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ATLS Chapters 1-3

QuestionAnswer
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 will both drop BP.
A RSI dose of sux usually lasts about ___ minutes. 5
What hypnotic/sedative/induction agent do you NOT want to use for a severely burned patient? SUX - patients with severe burns, crush injuries, hyperkalemia, or chronic paralytic/neuromuscular diseases should NOT get sux because of hyperkalemia risk.
Oxygen should flow at 15L for needle cricothyroidotomy, and have a Y-connector for insufflation if possible. What size needle do you use for adults? Kids? Adults 12-14 gauge, kids 16-18 gauge
Cricoid cartilage is the only circumferential support for the upper trachea in kids, therefore surgical cricothyroidotomy is not recommended in kids under the age of ___. 12
In a "normal" patient without significant chest wall injury or lung disease, needle cricothyroidotomy can provide adequate oxygenation for approximately ____ minutes. 30-45
For a patient with difficulty breathing, what things might you try before you provide a surgical airway? Chin-lift, jaw-thrust (NOT head-tilt while maintaining c-spine precautions), OPA (guedel), NPA (trumpet), LMA, Combitube, ET tube +/- bougie
How do you know if an OPA/Guedel is the correct size for the patient? A correctly sized OPA will extend from the corner of the patient's mouth to the external auditory canal.
What should do with the balloon on an ET tube/LMA/foley before you insert it? Inflate it to make sure it doesn't leak - then deflate and insert.
What size LMA do you use for kid, woman/small man, large woman/man? Kid: 3, Woman/small man: 4, Large woman/man: 5 (C3,4,5 keep the diaphragm alive)
The proper size ET tube for an infant is ______. The same size as the infant's nostril or little finger. (Usually size 3 for neonates, 3.5 for infants)
What size cuffed endotracheal tube do you use for an emergency cricothyroidotomy? 5 or 6
Use size 3 ET tubes for neonates, 3.5 for infants 0-6 months, and size 4 for infants 6-12 months. How do you calculate what size ET tube to use for toddlers and kids? Age/4 + 4 mm = internal diameter
Shock is defined as an abnormality of the circulatory system that results in inadequate organ perfusion and tissue oxygenation. What are the 4 different types? Neurogenic, cardiogenic, hypovolemic, septic
The most common cause of shock in the injured trauma patient is _____. hemorrhage
Approximately ___% of the body's total blood volume is located in the venous circuit. 70
Why does shock actually reduce the total volume of circulating blood? Anaerobic metabolism --> can't make more ATP --> Endoplasmic then mitochondrial damage --> lysosomes rupture --> sodium and WATER enter the cell, which SWELLS and dies.
Which vasopressors should you use to treat hemorrhagic shock? What are the drug doses? NEVER use pressors for hypovolemic shock - use VOLUME replacement. Pressors will worsen tissue perfusion in hemorrhagic shock.
Compensatory mechanisms may preclude a measurable fall in systolic blood pressure until up to __% of the patient's blood volume is lost. 30
Any patient who is cool and is tachycardic is considered to be ______ until proven otherwise. in shock
The definition of tachycardia depends on the patient's age. What heart rate is considered tachycardic for infants, toddlers/preschoolers, school age/prebuscent, and adults? Infants >160, toddlers/preschoolers >140, school age/prebuscent >120, adults >100
Elderly patients may not exhibit tachycardia in response to hypovolemia because of limited cardiac response to catecholamines. Why else might not they get tachy? They might be on a beta-blocker or have a pacemaker.
A FAST scan is an excellent way to diagnose cardiac tamponade. What signs suggest tamponade? Becks's Triad: JVD, muffled heart sounds, and hypotension (will be resistant to fluid therapy). Will also likely be tachycardic.
Patients with a tension pneumo and patients with cardiac tamponade may present with many of the same signs. What findings will you see with a tension pneumo that you will NOT see with tamponade? Absent breath sounds and hyperresonance to percussion over the affected hemithorax.
Immediate thoracic decompression is warranted for anyone with absent breath sounds, hyperresonance to percussion, tracheal deviation, ____, and ____. Acute respiratory distress & subcutaneous emphysema
Can isolated intracranial injuries cause neurogenic shock? NO
How do you calculate total blood volume in an adult? 70 mL per kg body weight. A 70 kg person has about 5 liters of circulating blood. (70*70=4900)
How do you calculate total blood volume in an child? Body weight in kg x 80-90 mL
The blood volume of an obese person is calculated based upon their ______ weight. ideal
Fluid replacement should be guided by ________, not simply by the initial classification (Class I-IV). The patient's response to initial replacment
How much blood volume is lost with Class I Hemorrhage? Up to 15% Donating 1 pint, or ~500 mL of blood is about a 10% volume loss and would qualify as Class I Hemorrhage!
How do you treat a Class I Hemorrhage? You don't (usually). Transcapillary refill and other compensatory mechanisms usually restore blood volume within 24 hours.
How much blood volume is lost with Class II Hemorrhage? 15-30% (750-1500 mL in a 70 kg adult)
How do you treat a Class II Hemorrhage? Usually just crystalloid resuscitation
Subtle CNS changes such as anxiety, fright, and hostility would be expected in a patient with a Class __ Hemorrhage. II
How much blood volume is lost with Class III Hemorrhage? 30-40% (2000 mL in a 70 kg adult)
A patient with inadequate perfusion, marked tachycardia and tachypnea, significant mental status change, and a measurable fall in systolic blood pressure likely has a Class ___ Hemorrhage. III or IV - These patients almost always require a blood transfusion, which depends on their response to initial fluid resuscitation. The first priority is stopping the hemorrhage.
Loss of more than ___% of blood volume results in loss of consciousness. 50
How much blood volume is lost with Class IV Hemorrhage? More than 40%. Unless very aggressive measures are taken the patient will die within minutes.
A Class ___ Hemorrhage represents the smallest volume of blood loss that is consistently associated wiht a drop in systolic blood pressure. III
Up to ______ mL of blood loss is commonly associated with femur fractures. 1500
Unexplained hypotension or cardiac dysrhythmias (usually bradycardia from excessive vagal stimulation) are often caused by ______, especially in children. gastric distention
How much crystalloid should you give an adult for an initial fluid resuscitation bolus? For kids? Adults: 2 liters, Kids: 20 mL/kg (may repeat and give as much as 60 mL/kg but with high reserve in kids, if they're in shock they should get blood sooner rather than later.
Each mL of blood loss whould be replaced with ___ mL of crystalloid, thus allowing for replacement of plasma volume lost into interstitial and intracellular spaces. 3
Blood on the floor x four more is a mnemonic for occult blood loss where? Chest, pelvis, retroperitoneum, and thigh
For children UNDER 1 year of age, UOP should be ___ mL/kg/hr. 2
Would patients in EARLY hypovolemic shock be acidodic or alkalotic? Alkalotic - respiratory alkalosis from tachypnea....followed later by mild metabolic acidosis in the early phase of shock.
"Rapid responders" whose vital signs return to normal (and stay there) after fluid resuscitation likely have/had a Class ___ Hemorrhage. I or II
"Transient responders" are associated with Class ___ Hemorrhage. II or III
What differential diagnoses should you always consider for "non-responders" following fluid resuscitation? NON-HEMORRHAGIC causes, e.g. tension pneumothorax, tamponade, blunt cardiac injury, MI, acute gastric distention, neurogenic shock...
Most patients receiving blood transfusions ____ need calcium replacement. don't
Created by: satori4all on 2010-06-19



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