ATLS Review Exam 5 2024

Oxygen flow rate for Bag Valve Mask (BVM)? - 15 L/min (at least 10) drug Intubation - -give meds if time -pre-oxygenate with high flow oxygen (if can't then need surgical airway) -suction available -size 8 ETT tube with working cuff -laryngoscope and GEB ready -visualize cords, inflate cuff -check position with breath sounds, co2 monitor, -secure tube and ventilate - CXR Circothyroidotomy - -sterile prep and 2% lidocaine -6mm ET tube -preoxygenate 100% NRB mask -give suchinylcholine -palpate cricothyroid membrane and incise 2-3cm vertically -incise base of membrane transversely -insert hemostat or scalpel and rotate 90 to open airway -insert tube, inflate cuff -check position with breath sounds, co2 monitor, -secure tube and ventilate - CXR Intubation Medications - induction: -etomidate .3mg/kg (20mg) -Succinylcholine 1-2mg/kg (100IV); careful with burns/electrical/crush injuries Laryngeal Mask Airway (LMA) size - 3: small female 4: large female/small male 5: large male DOPE - Dislodgement/ displacement Obstruction (may need to suction) Pneumothorax Equipment failure needle decompression - -sterile prep/drapes, 2% lidocaine -14 to 18 (8cm needle) over the needle catheter -Peds: 2nd intercostal space midclavicular line -Adults: 4th or 5th intercostal space anterior to midaxillary line -puncture parietal pleura and listen for air -remove needle and leave catheter -plug and apply dressing -chest tube chest tube - 28-32 French tube at 5th intercostal space just anterior to midaxillary line -transverse incision, puncture parietal pleura with curved Kelly above rib -enlarge and clear space with finger -advance clamped tube into apex -look for logging and listen for air movement -secure with sutures and connect under h20 seal -apply dressing, order CXR -immediate return of more then 1500mL indicates need for urgent thoracotomy or also if 200mL/hr for 2-4 hrs -color of blood is POOR predictor -injuries to mediastinal box should alert need for possible thoracotomy -acute hemothorax big enough to see on CXR may be treated with chest tube GCS scoring points - Eyes -4 Open spontaneously -3 Opens on verbal -2 Opens on pain -1 Unresponsive Speach -5 Speaks spontaneously, makes sense -4 Speaks spontaneously, but is confused -3 Speaks spontaneously, does NOT make sense