ATLS Study Guide Graded A 2025

what is the #1 cause of preventable deaths after trauma? – hemorrhage what initital labs should be drawn when starting an IV in trauma? – type and cross CBC for baselines preg test for females blod gases and lactate for shock what are the 3 contra indications for a foley in trauma? – blood at eth urethral meatus perineal ecchymosis high riding or non-palpable prostate pelvic instability if suspected doa retrograde urethrogram what 2 x-ray studies should be done in blunt trauma cases? – CXR pelvic x-ray think of them as adjuncts to the primary survey what is teh algorithm for the primary survey? – ABCDE a head to toe physical and complete Hx (AMPLE) what are the key questions to ask in regards to an automobile trauma? – Truck BEDDD belt ejection direction of impact deformity of steeringwheel damage to automobile you see contacts in on teh secondary survey, what do you do? – remove them to prevent injury in cases of edema if a trauma patient deteriortes, what should you do first? – reacess ABCDEs what is adequate UOP in an adult trauma pt? child 1 yr? - 0.5 mL/kg/h 1 mL/kg/h what is a good mnemonic for handoff of care for a trauma Pt? – MIST MoI (and time) Injuries found/suspected Sx and Signs Treatments initiated for primary survey, describe what you do for ABCDE (each one, detailed) - Airway: - ascertain patency - assess for obstruction Breathing: - expose neck/chest - determine rate/depth of respirations - palpate the neck and chest - percuss chest -auscultate chest Circulation: - identify sources of hemorrhage - identify potential sources of internal hemorrhage - assess pulse quality rate, regularity - asess skin color - BP Disability: - GCS - puplis - acess for lateralizing signs of spinal cord injury Exposure: - completely expose pt but prevent hypothermia adjuncts: - ABG - Co2 monitoring - ECG - insert urinary/gastric caths - CXR, AP pelvis - FAST/DPL for secondary survey, describe what you do for each body area (detailed)? - head: - inspect/palpate entire head - pupils -redo GCS - assess eyes, ears, nose, mouth - evaluate cranial nerves Neck: inspect - palpate trachea - feel carotids, *LISTEN FOR BRUITS* - CT neck Chest: - inspect - auscultate - palpate -percuss Abd: -inspect, auscultate -percuss -palpate -FAST -CT Perineum/rectum/vagina - access - rectal: tone, blood, bony fragments, prostate - vagina: blood, obv injury MSK: - inspect, palpate - all pulses - assess pelvis - back NEURO: - evaluate motor/sensory on all 4 extremities (hypoxia/hypercarbia) agitation suggests ? obtundation suggests? - hypoxia hypercarbia assessment for difficult intubation? MN - LEMON Look externally (receeding chin, overridding teeth, narrow opening, etc) Evaluate the 3-3-2 rule -3 fingers between teeth - 3 fingers b/w hyoid bone and chin - 2 fingers b/w thyroid notch and mouth floor Mallampati Obstruction: ie epiglottitis, abcess, trauma Neck mobility - have Pt place chin to chest then extending neck to look towards the ceiling in the cases of difficult intubation what is the first best assistance device? - bougie what size cannula do you use for jet insufflation? how much time inspiration/expiration? - adults: 14-16 G kids: 16-18 G through cricothyroid membrane or below obstruction 1 s on and 4 seconds off what is teh age minimum for a surgical cric? - 10 100% on pulse ox is a PaO2 of at least what? - 90 mmHg what is an example difficult airway algorithm? - waht do you do for the cant intubate cant ventilate patients? - surgical airway! what is the role of pressors for hemorrhagic shocK? - contraindicated! define shock? - inadequate tissue perfusion blunt cardiac injury should be most suspected with what MoI? - rapid deceleration according to ATLS, what is the best management for cardiac tamponade? - thoracotomy, NOT pericardiocentesis what type of shock produces hypotension without tachycardia? - neuorgenic T/F neurogenic shock can come from an isolated intracranial injury? - false, needs spinal cord injury neurogenic shock should be initially treated with what? - fluids --treat like hypovolemia first (usually go together) a 70 kg male has how much blood volume? - 5 L (7% by weight) 8-9% by weight for kids hypovolemic shock; classifications - 4 classes: I: 0-15% circulating blood loss, no hemodynamic effects (same as 1u blood donation) - no tx required II: 15-30%, HR increase, RR increase, decreased UOP, decreased pulse pressure, anxious, sweaty - crystaloids III: 30-40, BP falls, Hr really increases, lethargic, cold, diaphoretic - crystaloids most often followed by TRANSFUSION (KEY POINT FOR TESTS) IV: 40, BP plummets, no UOP, obtunded - RAPID TRANSFUSION / surgical management NB: to get the mL of blood loss need to recognize a 70kg male has 5 L of blood volume, so for example 1500 mL = 30% of 5000 mL why does pulse pressure decrease in class II hemorrhagic shock? - increase in catacholamines causes teh diastolic pressure to increase, thus narrowing the pulse pressure what is large bore in ATLS in IVs? - 16 g define controlled resussitation (ie balanced resuscitation)? - using permissive hypotension to balance the risks of rebleeding with teh goal of organ perfusion what other lab value (other than lactate) can be used to trend teh response of tx to shock? - base excess T/F: sodium bicarb should be used to tx metabolic acidosis associated with hypovolemic shock? - false how do you determine if someone is a rapid resopnder, transient responder, or minimal responder to hypovolemic shock tx? next step for each? who needs blood products? - rapid: when goign to maint thier VS return to normal - get a surgeon transient: after maint their HR increases and BP falls again - give blood - SURGEON ASAP, need for early operative/angiographic control minimal: never gets back to normal so you never get to maint fluids give blood - IMMEDIATE OPERATIVE/EMBOLIC INTERVENTION why does hypothermia affect alcoholics more? - EtOH causes peripheral vasodilation! you identify stridor and a posterior clavical on trauma Pt, what should you do? - closed reduction immediately! extend shoulder or use towel clamp an open pneumothorax is also called a what? management? - sucking chest wound occlusive dressing taped on three sides followed by a tube how many ribs must be fractured for a flail chest? management? - 2 or more in 2 or more palces producing paradoxical motion it by itself does not cause hypoxia but usually is accompanied by significant pulmonary contusion tx is O2, narcotics, local anesthetic (intercostal nerve blocks) define "massive hemothorax"? - raid accumulation of 1500 mL or 1/3 of pt blood vollume in chest cavity "in a hemothorax, early evacuation of XXX mL of fluid is almost always an indication for early thoracotomy, or if they continue to bleed at a rate of YYY or more per hour, or if they continue to require ZZZ"? - 1500 or more 200 mL/hr for 2 - 4 hours continued blood transfusions what is management of cardiac tamponade according to ATLS? - if a surgeon is prsent do an immediate thoracotomy. if surgical intervention is not possible, pericardiocentesis should be performed "BUT IS NOT DEFINIITVE TREATMENT FOR CARDIAC TAMPONADE" so if you do it always follow up with a thoracotomy what does ATLS say about emergency resuscitative thoracotomy indications? who "MUST" be there? - penetrating thoracic injuries who arrive in PEA.. a qualified surgeon MUST be present the high risk time window for dysrhymias in blunt cardiac injury is what? - first 24 hr as soon as you see a widened mediastinum on CXR in a patietn with a high force MoI, what should you do? - IMMEDIATE cardiothoracic surgery consult or if you are in a center that does not have that then an IMMEDIATE transferr if you suspect a laceration to the diaphragm, what initial Dx'ic step can you do? - insert a gastric tube and take xray when should you evaluate for abdominal internal bleeding in a trauma pt? - during teh C part of ABCDE what is the most common solid organ injured in blunt trauma? - spleen how often should you check for pelvic instability in a trauma? - ONCE ONLY, also only do if there is no obvious sign of a pelvic fracture if transfer think stabilization only , no extra CT scan in trauma should only be performed if what is normal? - vitals transfers key point: evaluations should NOT delay transfer of the patietn to a more appropriate level of care for severe injuries that have already been identified -