ATLS Review Exam 2 2024

Patients with a GSC of less than ___ usually require intubation. - 8 The "A" in ABCD stands for _______. - Airway maintenance with CERVICAL SPINE PROTECTION You should assume that any patient in a multisystem trauma with an altered level of consciousness or blunt injury above the clavicle has what type of injury? - Cervical spine injury Flail chest is invariably accompanied by ______ which can interfere with blood oxygenation. - pulmonary contusion - do NOT over fluid resuscitate these patients! Hypotension is caused by _____ until proven otherwise. - hypovolemia When you don't have/can't get a blood pressure, what are three things to look for when evaluating perfusion. - 1. Level of consciousness (brain perfusion), 2. Skin color (ashen face/grey extremities) 3. Pulse (bilateral femoral - thready/tachy) Elderly patients have a limited ability to ______ to compensate for blood loss. - increase heart rate Resuscitation fluids should be warmed 39 degrees Celsius (102.2 F). Can you use a microwave to do this? - YES - for CRYSTALLOID ONLY (but NOT for blood products). Urinary catheters are good for assessing renal perfusion and volume status. List 5 signs of urethral injury that might prevent you from inserting one. - Blood at urethral meatus, perineal ecchymosis, blood in scrotum, high-riding/non-palpable prostate, pelvic fracture Which arm should you NOT put a pulse-ox on? - The arm with a blood pressure cuff on it Name two anatomical things that can interfere with doing a FAST scan. - Obesity & intraluminal bowel gas When should radiographs be obtained? - During the SECONDARY survey. How do you get an ample patient history? - A=Allergies, M=Medications, P=PMH/Pregnancy, L=Last meal, E=Events/Environment of injury Why might you want a Bair Hugger for a patient who smells of alcohol? - Vasodilation can lead to hypothermia What things are you looking for when you do a DRE in a trauma? - Blood, high-riding prostate (in males), and sphincter tone What should you do for every female patient? - Pregnancy test (females of childbearing age) Adult patients should maintain UOP of at least ___ mL/kg/hr. Kids should have at least ___ mL/kg/hr. - Adults 0.5 mL/kg/hr, Kids 1.0 ml/kg/hr Preventing hypercarbia is critical in patients who have sustained a _____ injury. - head What two places would you LOOK at a patient if you suspect hypoxemia? - Lips and fingernail beds Patients may be abusive and belligerent because of _____, so don't just assume it's due to drugs, alcohol, or the fact that they are just inherently a jerk. - hypoxia Can a patient breathe on their own after complete cervical cord transection? - Yes, if the phrenic nerves (C3-C5) are spared. This will result in "abdominal" breathing. The intercostal muscles will be paralyzed though. Can you use an OPA (Guedel) in a conscious patient? - No, it could make them vomit. An NPA (trumpet) would be okay. Bougies are typically inserted blindly, how do you know you are in the trachea and not the esophagus? - You can feel the "clicks" as the distal tip rubs against the cartilaginous tracheal rings, or it will deviate right or left when entering either bronchus (usually at 50 cm). What do you NOT want to hear if you ascultate a patient after placement of an ET tube? - Borborygmi - rumbling or gurgling noises suggesting esophageal insertion. What is the RSI dose for etomidate? - 0.3 mg/kg (usually 20 mg) What is the RSI dose for sux? - 1-2 mg/kg (usually 100 mg) How does etomidate affect blood pressure? - It doesn't - at least it SHOULDN'T have any significant effect on BP. Ketamine will increase BP, and propofol and thiopental