A HIGH YIELD ATLS & TRAUMA EXAM
QUESTION WITH 100% CORRECT
ANSWERS
Approach Overview - Answer-*1. Preparation* → Known & Potential Problems, People,
Plan, & Props
• Equipment
*A*irway trays, BVM, C-spine equipment
*B*reathing → chest tube tray x2, decompression needles
*C*irculation → warmed IVF, O+/-
PRBCs, tourniquet, splints, thoracotomy tray
*D*rugs → code cart, RSI drugs, pain meds
*E*xtras → foleys, blankets, NG tube
*2. Triage* → Check for surgeon/TT/Trauma transfer cirteria → activate TT ± surgeon
*3. Primary Survey (ABCDE) & Resus*
*4. Adjuncts to Primary & Resus* → ECG, FAST, CXR, C-spine XR, AP pelvis XR,
ABG, coags, CBC, C7, Foley, NG
• Adjuncts should not interrupt resus
*5. Decide to transfer or not*
*6. Secondary Survey & AMPLE Hx*
*7. Continuous Post-Resus Monitoring & Re-evaluation*
*8. Transfer to Definitive Care*
Criteria for any
• Trauma Activation
• Transfer to Trauma Centre
• Presence of surgeon in trauma (Only the first 4 criteria) - Answer-• Shock (SBP<90)
• Required ETT
• GCS<8
• Pentrating trauma to head, neck or torso
• Limb amputation prox to wrist/ankle
• 2 long bone #
• Evidence of spinal cord injury
• Major peds or preg >20w trauma
, Chest trauma + unstable VS + suspected HTX or PTX - Answer-1) Immediate
needle/finger thoracostomies → chest tube
2) If >1500ml or >200ml/h → urgent thoracic consult
Classification of Hemorrhagic SHOCK - Answer-Class 1 → Normal VS (<750ml)
Class 2 → Tachy, ↓PP (750-1500ml)
Class 3 → HypoTN (1.5-2L)
Class 4 →↓LOC/lethargic (>2L)
Airway in trauma - Answer-• Always maintain C-spine
In trauma intubations, always ues
• Manual n-line stabilization
• A bougie
• RSI unless predicted difficult intubation or mid-face trauma or CI (→ awake ± cric)
• VL if possible (↓ c-spine movement)
Trauma Primary Survey - Answer-*Airway & C-Spine precautions*
• Decide to ETT or not
• If ETT → do neuro exam before ETT
*Breathing & Ventilation*
• Check: BS B/L, distress, asym, lacs/contusion/deformity/crepitus
• R/O & treat ATOM-FC
• O2 for all trauma patients
*Circulation & Hemorrhage Control*
• Check: Pulses, body-wide check for obvious bleeding (incl logroll+DRE , pelvis &
FAST
• R/O non-hemorrhagic shock
→ ATOM-FC + neurogenic shock
→ If suspect c-spine injury then expect neurogenic shock to follow (fluids won't work,
need pressors!)
• Circulation: If shock → warm NS/LR 2L bolus (20ml/kg PEDS) → O±blood & surgeon
if refractory
• Hemorrhage Control: quickly inspect the abdomen, pelvis & limbs for obvious massive
bleeds
→ External: direct pressure & splint
→ Internal: Pelvic binder & OR
*Disability*
• Check: GCS/AVPU, pupils, 4 limbs for lateralizing signs, suspicious head/neck/spinal
trauma
• R/O Intracranial (herniation) or spine injury that require urgent interventions
• Spinal precautions PRN
QUESTION WITH 100% CORRECT
ANSWERS
Approach Overview - Answer-*1. Preparation* → Known & Potential Problems, People,
Plan, & Props
• Equipment
*A*irway trays, BVM, C-spine equipment
*B*reathing → chest tube tray x2, decompression needles
*C*irculation → warmed IVF, O+/-
PRBCs, tourniquet, splints, thoracotomy tray
*D*rugs → code cart, RSI drugs, pain meds
*E*xtras → foleys, blankets, NG tube
*2. Triage* → Check for surgeon/TT/Trauma transfer cirteria → activate TT ± surgeon
*3. Primary Survey (ABCDE) & Resus*
*4. Adjuncts to Primary & Resus* → ECG, FAST, CXR, C-spine XR, AP pelvis XR,
ABG, coags, CBC, C7, Foley, NG
• Adjuncts should not interrupt resus
*5. Decide to transfer or not*
*6. Secondary Survey & AMPLE Hx*
*7. Continuous Post-Resus Monitoring & Re-evaluation*
*8. Transfer to Definitive Care*
Criteria for any
• Trauma Activation
• Transfer to Trauma Centre
• Presence of surgeon in trauma (Only the first 4 criteria) - Answer-• Shock (SBP<90)
• Required ETT
• GCS<8
• Pentrating trauma to head, neck or torso
• Limb amputation prox to wrist/ankle
• 2 long bone #
• Evidence of spinal cord injury
• Major peds or preg >20w trauma
, Chest trauma + unstable VS + suspected HTX or PTX - Answer-1) Immediate
needle/finger thoracostomies → chest tube
2) If >1500ml or >200ml/h → urgent thoracic consult
Classification of Hemorrhagic SHOCK - Answer-Class 1 → Normal VS (<750ml)
Class 2 → Tachy, ↓PP (750-1500ml)
Class 3 → HypoTN (1.5-2L)
Class 4 →↓LOC/lethargic (>2L)
Airway in trauma - Answer-• Always maintain C-spine
In trauma intubations, always ues
• Manual n-line stabilization
• A bougie
• RSI unless predicted difficult intubation or mid-face trauma or CI (→ awake ± cric)
• VL if possible (↓ c-spine movement)
Trauma Primary Survey - Answer-*Airway & C-Spine precautions*
• Decide to ETT or not
• If ETT → do neuro exam before ETT
*Breathing & Ventilation*
• Check: BS B/L, distress, asym, lacs/contusion/deformity/crepitus
• R/O & treat ATOM-FC
• O2 for all trauma patients
*Circulation & Hemorrhage Control*
• Check: Pulses, body-wide check for obvious bleeding (incl logroll+DRE , pelvis &
FAST
• R/O non-hemorrhagic shock
→ ATOM-FC + neurogenic shock
→ If suspect c-spine injury then expect neurogenic shock to follow (fluids won't work,
need pressors!)
• Circulation: If shock → warm NS/LR 2L bolus (20ml/kg PEDS) → O±blood & surgeon
if refractory
• Hemorrhage Control: quickly inspect the abdomen, pelvis & limbs for obvious massive
bleeds
→ External: direct pressure & splint
→ Internal: Pelvic binder & OR
*Disability*
• Check: GCS/AVPU, pupils, 4 limbs for lateralizing signs, suspicious head/neck/spinal
trauma
• R/O Intracranial (herniation) or spine injury that require urgent interventions
• Spinal precautions PRN
