ATLS TRAUMA
• What are indications for retrograde urethrogram in setting of trauma
Answer:
-Ptunable to void
-Pelvic binder placed
-Blood at meatus
-Scrotal hematoma
-Perineal ecchymosis
• What are the components of a FAST (Focused Assessment with Sonography for
Trauma)
Answer: Hepatorenal fossa (Morrison's pouch)
-Pericardial sac
-Splenorenal fossa
-Pelvis/pouch of douglas at bladder
• What are indications for laparotomy
Answer:
-Blunt abdominal trauma with hypotension and positive fast
-Gunshot wound in peritoneal cavity
-Evisceration
-Bleeding in stomach, rectum or GU tract following trauma
-Peritonitis (peritoneal signs)
-CT findings of ruptured GI tract, bladder injury
• Things to convey in Neurosurgery consult for TBI
Answer:
-Mechanism of injury
-Respiratory status (BP, oxygen sat)
-Neuro exam (GCS, pupil size and reactivity, focal neuro deficits)
-Injuries
-CT scan results if available
-Anticoagulation
• What is the cause of a "blown" pupil
Answer: Brain herniation that compresses CN III
> impairs parasympathetic pupillary constriction > unopposed sympathetic dilation
• Uncal herniation signs
, Answer:
Ipsilateral pupillary dilation
+
Contralateral hemiparesis
• Calculated Cerebral perfusion pressure is the difference between what twovalues
Answer: CPP = MAP = ICP
• How is the motor component of GCS calculated when there is asymmetrical
strength?
Answer: use the stronger side
• Signs of basilar skull fracture
Answer:
1. Raccoon eyes
2. Battle sign
3. leaking rhinorrhea/otorrhea of CSF
4. Hemotympanum
• Classic epidural bleed presentation
Answer: Lucid interval > neurologic deterioration
• Who do you scan with head trauma?
Answer:
GCS < 15
Suspected open or depressed skull fracture
Sign of basilar skull fx
Vomiting > 2x
>65 yo Anticoagulant use
• Pts with maxillofacial or head trauma should be presumed to have a injury
Answer: C spine injury >> C collar
• Objective signs of airway obstruction
Answer: Agitation (sign of hypoxia), Obtunded(hypercarbia), Snoring, gurgling,
stridor hoarseness
• Signs of inadequate ventilation
Answer: asymmetrical chest rise/fall, decreased/absentbreath sounds, capnography
• Mnemonic for evaluating difficult airway
Answer:
LEMONLook
• What are indications for retrograde urethrogram in setting of trauma
Answer:
-Ptunable to void
-Pelvic binder placed
-Blood at meatus
-Scrotal hematoma
-Perineal ecchymosis
• What are the components of a FAST (Focused Assessment with Sonography for
Trauma)
Answer: Hepatorenal fossa (Morrison's pouch)
-Pericardial sac
-Splenorenal fossa
-Pelvis/pouch of douglas at bladder
• What are indications for laparotomy
Answer:
-Blunt abdominal trauma with hypotension and positive fast
-Gunshot wound in peritoneal cavity
-Evisceration
-Bleeding in stomach, rectum or GU tract following trauma
-Peritonitis (peritoneal signs)
-CT findings of ruptured GI tract, bladder injury
• Things to convey in Neurosurgery consult for TBI
Answer:
-Mechanism of injury
-Respiratory status (BP, oxygen sat)
-Neuro exam (GCS, pupil size and reactivity, focal neuro deficits)
-Injuries
-CT scan results if available
-Anticoagulation
• What is the cause of a "blown" pupil
Answer: Brain herniation that compresses CN III
> impairs parasympathetic pupillary constriction > unopposed sympathetic dilation
• Uncal herniation signs
, Answer:
Ipsilateral pupillary dilation
+
Contralateral hemiparesis
• Calculated Cerebral perfusion pressure is the difference between what twovalues
Answer: CPP = MAP = ICP
• How is the motor component of GCS calculated when there is asymmetrical
strength?
Answer: use the stronger side
• Signs of basilar skull fracture
Answer:
1. Raccoon eyes
2. Battle sign
3. leaking rhinorrhea/otorrhea of CSF
4. Hemotympanum
• Classic epidural bleed presentation
Answer: Lucid interval > neurologic deterioration
• Who do you scan with head trauma?
Answer:
GCS < 15
Suspected open or depressed skull fracture
Sign of basilar skull fx
Vomiting > 2x
>65 yo Anticoagulant use
• Pts with maxillofacial or head trauma should be presumed to have a injury
Answer: C spine injury >> C collar
• Objective signs of airway obstruction
Answer: Agitation (sign of hypoxia), Obtunded(hypercarbia), Snoring, gurgling,
stridor hoarseness
• Signs of inadequate ventilation
Answer: asymmetrical chest rise/fall, decreased/absentbreath sounds, capnography
• Mnemonic for evaluating difficult airway
Answer:
LEMONLook
