ATLS EXAM
> 40% blood loss. heart rate increase, RR increase, BP decrease, pulse pressure decrease, urine output
and GCS decrease - ANS-MTP and base deficit is -10 or less
15-30% blood loss. increase in heart rate. decrease in pulse pressure. BP, RR, urine output do not
change - ANS-class II hemorrhagic shock. possible need for blood products, but mostly crystalloid fluid
and base deficit of -2 to -6. anxiety, fear
31-40% blood loss. heart rate increase, respiratory rate increase, blood pressure decrease, pulse
pressure decrease, urine output and GCS decrease - ANS-class III and this is the least amount of blood
loss that consistently causes a drop in systolic blood pressure. blood products needed and base deficit
is -6 to -10
A carboxyhemoglobin level greater than what percentage indicates a patient was involved in a fire and
has inhalation injury? - ANS-10%
A chest xray must be obtained after attempts at inserting a subclavian or IJ to document position of
line and evaluate for pneumo or hemothorax. - ANS-do not use sodium bicarb to treat metabolic
acidosis from hypovolemic shock
A clenched hand with a small electrical entrance wound should alert the clinician that a deep soft
tissue injury is likely much more extensive than is visable to the naked eye - ANS-true. patients with
severe electrical injuries require fasciotomies. Electricity can cause forced contraction of muscles,
doctors need to examine patient for skeletal and muscular damage, especially for fractures of the
spine and rhabdomyolysis
A tube placed in the trachea with the cuff inflated below the vocal cords and the tube connected to
oxygen enriched assisted ventilation and airway secured in place. - ANS-definitive airway
Abuse and burns - ANS-circular burns and burns with clear edges and unique patterns may reflect
cigarette burns or iron. Burns on the sole of the feet usually suggest child was placed in hot water. A
burn on the posterior aspect of the LE and buttocks
,Acute respiratory distress, subcutaneous emphysema, absent unilateral breath sounds,
hyperresonance to percussion, and tracheal shift supports the diagnosis of???? - ANS-tension
pneumothorax. needle or finger decompression temporarily relieves this life threatening condition
and follow this with a chest tube
Admission to hospital for pregnant patients: - ANS-vaginal bleeding, uterine irritability, abdominal
tenderness, pain or cramping, evidence of hypovolemia, changes in or absence of fetal heart tones and
or leakage of amniotic fluid
After the 10th week of pregnancy, cardiac output can increase 1.0-1.5 L/min because of the increase in
plasma volume and decrease in vascular resistance of the uterus and placenta. - ANS-The placenta
receives 20% of the patient's cardiac output during the 3rd trimester. In supine position, vena cava
compression can decrease cardiac output by 30% because of decreased venous return from lower
extremities.
Age related changes in the cardiovascular system place the elderly trauma patient at significant risk for
being inaccurately categorized as hemodynamically stable. - ANS-Elderly patients have a fixed heart
rate and fixed cardiac output, thus, their response to hypovolemia will involve increasing their
systemic vascular 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.
Airway-patients may have dentures that may loosen or obstruct the airway. If dentures are not
obstructing the airway, leave them in place for what? - ANS-bag mask ventilation, as it improves mask
fitting.
Always assume CO exposure in patients who were burned in enclosed areas. Patients with CO levels
less than 20% may not show any symptoms - ANS-HA and nausea (20-30%), confusion (30-40%), coma
(40-60%) and death (>60%). Cherry red skin color in patients may only be seen in moribund patients.
Measurements of arterial PaO2 do not reliably predict CO poisoning b/c a partial pressure of only 1
mm Hg results in an HbCO level of 40% or greater. Pulse ox cannot be relied on to rule out carbon
monoxide poisoning b/c we cant distinguish oxyhemoglobin from carboxyhemoglobin. A discrepancy
between pulse ox and arterial blood gas may be explained by presence of carboxyhemoglobin.
American Burn Association states 2 requirements for diagnosis of smoke inhalation injury: - ANS-1.
exposure to combustible agent
, 2. signs of exposure to smoke in the lower airway, below the vocal cords, seen on bronchoscopy.
A chest Xray and arterial blood gases should be ordered to evaluate the pulmonary status of a patient
with smoke inhalation injury, but normal values on admission DO NOT exclude an inhalation injury.
Amniotic fluid can cause amniotic fluid embolism and disseminated intravascular coagulation
following trauma if fluid enters maternal intravascular space. True or False - ANS-True
An abrupt decrease in maternal intravascular volume can result in a profound increase in uterine
vascular resistance reducing fetal oxygenation despite reasonably normal maternal vital signs. - ANS-
this is true
An injured patient who is cool to the touch and is tachycardic should be considered to be in shock until
proven otherwise. Massive blood loss may only produce a slight decrease in HCT/Hgb. - ANS-relying
solely on BP as an indicator of shock can delay recognition of the condition b/c compensatory
mechanisms can prevent measurable fall in systolic pressure until up to 30% of the patient's blood
volume is loss. A narrowed pulse pressure suggests significant blood loss and involvement in
compensatory mechanisms.
tachycardia is diagnosed as > 100 in adults
> 160 in infants
>140 in preschool aged children
>120 in children from school age to puberty.
Anatomical alterations in the thoracic cavity seem to account for the decreased residual volume
associated with diphragmatic elevation and chest x ray reveals increased lung marking and
prominence of the pulmonary vessels. - ANS-oxygen consumption increases during pregnancy and its
important when resuscitating injured pregnant patients to maintain adequate oxygenation above 95%
Anterior Cord Syndrome - ANS-injury to the motor and sensory pathways in the anterior part of cord.
paraplegia and bilateral loss of pain and temp. However, position, vibration, and deep pressure sense
are preserved (sensations from dorsal columns). commonly due to cord ischemia
> 40% blood loss. heart rate increase, RR increase, BP decrease, pulse pressure decrease, urine output
and GCS decrease - ANS-MTP and base deficit is -10 or less
15-30% blood loss. increase in heart rate. decrease in pulse pressure. BP, RR, urine output do not
change - ANS-class II hemorrhagic shock. possible need for blood products, but mostly crystalloid fluid
and base deficit of -2 to -6. anxiety, fear
31-40% blood loss. heart rate increase, respiratory rate increase, blood pressure decrease, pulse
pressure decrease, urine output and GCS decrease - ANS-class III and this is the least amount of blood
loss that consistently causes a drop in systolic blood pressure. blood products needed and base deficit
is -6 to -10
A carboxyhemoglobin level greater than what percentage indicates a patient was involved in a fire and
has inhalation injury? - ANS-10%
A chest xray must be obtained after attempts at inserting a subclavian or IJ to document position of
line and evaluate for pneumo or hemothorax. - ANS-do not use sodium bicarb to treat metabolic
acidosis from hypovolemic shock
A clenched hand with a small electrical entrance wound should alert the clinician that a deep soft
tissue injury is likely much more extensive than is visable to the naked eye - ANS-true. patients with
severe electrical injuries require fasciotomies. Electricity can cause forced contraction of muscles,
doctors need to examine patient for skeletal and muscular damage, especially for fractures of the
spine and rhabdomyolysis
A tube placed in the trachea with the cuff inflated below the vocal cords and the tube connected to
oxygen enriched assisted ventilation and airway secured in place. - ANS-definitive airway
Abuse and burns - ANS-circular burns and burns with clear edges and unique patterns may reflect
cigarette burns or iron. Burns on the sole of the feet usually suggest child was placed in hot water. A
burn on the posterior aspect of the LE and buttocks
,Acute respiratory distress, subcutaneous emphysema, absent unilateral breath sounds,
hyperresonance to percussion, and tracheal shift supports the diagnosis of???? - ANS-tension
pneumothorax. needle or finger decompression temporarily relieves this life threatening condition
and follow this with a chest tube
Admission to hospital for pregnant patients: - ANS-vaginal bleeding, uterine irritability, abdominal
tenderness, pain or cramping, evidence of hypovolemia, changes in or absence of fetal heart tones and
or leakage of amniotic fluid
After the 10th week of pregnancy, cardiac output can increase 1.0-1.5 L/min because of the increase in
plasma volume and decrease in vascular resistance of the uterus and placenta. - ANS-The placenta
receives 20% of the patient's cardiac output during the 3rd trimester. In supine position, vena cava
compression can decrease cardiac output by 30% because of decreased venous return from lower
extremities.
Age related changes in the cardiovascular system place the elderly trauma patient at significant risk for
being inaccurately categorized as hemodynamically stable. - ANS-Elderly patients have a fixed heart
rate and fixed cardiac output, thus, their response to hypovolemia will involve increasing their
systemic vascular 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.
Airway-patients may have dentures that may loosen or obstruct the airway. If dentures are not
obstructing the airway, leave them in place for what? - ANS-bag mask ventilation, as it improves mask
fitting.
Always assume CO exposure in patients who were burned in enclosed areas. Patients with CO levels
less than 20% may not show any symptoms - ANS-HA and nausea (20-30%), confusion (30-40%), coma
(40-60%) and death (>60%). Cherry red skin color in patients may only be seen in moribund patients.
Measurements of arterial PaO2 do not reliably predict CO poisoning b/c a partial pressure of only 1
mm Hg results in an HbCO level of 40% or greater. Pulse ox cannot be relied on to rule out carbon
monoxide poisoning b/c we cant distinguish oxyhemoglobin from carboxyhemoglobin. A discrepancy
between pulse ox and arterial blood gas may be explained by presence of carboxyhemoglobin.
American Burn Association states 2 requirements for diagnosis of smoke inhalation injury: - ANS-1.
exposure to combustible agent
, 2. signs of exposure to smoke in the lower airway, below the vocal cords, seen on bronchoscopy.
A chest Xray and arterial blood gases should be ordered to evaluate the pulmonary status of a patient
with smoke inhalation injury, but normal values on admission DO NOT exclude an inhalation injury.
Amniotic fluid can cause amniotic fluid embolism and disseminated intravascular coagulation
following trauma if fluid enters maternal intravascular space. True or False - ANS-True
An abrupt decrease in maternal intravascular volume can result in a profound increase in uterine
vascular resistance reducing fetal oxygenation despite reasonably normal maternal vital signs. - ANS-
this is true
An injured patient who is cool to the touch and is tachycardic should be considered to be in shock until
proven otherwise. Massive blood loss may only produce a slight decrease in HCT/Hgb. - ANS-relying
solely on BP as an indicator of shock can delay recognition of the condition b/c compensatory
mechanisms can prevent measurable fall in systolic pressure until up to 30% of the patient's blood
volume is loss. A narrowed pulse pressure suggests significant blood loss and involvement in
compensatory mechanisms.
tachycardia is diagnosed as > 100 in adults
> 160 in infants
>140 in preschool aged children
>120 in children from school age to puberty.
Anatomical alterations in the thoracic cavity seem to account for the decreased residual volume
associated with diphragmatic elevation and chest x ray reveals increased lung marking and
prominence of the pulmonary vessels. - ANS-oxygen consumption increases during pregnancy and its
important when resuscitating injured pregnant patients to maintain adequate oxygenation above 95%
Anterior Cord Syndrome - ANS-injury to the motor and sensory pathways in the anterior part of cord.
paraplegia and bilateral loss of pain and temp. However, position, vibration, and deep pressure sense
are preserved (sensations from dorsal columns). commonly due to cord ischemia
