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ATLS Chapters 7-13
| Question | Answer |
|---|---|
| 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. |
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