ITLS Exam Preparation Questions With Correct Answers

What is a Scene Size-Up? - Answer Observations made and actions taken at a trauma scene before actually approaching the patient. It is the initial step in the ITLS Primary Survey What does "OPIM" stand for? - Answer Other Potentially Infectious Material What equipment should you always take with you for trauma patients? - Answer -PPE (Personal Protection Equipment) -Patient transport device (stretcher, long spine board, and so on) with effective strapping and head motion-restriction device -Rigid cervical extrication collar of an appropriate size -Oxygen and airway equipment, which should include suction equipment and a BVM (Bag-Valve Mask) -Trauma box (bandage material, hemostatic agent, tourniquet, blood pressure cuff, stethoscope) What are some of the potential injury patterns for a mechanism of Injury of frontal impact? (Name 8) - Answer -Cervical-spine fracture -Flail chest -Myocardial contusion -Pneumothorax -Aortic disruption -Spleen or liver laceration -Posterior hip dislocation -Knee dislocation What are some of the potential injury patterns for a mechanism of lateral impact (T-bone)? (Name 8) - Answer -Contralateral neck sprain -Cervical-spine fracture -Lateral flail chest -Pneumothorax -Aortic disruption -Diaphragmatic rupture -Laceration of liver, kidney or spleen -Pelvic fracture What are potential injury patterns for a mechanism of ejection? - Answer Exposure to all mechanisms (and mortality increased) What are some of the potential injury patterns for a mechanism of Injury of pedestrian vs. car? (Name 4) - Answer -Head injury -Aortic disruption -Abdominal visceral injuries -Fracture pelvis and lower extremities What is "index of suspicion"? - Answer The medical provider's estimate of a disease or injury being present in a patient. A high index of suspicion means there is a high probability the injury is present. A low index of suspicion means there is a low risk of the injury. List the two basic mechanisms of motion injury - Answer Blunt and penetrating Identify the three collisions associated with a motor-vehicle collision (MVC) - Answer 1. Machine collision 2. Body collision 3. Organ collision resulting in rupture, shearing, or bruising Name the five common forms of MVCs - Answer 1. Frontal-impact (head-on collision) 2. Lateral-impact (T-bone collision) 3. Rear-impact collision 4. Rollover collision 5. Rotational collision Using the three collisions associated with a MVC, relate at least three frontal-impact collisions to potential patient injuries to deformity of the vehicle, interior structures and body structures. - Answer Machine collision = Deformed front end Body collision = Spider-web pattern of windshield Organ collision = Coup/contracoup brain, soft-tissue injury (scalp, face, neck), hyperextension/flexion of the cervical spine Machine collision = Deformed front end Body collision = Steering wheel ring fracture, deformity and column displacement Organ collision = Traumatic tattooing of patient's skin Machine collision = Deformity of vehicle Body collision = Dashboard fracture and deformity Organ collision = Facial trauma, coup/contracoup brain, hyperextension/flexion of the cervical spine, pelvis, hip and knee trauma Using the three collisions associated with a MVC, relate at least three lateral-impact collisions to potential patient injuries to deformity of the vehicle, interior structures and body structures. - Answer Machine collision = Deformed driver or passenger side Body collision = Degree of door deformity (ex: armrest bent, outward or inward bowing of door) Organ collision = This cannot be predicted by external exam alone. Instead, consider organs beneath areas of external injury: -Head = Coup/contracoup -Neck = Ranging from cervical-muscle strain to fracture or subluxation with neurologic deficit -Upper arm and shoulder = Injuries appear on the side of the impact and are common, as are injuries to the lower extremities -Thorax/abdomen = Injuries from soft-tissue injuries to flail chest, lung contusion, pneumothorax, hemothorax, or possible traumatic aortic dissection. Injuries include those to solid and hollow organs -Pelvis/legs = Pelvic, hip or femur fractures. Pelvic injuries may also include dislocation, bladder rupture and urethral injuries Describe potential injuries associated with proper and improper use of seat restraints, headrest and air bags in a head-on collision - Answer Proper use of seat restraint = Facial, head or neck injuries such as fractures, dislocations or spinal-cord injuries; Clavicle fractures (at the point where the chest strap crosses) and chest-wall injuries; Internal organ damage Improper use of seat restraint = Abdominal or lumbar spine injury; No restraint could possibly lead to ejection of vehicle Improper use of headrest = (second impact) Hyperextension of the cervical spine Proper use of air bags = Injuries from a second impact after deflation can lead to striking the steering wheel leading to internal injuries (thus, check under the deflated air bag for mechanical deformity; Leg, pelvis or abdominal injuries; Abrasions from the nylon bag, corneal abrasions and superficial burns on arms in the vicinity of the airbag vents Describe at least two potential injuries from rear-end collisions - Answer -Hyperextension of the cervical spine (if headrest too low) -lumbar-spine injury (if the seat breaks and falls backwards) *Rapid forward deceleration can occur from striking something in front after being struck from behind, thus leading to front impact injuries. How many more times is a person likely to die if they are ejected from a vehicle during an accident? - Answer 25 What four questions are used as a checklist in scene stabilization for a tractor accident? - Answer 1. Is the engine off? 2. Are the rear wheels locked? 3. Has the fuel situation and fire hazards been addressed? 4. Are there hydraulic fluid leaks or radiator leaks? Describe the three assessment criteria for falls - Answer 1. Distance of fall 2. Anatomic area impacted 3. Surface struck What are at least six anticipated injuries from a fall? - Answer -Fractures of the feet or legs -Hip and/or pelvic injuries -Axial loading to the lumbar and cervical spine -Vertebrae compression fracture -Vertical deceleration forces to the organs -Colles fractures of the wrists Identify the two most common forms of penetrating injuries - Answer Knife and gun Discuss associated mechanisms of the two most common forms of penetrating injuries and extent of these injuries - Answer Knife depends on the anatomic area penetrated, length of the blade, and angle of penetration. Low-energy injury and tissue damage confined to the direct path of the blade. Guns depends on the anatomic area penetrated, on type of weapon, caliber (size of bullet), and distance from which the weapon was fired. High-energy injury and tissue damage usually not confined to the direct path of the bullet. What are the four injury mechanisms involved in blast injuries - Answer 1. Primary = Air blast 2. Secondary = Material (shrapnel) propelled by the blast force 3. Tertiary = Body impact with ground or object 4. Quinary = (Delayed type of injury) Hyperinflammatory state from exposure to contaminants (ex: burns, chemical, biological, radiological) Relate how the four injury mechanisms involved in blast injuries relate to patient assessment - Answer 1. Primary = Air containing organs injuries (ex: Ears, lungs, gastrointestinal tract) can lead to ruptured tympanic membranes, pneumothorax, parenchymal hemorrhage, aveolar rupture 2. Secondary = May be penetrating or blunt, as well at higher velocities than high powered rifles 3. Tertiary = injuries similar to being ejected from a vehicle or fallen from a height. Injuries depend on what the person impacts 4. Quinary = Dirty bombs (dispersing toxic chemicals, biological agents or radiological agents) What four things can interrupt the patient assessment sequence in the ITLS Primary Survey? - Answer -The scene becomes unsafe -You must treat exsanguinating hemorrhage -You must treat an airway obstruction -You must treat cardiac arrest *Respiratory arrest, dyspnea, or bleeding management should be delegated to other team members while you continue assessment of the patient. In a team setting, when a critical condition has been found on a patient, when and how should it be managed? - Answer Instruct the other members of the emergency medical team to carry out the intervention immediately At least which 9 factors classify as a "Load N Go" patient? - Answer 1. Initial assessment reveals: -Altered mental status -Abnormal breathing -Abnormal circulation (shock or uncontrolled bleeding) 2. Signs discovered during the rapid trauma survey of conditions that can rapidly lead to shock: -Penetrating wounds of the torso -Abnormal chest exam (flail chest, open wound, tension pneumothorax, hemothorax) -Tender, distended abdomen -Pelvic instability -Bilateral femur fractures 3. Significant mechanism of injury and/or poor general health of patient What does "MCI" stand for? - Answer "Multiple Casualty Incident" What does "SMR" stand for? - Answer "Spinal Motion Restriction" What does "ETCO2" stand for? - Answer "End-Tidal CO2" What is normal ETCO2 range? - Answer 35-40 mmHg Name at least three events that trigger the need to perform an ITLS Ongoing Exam? - Answer -Each time the patient is moved -Each time an intervention is performed -Any time the patient's condition worsens How often should the ITLS Ongoing exam be performed? (two different scenarios) - Answer 1. Every 5 minutes for unstable patients 2. Every 15 minutes for stable patients How quickly should you identify which patients require "Load and Go"? - Answer Within two minutes Describe the anatomy of the respiratory system - Answer Nose, Uvula -> Mouth, teeth, tongue -> ->Tonsil, Epiglottis, Hyoid bone, Vocal cords, Trachea Describe the physiology of the respiratory system starting from the nose and mouth until gas exchange happens - Answer The airway begins at the tip of the nose and the lips and proceeds then if through the nose down the nasopharynx, if through the mouth, oropharynx, into the hypopharynx and then down the larynx through the trachea and bronchi ending at the alveolocapillary membrane. What does "ELM" stand for? - Answer "External Laryngeal Manipulation" What are the major anatomic landmarks from the teeth (for placing an endotracheal tube at the correct level for an average adult)? - Answer 15 cm -> Teeth to vocal cords 20 cm -> Teeth to sternal notch 25 cm -> Teeth to carina How do you calculate the remaining minutes of oxygen for the three class of oxygen tanks? - Answer Cylinder pressure remaining (PSI) - Safe residual pressure (200PSI) X Constant (D=0.16, E=0.28, M=1.37) / L/min = Minutes remaining (flow rate) What is the Glasgow Coma Score for an adult? - Answer -------------- EYES -------------- 4 Open 3 To voice 2 To pain 1 No response -------------- VERBAL -------------- 5 Oriented & alert 4 Disoriented 3 Nonsensical-speech 2 Moans, unintelligible 1 No response -------------- MOTOR -------------- 6 Follows commands 5 Localizes pain 4 Withdraws to pain 3 Decorticate flexion 2 Decerebrate extension 1 No response Explain the importance of observation as it relates to airway control - Answer Continual observation of the patient to anticipate problems is essential to ensure airway control and adequate ventilation. What does "BIAD" stand for? - Answer "Blind Insertion Airway Device" What does "RSI" stand for? - Answer "Rapid Sequence Intubation" (also referred to as "DAI", Drug-Assisted Intubation) Describe methods to deliver supplemental oxygen to the trauma patient - Answer 1. Nasal cannula 2. Simple face mask 3. Nonrebreathing masks 4. Bag-valve-mask By how much can you increase the oxygen percentage delivered during mouth-to-mask breathing by placing a nasal cannula on yourself? - Answer From 17% to around 30% What does "FROPVD" stand for? What is it? - Answer Flow-Restricted Oxygen-Powered Ventilation Device. Artificial ventilation device that provides 100% oxygen at a flow rate of 40 L/min at a maximum pressure of 50 ± 5 cm water What is "minute volume"? What range is usually seen? - Answer The volume of air breathed in and out in one minute. This varies from 5 to 12 liters per minute What do you call it when the movement of air into and out of the lungs is unable to maintain the carbon dioxide level below 45 mmHg - Answer Hypoventilation Normal ventilation by healthy lungs will produce an oxygen level of about _______ in the blood. - Answer 100 mmHg What does "IPPV" stand for? What is it? - Answer "Intermittent Positive Pressure Ventilation". Actively forcing air or oxygen in through the glottic opening (ex: using a BVM) Briefly describe the indications, contraindications, advantages, and disadvantages of the bag-valve mask - Answer Indications = hypoventilating or insufficient movement of air Contraindications = [none found in book] Advantages = Assists in ventilation Disadvantages = Mask air leakage. Too much force of ventilation could cause gastric inssuflation, too quick ventilation could hyperventilate. What is lung compliance? - Answer The "give" or elasticity of the lungs Briefly describe the indications, contraindications, advantages, and disadvantages of the flow-restricted oxygen-powered ventilation devices - Answer Indications = Medical Director's advice and patient requires 100% oxygen Contraindications = Can't intubate patient Advantages = Can deliver 100% oxygen, frees up your hands to address other patient's issues Disadvantages = Can cause or worsen pneumothorax Predictors of difficult mask ventilation can be remembered using "BOOTS", what does it stand for? - Answer Beards Obesity Older patients Toothlessness Snores or Stridors What is the 6 step process in responding to the difficulty of bag-valve-mask ventilation? - Answer 1. Reposition 2. OPA/NPA 3. Two-person bag 4. Consider obstruction 5. BIAD 6. Laryngoscopy and intubation Suction units should always be stored with which other essential tool? - Answer Oxygen kit Briefly describe the indications, contraindications, advantages, and disadvantages of the blind insertion airway devices - Answer Indications = Can't get an OPA/NPA inserted Contraindications = [None found in book] Advantages = Can insert without having to visualize the larynx, easier and faster to insert than an ET tube Disadvantages = Not as effective as ET tubes in preventing aspiration Briefly describe the indications, contraindications, advantages, and disadvantages of the endotracheal intubation - Answer Indications =Jaw thrust lift alone insufficient to keep tongue from blocking airway Contraindications = Gag reflex, SMR making it difficult Advantages = opens airway where tongue or other restrictions made it difficult Disadvantages = Gag reflex, improper insertion could lead air to stomach Briefly describe the indications, contraindications, advantages, and disadvantages of the nasopharyngeal airways - Answer Indications = tongue or epiglottis fell against posterior pharyngeal wall Contraindications = [none found in book] Advantages = Better tolerated than an OPA with an intact gag reflex Disadvantages = bleeding and trauma to the nasal mucosa is common, mild hemorrhage from the nose after insertion What length of an ET tube can be cut to serve as an NPA? - Answer 6 or 6.6 mm Briefly describe the indications, contraindications, advantages, and disadvantages of the oropharyngeal airways - Answer Indications = tongue fell against posterior pharyngeal wall Contraindications = Gag reflex Advantages = maintains open airway Disadvantages = Gag reflex, improper insertion could lead air to stomach Describe the predictors of difficult mask ventilation and endotracheal intubation - Answer Beards Obesity Older patients Toothlessness Snores or Stridor Describe apneic oxygenation - Answer Most commonly provided using nasal cannulae in addition to a face mask Describe external laryngeal manipulation - Answer Manipulation of the thyroid cartilage can help bring the vocal cords into view during ET intubation. This is done by usually pressing the thyroid cartilage backward against the esophagus and then upward and slightly to the patient's right side. Also known as BURP (Back-Up-Right-Pressure) Describe the essential components of an airway kit - Answer [P.83, doubt this is on the test. Will confirm after I've taken it]