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ATLS Chapters 7-13

What are the signs of neurogenic shock? Vasodilation of lower extremity blood vessels – resulting in pooling of blood and hypotension. This loss of sympathetic tone may cause bradycardia or inhibit the tachycardic response to hypovolemia.
How do you treat neurogenic shock? Judicious use of pressors and MODERATE fluid resuscitation. Too much fluid may result in overload and pulmonary edema.
What is the most common type of C1 fracture? Burst fractures (Jefferson fracture)
What’s the difference between types I, II, and III odontoid process fractures? I=tip of odontoid, II=fx at base, III=base of odontoid and extends obliquely into body of axis. (Odontoid process = dens).
What are the indications for c-spine radiographs in a trauma patient? Which x-ray views should be obtained? Midline neck pain, tenderness on palpation, neurological deficits related to c-spine injuries, altered LOC or intoxication. 1) Lateral, 2) AP, 3) Open mouth odontoid view
With the proper views of the c-spine, and a qualified radiologist – what is the sensitivity for finding unstable cervical spine injuries? >97% (CT with 3mm slices >99%).
Ten percent of all patients with a c-spine fracture have what? A second, noncontiguous vertebral column fracture. (So scan the rest of their spine).
Attempts to align the spine for the purpose of immobilization on the backboard are not recommended if they _______. cause pain
Can you clear a c-spine without films? Yes, if they are awake, alert, sober, neurological normal, have NO pain, and can flex, extend, and move their head to both sides without pain – you don’t need films.
Should a quadriplegic or paraplegic patient be put on a hard board? Not for more than 2 hours – get them off ASAP.
What’s a big difference in a physical finding between hypovolemic and neurogenic shock? Hypovolemic = usually TACHY, Neurogenic = usually BRADY
Partial or total loss of respiratory function may be seen in a patient with a cervical spine injury above ___. C6
Why might someone not be able to breathe if they have a long bone fracture? Fat embolism – uncommon though
Abnormal arterial blood flow is indicated by an ABI of ____. <0.9
By LOOKING at the patient, what findings might suggest pelvic injury? Leg-length discrepancy, rotation (usually external)
Crush injuries may result in rhabdomyolysis – casts block flow, also iron is released which forms ROS which then damage cells and impair ability to regulate K+ etc… What can you do to prevent this? Volume expansion, and alkalization of urine with bicarb will reduce intratubular precipitation of myoglobin. UOP should be 100 mL/hr until myoglobinuria is cleared.
Muscle does not tolerate lack of arterial flow (tourniquet) for more than ___ hours before necrosis begins. 6
What things increase the risk for tetanus? Wounds >6 hours old, wounds contused or abraded, >1 cm deep, from high velocity missiles, due to burns or cold, and significantly contaminated wounds.
Should legs be completely straight when splinting? No, flexion of 10 degrees recommended to take pressure off neurovascular structures.
Any patient with burns covering more than ___% of BSA require fluid resuscitation. 20
The palmer surface of a patient’s hand represents approximately ___% of their BSA. 1%
A high index of suspicion for inhalation injury must be maintained, because patients may not display clinical evidence for up to ___ hours, by this time edema may prevent non-surgical intubation. 24
Carbon monoxide has ____ times the affinity for oxygen as hemoglobin. 240
Patients with CO levels less than ___% usually don’t have any physical symptoms. 20%
Adult head BSA = ___%. 9 (ENTIRE head front and back = 9)
Baby head BSA = __% 18 (9 front, 9 back)
What is the main difference between adult and baby BSA determination for burns? Entire head on baby is 18, whereas it’s 9 for adults. This difference of 9 is made up by the fact that each side (front/back) on adult = 9, but only 7 for kids. (36 vs 28).
Chest BSA = ___%. 18
Back BSA = ___%. 18
Arm BSA = ___%. 9 TOTAL (front AND back).
Leg BSA for adult = ___%. 18 TOTAL (9 front, 9 back).
Baby front or back of leg BSA =___%. 7 (TOTAL leg = 14%)
If you add up BSA head, chest, back, arms, and legs you get 99% of BSA. What is the remaining 1%? Perineum
Partial/2nd degree burns extend into the _____ whereas full thickness/3rd degree burns ______. Partial – go into dermis, FULL go all the way through dermis and into/beyond SQ tissue.
For patients with CO poisoning, the ½ life is ___ when breathing room air and ___ breathing 100% oxygen 4 hours on RA, 40 min on 100% O2
How do you calculate the Parkland formula? 4 * weight (kg) * percent BSA burned = volume in 24 hours (1st half in 8 hrs, 2nd half over 16 hrs).4*70kg*25 percent = 7 liters in 24 hours. ***Use 25, NOT 0.25)***
Partial or full thickness burns of ___% in patients less than 10 or older than 50 warrants transfer to a burn center. 10%
What percent partial/full thickness burns would qualify a 25 year old for a burn center transfer? 20%
What anatomical positions with partial/full thickness burns warrant burn center transfer? Face, eyes, ears, hands, genitalia, perineum, feet, skin overlying joints.
Does an inhalation injury warrant transfer to a burn center? YES!!!!!
Should you treat frostbite by soaking body part in water or not? YES, 40 degree (104F) for 20-30 min should suffice. Don’t warm if there is risk of REFREEZING.
Insofar as hypothermia is concerned, patients are not pronounced dead until they are _____ and dead. warm
What are you thinking if a child has broken ribs? MASSIVE force and highly likely organ damage (since their ribs are very pliable, a huge amount of force is required to break them, there is often underlying organ damage WITHOUT broken ribs).
How should you insert a Guedel in a kid? Use tongue blade depressor and insert gently without turning – otherwise there is great risk for trauma and resultant hemorrhage. NOT the 180 degree spin trick.
The normal systolic BP in kids can be estimated by what? 90 mm Hg + (age x 2)
How do you estimate a child’s total circulating volume? 80 mL/kg
When shock in a child is suspected, how much fluid do you give them? 20 mL/kg warm crystalloid May need to repeat up to 3 times (60 mL/kg) then consider blood products.
Optimal UOP for infants is ___ mL/kg/hr. 2 (1.5 for younger kids, and 1.0 for older kids).
How much warmed crystalloid should be used for a DPL in kids? 10 mL/kg (up to 1000 mL)
What would you see in an infant that would make you suspect very severe brain injury despite normal LOC? Bulging fontanelles – these allow tolerance for expanding masses/swelling…
What is a possible mistake about a blood pressure of 120/80 in a 87 year old man? Assuming that normal blood pressure = normovolemia. Many geriatric patients have uncontrolled hypertension, and if their normal systolic is 180, then 120/80 is relative HYPOtension for them.
How well do geriatric patients do with non-operative management of abdominal injuries compared to younger people? Not as well – the risks of non-operative management are often worse than the risks of surgery.
Why would geriatric patients be MORE susceptible to head bleeds when there is increased space around a shrinking brain to protect them from contusion? Atrophic brains = stretching of the parasagittal bridging veins, making them more prone to rupture upon impact.
Plasma volume increases during pregnancy, what happens to hematocrit? Decreases – dilution by plasma (31-35% is normal in pregnancy)
What would you think of a WBC of 15,000 in a pregnant woman? Normal, it can go up to 25,000 during labor!
What should you always assume about a pregnant patient’s stomach? That it is always full. (Gastric emptying time increases during pregnancy). Early NG tube placement recommended.
A PaCO2 of 35 to 40 in a pregnant patient may indicate what? Impending respiratory failure. It is usually around 30 due to hyperventilation due to increased levels of progesterone.
True or False: All Rh negative pregnant trauma patients should get Rhogam? True, unless the injury is remote from the uterus (distal extremity injury only). This therapy should be initiated within 72 hours of injury.
When worn correctly, seatbelts reduce fatalities by ___%. 65-70%, with a 10-fold reduction in serious injury.
Created by: satori4all
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