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
