ADVANCED TRAUMA LIFE SUPPORT EXAM AND PRACTICE EXAM NEWEST 2024 ACTUAL EXAM 400 QUESTIONS AND CORRECT DETAILED ANSWERS (VERIFIED ANSWERS) |ALREADY GRADED A+

ADVANCED TRAUMA LIFE SUPPORT EXAM AND PRACTICE EXAM NEWEST 2024 ACTUAL EXAM 400 QUESTIONS AND CORRECT DETAILED ANSWERS (VERIFIED ANSWERS) |ALREADY GRADED A+ How should you position the patient before placing a subclavian or IJ line? - ....ANSWER....Supine, head down 15 degrees to distend neck neck veins and prevent embolism, only turn head away is C-spine has been cleared first. How long can you keep and IO line in - ....ANSWER....Intraosseous infusions should be limited to emergency resuscitation and should be discontinued as soon as other venous access is obtained Where do you want to make an incision for a saphenous vein cutdown and how long should your incisions be? - ....ANSWER....1 cm superior, 1 cm anterior to medial malleolus. 2.5 cm transverse incusion through the skin and SQ, careful to not to inure the vessel. A patient arrives to the trauma bay intubated and there are absent breath sounds over the left hemithorax, where should you place your decompression needle? - ....ANSWER....This may NOT be a pneumothorax, for intubated patients always suspect a right main-stem before attempting needle decompression. Where would you insert a large caliber needle to decompress a tension pneumo - ....ANSWER....2nd IC space in the midclavicular line of affected hemithorax For an open pneumothorax, (sucking chest wound) air passes preferentially through the chest wall defect (least resistance) if the diameter of the defect is at least ___ the diameter of the trachea. - ....ANSWER....2/3 Flail chest results from multiple rib fractures - by definition this would be ___ or more ribs, fractured in ___ or more places. - ....ANSWER....2 or more ribs fractured in 2 or more places Both tension pneumothorax and massive hemothorax are associated with decreased breath sounds on auscultation, so you can tell which it is by _______. - ....ANSWER....Percussion - hyperresonant with pnuemo, dull with hemothorax. If a patient doesn't have JVD, does this mean they don't have a tension pneumo or tamponade? - ....ANSWER....No, they might have a massive internal hemorrhage and be hypovolemic. By definition, how much blood is in the chest cavity to call it a "massive hemothorax"? - ....ANSWER....1500 mL or 1/3 or more of the patient's total blood volume. (Some also define it as continued blood loss of 200 mL/hr for 2-4 hoursbut ATLS does NOT use this rate for any mandatory treatment decisions). What size chest tube might you use to evacuate a massive hemothorax? - ....ANSWER....#38 French - inserted at the 4th or 5th intercostal space, just anterior to the midaxillary line. What is Kussmaul's sign? - ....ANSWER....A rise in venous pressure with inspiration while breathing spontaneously, and is a true paradoxical venous pressure abnormality associated with cardiac tamponade. How well do CPR compressions work on someone with a penetrating chest injury and hypovolemia? - ....ANSWER...."Closed heart massage for cardiac arrest or PEA is INEFFECTIVE in patients with hypovolemia." Patients with PENETRATING thoracic injuries who arrive pulseless, but with myocardial electrial activity, may be candidates for an ED thoacotomy. Are patients with PEA who have sustained blunt thoracic injuries candidates for an ED thoracotomy? - ....ANSWER....NO - Only PEA with PENETRATING thoracic injuries should get an ED thoracotomy. An ED thoracotomy can allow you to do what? - ....ANSWER....Evacuate pericardial blood, directly control hemorrhage, cardiac massage, cross-clamp the descending aorta to slow blood loss below the diaphragm and increase perfusion to the heart and brain. For a patient with a traumatic simple pneumothorax, what should you do BEFORE you start positive pressure ventilation or take them to surgery for a GA? - ....ANSWER....Chest tube - positive pressure ventilation can turn a sumple pneumo into a tension pneumo, so put in a chest tube first. Should you evacuate a simple hemothorax if it is not causing any respiratory problems? - ....ANSWER....YES - A simple hemothorax, if not fully evacuated, may result in a retained, clotted hemothroax with lung entrapment or, if infected, develop into an empyema. A pneumothorax associated with a persistent large air leak after tube thoracostomy suggests a _______ injury. - ....ANSWER....tracheobronchial - Use bronchoscopy to confirm, you may need more than one chest tube before definitive operative management. What radiographic findings are suggestive of traumatic aortic disruption? - ....ANSWER....Widened mediastinum, obliteration of aortic knob, deviation of trachea to the right, depression of left mainstem bronchus, deviation of esophagus (NG tube) to right, widened paratracheal stripe, fx'd 1st/2nd ribs or scapula. A deceleration injury victim with a left pnuemothorax or hemothorax without rib fractures, is in pain or shock out of proportion to the apparent injury, and has particulate matter in their chest tube may have _________. - ....ANSWER....an ESOPHAGEAL RUPTURE - a forceful blow causes expulsion of gastric contents into the esophagus, producing a linear tear in the lower esophagus allowing leakage into the mediastinum. Fractures for the lower ribs (10-12) should increase suspicion for _____ injury. - ....ANSWER....hepatosplenic Why are upper torso, facial, and arm plethora with petechiae associated with crush injuries to the chest? - ....ANSWER....Temporary compression of the superior vena cava. How does ATLS suggest you should review a chest radiograph? - ....ANSWER....Trachea & bronchi, pleural spaces and parenchyma, mediastinum, diaphragm, bones, soft tissues, tubes & lines. You should use a size 16 or 18 gauge 6" needle for pericardiocentesis. How do you insert it