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ATLS Study Cards With Complete
Solution/216 Questions and Answers
Glasgo w Coma Scale Correct ans - Chance fracture Correct ans - Transverse fracture through vertebra. In children usually associated with enterc disruption. Seen in motor vehicle accidents involving only lap belt. May be associated with retroperitoneal and Abdominal visceral injuries. Anterior hip dislocation Correct ans - Flexed, abducted, externally rotated. Burst fracture Correct ans - Associated with vertebral- axial compression injuries Posterior hip dislocation Correct ans - Flexed, aDDucted, internally rotated Anterior shoulder dislocation Correct ans - Squared off appearance Posterior shoulder dislocation Correct ans - Lock in internal rotation. Ankle dislocation Correct ans - Most are Externally rotated, with a prominent medial malleolus. FULL thickness (3rd degree) burn Correct ans - Dark or white and leathery. Translucent white as well. Painless and generally "dry" Does not blanch with pressure. Very little swelling of burned tissue. Principle Life saving measures for patients with burn injuries include Correct ans - -Establishing airway control -Stopping the burning. process -Intravenous access Factors that increase the risk for upper AIRWAY OBSTRUCTION in burns include: Correct ans - -Burns to the head and face -Burn size and depth -Burns inside the mouth Partial thickness burn Correct ans- Red remodeled appearance
with associated swelling and blister formation. May have weeping or wet appearance and is painfully hypersensitive even to air current.
In very small children, less than 10 kilograms, it may be necessary to add glucose to the IV fluids to avoid hypoglycemia. Any adjustment in IV fluid rate should be based on urine output. In an adult, urine output above 0.5 ml/ kilogram should result in reduction of IV fluid rate. Initial treatment of frostbite/ cold injuries Correct ans - Place injured part in circulating water and a constant 40 degrees centigrade until pink color and perfusion return, usually within 20 to 30 minutes. Antibiotics are not indicated empirically unless infection develops later. Persisted ACIDEMIA in burn victims may reflect... Correct ans - Cyanide poisoning. (Cyanide is a naturally occurring toxin that may be inhaled in a confined space fire). Hypothermia Severe hypothermia Correct ans- Core temperature of 36 degrees centigrade Temperature below 32 degrees centigrade Definition of frostbite. Correct ans - Freezing of tissue with intracellular ice crystal formation, microvascular occlusion, subsequent tissue anoxia. First degree frostbite Correct ans- Hyperemia and edema without skin necrosis Second-degree frostbite Correct ans- Large clear vesicle formation accompanies hyperemia and edema with partial thickness skin necrosis 3rd degree frostbite Correct ans- Full thickness and subcutaneous necrosis occurs, commonly with hemorrhage and vesicle formation. Although a compartment pressure > systolic blood pressure is required to lose a pulse distal to in extremity burn, a pressure of what was in the compartment may lead to muscle necrosis Correct ans - 30 mm Hg. If a pressure of greater than 30 mm Hg in a burned extremity is present, eschatotomy is indicated. Difference between fasciotomy and eschatotomy Correct ans - Compartment syndrome is also present with circumferential chest and abdominal burns, which lead to increased peak
inspiratory pressures. Eschatotomy in circumferential chest and abdominal burns. Correct ans
- We are generally not needed before the first 6 hours after a burn.
Fundal height in pregnancy Correct ans - The amniotic fluid may cause amniotic fluid EMBOLISM and DIC following trauma if the fluid gains access to maternal intravascular space. Physiologic changes in pregnancy Correct ans - 1.Physiologic changes in pregnancysmall increase in rent till volume resulting in a decrease in hematocrit. 2.Elevation and WBC as high as 25,000. 3.Mild elevation in clotting factors. Bleeding and clotting times are unchanged, however.
- Arterial pH 7.40-7.
- PaCO2: 25-30mmHg
- Bicarbonate space 17-22 (Compensatory metabolic Acidosis). A resting PaCO2 of 35 to 40 mm in the setting of pregnancy Correct ans
- may represent impending respiratory failure. Normal PaCO2 for a pregnant woman is between 25 to 30 mmHg Kleinhauer-Betke test Correct ans - Maternal blood smear test which allows detection of fetal RBCs in the maternal circulation, indicates fetomaternal hemorrhage. Indication for Rh immunoglobulin therapy. Drugs to avoid in hypovolemia, head injured and intoxicated patients. Correct ans - Benzodiazepines, fentanyl propofol, ketamine Initial Assessment components of seriously injured patient Correct ans
Primary survey Correct ans - 1. Airway maintenance with cervical spine protection
- Breathing and ventilation
- Circulation & hemorrhage control
- Disability: neurological status
- Environment/
Exposure: completely undress the patient but prevent hypothermia
injury Soft tissue neck injury
Ejection from automobile Correct ans - Ejection from the vehicle precludes meaningful prediction of injury patterns. Patient at greater risk from virtually all injury mechanisms. Motor vehicle impact with pedestrian. Correct ans - Head injury Traumatic aortic disruption Blunt force to the neck or Traction injury from a shoulder harness restraint Correct ans - Can cause carotid disruption dissection or thrombosis. Symptoms may develop late Auscultation of chest Correct ans - Auscultate high on the anterior chest for PNEUMOTHORAX and at the posterior basis for detection of HEMOTHORAX Distended neck veins Correct ans - Seen in Cardiac Tampanode or Tension Pneumothorax. Abdominal injury Patients with unexplained hypotension, neurological injury, impaired sensorium secondary to alcohol and/or other drugs, and equivocal or normal findings Correct ans - Should be considered candidates for DPL, or FAST. If hemodynamically stable, CT scan of the abdomen Any increase in intracranial pressure can REDUCE cerebral perfusion pressure, and lead to secondary brain injury. Correct ans - Complete cervical cord transection which SPARES the phrenic nerve, C3 and C4, results in... Correct ans - Results in quadriplegia and ABDOMINAL breathing but paralysis of the intercostal muscles. Assisted ventilation may be required. Size of plastic cannula for cricothyroidotomy for jet insufflation Correct ans - 12 to 14 gauge; 8.5 cm length LMA sizes Correct ans - 3 for small female 4 for large female 5 for large male RANGES FROM 1 FOR NEONATE 5 FOR ADULTS Consider Use when you cannot extend the neck (c-collar in place)
of body weight.
Blood loss associated with a fractured tibia or humerus Correct ans
- 750 milliliters of blood Blood loss associated with a femur fracture Correct ans - Up to 1500 milliliters of blood Blood loss associated with pelvic fractures Correct ans - 2 liters or more. Initial warmed IV fluid bolus for shock. Correct ans - 1- 2 liters normal saline or LR for adults, and 20 ml/kilogram for pediatric patients. Normal urinary output for adult Correct ans - 0.5 milliliters per kilogram per hour Normal urinary output for children greater than 1 year of age Correct ans - 1 milliliter per kilogram per hour Normal urine output for child less than 1 year of ageCorrect ans - 2 milliliters per kilogram per hour Responses to initial fluid resuscitation in shock Correct ans - What needs to happen when there is failure to respond to crystalloid and blood administration in the emergency room in the setting of a motor vehicle accident or trauma resulting in shock. Correct ans - Depends, but some intervention such as operation or angioembolization to control exsanguinate hemorrhage Three other causes of failure to respond to IV fluids that are not HEMORRHAGIC in origin. Correct ans - =Tension pneumothorax, =Bunt cardiac injury, =Pericardial tamponade Type-specific blood Correct ans - Indicated in the setting of TRANSIENT responders. Blood to be transfused for minimal or no response trauma patients after crystalloid fluid resuscitation. Correct ans - Typed only packed red blood cells. Rh neg (O negative) preferred for females of childbearing age. Definition of massive transfusion of pack RBC: Correct ans - Greater than 10 units attack with blood cells in the first 24 hours of
Preferred temperature of packed red blood cells or peritoneal or thoracic cavity crystalloid solutions for hypothermia Correct ans - 39 degrees centigrade Most common cause of poor response to IV fluids in the setting of shock. Correct ans - Undiagnosed source of bleeding. Central venous pressure Correct ans - Reflects right heart function. May not represent left heart function in patients with primary myocardial dysfunction or abnormal pulmonary circulation. Conditions to consider if a patient does not respond to fluid therapy Correct ans - Unrecognized fluid loss, Ventilatory problems Tension pneumothorax Cardiac tamponade Hypoadrenalism Neurogenic shock Massive hemothorax findings on physical exam Correct ans - Tracheal deviation FLAT neck veins (due to heavy blood loss) Percussion dullness Absent breath sounds Distended neck veins are seen in what two conditions Correct ans
- Cardiac tamponade Tension pneumothorax Conditions to consider in transient responders in the setting of shock. Correct ans - 1. Hemorrhagic: Bleeding within the abdomen, pelvis, retroperitoneum, extremity fracture, or obvious external bleeding.
- Nonhemorrhagic: Tension pneumothorax or cardiac tamponade NONresponder to IV fluids. Diagnostic consideration Correct ans
- Blunt cardiac injury. Intraosseous needle size. Correct ans - 18 gauge spinal needle
with stylet. Physical signs suggesting a pelvic fracture on physical exam Correct ans
ml of fluid is immediately evacuated.
Less than 1500 milliliters of fluid evacuated but continued blood loss of 200 milliliters per hour for 2 to 4 hours Beck's triad in cardiac tamponade Correct ans - Venous pressure elevation, decline in arterial pressure, muffled heart tones. Kussmal's sign Correct ans - Paradoxical RISE in central venous pressure with inspiration. Seen in cardiac tamponade. Resuscitative thoracotomy Correct ans - Patients with PENETRATING injuries to the chest, pulseless, but with myocardial electrical activity may be candidates. Patients with BLUNT injuries to the chest, arrive pulseless but with myocardial electrical activity are NOT candidates. SIMPLE hemothorax Correct ans - Less than 1500 milliliters of blood. Most common cause is laceration of an intercostal vessel or internal mammary artery or lung laceration due to penetrating or blunt trauma. Typical presentation of tracheobronchial tree injuryCorrect ans - Hemoptysis, subcutaneous emphysema, tension pneumothorax; incomplete expansion of the lung after placement of a chest tube also suggests tracheobronchial tree injury. Confirmed by bronchoscopy. Treatment of tracheobronchial tree injury Correct ans - Surgical. Most common findings in blunt cardiac injury Correct ans - Multiple PVCs, unexplained sinus tachycardia, atrial fibrillation, bundle branch block, ST segment changes. Ligamentum arteriosum Correct ans - Site of incomplete laceration in traumatic aortic disruption Radiologic signs on chest x-ray in traumatic aortic rupture that indicate the likelihood of major vascular injury Correct ans - Widened mediastinum Obliteration of aortic knob. Deviation of trachea to the RIGHT Depression of left main stem bronchus Obliteration of space between the pulmonary artery and the aorta. Deviation of esophagus to the right Widened paratracheal stripe Presence of a plural or apical
