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Patients with a GSC of less than ___ usually require intubation.
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The "A" in ABCD stands for _______.
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ATLS Chapters 1-3
| Question | Answer |
|---|---|
| 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 |
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