ATLS Review Exam 5 2024
Oxygen Flow Rate for Bag Valve Mask (BVM)
• 15 L/min (at least 10 L/min)
Intubation
• Preparation:
o Administer medications if time permits
o Pre-oxygenate with high-flow oxygen (if unable, proceed to surgical
airway)
o Ensure suction is available
o Use a size 8 ETT tube with a working cuff
o Have a laryngoscope and GEB ready
• Procedure:
o Visualize vocal cords
o Inflate cuff
o Check tube position with breath sounds and CO₂ monitor
o Secure the tube and begin ventilation
o Obtain a Chest X-Ray (CXR)
Cricothyroidotomy
• Preparation:
o Perform sterile preparation and use 2% lidocaine
, o Use a 6mm ET tube
o Pre-oxygenate with 100% NRB mask
o Administer suxamethonium
• Procedure:
o Palpate the cricothyroid membrane and make a 2-3 cm vertical incision
o Incise the base of the membrane transversely
o Insert a hemostat or scalpel and rotate 90 degrees to open the airway
o Insert the tube, inflate the cuff
o Check position with breath sounds and CO₂ monitor
o Secure the tube and begin ventilation
o Obtain a Chest X-Ray (CXR)
Intubation Medications
• Induction:
o Etomidate 0.3 mg/kg (e.g., 20 mg)
• Paralytic:
o Succinylcholine 1-2 mg/kg (typically 100 mg IV)
▪ Cautions: Avoid in burns, electrical, crush injuries, and renal failure
patients due to the risk of hyperkalemia
Laryngeal Mask Airway (LMA) Sizes
• Size 3: Small female
• Size 4: Large female/Small male
• Size 5: Large male
, DOPE Checklist for Airway Issues
• D: Dislodgement/Displacement
• O: Obstruction (may need to suction)
• P: Pneumothorax
• E: Equipment Failure
Needle Decompression
• Preparation:
o Perform sterile preparation and use drapes
o Administer 2% lidocaine
o Use an 8 cm needle (14 to 18 gauge)
• Procedure:
o Pediatrics: 2nd intercostal space at the midclavicular line
o Adults: 4th or 5th intercostal space anterior to the midaxillary line
o Puncture the parietal pleura and listen for air
o Remove the needle and leave the catheter in place
o Plug and apply dressing
o Proceed to chest tube insertion
Chest Tube Insertion
• Tube Specifications:
o Use a 28-32 French tube at the 5th intercostal space just anterior to the
midaxillary line
• Procedure:
o Make a transverse incision
o Puncture the parietal pleura with a curved Kelly above the rib
Oxygen Flow Rate for Bag Valve Mask (BVM)
• 15 L/min (at least 10 L/min)
Intubation
• Preparation:
o Administer medications if time permits
o Pre-oxygenate with high-flow oxygen (if unable, proceed to surgical
airway)
o Ensure suction is available
o Use a size 8 ETT tube with a working cuff
o Have a laryngoscope and GEB ready
• Procedure:
o Visualize vocal cords
o Inflate cuff
o Check tube position with breath sounds and CO₂ monitor
o Secure the tube and begin ventilation
o Obtain a Chest X-Ray (CXR)
Cricothyroidotomy
• Preparation:
o Perform sterile preparation and use 2% lidocaine
, o Use a 6mm ET tube
o Pre-oxygenate with 100% NRB mask
o Administer suxamethonium
• Procedure:
o Palpate the cricothyroid membrane and make a 2-3 cm vertical incision
o Incise the base of the membrane transversely
o Insert a hemostat or scalpel and rotate 90 degrees to open the airway
o Insert the tube, inflate the cuff
o Check position with breath sounds and CO₂ monitor
o Secure the tube and begin ventilation
o Obtain a Chest X-Ray (CXR)
Intubation Medications
• Induction:
o Etomidate 0.3 mg/kg (e.g., 20 mg)
• Paralytic:
o Succinylcholine 1-2 mg/kg (typically 100 mg IV)
▪ Cautions: Avoid in burns, electrical, crush injuries, and renal failure
patients due to the risk of hyperkalemia
Laryngeal Mask Airway (LMA) Sizes
• Size 3: Small female
• Size 4: Large female/Small male
• Size 5: Large male
, DOPE Checklist for Airway Issues
• D: Dislodgement/Displacement
• O: Obstruction (may need to suction)
• P: Pneumothorax
• E: Equipment Failure
Needle Decompression
• Preparation:
o Perform sterile preparation and use drapes
o Administer 2% lidocaine
o Use an 8 cm needle (14 to 18 gauge)
• Procedure:
o Pediatrics: 2nd intercostal space at the midclavicular line
o Adults: 4th or 5th intercostal space anterior to the midaxillary line
o Puncture the parietal pleura and listen for air
o Remove the needle and leave the catheter in place
o Plug and apply dressing
o Proceed to chest tube insertion
Chest Tube Insertion
• Tube Specifications:
o Use a 28-32 French tube at the 5th intercostal space just anterior to the
midaxillary line
• Procedure:
o Make a transverse incision
o Puncture the parietal pleura with a curved Kelly above the rib
