ATLS EXAM
True or false? Although the mechanism of injury may be True
similar to those for the younger population, data shows
increased mortality with similar severity of injury in older
adults.
In the elderly population, what is decreased physiological aging is characterized by impaired adaptive and homeostatic mechanisms that
reserve? caused an increased susceptibility to the stress of injury. Insults tolerated by the
younger population can lead to devastating results in elderly patients.
Pre-existing conditions that affect morbidity and mortality cirrhosis, coagulopathy, COPD, ischemic heart disease, DM
include:
What is the most common mechanism of injury in the Fall. Nonfatal falls are common in women and fractures are common in women
elderly? who fall. Falls are the most common cause of TBI.
In the elderly population, what are risk factors for falls? advanced age, physical impairment, history of previous fall, medication use,
dementia, unsteady gait, and visual, cognitive impairment
Most of elderly traffic fatalities occur in the daytime and Older people drive on more familiar roads and at lower speeds and tend to drive
on weekends and typically involve other vehicles. Why? during the day. Older people have slower reaction time, a larger blind spot,
limited cervical mobility, decreased hearing, and cognitive impairment.
True or False? Mortality associated with small to True
moderate sized burns in older adults remains high
Spilled hot liquids on the leg, which in younger patients this is true
may re-epithelialize due to an adequate number of hair
follicles, will result in a full thickness burn in older
patients.
Airway-patients may have dentures that may loosen or bag mask ventilation, as it improves mask fitting.
obstruct the airway. If dentures are not obstructing the
airway, leave them in place for what?
When preforming rapid sequence intubation, the dose of 20-40%
benzos, barbiturates, and other sedatives should be
reduced to what percentage to minimize the risk of
cardiovascular depression?
Functional changes in cardiac system include declining this results in lack of classic response to hypovolemia, risk for cardiac ischemia,
function, decreased sensitivity to catecholamines, elevated BP at baseline, and increased risk of dysrythmias.
atherosclerosis of coronary vessels, increased afterload,
fixed heart rate (beta blockers)
Functional changes in pulmonary system include thus they are at increased risk for respiratory failure, increased risk for
decreased elastic recoil, reduced residual capacity, pneumonia, and poor tolerance to rib fractures
decreased gas exchange and decreased cough reflex
Functional changes in renal system include loss of renal resulting in drug dosing for renal insufficiency, decreased ability to concentrate
mass, decreased GFR, and decreased sensitivity to ADH urine, increased risk for AKI and urine flow may be normal with hypovolemia
and aldosterone
Functional changes to MSK include loss of lean body resulting in increased risk for fractures, decreased mobility, difficulty for oral
mass, osteoporosis, changes in joints and cartilage, c intubation, risk of skin injury, increased risk for hypothermia, challenges in
spine degenerative changes and loss of skin elastin and rehabiliation
subcutaneous fat
Functional changes in Endocrine system include resulting in occult hypothyroidism, relative hypercortisone states and increased
decreased production and response to thyroxin and risk of infection
decreased dehydroepiandrosterone (DHEA)
, ATLS EXAM
True or false: Arthritis can complicate the airway and true
cervical spine. Patients can have multilevel degenerative
changes affecting disk spaces and posterior elements
associated with severe central canal stenosis, cord
compression, and myelomalacia
In elderly population, due to their changes in pulmonary respiratory failure may present insidiously in older adults.
system, placing a gauze between gums and cheek to
achieve seal when using bag valve mask ventilation is
okay. In addition, because aging causes a suppressed
heart rate response to hypoxia......
Age related changes in the cardiovascular system place Elderly patients have a fixed heart rate and fixed cardiac output, thus, their
the elderly trauma patient at significant risk for being response to hypovolemia will involve increasing their systemic vascular
inaccurately categorized as hemodynamically stable. resistance. Furthermore, since older patients have HTN, an acceptable BP may
truly reflect a hypotensive state. A systolic BP of 110 is to be utilized as the
threshold for identifying hypotension in patients 65 and older.
Do no equate blood pressure with shock in older patients BP in older patients may look normal due to the medications they are on. Use
lactate and base deficit to evaluate for evidence of shock
what 2 factors place elderly patients at risk for aging causes dura to become more adherent to the skull increasing risk of injury
intracranial hemorrhage? and older patients are on anticoagulant and antiplatelet medications.
Loss of subcutaneous fat, nutritional deficiencies, chronic Rapid evaluation and when possible early liberation from spine boards and
medical conditions place elderly patients as risk for cervical collars will minimize complications.
hypothermia and complications for immobility.
True or False: Fall prevention is the mainstay of reducing true
the mortality associated with pelvic fractures.
poor hygiene, dehydration, oral injury, contusions Elder maltreatment. The presence of physical findings of maltreatment should
affecting the inner arms, inner thighs, palms, soles, prompt a detailed history. if history conflicts with findings, immediately report
scalp, ear, nasal bridge and temple injury from being findings to authorities.
struck while wearing glasses, contact burns and scalds.
These are all signs of.......?
True of false: early activation of the trauma team may be True. A simple injury such as an open tibia fracture in a frail elderly patient may
required for elderly patients who do not meet traditional become life threatening.
criteria for activation
Common mechanisms of injury include falls, MVC, common injuries in the elderly include rib fractures, TBI, pelvic fractures
burns, and penetrating injuries
The best initial treatment for the fetus is to provide True. Also if xray examination is indicated during the pregnant patient's
optimal resuscitation of the mother. True or False? treatment, it should not be withheld because of the pregnancy.
What happens as the uterus enlarged and the bowel is When the uterus enlarges it pushes the bowel cephalad and the uterus lies in the
pushed cephalad. upper abdomen. As a result, the bowel is somewhat protected from blunt
abdominal trauma, whereas the uterus and its contents (fetus and placenta)
become more vulnerable. Uterus remains intrapelvic until 12 weeks and then at
20 weeks it is at the umbilicus, and at 34-36 weeks it reaches the costal margin.
Amniotic fluid can cause amniotic fluid embolism and True
disseminated intravascular coagulation following trauma
if fluid enters maternal intravascular space. True or False
By the third trimester, what is the complication of trauma by the third trimester, the uterus is large and thin walled. In vertex presentation,
to the pelvis of the mother? fetal head is usually in the pelvis and the remainder of the fetus is exposed
above the pelvic brim. Pelvic fractures in late gestation can result in skull fracture
or intracranial injury to the fetus. Also we can have a placental abruption due to
its little elasticity and vulnerability to sheer forces.
True or false? Although the mechanism of injury may be True
similar to those for the younger population, data shows
increased mortality with similar severity of injury in older
adults.
In the elderly population, what is decreased physiological aging is characterized by impaired adaptive and homeostatic mechanisms that
reserve? caused an increased susceptibility to the stress of injury. Insults tolerated by the
younger population can lead to devastating results in elderly patients.
Pre-existing conditions that affect morbidity and mortality cirrhosis, coagulopathy, COPD, ischemic heart disease, DM
include:
What is the most common mechanism of injury in the Fall. Nonfatal falls are common in women and fractures are common in women
elderly? who fall. Falls are the most common cause of TBI.
In the elderly population, what are risk factors for falls? advanced age, physical impairment, history of previous fall, medication use,
dementia, unsteady gait, and visual, cognitive impairment
Most of elderly traffic fatalities occur in the daytime and Older people drive on more familiar roads and at lower speeds and tend to drive
on weekends and typically involve other vehicles. Why? during the day. Older people have slower reaction time, a larger blind spot,
limited cervical mobility, decreased hearing, and cognitive impairment.
True or False? Mortality associated with small to True
moderate sized burns in older adults remains high
Spilled hot liquids on the leg, which in younger patients this is true
may re-epithelialize due to an adequate number of hair
follicles, will result in a full thickness burn in older
patients.
Airway-patients may have dentures that may loosen or bag mask ventilation, as it improves mask fitting.
obstruct the airway. If dentures are not obstructing the
airway, leave them in place for what?
When preforming rapid sequence intubation, the dose of 20-40%
benzos, barbiturates, and other sedatives should be
reduced to what percentage to minimize the risk of
cardiovascular depression?
Functional changes in cardiac system include declining this results in lack of classic response to hypovolemia, risk for cardiac ischemia,
function, decreased sensitivity to catecholamines, elevated BP at baseline, and increased risk of dysrythmias.
atherosclerosis of coronary vessels, increased afterload,
fixed heart rate (beta blockers)
Functional changes in pulmonary system include thus they are at increased risk for respiratory failure, increased risk for
decreased elastic recoil, reduced residual capacity, pneumonia, and poor tolerance to rib fractures
decreased gas exchange and decreased cough reflex
Functional changes in renal system include loss of renal resulting in drug dosing for renal insufficiency, decreased ability to concentrate
mass, decreased GFR, and decreased sensitivity to ADH urine, increased risk for AKI and urine flow may be normal with hypovolemia
and aldosterone
Functional changes to MSK include loss of lean body resulting in increased risk for fractures, decreased mobility, difficulty for oral
mass, osteoporosis, changes in joints and cartilage, c intubation, risk of skin injury, increased risk for hypothermia, challenges in
spine degenerative changes and loss of skin elastin and rehabiliation
subcutaneous fat
Functional changes in Endocrine system include resulting in occult hypothyroidism, relative hypercortisone states and increased
decreased production and response to thyroxin and risk of infection
decreased dehydroepiandrosterone (DHEA)
, ATLS EXAM
True or false: Arthritis can complicate the airway and true
cervical spine. Patients can have multilevel degenerative
changes affecting disk spaces and posterior elements
associated with severe central canal stenosis, cord
compression, and myelomalacia
In elderly population, due to their changes in pulmonary respiratory failure may present insidiously in older adults.
system, placing a gauze between gums and cheek to
achieve seal when using bag valve mask ventilation is
okay. In addition, because aging causes a suppressed
heart rate response to hypoxia......
Age related changes in the cardiovascular system place Elderly patients have a fixed heart rate and fixed cardiac output, thus, their
the elderly trauma patient at significant risk for being response to hypovolemia will involve increasing their systemic vascular
inaccurately categorized as hemodynamically stable. resistance. Furthermore, since older patients have HTN, an acceptable BP may
truly reflect a hypotensive state. A systolic BP of 110 is to be utilized as the
threshold for identifying hypotension in patients 65 and older.
Do no equate blood pressure with shock in older patients BP in older patients may look normal due to the medications they are on. Use
lactate and base deficit to evaluate for evidence of shock
what 2 factors place elderly patients at risk for aging causes dura to become more adherent to the skull increasing risk of injury
intracranial hemorrhage? and older patients are on anticoagulant and antiplatelet medications.
Loss of subcutaneous fat, nutritional deficiencies, chronic Rapid evaluation and when possible early liberation from spine boards and
medical conditions place elderly patients as risk for cervical collars will minimize complications.
hypothermia and complications for immobility.
True or False: Fall prevention is the mainstay of reducing true
the mortality associated with pelvic fractures.
poor hygiene, dehydration, oral injury, contusions Elder maltreatment. The presence of physical findings of maltreatment should
affecting the inner arms, inner thighs, palms, soles, prompt a detailed history. if history conflicts with findings, immediately report
scalp, ear, nasal bridge and temple injury from being findings to authorities.
struck while wearing glasses, contact burns and scalds.
These are all signs of.......?
True of false: early activation of the trauma team may be True. A simple injury such as an open tibia fracture in a frail elderly patient may
required for elderly patients who do not meet traditional become life threatening.
criteria for activation
Common mechanisms of injury include falls, MVC, common injuries in the elderly include rib fractures, TBI, pelvic fractures
burns, and penetrating injuries
The best initial treatment for the fetus is to provide True. Also if xray examination is indicated during the pregnant patient's
optimal resuscitation of the mother. True or False? treatment, it should not be withheld because of the pregnancy.
What happens as the uterus enlarged and the bowel is When the uterus enlarges it pushes the bowel cephalad and the uterus lies in the
pushed cephalad. upper abdomen. As a result, the bowel is somewhat protected from blunt
abdominal trauma, whereas the uterus and its contents (fetus and placenta)
become more vulnerable. Uterus remains intrapelvic until 12 weeks and then at
20 weeks it is at the umbilicus, and at 34-36 weeks it reaches the costal margin.
Amniotic fluid can cause amniotic fluid embolism and True
disseminated intravascular coagulation following trauma
if fluid enters maternal intravascular space. True or False
By the third trimester, what is the complication of trauma by the third trimester, the uterus is large and thin walled. In vertex presentation,
to the pelvis of the mother? fetal head is usually in the pelvis and the remainder of the fetus is exposed
above the pelvic brim. Pelvic fractures in late gestation can result in skull fracture
or intracranial injury to the fetus. Also we can have a placental abruption due to
its little elasticity and vulnerability to sheer forces.
