ATLS EXAM
True or false? Although the mechanism of injury may be similar to those for the younger population,
data shows increased mortality with similar severity of injury in older adults. - Ans-TrueIn the elderly
population, what is decreased physiological reserve? - Ans-aging is characterized by impaired adaptive
and homeostatic mechanisms that caused an increased susceptibility to the stress of injury. Insults
tolerated by the younger population can lead to devastating results in elderly patients.Pre-existing
conditions that affect morbidity and mortality include: - Ans-cirrhosis, coagulopathy, COPD, ischemic
heart disease, DMWhat is the most common mechanism of injury in the elderly? - Ans-Fall. Nonfatal falls
are common in women and fractures are common in women who fall. Falls are the most common cause
of TBI.In the elderly population, what are risk factors for falls? - Ans-advanced age, physical impairment,
history of previous fall, medication use, dementia, unsteady gait, and visual, cognitive impairmentMost
of elderly traffic fatalities occur in the daytime and on weekends and typically involve other vehicles.
Why? - Ans-Older people drive on more familiar roads and at lower speeds and tend to drive during the
day. Older people have slower reaction time, a larger blind spot, limited cervical mobility, decreased
hearing, and cognitive impairment.True or False? Mortality associated with small to moderate sized
burns in older adults remains high - Ans-TrueSpilled hot liquids on the leg, which in younger patients
may re-epithelialize due to an adequate number of hair follicles, will result in a full thickness burn in
older patients. - Ans-this is trueAirway-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.When preforming rapid sequence intubation, the dose of benzos,
barbiturates, and other sedatives should be reduced to what percentage to minimize the risk of
cardiovascular depression? - Ans-20-40%Functional changes in cardiac system include declining function,
decreased sensitivity to catecholamines, atherosclerosis of coronary vessels, increased afterload, fixed
heart rate (beta blockers) - Ans-this results in lack of classic response to hypovolemia, risk for cardiac
ischemia, elevated BP at baseline, and increased risk of dysrythmias.Functional changes in pulmonary
system include decreased elastic recoil, reduced residual capacity, decreased gas exchange and
decreased cough reflex - Ans-thus they are at increased risk for respiratory failure, increased risk for
pneumonia, and poor tolerance to rib fracturesFunctional changes in renal system include loss of renal
mass, decreased GFR, and decreased sensitivity to ADH and aldosterone - Ans-resulting in drug dosing
for renal insufficiency, decreased ability to concentrate urine, increased risk for AKI and urine flow may
be normal with hypovolemiaFunctional changes to MSK include loss of lean body mass, osteoporosis,
changes in joints and cartilage, c spine degenerative changes and loss of skin elastin and subcutaneous
fat - Ans-resulting in increased risk for fractures, decreased mobility, difficulty for oral intubation, risk of
skin injury, increased risk for hypothermia, challenges in rehabiliationFunctional changes in Endocrine
system include decreased production and response to thyroxin and decreased dehydroepiandrosterone
(DHEA) - Ans-resulting in occult hypothyroidism, relative hypercortisone states and increased risk of
infectionTrue or false: Arthritis can complicate the airway and cervical spine. Patients can have multilevel
degenerative changes affecting disk spaces and posterior elements associated with severe central canal
stenosis, cord compression, and myelomalacia - Ans-trueIn elderly population, due to their changes in
pulmonary system, placing a gauze between gums and cheek to achieve seal when using bag valve mask
ventilation is okay. In addition, because aging causes a suppressed heart rate response to hypoxia...... -
Ans-respiratory failure may present insidiously in older adults.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.Do no equate
blood pressure with shock in older patients - Ans-BP in older patients may look normal due to the
medications they are on. Use lactate and base deficit to evaluate for evidence of shockwhat 2 factors
place elderly patients at risk for intracranial hemorrhage? - Ans-aging causes dura to become more
adherent to the skull increasing risk of injury and older patients are on anticoagulant and antiplatelet
medications.Loss of subcutaneous fat, nutritional deficiencies, chronic medical conditions place elderly
patients as risk for hypothermia and complications for immobility. - Ans-Rapid evaluation and when
possible early liberation from spine boards and cervical collars will minimize complications.True or False:
Fall prevention is the mainstay of reducing the mortality associated with pelvic fractures. - Ans-truepoor
hygiene, dehydration, oral injury, contusions affecting the inner arms, inner thighs, palms, soles, scalp,
ear, nasal bridge and temple injury from being struck while wearing glasses, contact burns and scalds.
These are all signs of.......? - Ans-Elder maltreatment. The presence of physical findings of maltreatment
should prompt a detailed history. if history conflicts with findings, immediately report findings to
authorities.True of false: early activation of the trauma team may be required for elderly patients who do
not meet traditional criteria for activation - Ans-True. A simple injury such as an open tibia fracture in a
frail elderly patient may become life threatening.Common mechanisms of injury include falls, MVC,
burns, and penetrating injuries - Ans-common injuries in the elderly include rib fractures, TBI, pelvic
fracturesThe best initial treatment for the fetus is to provide optimal resuscitation of the mother. True or
False? - Ans-True. Also if xray examination is indicated during the pregnant patient's treatment, it should
not be withheld because of the pregnancy.What happens as the uterus enlarged and the bowel is pushed
cephalad. - Ans-When the uterus enlarges it pushes the bowel cephalad and the uterus lies in the upper
abdomen. As a result, the bowel is somewhat protected from blunt abdominal trauma, whereas the
uterus and its contents (fetus and placenta) become more vulnerable. Uterus remains intrapelvic until 12
weeks and then at 20 weeks it is at the umbilicus, and at 34-36 weeks it reaches the costal
margin.Amniotic fluid can cause amniotic fluid embolism and disseminated intravascular coagulation
following trauma if fluid enters maternal intravascular space. True or False - Ans-TrueBy the third
trimester, what is the complication of trauma to the pelvis of the mother? - Ans-by the third trimester,
the uterus is large and thin walled. In vertex presentation, fetal head is usually in the pelvis and the
remainder of the fetus is exposed above the pelvic brim. Pelvic fractures in late gestation can result in
skull fracture or intracranial injury to the fetus. Also we can have a placental abruption due to its little
elasticity and vulnerability to sheer forces.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 truePhysiological anemia of pregnancy - Ans-A smaller increase
in red blood cell volume can occur resulting in a decreased hematocrit level. Thus, in late pregnancy a
hematocrit of 31-33% is normal.Healthy pregnancy patients can lose 1200-1500 mL of blood before
exhibiting signs and symptoms of hypovolemia. How can this manifest? - Ans-this amount of hemorrhage
may be reflected by fetal distress as evidenced by an abnormal fetal heart rate.What are some of the lab
changes in pregnancy? - Ans-WBC increases to 12000 and during labor can be 25000. Fibrinogen and
other clotting factors are mildly elevated and PT and pTT are shortened, but bleeding time and clotting
time are unchanged.After the 10th week of pregnancy, cardiac output can increase 1.0-1.5 L/min
True or false? Although the mechanism of injury may be similar to those for the younger population,
data shows increased mortality with similar severity of injury in older adults. - Ans-TrueIn the elderly
population, what is decreased physiological reserve? - Ans-aging is characterized by impaired adaptive
and homeostatic mechanisms that caused an increased susceptibility to the stress of injury. Insults
tolerated by the younger population can lead to devastating results in elderly patients.Pre-existing
conditions that affect morbidity and mortality include: - Ans-cirrhosis, coagulopathy, COPD, ischemic
heart disease, DMWhat is the most common mechanism of injury in the elderly? - Ans-Fall. Nonfatal falls
are common in women and fractures are common in women who fall. Falls are the most common cause
of TBI.In the elderly population, what are risk factors for falls? - Ans-advanced age, physical impairment,
history of previous fall, medication use, dementia, unsteady gait, and visual, cognitive impairmentMost
of elderly traffic fatalities occur in the daytime and on weekends and typically involve other vehicles.
Why? - Ans-Older people drive on more familiar roads and at lower speeds and tend to drive during the
day. Older people have slower reaction time, a larger blind spot, limited cervical mobility, decreased
hearing, and cognitive impairment.True or False? Mortality associated with small to moderate sized
burns in older adults remains high - Ans-TrueSpilled hot liquids on the leg, which in younger patients
may re-epithelialize due to an adequate number of hair follicles, will result in a full thickness burn in
older patients. - Ans-this is trueAirway-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.When preforming rapid sequence intubation, the dose of benzos,
barbiturates, and other sedatives should be reduced to what percentage to minimize the risk of
cardiovascular depression? - Ans-20-40%Functional changes in cardiac system include declining function,
decreased sensitivity to catecholamines, atherosclerosis of coronary vessels, increased afterload, fixed
heart rate (beta blockers) - Ans-this results in lack of classic response to hypovolemia, risk for cardiac
ischemia, elevated BP at baseline, and increased risk of dysrythmias.Functional changes in pulmonary
system include decreased elastic recoil, reduced residual capacity, decreased gas exchange and
decreased cough reflex - Ans-thus they are at increased risk for respiratory failure, increased risk for
pneumonia, and poor tolerance to rib fracturesFunctional changes in renal system include loss of renal
mass, decreased GFR, and decreased sensitivity to ADH and aldosterone - Ans-resulting in drug dosing
for renal insufficiency, decreased ability to concentrate urine, increased risk for AKI and urine flow may
be normal with hypovolemiaFunctional changes to MSK include loss of lean body mass, osteoporosis,
changes in joints and cartilage, c spine degenerative changes and loss of skin elastin and subcutaneous
fat - Ans-resulting in increased risk for fractures, decreased mobility, difficulty for oral intubation, risk of
skin injury, increased risk for hypothermia, challenges in rehabiliationFunctional changes in Endocrine
system include decreased production and response to thyroxin and decreased dehydroepiandrosterone
(DHEA) - Ans-resulting in occult hypothyroidism, relative hypercortisone states and increased risk of
infectionTrue or false: Arthritis can complicate the airway and cervical spine. Patients can have multilevel
degenerative changes affecting disk spaces and posterior elements associated with severe central canal
stenosis, cord compression, and myelomalacia - Ans-trueIn elderly population, due to their changes in
pulmonary system, placing a gauze between gums and cheek to achieve seal when using bag valve mask
ventilation is okay. In addition, because aging causes a suppressed heart rate response to hypoxia...... -
Ans-respiratory failure may present insidiously in older adults.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.Do no equate
blood pressure with shock in older patients - Ans-BP in older patients may look normal due to the
medications they are on. Use lactate and base deficit to evaluate for evidence of shockwhat 2 factors
place elderly patients at risk for intracranial hemorrhage? - Ans-aging causes dura to become more
adherent to the skull increasing risk of injury and older patients are on anticoagulant and antiplatelet
medications.Loss of subcutaneous fat, nutritional deficiencies, chronic medical conditions place elderly
patients as risk for hypothermia and complications for immobility. - Ans-Rapid evaluation and when
possible early liberation from spine boards and cervical collars will minimize complications.True or False:
Fall prevention is the mainstay of reducing the mortality associated with pelvic fractures. - Ans-truepoor
hygiene, dehydration, oral injury, contusions affecting the inner arms, inner thighs, palms, soles, scalp,
ear, nasal bridge and temple injury from being struck while wearing glasses, contact burns and scalds.
These are all signs of.......? - Ans-Elder maltreatment. The presence of physical findings of maltreatment
should prompt a detailed history. if history conflicts with findings, immediately report findings to
authorities.True of false: early activation of the trauma team may be required for elderly patients who do
not meet traditional criteria for activation - Ans-True. A simple injury such as an open tibia fracture in a
frail elderly patient may become life threatening.Common mechanisms of injury include falls, MVC,
burns, and penetrating injuries - Ans-common injuries in the elderly include rib fractures, TBI, pelvic
fracturesThe best initial treatment for the fetus is to provide optimal resuscitation of the mother. True or
False? - Ans-True. Also if xray examination is indicated during the pregnant patient's treatment, it should
not be withheld because of the pregnancy.What happens as the uterus enlarged and the bowel is pushed
cephalad. - Ans-When the uterus enlarges it pushes the bowel cephalad and the uterus lies in the upper
abdomen. As a result, the bowel is somewhat protected from blunt abdominal trauma, whereas the
uterus and its contents (fetus and placenta) become more vulnerable. Uterus remains intrapelvic until 12
weeks and then at 20 weeks it is at the umbilicus, and at 34-36 weeks it reaches the costal
margin.Amniotic fluid can cause amniotic fluid embolism and disseminated intravascular coagulation
following trauma if fluid enters maternal intravascular space. True or False - Ans-TrueBy the third
trimester, what is the complication of trauma to the pelvis of the mother? - Ans-by the third trimester,
the uterus is large and thin walled. In vertex presentation, fetal head is usually in the pelvis and the
remainder of the fetus is exposed above the pelvic brim. Pelvic fractures in late gestation can result in
skull fracture or intracranial injury to the fetus. Also we can have a placental abruption due to its little
elasticity and vulnerability to sheer forces.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 truePhysiological anemia of pregnancy - Ans-A smaller increase
in red blood cell volume can occur resulting in a decreased hematocrit level. Thus, in late pregnancy a
hematocrit of 31-33% is normal.Healthy pregnancy patients can lose 1200-1500 mL of blood before
exhibiting signs and symptoms of hypovolemia. How can this manifest? - Ans-this amount of hemorrhage
may be reflected by fetal distress as evidenced by an abnormal fetal heart rate.What are some of the lab
changes in pregnancy? - Ans-WBC increases to 12000 and during labor can be 25000. Fibrinogen and
other clotting factors are mildly elevated and PT and pTT are shortened, but bleeding time and clotting
time are unchanged.After the 10th week of pregnancy, cardiac output can increase 1.0-1.5 L/min
