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 visible 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 visible 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
