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ATLS - Ch 1

Assessment & Management

Give three signs for transport to trauma center 1-GCS < 14 2-RR < 10 or > 29 3-SBP < 90
Give twelve MVA criteria for transport to trauma center 1-Ejection 2-Death 3-Run over or thrown 4-Unrestrained > 40 mph 5-Deformity > 20 in 6-Intrusion > 12 in 7-Extrication > 20 min 8-Fall > 20 ft 9-Rollover 10-Hit > 5 mph 11-Motorcycle > 20 mph 12-Separation
Give nine situations prompting transport to trauma center 1-Flail 2-Fx 2+ proximal long bones 3-Amputation > wrist or ankle, crushed, mangled, degloved 4-Penetration to head, neck, chest, extremities prox to knee or elbow 5-Open or depressed skull 6-Paralysis 7-Pelvic fx 8-Trauma & burns 9-Isolated major burns
After evaluating airway, Protect the cervcial spine
When is definitive airway management indicated? (3) 1-Tracheal/laryngeal fractures 2-GCS < 8 3-Nonpurposeful motor responses
How do you confirm ETT placement? (5) 1-Auscultation bilateral breath sounds 2-Watching chest rise & fall 3-End-tidal CO2 detector 4-Visualizing ETT through cords 5-CXR
What is No. 1 cause of preventable post-traumatic death? Hemorrhage
Give three examples of occult hemorrhage 1-Thoracic/abdominal cavity 2-Surrounding femur fracture 3-Pelvic fx c retroperitoneal hemorrhage
What is an unlikely cause of occult hemorrhage? Neurogenic shock secondary to spinal cord injury
___ patients may not demonstrate ____ as an early sign of significant blood loss. Elderly, pediatric, athletic....tachycardia
How should rapid external hemorrhage be controlled during the primary survey? direct manual compression
GCS measures ____ ____ and ____. Eye opening, BEST Motor Response, and Verbal Response
Give four contributions to low GCS 1-Hemorrhage 2-Hypoglycemia 3-Meds & Drugs 4-C-spine injury
Which type of hematoma leads to rapid ____ sometimes after a ____ interval? alteration in mental status lucid epidural, not subdural
What factors determine maximum rate of fluid administration? 1-Internal diameter of IV catheter and 2-inversely, the length of IV catheter, not the size of the vein
Which IV fluid is preferred and how is it prepared? Ringers lactate warmed
What can IV NS cause? hyperchloremic acidosis, especially with impaired renal function
Give blood priority: MTSp UTSp ONeg
Give three considerations in PEA 1-Cardiac tamponade 2-Tension Pneumothorax 3-Massive hemorrhage c hypovolemia
When should urethral injury be suspected? (6) 1-Blood at penile urethral meatus 2-Perineal ecchymosis 3-Nonpalpable prostate (high-riding) 4-Ecchymotic scrotum 5-Blood in scrotum 6-Pelvic fracutre
When should a Foley not be inserted? When urethral injury suspected
Best way to diagnose urethral injury Retrograde urethrogram
Give four complications of NG tube insertion 1-Insertion into brain via fx cribriform plate 2-Pulmonary aspiration of oropharyngeal or gastric contents 3-Bradycardia 4-Vomiting
What does pulse oximetry measure? Percent of hemoglobin saturated with oxygen
Give four ways to evaluate cervical vasculature 1-U/S 2-Contrast CT 3-MRI/MRA 4-Angiography
Give four criteria for surgical exploration of penetrating trauma to neck 1-Expanding hematoma 2-Airway compromise 3-Arterial bleeding 4-New bruit
Give two examples of delayed abdominal trauma 1-Small bowel injury 2-Pancreatic injury
Which findings are consistent with tension pneumothorax? (5) 1-Distended neck veins 2-Hyperresonance to percussion 3-Decreased breath sounds 4-Tracheal deviation 5-Hypotension
Which findings are consistent with cardiac tamponade? (3) 1-Hypotension 2-Distended neck veins 3-distant heart sounds
Which findings are consistent with aortic rupture? (7) 1-Widened mediastinum 2-Blurring/obliteration of aortic knob 3-Rightward deviation of trachea and esophagus 4-Depression of left mainstem bronchus 5-Obliteration of space between PA and Aorta 6-Widened paratracheal stripe 7-Widened paraspinal interface
Three indications for DPL 1-Unexplained hypotension 2-Abdominal pain and tenderness 3-Inability to perform reliable exam d/t neuro injury or altered mental status
Urethral injury is more common in ____. Males
Immobilization if neuro injury suspected 1-Semi-rigid cervical collar 2-long spine board
Adult maintenance urine output 0.5 mL/kg/hour
Child maintenance urine output 1.0 mL/kg/hour
Under 1 year of age maintenance urine output 2.0 mL/kg/hour
Route of pain meds for trauma patient IV, not oral or IM
Best method for opening airway in trauma patient Chin lift or Jaw thrust
What should you do with an open pneumothorax? Seal it on three sides, not four
Ten steps in initial assessment process 1-8 1-Preparation 2-Triage 3-Primary Survey 4-Resuscitation 5-Adjuncts to Primary Survey and Resuscitation 6-Consider need for Patient Transport 7-Secondary Survey (Head to Toe Evaluation and Patient History 8-Adjuncts to Secondary Survey
Ten steps in initial assessment process 9-10 9-Continued Postresuscitation Monitoring and Reevaluation 10-Definitive Care
Prehospital emphasis 1-Airway maintenance 2-Control of external bleeding and shock 3-Immobilization of patient 4-Transport to closest appropriate facility 5-Minimization of scene time 6-Obtaining/reporting information, mechanism of injury
Give six more reasons to transfer to trauma center 10-Crush, degloved, or mangled extremity 11-Pregnancy > 20 wks 12-Time-sensitive extremity injury 13-End-stage renal disease requiring dialysis 14-Burns w/o trauma: Triage to burn facility 15-Burns w trauma: Triage to trauma center
Considerations for Hospital Phase of trauma care (6) 1-Proper airway equipment 2-Warmed IV crystalloid solutions 3-Appropriate monitoring capabilities 4-Method to summon additional help 5-Transfer agreements 6-Universal precautions
Appropriate patients should arrive at appropriate hospitals.
Two types of triage situations 1-Multiple casualities 2-Mass casualities
Characteristics and goal of Multiple Casualities 1-Number and severity do not exceed ability 2-Life-threateningand multiple-system injuries treated first
Characteristics and goal of Mass Casualities 1-Number and severity DO exceed capability 2-Greatest chance of survival and least expenditure treated first
Ten-second assessment (3) 1-injuries 2-vital signs 3-injury mechanism
Trauma is a common cause of death in the elderly.
Two things to promote survival in elderly trauma patients 1-prompt, aggressive resuscitation 2-early recognition of preexisting conditions and medication use
What suggests airway is not in immediate jeopardy? Patient able to communicate verbally.
Does neurologic exam alone exclude C-spine injury? No
Assume a C-spine injury in patients with (3) 1-multi-system trauma 2-altered level of consciousness 3-blunt injury above the clavicle
Airway patency alone does not ensure adequate ventilation.
Ventilation requires adequate function of the (3) lungs, chest wall, and diaphragm
Impaired ventilation during primary survey (4) 1-tension pneumothorax 2-flail chest w pulmonary contusion 3-massive hemothorax 4-open pneumothorax
Impaired ventilation during secondary survey (4) 1-simple pneumothorax 2-simple hemothorax 3-fractured ribs 4-pulmonary contusions
Intubation and vigorous bag-valve ventilation can make patient worse with pneumothorax or tension pneumothorax
Until proven otherwise, injury related hypotension is considered hypovolemic in origin.
Three elements of hypovolemia 1-level of consciousness 2-skin color 3-pulse
A conscious patient may have lost a significant amount of blood.
Skin in hypovolemic patient may show 1-ashen, gray facial skin 2-white extremities
Easily accessible central pulses carotid and femoral
Pulses in hypovolemia thready, rapid, irregular, absent
What kind of hemorrhage is identified and controlled during what survey? external primary
Two things not to use during primary control of hemorrhage tourniquets and hemostats
When is a rapid neuro exam done? at the end of the primary survey
Four things assessed during rapid neuro exam 1-level of consciousness 2-pupillary size and reaction 3-lateralizing signs 4-spinal cord injury level
What correlation with CO does BP have in elderly? little
What can increase blood loss in elderly? anticoagulation therapy
Regarding room temperature, consider ____ rather than ____. patient's body temp health-care providers
Immediate ____ should be started if tension pneumothorax is suspected. chest decompression
How many, and what kind of IV catheters? Two, large-bore
Prioritize volume resuscitation vs definitive control of hemorrhage definitive control of hemorrhage
Shock w injury most often ____ in origin. hypovolemic
What can and cannot be warmed in a microwave oven? crystalloid fluids blood products
Name nine adjuncts used during primary survey 1-electrocardiographic monitoring 2-urinary catheters 3-gastric catheters 4-ventilatory rate 5-ABG levels 6-pulse oximetry 7-blood pressure 8-x-rays 9-diagnostic studies
Dysrhythmias can indicate blunt cardiac injury
Hypoxia, hypoperfusion and/or hypothermia can cause what dysrhythmias? (3) 1-bradycardia 2-aberrant conduction 3-premature beats
Rectal exam and genital exam should be done before inserting a urinary catheter
Gastric tube used to 1-reduce stomach distension 2-decrease risk of aspiration
Blood in gastric aspirate may indicate (3) 1-oropharyngeal (swallowed) blood 2-traumatic insertion 3-actual injury to upper digestive trace
Capnography does not confirm proper placement of tube in trachea.
Pulse oximetry does not measure the partial pressure of oxygen, nor the partial pressure of carbon dioxide
Blood pressure may be a poor measure of actual tissue perfusion
On which arm should pulse oximetry not be placed? the one with the blood pressure cuff on
Essential x-rays should be obtained EVEN in pregnant patients
F A S T Focused Assessment Sonography in Trauma
D P L Diagnostic Peritoneal Lavage
Two limiting factors in FAST obesity and intraluminal bowel gas
Three limiting factors in DPL 1-obesity 2-previous abdominal operations 3-pregnancy
Potential in unresponsive or unstable patient (2) 1-missing an injry 2-failing to appreciate significance of injury
Medical assessment always includes history of mechanism of injury
A in AMPLE Allergies
M in AMPLE Medications currently used
P in AMPLE Past illness and Pregnancy
L in AMPLE Last Meal
E in AMPLE Events/Environment related to injury
Four categories of injury 1-Blunt trauma 2-Penetrating trauma 3-Thermal injuries 4-Hazardous environment
Considerations in blunt trauma from MVC (5) 1-seat-belt use 2-steering wheel deformation 3-direction of impact 4-damage (deformation or intrusion) 5-ejection
Considerations in penetrating trauma (2) 1-organs in the path 2-velocity of the missile
Clues to extent of injury in gunshot victims (4) 1-velocity 2-caliber 3-presumed path of bullet 4-distance from weapon to wound
Burns can occur ____ or with ____ alone blunt and penetrating trauma
Two considerations in a fire 1-inhalation injury 2-carbon monoxide poisoning
Two considerations about exposure to hazardous environment 1-pulmonary, cardiac, internal organ dysfunction in patient 2-hazard to healthcare providers
Eyes should be evaluated for (7) 1-visual acuity 2-pupillary size 3-hemorrhage of conjunctiva and/or fundi 4-penetrating injury 5-contact lenses (remove before edema) 6-dislocation of lens 7-ocular entrapment
Mechanism of Injury (5) 1-Frontal impact 2-Side impact 3-Rear impact 4-Ejection 5-Pedestrian struck by motor vehicle
MOI Mechanism of Injury
SIP Suspected Injury Pattern
SIP in Frontal Impact MVC (7) 1-Cervical spine fracture 2-Anterior flail chest 3-Myocardial contusion 4-Pneumothorax 5-Traumatic aortic disruption 6-Fractured spleen or liver 7-Posterior fracture/dislocation of hip and/or knee
SIP in Side Impact MVC (8) 1-Contralateral neck sprain 2-Cervical spine fracture 3-lateral flail chest 4-Pneumothorax 5-Traumatic aortic disruption 6-Diaphragmatic rupture 7-Fracture spleen/liver and/or kidneys, depending on side of impact 8-Fractured pelvis or acetabulum
SIP in Rear Impact MVC (2) 1-Cervical spine injury 2-Soft tissue injury to neck
SIP in Ejection from vehicle Meaningful pattern precluded
SIP in Pedestrian Struck by Vehicle (4) 1-Head injury 2-Traumatic aortic disruption 3-Abdominal visceral injuries 4-Fractured lower extremities/pelvis
Patient with mid-face fracture can have fracture of cribriform plate
Presumption with maxillofacial or head trauma unstable cervical spine injury
Does not exclued injury to cervical spine absence of neurological deficit
Exam of neck includes (3) 1-Inspection 2-Palpation 3-Auscultation
Unexplained or isolated paralysis of upper extremity suspect cervical nerve root injury and document
Palpation of chest cage includes (3) 1-clavicles 2-ribs 3-sternum
Auscultation of breath sounds for hemothorax posterior bases
Auscultation of breath sounds for pneumothorax high on anterior chest
Children often sustain significant injury to the ____ without evidence of ____. 1-intrathoracic structures 2-thoracic skeletal trauma
What are you looking for in vaginal exam? 1-blood in vaginal vault 2-vaginal lacerations
Pelvic fractures should be suspected when you identify ecchymosis over the (4) 1-iliac wings 2-pubis 3-labia 4-scrotum
Manipulation of the pelvis should be done only once
Complete musculoskeletal exam includes the back
Prioritize treatment vs consent consent, then treatment, usually, but when not possible, treat, then obtain consent
Created by: tcrouch2000
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