ATLS EXAM STUDY GUIDE QUESTIONS AND
ANSWERS LATEST UPDATED AND VERIFIED.
Blanched skin associated with fractures and dislocations can lead to soft tissue
necrosis. The purpose of promptly reducing this injury is to prevent pressure
necrosis of the lateral left ankle soft tissue
the only reason to forgo an xray exam before treating a dislocation or fracture is
the presence of vascular compromise or impending skin breakdown, often seen with
fracture dislocations of the ankle
Treat all patients with open fractures as soon as possible with iv antibiotics
cephalosporins are necessary for all open fractures
operative revascularization to an avascular extremity is important to treat
emergently.
muscle necrosis begins where there is a lack of blood flow for 6 hours. is there is an
associated fracture deformity, correct it by gently pulling the limb out to length,
realigning the fracture and splinting the injured extremity. This maneuver can
restore the blood flow
High risk activities that can cause compartment syndrome include:
excessive exercise
burns
severe crush injury to muscle
localized prolonged external pressure to an extremity
increased capillary permeability secondary to reperfusion of ischemic muscle.
Compartment syndrome is a clinical diagnosis and pressure measurements are
only an adjunct to aid in its diagnosis. a pressure greater than 30 can cause
anoxia.
the absence of a palpable distal pulse is an uncommon or late finding and is not
necessary to diagnose compartment syndrome.
Capillary refill times are also unreliable
,weakness or paralysis of the involved muscle is a late sign and indicates nerve or
muscle damage
the lower the systemic pressure, the lower the compartment pressure that causes
compartment syndrome
risk of tetanus:
wounds that are more than 6 hours old
contused or abraded
more than 1cm in depth
from high velocity missiles
due to burns or cold
significantly contaminated
ischemic tissue or denervated wounds
True or false? on page 162. To exclude occult dislocation and concomitant
injury, x ray films must include the joints above and below the suspected
fracture site
true. unless life threatening, splinting of extremity injuries should be done during the
secondary survey.
do not apply traction to patients with an ipsilateral tibia shaft fracture.
true
Laryngeal Trauma presents as hoarseness, subcutaneous emphysema, and
palpable fracture
true. sounds of airway obstruction and include snoring, gurgling, stridor, hoarseness,
cyanosis, agitation
LEMON assessment for difficult airway
Look, evaluate 3-3-2 rule, mallampati, obstruction, neck mobility
Do not give a nasopharyngeal airway to someone suspected of having a
cribriform plate fracture.
also do not give nasotracheal intubation to patients with basillar skull fracture
, 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.
definitive airway
patients use the gum elastic bougie when vocal cords cannot be visualized on
direct laryngoscopy.
using the GEB has allowed for rapid intubation of nearly 80% of prehospital
patients in whom laryngoscopy was difficult. A GEB inserted into the esophagus will
pass its full length without resistance
Reliable ways to detect proper intubation
proper placement of the tube is suggested but not confirmed:
1. hearing equal breath sounds bilaterally
2. detecting no borborygmi (rumbling or gurgling noises) in the epigastrium. the
presence of this with inspiration suggestion esophageal intubation and warrants
removal of tube
3. A CO2 detector ideally capnograph or colorimetric CO2 monitoring device. If
CO2 is not detected in exhaled air, then esophageal intubation has occurred.
4. Proper position of the tube is best confirmed via chest xray
definitive control of hemorrhage and restoration of adequate circulating volume
are the goals of treating hemorrhagic shock.
never give vasopressors as the first line treatment as they worsen tissue perfusion.
most injured patients who are in hemorrhagic shock require early surgical
intervention or angioembolization to reverse the shock state. The presence of shock
in a trauma patient warrants the immediate involvement of a surgeon.
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.
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.
ANSWERS LATEST UPDATED AND VERIFIED.
Blanched skin associated with fractures and dislocations can lead to soft tissue
necrosis. The purpose of promptly reducing this injury is to prevent pressure
necrosis of the lateral left ankle soft tissue
the only reason to forgo an xray exam before treating a dislocation or fracture is
the presence of vascular compromise or impending skin breakdown, often seen with
fracture dislocations of the ankle
Treat all patients with open fractures as soon as possible with iv antibiotics
cephalosporins are necessary for all open fractures
operative revascularization to an avascular extremity is important to treat
emergently.
muscle necrosis begins where there is a lack of blood flow for 6 hours. is there is an
associated fracture deformity, correct it by gently pulling the limb out to length,
realigning the fracture and splinting the injured extremity. This maneuver can
restore the blood flow
High risk activities that can cause compartment syndrome include:
excessive exercise
burns
severe crush injury to muscle
localized prolonged external pressure to an extremity
increased capillary permeability secondary to reperfusion of ischemic muscle.
Compartment syndrome is a clinical diagnosis and pressure measurements are
only an adjunct to aid in its diagnosis. a pressure greater than 30 can cause
anoxia.
the absence of a palpable distal pulse is an uncommon or late finding and is not
necessary to diagnose compartment syndrome.
Capillary refill times are also unreliable
,weakness or paralysis of the involved muscle is a late sign and indicates nerve or
muscle damage
the lower the systemic pressure, the lower the compartment pressure that causes
compartment syndrome
risk of tetanus:
wounds that are more than 6 hours old
contused or abraded
more than 1cm in depth
from high velocity missiles
due to burns or cold
significantly contaminated
ischemic tissue or denervated wounds
True or false? on page 162. To exclude occult dislocation and concomitant
injury, x ray films must include the joints above and below the suspected
fracture site
true. unless life threatening, splinting of extremity injuries should be done during the
secondary survey.
do not apply traction to patients with an ipsilateral tibia shaft fracture.
true
Laryngeal Trauma presents as hoarseness, subcutaneous emphysema, and
palpable fracture
true. sounds of airway obstruction and include snoring, gurgling, stridor, hoarseness,
cyanosis, agitation
LEMON assessment for difficult airway
Look, evaluate 3-3-2 rule, mallampati, obstruction, neck mobility
Do not give a nasopharyngeal airway to someone suspected of having a
cribriform plate fracture.
also do not give nasotracheal intubation to patients with basillar skull fracture
, 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.
definitive airway
patients use the gum elastic bougie when vocal cords cannot be visualized on
direct laryngoscopy.
using the GEB has allowed for rapid intubation of nearly 80% of prehospital
patients in whom laryngoscopy was difficult. A GEB inserted into the esophagus will
pass its full length without resistance
Reliable ways to detect proper intubation
proper placement of the tube is suggested but not confirmed:
1. hearing equal breath sounds bilaterally
2. detecting no borborygmi (rumbling or gurgling noises) in the epigastrium. the
presence of this with inspiration suggestion esophageal intubation and warrants
removal of tube
3. A CO2 detector ideally capnograph or colorimetric CO2 monitoring device. If
CO2 is not detected in exhaled air, then esophageal intubation has occurred.
4. Proper position of the tube is best confirmed via chest xray
definitive control of hemorrhage and restoration of adequate circulating volume
are the goals of treating hemorrhagic shock.
never give vasopressors as the first line treatment as they worsen tissue perfusion.
most injured patients who are in hemorrhagic shock require early surgical
intervention or angioembolization to reverse the shock state. The presence of shock
in a trauma patient warrants the immediate involvement of a surgeon.
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.
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.
