.
Atlanta-occipital extension: ability to extend the head at the Atlanta-occipital junction to
achieve "sniffing position"
Pathology: anatomic airway obstruction (edema, infection, burns, trauma ect) **Stridor
is a relative contraindication for RSI**
Scene Size-up - answer Observations made and actions taken at a trauma scene
before actually approaching the patient. Initial step in the ITLS Primary Survey. Starts at
dispatch.
Steps of scene size-up - answer1. Standard precautions (PPE)
2. Scene safety
3. Initial triage (# of patients)
4. Need for more help/equipment
5. MOI
OPIM - answer Other potentially infectious material
High-energy event - answerMOI in which it is likely that there was a large release of
uncut rolled kinetic energy
Kinetic Energy formula - answerKinetic energy = 1/2 (M x V squared)
MOI Frontal impact potential injuries - answer- Cervical spine fracture
- Flail chest
- Myocardial contusion
- Pneumothorax
- Aortic disruption
- Spleen or liver laceration
- Posterior hip dislocation
- Knee dislocation
MOI Lateral impact (T-bone) potential injuries - answer- Contralateral neck sprain
- Cervical-spine fracture
- Lateral flail chest
- Aortic disruption
- Diaphragmatic rupture
- Laceration of spleen, liver, kidney
- Pelvic fracture
MOI Rear impact potential injuries - answer- Cervical-spine injury
MOI Ejection potential injuries - answerExposure to all mechanisms and mortality
increased
MOI Ped vs car potential injuries - answer- Head injury
,- Aortic disruption
- Abdominal visceral injuries
- Fracture lower extremities and pelvic
Rapid trauma survey - answerBrief head to toe exam to identify life-threatening injuries
Focused exam - answerUsed when there is localized MOI or isolated injury. Exam
limited to area of injury
MVC types - answer1. Frontal-impact (head-on collision)
2. Lateral-impact (T-bone collision)
3. Rear-impact collision
4. Rollover
5. Rotational
The three separate collision events - answer1. Machine collision
2. Body collision
3. Organ collision
Rollover collision high risk injury - answerAxial-loading injuries
Rotational collision consideration - answerIt is a combination of a frontal and lateral
impact MOI.
Firearm terminology - answerCaliber (internal diameter of the barrel)
Rifling (spiral groove in the interior surface of the barrow
Ammunition (case, primer, power, and bullet)
Bullet construction (Soft/hollow nose, jacket type)
Missile size (large the bullet = more resistance -> larger the permanent tract)
Missile deformity (soft nose flatten on impact = larger surface area of damage)
Semijacket (expands and adds to surface area)
Tumbling (causes a wider path of destruction)
Yaw (missile oscillate vertically and horizontally (wobble) about its axis = larger surface
area)
Blast injury factors - answerPrimary (initial air blast. Almost always effects air-filled body
structures)
Secondary (patient being struck by material propelled by the blast)
Tertiary (body being thrown, resulting in an impact with ground/object)
Quaternary (thermal burns, inhalation of toxic dust/fumes)
Quinary (Hyperinflammatory state from contaminant in the blast such as chemical,
biological or radiological materials)
Primary Survey - answerBrief exam to find immediately life-threatening condition.
Consist of scene size-up, initial assessment and either the rapid trauma survey or the
focused exam
,Initial assessment - answerPrioritize the patient and indemnify immediately life-
threatening conditions
1. General impressions
2. Life threatening bleeding (CABC)
3. LOC
4. Airway (c-spine control prn)
5. Breathing
6. Circulation (bleeding control)
Rapid Trauma Survey - answerBrief head to toe to identify life-threatening injuries
1. Head. And neck
2. Chest. (Symmetry, breath sounds, heart tones, trauma)
3. Abdomen
4. Pelvis
5. Lower / Upper extremities
6. Mother and sensory
7. Posterior
**If critical patient transfer to ambulate to complete exam**
Focused exam - answerUsed when focused or localized MOI / injury
1. Evaluate need for spinal
2. Vital sings
3. If ALOC (pupils - GCS)
Ongoing exam - answerAbbreviated exam to determine changes in patient condition.
Completed every 5 mins for critical patient and 15 minutes for stable patients. Should be
performed every time the patient is moved, an intervention performed, patient condition
worsens. May take the place of secondary survey if time restraints is a factor.
Secondary Survey - answerComprehensive head-to-toe exam to find additional injuries
that may have been missed.
Progression of Important Larynx structures (moving inferior) - answerHyoid, thyroid
cartilage, crico thyroid membrane, cricoid cartilage
ELM/BURP - answerBackwards upwards rightward pressure of the thyroid cartilage
Sellick Maneuver - answerCricoid pressure as high as 100cm H2O posteriorly, closing
off the esophagus. Routine use is no longer recommended.
, Landmarking cricoid membrane - answerA: Find the most prominent part of the thyroid
cartilage. Slide index finger down until you feel a second notch (this is the cricoid
cartilage). The Cricoid membrane is between these two landmarks.
B: Find eternal notch. Move upward until you feel the first prominent cartilage "bump"
which is the cricoid cartilage. Just superiorly to this is the cricoid membrane. This
method is useful for difficult airways (i.e thick necks ect)
Location where the cuff of ETT should lie - answerNear the sternal notch
Landmarking the sternal notch - answerPalpated at the junction of the clavicles with the
upper edge of the sternum
Three important numbers for ETT landmarking - answer15 cm from the teeth = vocal
cords
20 cm = sternal notch
25cm = carina
Alternative method: 3x ETT size (8.0mm ETT x3 = no more than 24cm at teeth)
Note: flexion/extension can move ETT between 2.0-2.5cm up or down
Anatomical dead space - answerThe trachea and bronchi
Carbon dioxides effects on cerebral vessels - answerVasodilation
Three essential tasks to maintain a patent airway - answer1. Observation (pulse
oximetry and capnography)
2. Suction
3. Airway adjuncts
Patients who tolerate a OPA should be considered candidates for this procedure -
answerETT. They are not able to protect their lower airway and are considered high risk
for aspiration
PALM - answerPharmacological assisted laryngeal airway
MMAP - answerMnemonic to predict a difficult airway
Mallampati
Measurement (3-3-1): 3 fingers from chin (mentum) to hyoid, 3 fingers in open mouth,
1cm of space between the lower teeth and the upper teeth when the jaw in protruded
forward.
Atlanta-occipital extension: ability to extend the head at the Atlanta-occipital junction to
achieve "sniffing position"
Pathology: anatomic airway obstruction (edema, infection, burns, trauma ect) **Stridor
is a relative contraindication for RSI**
