ATLS FINAL EXAM QUESTIONS AND ANSWERS A+ GRADED 100% VERIFIED

ATLS FINAL EXAM QUESTIONS AND ANSWERS A+ GRADED 100% VERIFIED APPROVED BY: Want to earn $103 per month? 1. what is the #1 cause of preventable deaths after trauma?: hemorrhage 2. 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 3. 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 4. 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 5. what is teh algorithm for the primary survey?: ABCDE a head to toe physical and complete Hx (AMPLE) 6. 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 7. you see contacts in on teh secondary survey, what do you do?: remove them to prevent injury in cases of edema 8. if a trauma patient deteriortes, what should you do first?: reacess ABCDEs 9. what is adequate UOP in an adult trauma pt? child > 1 yr?: 0.5 mL/kg/h 1 mL/kg/h 10. what is a good mnemonic for handoff of care for a trauma Pt?: MIST MoI (and time) Injuries found/suspected 1 / 13 Want to earn $103 per month? Sx and Signs Treatments initiated 11. 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 12. 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 2 / 13 ATLS Study online at Want to earn $103 per month? 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 13. (hypoxia/hypercarbia) agitation suggests ? obtundation suggests?: hypoxia hypercarbia 14. 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 3 / 13 Want to earn $103 per month? 15. in the cases of difficult intubation what is the first best assistance device?: bougie 16. 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 17. what is teh age minimum for a surgical cric?: 10 18. 100% on pulse ox is a PaO2 of at least what?: 90 mmHg 19. what is an example difficult airway algorithm?: 20. waht do you do for the cant intubate cant ventilate patients?: surgical airway! 21. what is the role of pressors for hemorrhagic shocK?: contraindicated! 22. define shock?: inadequate tissue perfusion 23. blunt cardiac injury should be most suspected with what MoI?: rapid deceleration 24. according to ATLS, what is the best management for cardiac tamponade?: thoracotomy, NOT pericardiocentesis 25. what type of shock produces hypotension without tachycardia?: neuorgenic 26. T/F neurogenic shock can come from an isolated intracranial injury?: - false, needs spinal cord injury 27. neurogenic shock should be initially treated with what?: fluids --treat like hypovolemia first (usually go together) 28. a 70 kg male has how much blood volume?: 5 L (7% by weight) 8-9% by weight for kids 29. hypovolemic shock; classifications: 4 classes: I: 0-15% circulating blood loss, no hemodynamic effects (same as 1u blood 4 / 13 Want to earn $103 per month? 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 30. why does pulse pressure decrease in class II hemorrhagic shock?: increase in catacholamines causes teh diastolic pressure to increase, thus narrowing the pulse pressure 31. what is large bore in ATLS in IVs?: 16 g 32. define controlled resussitation (ie balanced resuscitation)?: using permissive hypotension to balance the risks of rebleeding with teh goal of organ perfusion 33. what other lab value (other than lactate) can be used to trend teh response of tx to shock?: base excess 34. T/F: sodium bicarb should be used to tx metabolic acidosis associated with hypovolemic shock?: false 35. 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 36. why does hypothermia affect alcoholics more?: EtOH causes peripheral vasodilation! 5 / 13 Want to earn $103 per month? 37. you identify stridor and a posterior clavical on trauma Pt, what should you do?: closed reduction immediately! extend shoulder or use towel clamp 38. an open pneumothorax is also called a what? management?: sucking chest wound occlusive dressing taped on three sides followed by a tube 39. 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) 40. define "massive hemothorax"?: raid accumulation of 1500 mL or 1/3 of pt blood vollume in chest cavity 41. "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 42. 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 43. 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 44. the high risk time window for dysrhymias in blunt cardiac injury is what?- : first 24 hr 45. 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 6 / 13 Want to earn $103 per month? 46. if you suspect a laceration to the diaphragm, what initial Dx'ic step can you do?: insert a gastric tube and take xray 47. when should you evaluate for abdominal internal bleeding in a trauma pt?: during teh C part of ABCDE 48. what is the most common solid organ injured in blunt trauma?: spleen 49. 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 50. CT scan in trauma should only be performed if what is normal?: vitals 51. 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: . 52. during what part of the primary survey should pelvic stabilization be thought of?: abCde C 53. major head trauma comes in, you facility does not have neurosurg, should you get a CT before or after transfer?: "obtaining a CT SHOUD NOT DELAY PATIENT TRANSFER to a trauma center" 54. what are the "two classic signs" of uncal herniation?: ispilateral pupil dilation with contralateral hemiparesis 55. what is normal ICP in resting state?: 10 mmHg 56. when accessing GCS, what do you do if there is asymetry b/w right and left?: use the best as this is the most reliable predictor of outcome (but record the asymetry) 57. cerebral perfusion pressure = ?: MAP - ICP 58. the goal of manageing someone with aTBI is what?: preventing secondary brain injury due to hypoxia, ischemia, edema, etc 59. what are the questions to ask someone who comes in with a head injury?: MoI, time o finjury, LOC alertness amnesia (retro, antero) HA confusion blood thinners 7 / 13 Want to earn $103 per month? Sz N/V 60. how do you determine who needs a CT scan after head injury?: canadian CT head rules 61. KEY POINT: DO NOT DELAY TRANSFER TO GET A CT SCAN!: REPEAT REPEAT REPEAT 62. TBI: hypercapnea vs hypo, which causes ischemia, which edema?: ischemia: hypo edema: hyper 63. what are teh 3 general therapeutic agents to reduce ICP after a severe brain injury?: mannitol moderate hyperventilation (32-35 PCO2) hypertonic saline 64. what are some physiologic changes in pregnancy?: Blood volume increases until 34wk Physiological anemia HCT 31-34 NL in pregnancy Blood loss of ml before sign of hypovolemia However fetal distress may be seen CO- increase bt 1-1.5 L/min with decreased vascular resistance. Severe hypovolemia until symptoms occur HR increase by 10-15 beat/min max by 3rd trimester wi BP decreased systolic and diastolic in 5-15mmHg Hypocarbia is common paCO2 30mm Oxygen consumption increase 65. what are the 6 therapies for TBI?: 1. IVF (LR or NS) 2. Mannitol: only euvolemic Pt, 1g/kg over 5 min bolus 3. hypertonic saline: 3%, may be preferencial agent in hypotensions 4. temporary hyperventilation: low end of normocarbia (35mmHg) is preferred range 5. anticonvulsants: 1g IV phenytoin followed by maintenance of 100mg/8hr *MAY INHIBIT BRAIN RECOVERY< ONLY USE WHEN ABSOLUTELY NECESSARY! 6 barbituates: do not use if hypotension or hypovolemia 66. what BP should a TBI Pt get?: at least 100 mmHg systolic 8 / 13 Want to earn $103 per month? 67. hwo do you Dx brain death?: 1. GCS 3 2. non reactive pupils 3. absent brainstem reflexes (doll's eye) and no gag 4 no spontaneous ventilation 68. what neurologic exam stuff doyou do in the primary survey?: as a part of D: pupilary resonse GCS lateralizing signs 69. what type of spinal cord injury results in greater loss of motor in upper vs lower?: central cord syndrome 70. chance fracture =?: transverse fractures though vertebral body 71. what MoI causes a burst fracture?: vertical axial compression 72. what ABI makes you worried for an extremity injury?: .9 or less 73. to avoid rhabdomyolysis after a crush injury, what should you do?: IVF until UOP is at least 100 mL/hr until myoglobinuria is cleared 74. what is normal capillary refill?: < 2 seconds 75. what is normal pupil size: The normal pupil size in adults varies from 2 to 4 mm in diameter in bright light to 4 to 8 mm in the dark. 76. at waht CO level (%age) do you start getting Sx?: 20 % HA, N/V, confusion 77. what is the best monitor for circulating blood volume in a burn?: urinary output via catheter 78. what is the initial fluid rate for burn patietns?: Parkland Formulas Fluid Requirements = TBSA burned(%) x Wt (kg) x 4mL Give 1/2 of total requirements in 1st 8 hours, then give 2nd half over next 16 hours. 79. at what point (time) does limb iscemia cause irreversible necrosis?: Ischemic injury to muscles and nerves occurs after 4 hours of complete ischemia. This becomes irreversible at some point over the next 4 hours (i.e. 4-8 hours after the onset of ischemia), 80. what are S/Sx of compartment syndrome? MN: 1. pain (especially on passive stretching) 2. pallor 3. perishingly cold 9 / 13 Want to earn $103 per month? 4. pulselessness 5. paralysis 6. paraesthesiae 81. what comparement pressure is normal? what is indication for fasciotomy?: normal is 15 A delta pressure <20 mmHg is a definite indication for fasciotomy, <30 mmHg may be a relative indication 82. what is the BSA for a baby's arm? leg?: 83. what type of burn is weepy? leathery?: weep: 2nd deg leather: 3rd 84. what Abx do you give to a burn pt?: NONE 85. what core temp is hypothermia according to ATLS? severe hypothermia?- : below 35, severe below 30 86. using the pediatric trauma score, what score shoudl be transferred to a pediatric trauma center?: less than 8 87. waht is a good rule of thumb for optimal ETT depth in a ped?: 3 x the tube size 88. what is an infants blood volume?: 80 mL/kg a childs is 70 mL/kg 89. at what bolus of IVF should you start to consider pRBCs? what is the dosage for the pRBC in peds?: at the 3rd 20 mL/kg bolus pRBC bolus is 10 ml/kg 90. hwo do you modifiy the GCS for intubation?: Patients who are intubated are unable to speak, and their verbal score cannot be assessed. They are evaluated only based on eye opening and motor scores, and the suffix T is added to their score to indicate intubation. In intubated patients, the maximum GCS score is 10T and the minimum score is 2T. 91. how do you modify the GCS for peds?: verbal only: 5: appropriate words, fixes and follows 4: cries but consolable 10 / 13 Want to earn $103 per month? 3: persistently irritable 2: resteless, agitated 1: none 92. what is the most common cause of injury death in infants?: homicide 93. what should you do with dentures during airway?: if intact and well fitting you can leave, if loose or borken then remove 94. what does blood volume do as we age?: decreases 95. normal blood pressure and HR means normovolemia in a geriatric pt?: - FALSE 96. as a preggo mom loses blood what happens first?: BEFORE ANY CHANGE IN VITAL SIGNS the uterine vascular resistance greatly increases reducing fetal oxygenation! 97. how much blood can a preggo lose before exhibiting S/Sx of hypovolemia?: 1500 mL! 98. what happens to mom's BP during pregnancy?: in 2nd trimester there is a 5-15 mmHg fall in both SBP and DBP 99. what percentage of circulating blood volume does the placenta get during 3rd trimester?: 20%! 100. when should you access the fetus in a trauma?: after assessing and rescusitating the mom, but before conducting a secondary survey on mom 101. what happens to blood Co2 levels during preggo?: hypocapnea to 30 mmHg is common in late pregancy, therefore 35-40 mmHg may represent impending respiratory failure! 102. at what temperature can you start giving cardiac drugs and defibing a coding hypothermic pt?: 28C 103. what seperates heat exhaustion from heat stroke?: HE: CBT<39C, intact mental function HS: CBT>40C, life threatening, AMS, seizure, delirium, may progress to DIC 104. define red, yellow, green, blue, and grey in triage?: red: immediate life threatening yellow: require tx in 6 hr green: walking wounded blue: injuries greater than life or resouces grey: dead 11 / 13 Want to earn $103 per month? 105. what BP can you feel carotid? femoral? radial?: carotid: 60 femoral: 70 radial: 80 106. what is the difference b/w a mupltiple casualty incident and a mass casualty event?: in MCE the resources are overwhelmed, MCI they are not 107. how much do seat belts reduce fatalaties?: 70% 108. what is tetanus mangement?: 109. if you have a torn aorta vs a splenich lac in an unstable pt, what do you do according to ATLS?: emergent laparatomy --the aortic tear is stable! splenich lac is active and causing teh shock until proven otherwise 110. when do you do a lapartomy for a pelvic fracture?: after you confirm a positive FAST or DPL if you can't then do angiography remember in all cases to do a pelvic wrap 111. waht are teh 5 things "to memorize" to ID shock?: decreased LOC, dec cap refills, dec pulse intensity, increasted HR, cool extremities 112. what are teh 5 potential bleeding spaces in trauma?: chest, peritoneum/pelvis, retroperitoneum, thigh, floor 113. what is the "lethal triad of shock"?: coagulopathy, hypothermia, acidosis 114. what is teh key way to describe immobilizign someones head in ATLS?- : "placign them in cervical in-line traction" 115. what is the only scenaria where you should intubate a patient before listening to their chest? why do you do this?: they are completely apneic or their airway is about to collapse in case there is a PTX 116. when you fully expire what part of the chest can you liver and stomach rise to?: nipple line 117. what is teh temperature of a frostbite tx pool?: 40C 12 / 13 Want to earn $103 per month? 118. what ist eh goal SBP in a head injury?: 90 mmHg 119. waht is the indication for mannitol in a head injury?: ONLY if there is S/Sx of tentorial herniation 120. when doing a neuro exam in trauma what do you need to document?: CN pupils GCS FULL BODY MOTOR AND SENSORY being sure to document teh level for both 121. what 2 bone fractures need to be splinted in the primary survey?: pelvis and femur 122. what compartment pressure suggests compartment syndrome?: >35 mmHg 123. cerebral contusions can ? into a paranchymal hematoma?: - coalesce 124. what are the steps to reading a spine film?: identify the 3 lines: anterior spinal anterior vertebra spinolaminar line step off? dens fxr? disc spaces? 125. what is SCIWORA? who gets it?: Spinal cord injury without radiographic abnormality mostly kids 126. when is the FAST exam ideally performed?: immediately after teh primary survey 13 / 13