ATLS Chapters 1-3
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| show | 8
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| show | Airway maintenance with CERVICAL SPINE PROTECTION
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| 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? | show 🗑
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| Flail chest is invariably accompanied by ______ which can interfere with blood oxygenation. | show 🗑
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| Hypotension is caused by _____ until proven otherwise. | show 🗑
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| show | 1. Level of consciousness (brain perfusion), 2. Skin color (ashen face/grey extremities) 3. Pulse (bilateral femoral - thready/tachy)
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| Elderly patients have a limited ability to ______ to compensate for blood loss. | show 🗑
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| Resuscitation fluids should be warmed 39 degrees Celsius (102.2 F). Can you use a microwave to do this? | show 🗑
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| Urinary catheters are good for assessing renal perfusion and volume status. List 5 signs of urethral injury that might prevent you from inserting one. | show 🗑
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| Which arm should you NOT put a pulse-ox on? | show 🗑
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| show | Obesity & intraluminal bowel gas
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| When should radiographs be obtained? | show 🗑
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| show | A=Allergies, M=Medications, P=PMH/Pregnancy, L=Last meal, E=Events/Environment of injury
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| show | Vasodilation can lead to hypothermia
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| show | Blood, high-riding prostate (in males), and sphincter tone
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| What should you do for every female patient? | show 🗑
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| show | Adults 0.5 mL/kg/hr, Kids 1.0 ml/kg/hr
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| Preventing hypercarbia is critical in patients who have sustained a _____ injury. | show 🗑
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| show | Lips and fingernail beds
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| 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. | show 🗑
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| show | Yes, if the phrenic nerves (C3-C5) are spared. This will result in "abdominal" breathing. The intercostal muscles will be paralyzed though.
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| show | No, it could make them vomit. An NPA (trumpet) would be okay.
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| Bougies are typically inserted blindly, how do you know you are in the trachea and not the esophagus? | show 🗑
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| What do you NOT want to hear if you ascultate a patient after placement of an ET tube? | show 🗑
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| What is the RSI dose for etomidate? | show 🗑
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| show | 1-2 mg/kg (usually 100 mg)
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| show | 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.
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| show | 5
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| show | SUX - patients with severe burns, crush injuries, hyperkalemia, or chronic paralytic/neuromuscular diseases should NOT get sux because of hyperkalemia risk.
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| show | Adults 12-14 gauge, kids 16-18 gauge
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| 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 ___. | show 🗑
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| In a "normal" patient without significant chest wall injury or lung disease, needle cricothyroidotomy can provide adequate oxygenation for approximately ____ minutes. | show 🗑
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| show | Chin-lift, jaw-thrust (NOT head-tilt while maintaining c-spine precautions), OPA (guedel), NPA (trumpet), LMA, Combitube, ET tube +/- bougie
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| How do you know if an OPA/Guedel is the correct size for the patient? | show 🗑
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| show | Inflate it to make sure it doesn't leak - then deflate and insert.
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| What size LMA do you use for kid, woman/small man, large woman/man? | show 🗑
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| show | The same size as the infant's nostril or little finger. (Usually size 3 for neonates, 3.5 for infants)
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| show | 5 or 6
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| show | Age/4 + 4 mm = internal diameter
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| show | Neurogenic, cardiogenic, hypovolemic, septic
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| The most common cause of shock in the injured trauma patient is _____. | show 🗑
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| show | 70
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| Why does shock actually reduce the total volume of circulating blood? | show 🗑
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| Which vasopressors should you use to treat hemorrhagic shock? What are the drug doses? | show 🗑
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| show | 30
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| show | in shock
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| show | Infants >160, toddlers/preschoolers >140, school age/prebuscent >120, adults >100
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| Elderly patients may not exhibit tachycardia in response to hypovolemia because of limited cardiac response to catecholamines. Why else might not they get tachy? | show 🗑
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| A FAST scan is an excellent way to diagnose cardiac tamponade. What signs suggest tamponade? | show 🗑
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| show | Absent breath sounds and hyperresonance to percussion over the affected hemithorax.
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| show | Acute respiratory distress & subcutaneous emphysema
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| Can isolated intracranial injuries cause neurogenic shock? | show 🗑
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| How do you calculate total blood volume in an adult? | show 🗑
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| show | Body weight in kg x 80-90 mL
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| show | ideal
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| show | The patient's response to initial replacment
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| show | Up to 15% Donating 1 pint, or ~500 mL of blood is about a 10% volume loss and would qualify as Class I Hemorrhage!
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| show | You don't (usually). Transcapillary refill and other compensatory mechanisms usually restore blood volume within 24 hours.
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| How much blood volume is lost with Class II Hemorrhage? | show 🗑
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| show | Usually just crystalloid resuscitation
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| show | II
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| show | 30-40% (2000 mL in a 70 kg adult)
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| show | 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.
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| show | 50
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| show | More than 40%. Unless very aggressive measures are taken the patient will die within minutes.
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| A Class ___ Hemorrhage represents the smallest volume of blood loss that is consistently associated wiht a drop in systolic blood pressure. | show 🗑
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| Up to ______ mL of blood loss is commonly associated with femur fractures. | show 🗑
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| Unexplained hypotension or cardiac dysrhythmias (usually bradycardia from excessive vagal stimulation) are often caused by ______, especially in children. | show 🗑
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| How much crystalloid should you give an adult for an initial fluid resuscitation bolus? For kids? | show 🗑
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| 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. | show 🗑
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| Blood on the floor x four more is a mnemonic for occult blood loss where? | show 🗑
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| For children UNDER 1 year of age, UOP should be ___ mL/kg/hr. | show 🗑
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| show | Alkalotic - respiratory alkalosis from tachypnea....followed later by mild metabolic acidosis in the early phase of shock.
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| "Rapid responders" whose vital signs return to normal (and stay there) after fluid resuscitation likely have/had a Class ___ Hemorrhage. | show 🗑
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| "Transient responders" are associated with Class ___ Hemorrhage. | show 🗑
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| show | NON-HEMORRHAGIC causes, e.g. tension pneumothorax, tamponade, blunt cardiac injury, MI, acute gastric distention, neurogenic shock...
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| Most patients receiving blood transfusions ____ need calcium replacement. | show 🗑
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