SUMMARY ATLS EXAMINATION ATLS Chapters 1-3

Question Patients with a GSC of less than ___ usually require intubation. The "A" in ABCD stands for _______. (ou should assume that any )atient in a multisystem trauma with an altered le*el of ons iousness or blunt in+ury abo*e the la*i le has what ty)e of in+ury, -lail hest is in*ariably a om)anied by ______ whi h an interfere with blood o.y/enation. 2y)otension is aused by _____ until )ro*en otherwise. 3hen you don4t ha*e5 an4t /et a blood )ressure6 what are three thin/s to loo7 for when e*aluatin/ )erfusion. !lderly )atients ha*e a limited ability to ______ to om)ensate for blood loss. "esus itation fluids should be warmed <= de/rees Celsius 98>;.; -:. Can you use a mi rowa*e to do this, ?rinary atheters are /ood for assessin/ renal )erfusion and *olume status. %ist @ si/ns of urethral in+ury that mi/ht )re*ent you from insertin/ one. 3hi h arm should you &'T )ut a )ulse0o. on, &ame two anatomi al thin/s that an interfere with doin/ a -AST s an. 3hen should radio/ra)hs be obtained, 2ow do you /et an am)le )atient history, Answer 8 Airway maintenan e with C!"#$CA% SP$&! P"'T!CT$'& Cer*i al s)ine in+ury )ulmonary ontusion 0 do &'T o*er fluid resus itate these )atients1 hy)o*olemia 8. %e*el of ons iousness 9brain )erfusion:6 ;. S7in olor 9ashen fa e5/rey e.tremities: <. Pulse 9bilateral femoral 0 thready5ta hy: in rease heart rate (!S 0 for C"(STA%%'$D '&%( 9but &'T for blood )rodu ts:. Blood at urethral meatus6 )erineal e hymosis6 blood in s rotum6 hi/h0 ridin/5non0)al)able )rostate6 )el*i fra ture The arm with a blood )ressure uff on it 'besity A intraluminal bowel /as Durin/ the S!C'&DA"( sur*ey. ABAller/ies6 CBCedi ations6 PBPC25Pre/nan y6 %B%ast meal6 !B!*ents5!n*ironment of in+ury

3hy mi/ht you want a Bair 2u//er for a )atient #asodilation an lead to hy)othermia who smells of al ohol, 3hat thin/s are you loo7in/ for when you do a Blood6 hi/h0ridin/ )rostate 9in males:6 and D"! in a trauma, s)hin ter tone 3hat should you do for e*ery female )atient, Adult )atients should maintain ?'P of at least Pre/nan y test 9females of hildbearin/ a/e: Adults >.@ m%57/5hr6 Dids 8.> ml57/5hr

___ m%57/5hr. Dids should ha*e at least ___ m%57/5hr. Pre*entin/ hy)er arbia is riti al in )atients who head ha*e sustained a _____ in+ury. 3hat two )la es would you %''D at a )atient if %i)s and fin/ernail beds you sus)e t hy)o.emia, Patients may be abusi*e and belli/erent be ause of _____6 so don4t +ust assume it4s due to dru/s6 hy)o.ia al ohol6 or the fa t that they are +ust inherently a +er7. (es6 if the )hreni ner*es 9C<0C@: are Can a )atient breathe on their own after om)lete s)ared. This will result in "abdominal" er*i al ord transe tion, breathin/. The inter ostal mus les will be )aralyEed thou/h. Can you use an 'PA 9Guedel: in a ons ious &o6 it ould ma7e them *omit. An &PA )atient, 9trum)et: would be o7ay. (ou an feel the " li 7s" as the distal ti) Bou/ies are ty)i ally inserted blindly6 how do rubs a/ainst the artila/inous tra heal rin/s6 you 7now you are in the tra hea and not the or it will de*iate ri/ht or left when enterin/ eso)ha/us, either bron hus 9usually at @> m:. 3hat do you &'T want to hear if you as ultate a Borbory/mi 0 rumblin/ or /ur/lin/ noises )atient after )la ement of an !T tube, su//estin/ eso)ha/eal insertion. 3hat is the "S$ dose for etomidate, >.< m/57/ 9usually ;> m/: 3hat is the "S$ dose for su., 80; m/57/ 9usually 8>> m/: $t doesn4t 0 at least it S2'?%D&4T ha*e any si/nifi ant effe t on BP. Detamine will 2ow does etomidate affe t blood )ressure, in rease BP6 and )ro)ofol and thio)ental will both dro) BP. A "S$ dose of su. usually lasts about ___ @ minutes. S?F 0 )atients with se*ere burns6 rush 3hat hy)noti 5sedati*e5indu tion a/ent do you in+uries6 hy)er7alemia6 or hroni &'T want to use for a se*erely burned )atient, )aralyti 5neuromus ular diseases should &'T /et su. be ause of hy)er7alemia ris7. '.y/en should flow at 8@% for needle ri othyroidotomy6 and ha*e a (0 onne tor for Adults 8;08G /au/e6 7ids 8H088 /au/e insufflation if )ossible. 3hat siEe needle do you use for adults, Dids, Cri oid artila/e is the only ir umferential su))ort for the u))er tra hea in 7ids6 therefore 8; sur/i al ri othyroidotomy is not re ommended in 7ids under the a/e of ___. $n a "normal" )atient without si/nifi ant hest wall in+ury or lun/ disease6 needle <>0G@ ri othyroidotomy an )ro*ide adequate o.y/enation for a))ro.imately ____ minutes. -or a )atient with diffi ulty breathin/6 what Chin0lift6 +aw0thrust 9&'T head0tilt while thin/s mi/ht you try before you )ro*ide a maintainin/ 0s)ine )re autions:6 'PA

9/uedel:6 &PA 9trum)et:6 %CA6 Combitube6 !T tube I50 bou/ie A orre tly siEed 'PA will e.tend from the 2ow do you 7now if an 'PA5Guedel is the orner of the )atient4s mouth to the e.ternal orre t siEe for the )atient, auditory anal. 3hat should do with the balloon on an !T $nflate it to ma7e sure it doesn4t lea7 0 then tube5%CA5foley before you insert it, deflate and insert. DidJ <6 3oman5small manJ G6 %ar/e 3hat siEe %CA do you use for 7id6 woman5small woman5manJ @ 9C<6G6@ 7ee) the dia)hra/m man6 lar/e woman5man, ali*e: The same siEe as the infant4s nostril or little The )ro)er siEe !T tube for an infant is ______. fin/er. 9?sually siEe < for neonates6 <.@ for infants: 3hat siEe uffed endotra heal tube do you use @ or H for an emer/en y ri othyroidotomy, ?se siEe < !T tubes for neonates6 <.@ for infants >0H months6 and siEe G for infants H08; months. A/e5G I G mm B internal diameter 2ow do you al ulate what siEe !T tube to use for toddlers and 7ids, Sho 7 is defined as an abnormality of the ir ulatory system that results in inadequate &euro/eni 6 ardio/eni 6 hy)o*olemi 6 or/an )erfusion and tissue o.y/enation. 3hat are se)ti the G different ty)es, The most ommon ause of sho 7 in the in+ured hemorrha/e trauma )atient is _____. A))ro.imately ___K of the body4s total blood L> *olume is lo ated in the *enous ir uit. Anaerobi metabolism 00M an4t ma7e more ATP 00M !ndo)lasmi then mito hondrial 3hy does sho 7 a tually redu e the total *olume dama/e 00M lysosomes ru)ture 00M sodium of ir ulatin/ blood, and 3AT!" enter the ell6 whi h S3!%%S and dies. &!#!" use )ressors for hy)o*olemi 3hi h *aso)ressors should you use to treat sho 7 0 use #'%?C! re)la ement. hemorrha/i sho 7, 3hat are the dru/ doses, Pressors will worsen tissue )erfusion in hemorrha/i sho 7. Com)ensatory me hanisms may )re lude a measurable fall in systoli blood )ressure until u) <> to __K of the )atient4s blood *olume is lost. Any )atient who is ool and is ta hy ardi is in sho 7 onsidered to be ______ until )ro*en otherwise. The definition of ta hy ardia de)ends on the )atient4s a/e. 3hat heart rate is onsidered $nfants M8H>6 toddlers5)res hoolers M8G>6 ta hy ardi for infants6 toddlers5)res hoolers6 s hool a/e5)rebus ent M8;>6 adults M8>> s hool a/e5)rebus ent6 and adults, !lderly )atients may not e.hibit ta hy ardia in They mi/ht be on a beta0blo 7er or ha*e a res)onse to hy)o*olemia be ause of limited )a ema7er. ardia res)onse to ate holamines. 3hy else sur/i al airway,

mi/ht not they /et ta hy, A -AST s an is an e. ellent way to dia/nose ardia tam)onade. 3hat si/ns su//est tam)onade, Patients with a tension )neumo and )atients with ardia tam)onade may )resent with many of the same si/ns. 3hat findin/s will you see with a tension )neumo that you will &'T see with tam)onade, $mmediate thora i de om)ression is warranted for anyone with absent breath sounds6 hy)erresonan e to )er ussion6 tra heal de*iation6 ____6 and ____. Can isolated intra ranial in+uries ause neuro/eni sho 7, 2ow do you al ulate total blood *olume in an adult,

Be 7s4s TriadJ N#D6 muffled heart sounds6 and hy)otension 9will be resistant to fluid thera)y:. 3ill also li7ely be ta hy ardi . Absent breath sounds and hy)erresonan e to )er ussion o*er the affe ted hemithora..

A ute res)iratory distress A sub utaneous em)hysema &' L> m% )er 7/ body wei/ht. A L> 7/ )erson has about @ liters of ir ulatin/ blood. 9L>OL>BG=>>:

2ow do you al ulate total blood *olume in an Body wei/ht in 7/ . 8>0=> m% hild, The blood *olume of an obese )erson is ideal al ulated based u)on their ______ wei/ht. -luid re)la ement should be /uided by ________6 not sim)ly by the initial lassifi ation The )atient4s res)onse to initial re)la ment 9Class $0$#:. ?) to 8@K Donatin/ 8 )int6 or P@>> m% of 2ow mu h blood *olume is lost with Class $ blood is about a 8>K *olume loss and 2emorrha/e, would qualify as Class $ 2emorrha/e1 (ou don4t 9usually:. Trans a)illary refill and other om)ensatory me hanisms 2ow do you treat a Class $ 2emorrha/e, usually restore blood *olume within ;G hours. 2ow mu h blood *olume is lost with Class $$ 8@0<>K 9L@>08@>> m% in a L> 7/ adult: 2emorrha/e, 2ow do you treat a Class $$ 2emorrha/e, ?sually +ust rystalloid resus itation Subtle C&S han/es su h as an.iety6 fri/ht6 and hostility would be e.)e ted in a )atient with a $$ Class __ 2emorrha/e. 2ow mu h blood *olume is lost with Class $$$ <>0G>K 9;>>> m% in a L> 7/ adult: 2emorrha/e, A )atient with inadequate )erfusion6 mar7ed $$$ or $# 0 These )atients almost always ta hy ardia and ta hy)nea6 si/nifi ant mental require a blood transfusion6 whi h de)ends status han/e6 and a measurable fall in systoli on their res)onse to initial fluid blood )ressure li7ely has a Class ___ resus itation. The first )riority is sto))in/ 2emorrha/e. the hemorrha/e. %oss of more than ___K of blood *olume results @> in loss of ons iousness. 2ow mu h blood *olume is lost with Class $# Core than G>K. ?nless *ery a//ressi*e

2emorrha/e,

measures are ta7en the )atient will die within minutes.

A Class ___ 2emorrha/e re)resents the smallest *olume of blood loss that is onsistently $$$ asso iated wiht a dro) in systoli blood )ressure. ?) to ______ m% of blood loss is ommonly 8@>> asso iated with femur fra tures. ?ne.)lained hy)otension or ardia dysrhythmias 9usually brady ardia from /astri distention e. essi*e *a/al stimulation: are often aused by ______6 es)e ially in hildren. AdultsJ ; liters6 DidsJ ;> m%57/ 9may re)eat and /i*e as mu h as H> m%57/ but 2ow mu h rystalloid should you /i*e an adult with hi/h reser*e in 7ids6 if they4re in sho 7 for an initial fluid resus itation bolus, -or 7ids, they should /et blood sooner rather than later. !a h m% of blood loss whould be re)la ed with ___ m% of rystalloid6 thus allowin/ for < re)la ement of )lasma *olume lost into interstitial and intra ellular s)a es. Blood on the floor . four more is a mnemoni for Chest6 )el*is6 retro)eritoneum6 and thi/h o ult blood loss where, -or hildren ?&D!" 8 year of a/e6 ?'P should ; be ___ m%57/5hr. Al7aloti 0 res)iratory al7alosis from 3ould )atients in !A"%( hy)o*olemi sho 7 be ta hy)nea....followed later by mild a idodi or al7aloti , metaboli a idosis in the early )hase of sho 7. ""a)id res)onders" whose *ital si/ns return to normal 9and stay there: after fluid resus itation $ or $$ li7ely ha*e5had a Class ___ 2emorrha/e. "Transient res)onders" are asso iated with Class $$ or $$$ ___ 2emorrha/e. &'&02!C'""2AG$C auses6 e./. 3hat differential dia/noses should you always tension )neumothora.6 tam)onade6 blunt onsider for "non0res)onders" followin/ fluid ardia in+ury6 C$6 a ute /astri distention6 resus itation, neuro/eni sho 7... Cost )atients re ei*in/ blood transfusions ____ don4t need al ium re)la ement.

ATLS Chapters -!
Question Answer 2ow should you )osition the )atient before S?P$&!6 head down 8@ de/rees to distend ne 7

*eins and )re*ent embolism6 only turn head away if C0SP$&! 2AS B!!& C%!A"!D -$"ST. $ntraosseous infusion should be limited to emer/en y resus itation and shoudl be 2ow lon/ an you 7ee) an $' line in, dis ontinued as soon as other *enous a ess is obtained. The sa)henous *ein an be a essed 3here do you want to ma7e an in ision for a))ro.imately 8 m anterior and 8 m su)erior a sa)henous *ein utdown and how lon/ to the medial malleolus. Ca7e a ;.@ m should your in ision be, trans*erse in ision throu/h the s7in and SQ tissue6 areful not to in+ure the *essel. A )atient arri*es to the trauma bay intubated This may &'T be a )neumothora.6 for intubated and there are absent breath sounds o*er the )atients always sus)e t a ri/ht main0stem before left hemithora.6 where should you )la e attem)tin/ needle de om)ression. your de om)ression needle, 3here would you insert a lar/e aliber $nto the ;nd inter ostal s)a e in the needle to de om)ress a tension mid la*i ular line of the affe ted hemithora.. )nuemothora., -or an o)en )neumothora.6 9su 7in/ hest wound: air )asses )referentially throu/h the hest wall defe t 9least resistan e: if the ;5< diameter of the defe t is at least ___ the diameter of the tra hea. -lail hest results from multi)le rib fra tures 0 by definition this would be ___ or more ; or more ribs fra tured in ; or more )la es ribs6 fra tured in ___ or more )la es. Both tension )neumothora. and massi*e hemothora. are asso iated with de reased Per ussion 0 hy)erresonant with )nuemo6 dull breath sounds on aus ultation6 so you an with hemothora.. tell whi h it is by _______. $f a )atient doesn4t ha*e N#D6 does this &o6 they mi/ht ha*e a massi*e internal mean they don4t ha*e a tension )neumo or hemorrha/e and be hy)o*olemi . tam)onade, 8@>> m% or 85< or more of the )atient4s total By definition6 how mu h blood is in the blood *olume. 9Some also define it as ontinued hest a*ity to all it a "massi*e blood loss of ;>> m%5hr for ;0G hours0 but hemothora.", AT%S does &'T use this rate for any mandatory treatment de isions:. 3hat siEe hest tube mi/ht you use to R<8 -ren h 0 inserted at the Gth or @th inter ostal e*a uate a massi*e hemothora., s)a e6 +ust anterior to the mida.illary line. A rise in *enous )ressure with ins)iration while breathin/ s)ontaneously6 and is a true 3hat is Dussmaul4s si/n, )arado.i al *enous )ressure abnormality asso iated with ardia tam)onade. 2ow well do CP" om)ressions wor7 on "Closed heart massa/e for ardia arrest or P!A someone with a )enetratin/ hest in+ury and is $&!--!CT$#! in )atients with hy)o*olemia, hy)o*olemia." Patients with P!&!T"AT$&G thora i in+uries who arri*e )ulseless6 but with )la in/ a sub la*ian or $N line,

myo ardial ele trial a ti*ity6 may be andidates for an !D thoa otomy. Are )atients with P!A who ha*e sustained &' 0 'nly P!A with P!&!T"AT$&G thora i blunt thora i in+uries andidates for an !D in+uries should /et an !D thora otomy. thora otomy, !*a uate )eri ardial blood6 dire ly ontrol hemorrha/e6 ardia massa/e6 ross0 lam) the An !D thora otomy an allow you to do des endin/ aorta to slow blood loss below the what, dia)hra/m and in rease )erfusion to the heart and brain. -or a )atient with a traumati sim)le )neumothora.6 what should you do C2!ST T?B! 0 )ositi*e )ressure *entilation B!-'"! you start )ositi*e )ressure an turn a sim)le )neumo into a tension )neumo6 *entilation or ta7e them to sur/ery for a so )ut in a hest tube first. GA, (!S 0 A sim)le hemothora.6 if not fully Should you e*a uate a sim)le hemothora. if e*a uated6 may result in a retained6 lotted it is not ausin/ any res)iratory )roblems, hemothroa. with lun/ entra)ment or6 if infe ted6 de*elo) into an em)yema. A )neumothora. asso iated with a )ersistent tra heobron hial 0 ?se bron hos o)y to onfirm6 lar/e air lea7 after tube thora ostomy you may need more than one hest tube before su//ests a _______ in+ury. definiti*e o)erati*e mana/ement. 3idened mediastinum6 obliteration of aorti 7nob6 de*iation of tra hea to the ri/ht6 3hat radio/ra)hi findin/s are su//esti*e de)ression of left mainstem bron hus6 de*iation of traumati aorti disru)tion, of eso)ha/us 9&G tube: to ri/ht6 widened )aratra heal stri)e6 f.4d 8st5;nd ribs or s a)ula. A de eleration in+ury *i tim with a left an !S'P2AG!A% "?PT?"! 0 a for eful blow )nuemothora. or hemothora. without rib auses e.)ulsion of /astri ontents into the fra tures6 is in )ain or sho 7 out of eso)ha/us6 )rodu in/ a linear tear in the lower )ro)ortion to the a))arent in+ury6 and has eso)ha/us allowin/ lea7a/e into the )arti ulate matter in their hest tube may mediastinum. ha*e _________. -ra tures for the lower ribs 98>08;: should he)atos)leni in rease sus)i ion for _____ in+ury. 3hy are u))er torso6 fa ial6 and arm Tem)orary om)ression of the su)erior *ena )lethora with )ete hiae asso iated with a*a. rush in+uries to the hest, Tra hea A bron hi6 )leural s)a es and 2ow does AT%S su//est you should re*iew )aren hyma6 mediastinum6 dia)hra/m6 bones6 a hest radio/ra)h, soft tissues6 tubes A lines. Pun ture the s7in 80; m inferior to the left (ou should use a siEe 8H or 88 /au/e H" .i)hohondral +un tion at a G@ de/ree an/le to the needle for )eri ardio entesis. 2ow do you s7in towards the heart6 aimin/ toward the to) of insert it, the left s a)ula. 3hat4s a /ood way to 7now if you4*e !CG Chan/es 0 e.treme ST0 han/es6 widened ad*an ed your needle too far durin/ Q"S6 P#Cs6 et ... 3ithdrawl needle until !CG )eri ardio entesis and ha*e entered returns to baseline. *entri ular mus le,

%o 7 the sto) o 7 and lea*e the atheter in )la e 3hat should you do with your needle after in ase it needs to be ree*a uated. $f )ossible6 you su essfully e*a uate blood durin/ use the Seldin/er te hnique to )ass a 8G /au/e )eri ardio entesis, fle.ible atheter o*er the /uidewire. This is &'T a definiti*e treatment. -or )atients with fa ial fra tures or basillar s7ull fra tures6 /astri tubes should be throu/h the mouth inserted ____ before doin/ a DP%. inability to *oid6 unstable )el*i fra ture6 blood (ou need to do retro/rade urethro/ra)hy at urethral meatus6 s rotal hematoma6 )erineal P"$'" to foley )la ement if _____. e hymoses6 or hi/h0ridin/ )rostate. DP% is onsidered to be __K sensiti*e for =8 dete tin/ intra)eritoneal bleedin/. 3hat are the four )la es you should loo7 Cediastinum6 he)atorenal fossa6 s)lenorenal first when doin/ a -AST s an, fossa6 )ou h of Dou/las. Chan/e in sensorium 9brain in+ury5!t'2 or dru/ into.i ation:6 han/e in sensation 9s)inal ord DP% is indi ated when a )atient with in+ury:6 in+ury to ad+a ent stru tures 9)el*is6 multi)le blunt in+uries is hemodynami ally lumbar s)ine:6 la)0belt si/n 9from seatbelt:6 or if unstable6 es)e ially when they ha*e _____. )atient is /oin/ for lon/ studies 9CT6 ortho sur/ery...:. 3hat is the only ABS'%?T! An e.istin/ indi ation for la)arotomy. ontraindi ation to DP%, Corbid obesity6 ad*an ed irrhosis6 )ree.istin/ 3hat are some "!%AT$#! oa/ulo)athy6 and )re*ious abdominal ontraindi ations to DP%, o)erations 9adhesions:. P!%#$C -"ACT?"!S 9don4t want to enter 3hen should you use an o)en )el*i hematoma: and AD#A&C!D S?P"A?CB$%$CA% a))roa h for a DP%, P"!G&A&C( 9don4t want to dama/e enlar/ed uterus:. 3hen doin/ a DP%6 what $&$T$A% findin/s -ree blood 9M8> m%: or G$ ontents 9*e/etable 9not from lab: would mandate a la)arotomy, fiber6 bile:. $f you don4t /et /ross blood u)on initial DP% Adult 0 86>>> m% warm isotoni rystalloid. Did as)iration6 what do you do ne.t for an adult, 0 8> m%57/ -or a hild, (ou4*e +ust )ut a bun h of fluid in the belly and as)irated more fluid for your DP%. &o M8>>6>>> red ells5mmS<6 @>> white /ross G$ ontents or anythin/ alarmin/ are ells5mmS<6 or BACT!"$A 9on /ram stain:. )resent6 what Q?A&TAT$#! thin/s would ma7e the DP% )ositi*e, (our trauma )atient needs an ur/ent &o6 if they need an emer/ent la)arotomy they la)arotomy6 an you ta7e them to the CT are unstable 0 unstable )atients should &'T /o s anner first to e*aluate in+uries, to the CT s anner1 3hat are some indi ations for la)arotomy in ?nstable6 GS36 )eritoneal irritation6 fas ial )atients with )enetratin/ abdominal )enetration wounds, 3hat )er enta/e of stab wounds to the ;@0<<K anterior abdomen do &'T )enetrate the

)eritoneum, Does an early normal serum amylase le*el e. lude ma+or )an reati trauma, Do you need to o)erate on anyone with an isolated soild or/an in+ury,

&' &o 0 not if they remain hemodynami ally stable 9'f all )atients who are initially thou/ht to ha*ea $S'%AT!D solid or/an in+ury6 T@K will ha*e hollow *is us in+ury as well:.

3hi h is %!SS li7ely to ha*e a life0 Closed boo7 0 the )el*i *olume is om)ressed6 threatin/ hemorrha/e 0 an o)en boo7 or so not as mu h room for blood. losed boo7 )el*i fra ture, Anterior5)osterior for es auses _____ boo7 )el*i fra tures6 and lateral for es ause AP B ')en Boo76 %AT!"A% B Closed Boo7 _____ boo7 fra tures. 3hi h are more ommon6 o)en or losed C%'S!D B''D 0 H>0L>K 9')en boo7 8@0;>K6 boo7 )el*i fra turs, *erti al shear @08@K: $f a )atient with a )el*i fra ture is )ositi*e for intra)eritoneal /ross blood6 a e.0la) is warranted. 3hat is your ne.t mo*e if that An/io/ra)hy same )atient is &!GAT$#! for /ross intra)eritoneal blood, 3hat do you need to do B!-'"! you do a D!C'CP"!SS B%ADD!"6 D!C'CP"!SS DP%, 9'ther than /ettin/ stuff to/ether and ST'CAC2 sur/i ally )re))in/6 et ...: 3hat is "adequate" fluid return when /ettin/ <>K DP% fluid ba 7, A blown )u)il in a )atient with a traumati Su)erfi ial )arasym)atheti fibers of the C& $$$ in+ury is aused by om)ression of whi h 9o ulomotor:. ner*e, 8>mm 2/ 9Pressures M;>6 )arti ularly if 3hat is a "normal" $CP in the restin/ state, sustained6 are asso iated with )oor out omes:. The Conro0Dellie Do trine des ribes #enous Blood A CS- 9de reased in equal om)ensatory me hanisms inside the *olumes6 when this is e.hausted6 herniation an al*arium to stabiliEe )ressure 0 what are the o ur and brain )erfusion will li7ely be ; main5first ones, inadequate:. Patients with a GCS of <08 meet the a e)ted definition of " oma" or "se*ere Cinor B 8<08@6 Coderate B 808; brain in+ury." 3hat are the GCS s ores for "minor" and "moderate" brain in+ury, 3hen al ulatin/ GCS and there is ri/ht5left The "B!ST" res)onse. 9Better )redi tor than assymetry in the motor res)onse 0 whi h one worst res)onse: do you use, P!"$'"B$TA% !CC2(C'S$S 9ra oon eyes:6 3hat si/ns mi/ht you see if a )atient has a "!T"'A?"$C?%A" !CC2(C'S$S 9Battle basillar s7ull fra ture, si/n:6 and otorrhea5rhinorrhea. 3hat do you need to 7now about the GCS, !#!"(T2$&G 0 Dnow it C'%D1 3hat thin/s mi/ht require a )erson with Abnormal CT 9or no s an a*ailable:6 )enetratin/ C$&'" brain in+ury /et admitted, head in+ury6 )rolon/ed %'C6 worsenin/ %'C6 moderate to se*ere 2A6 si/nifi ant dru/5al ohol

into.i ation6 s7ull f.6 oto5rhinorrhea6 nobody at home to wat h6 GCS stays T8@6 fo al neuro defi its. 3hat would you want to do if a )atient with a minor brain in+ury fails to rea h a GCS of 8@ within ; hour )ost in+ury6 had %'C M@ min6 are older than H@6 emesis . ;6 or had retro/rade amnesia M<> minutes, 3hat ; thin/s do you need to do first for e*eryone with a C'D!"AT! brain in+ury 9a ordin/ to AT%S al/orithm:, 2i/h le*els of C'; will ause erebral *as ulature to _____. CT s an 0 !*erythin/ but the <> min amnesia ma7es them 2$G2 ris7 for neurosur/i al inter*ention 9as would a basillar s7ull f.:. CT s an6 admit to fa iolity a)able of definiti*e neurosur/i al are 9Coderate B GCS =08;: Dilate 9to in rease blood flow: 0 so you mi/ht want to 2(P!"*entilate )eo)le with brain in+uries.

$deally6 you want to wait to )erform a GCS on a )erson with S!#!"! brain in+ury until BP is normaliEed what, A -AST s an6 DP%6 or e.0la) should ta7e 8>> $f a )atient has a systoli o*er 8>> with )riority o*er a CT s an if you an4t /et the e*iden e of intra ranial mass 9blown )u)il6 brain in+ured )atient4s BP u) to ____ mm unequal motor e.am: T2!& a CT would ta7e 2/. first )riority. A midline shift of /reater than ___ often indi ates the need for neurosur/i al @mm e*a uation of the mass5blood. (our )atient has a dilated )u)il and you want to /i*e mannitol on the way to the CT >.;@08.> /57/ *ia ra)id bolus s anner or '". 3hat is the orre t dose, A ast utter should be remo*ed to remo*e a the )atient e.)erien es )ain or )aresthesias trauma *i tim4s helmet if there is e*iden e durin/ an initial attem)t to remo*e the helmet. of a 0s)ine in+ury or if _____.

ATLS Chapters "-13

Question 3hat are the si/ns of neuro/eni sho 7, Answer #asodilation of lower e.tremity blood *essels U resultin/ in )oolin/ of blood and hy)otension. This loss of sym)atheti tone may ause brady ardia or inhibit the ta hy ardi res)onse to hy)o*olemia. Nudi ious use of )ressors and C'D!"AT! fluid resus itation. Too mu h fluid may result in o*erload and )ulmonary edema. Burst fra tures 9Nefferson fra ture:

2ow do you treat neuro/eni sho 7, 3hat is the most ommon ty)e of C8

fra ture, $Bti) of odontoid6 $$Bf. at base6 $$$Bbase of 3hatVs the differen e between ty)es $6 $$6 and odontoid and e.tends obliquely into body of $$$ odontoid )ro ess fra tures, a.is. 9'dontoid )ro ess B dens:. Cidline ne 7 )ain6 tenderness on )al)ation6 3hat are the indi ations for 0s)ine neurolo/i al defi its related to 0s)ine in+uries6 radio/ra)hs in a trauma )atient, 3hi h .0ray altered %'C or into.i ation. 8: %ateral6 ;: AP6 *iews should be obtained, <: ')en mouth odontoid *iew 3ith the )ro)er *iews of the 0s)ine6 and a qualified radiolo/ist U what is the sensiti*ity M=LK 9CT with <mm sli es M==K:. for findin/ unstable er*i al s)ine in+uries, Ten )er ent of all )atients with a 0s)ine A se ond6 non onti/uous *ertebral olumn fra ture ha*e what, fra ture. 9So s an the rest of their s)ine:. Attem)ts to ali/n the s)ine for the )ur)ose of immobiliEation on the ba 7board are not ause )ain re ommended if they _______. (es6 if they are awa7e6 alert6 sober6 neurolo/i al normal6 ha*e &' )ain6 and an Can you lear a 0s)ine without films, fle.6 e.tend6 and mo*e their head to both sides without )ain U you donVt need films. Should a quadri)le/i or )ara)le/i )atient &ot for more than ; hours U /et them off be )ut on a hard board, ASAP. 3hatVs a bi/ differen e in a )hysi al findin/ 2y)o*olemi B usually TAC2(6 &euro/eni B between hy)o*olemi and neuro/eni sho 7, usually B"AD( Partial or total loss of res)iratory fun tion may be seen in a )atient with a er*i al s)ine CH in+ury abo*e ___. 3hy mi/ht someone not be able to breathe if -at embolism U un ommon thou/h they ha*e a lon/ bone fra ture, Abnormal arterial blood flow is indi ated by T>.= an AB$ of ____. By %''D$&G at the )atient6 what findin/s %e/0len/th dis re)an y6 rotation 9usually mi/ht su//est )el*i in+ury, e.ternal: Crush in+uries may result in rhabdomyolysis #olume e.)ansion6 and al7aliEation of urine U asts blo 7 flow6 also iron is released whi h with bi arb will redu e intratubular forms "'S whi h then dama/e ells and )re i)itation of myo/lobin. ?'P should be 8>> im)air ability to re/ulate DI et W 3hat an m%5hr until myo/lobinuria is leared. you do to )re*ent this, Cus le does not tolerate la 7 of arterial flow 9tourniquet: for more than ___ hours before H ne rosis be/ins. 3ounds MH hours old6 wounds ontused or abraded6 M8 m dee)6 from hi/h *elo ity 3hat thin/s in rease the ris7 for tetanus, missiles6 due to burns or old6 and si/nifi antly ontaminated wounds. Should le/s be om)letely strai/ht when &o6 fle.ion of 8> de/rees re ommended to ta7e s)lintin/, )ressure off neuro*as ular stru tures. Any )atient with burns o*erin/ more than ;>

___K of BSA require fluid resus itation. The )almer surfa e of a )atientVs hand 8K re)resents a))ro.imately ___K of their BSA. A hi/h inde. of sus)i ion for inhalation in+ury must be maintained6 be ause )atients may not dis)lay lini al e*iden e for u) to ;G ___ hours6 by this time edema may )re*ent non0sur/i al intubation. Carbon mono.ide has ____ times the affinity ;G> for o.y/en as hemo/lobin. Patients with C' le*els less than ___K ;>K usually donVt ha*e any )hysi al sym)toms. Adult head BSA B ___K. = 9!&T$"! head front and ba 7 B =: Baby head BSA B __K 88 9= front6 = ba 7: !ntire head on baby is 886 whereas itVs = for 3hat is the main differen e between adult adults. This differen e of = is made u) by the and baby BSA determination for burns, fa t that ea h side 9front5ba 7: on adult B =6 but only L for 7ids. 9<H *s ;8:. Chest BSA B ___K. 88 Ba 7 BSA B ___K. 88 Arm BSA B ___K. = T'TA% 9front A&D ba 7:. %e/ BSA for adult B ___K. 88 T'TA% 9= front6 = ba 7:. Baby front or ba 7 of le/ BSA B___K. L 9T'TA% le/ B 8GK: $f you add u) BSA head6 hest6 ba 76 arms6 and le/s you /et ==K of BSA. 3hat is the Perineum remainin/ 8K, Partial5;nd de/ree burns e.tend into the Partial U /o into dermis6 -?%% /o all the way _____ whereas full thi 7ness5<rd de/ree throu/h dermis and into5beyond SQ tissue. burns ______. -or )atients with C' )oisonin/6 the X life is ___ when breathin/ room air and ___ G hours on "A6 G> min on 8>>K '; breathin/ 8>>K o.y/en G O wei/ht 97/: O )er ent BSA burned B *olume in ;G hours 98st half in 8 hrs6 ;nd half 2ow do you al ulate the Par7land formula, o*er 8H hrs:.GOL>7/O;@ )er ent B L liters in ;G hours. OOO?se ;@6 &'T >.;@:OOO Partial or full thi 7ness burns of ___K in )atients less than 8> or older than @> warrants 8>K transfer to a burn enter. 3hat )er ent )artial5full thi 7ness burns would qualify a ;@ year old for a burn enter ;>K transfer, 3hat anatomi al )ositions with )artial5full -a e6 eyes6 ears6 hands6 /enitalia6 )erineum6 thi 7ness burns warrant burn enter transfer, feet6 s7in o*erlyin/ +oints. Does an inhalation in+ury warrant transfer to (!S11111 a burn enter, Should you treat frostbite by soa7in/ body (!S6 G> de/ree 98>G-: for ;>0<> min should )art in water or not, suffi e. DonVt warm if there is ris7 of

"!-"!!Y$&G. $nsofar as hy)othermia is on erned6 )atients are not )ronoun ed dead until they are _____ warm and dead. CASS$#! for e and hi/hly li7ely or/an dama/e 9sin e their ribs are *ery )liable6 a hu/e 3hat are you thin7in/ if a hild has bro7en amount of for e is required to brea7 them6 there ribs, is often underlyin/ or/an dama/e 3$T2'?T bro7en ribs:. ?se ton/ue blade de)ressor and insert /ently without turnin/ U otherwise there is /reat ris7 2ow should you insert a Guedel in a 7id, for trauma and resultant hemorrha/e. &'T the 88> de/ree s)in tri 7. The normal systoli BP in 7ids an be => mm 2/ I 9a/e . ;: estimated by what, 2ow do you estimate a hildVs total 8> m%57/ ir ulatin/ *olume, ;> m%57/ warm rystalloid Cay need to re)eat 3hen sho 7 in a hild is sus)e ted6 how u) to < times 9H> m%57/: then onsider blood mu h fluid do you /i*e them, )rodu ts. ')timal ?'P for infants is ___ m%57/5hr. ; 98.@ for youn/er 7ids6 and 8.> for older 7ids:. 2ow mu h warmed rystalloid should be 8> m%57/ 9u) to 8>>> m%: used for a DP% in 7ids, 3hat would you see in an infant that would Bul/in/ fontanelles U these allow toleran e for ma7e you sus)e t *ery se*ere brain in+ury e.)andin/ masses5swellin/W des)ite normal %'C, Assumin/ that normal blood )ressure B normo*olemia. Cany /eriatri )atients ha*e 3hat is a )ossible mista7e about a blood un ontrolled hy)ertension6 and if their normal )ressure of 8;>58> in a 8L year old man, systoli is 88>6 then 8;>58> is relati*e 2(P'tension for them. 2ow well do /eriatri )atients do with non0 &ot as well U the ris7s of non0o)erati*e o)erati*e mana/ement of abdominal in+uries mana/ement are often worse than the ris7s of om)ared to youn/er )eo)le, sur/ery. 3hy would /eriatri )atients be C'"! Atro)hi brains B stret hin/ of the )arasa/ittal sus e)tible to head bleeds when there is brid/in/ *eins6 ma7in/ them more )rone to in reased s)a e around a shrin7in/ brain to ru)ture u)on im)a t. )rote t them from ontusion, Plasma *olume in reases durin/ )re/nan y6 De reases U dilution by )lasma 9<80<@K is what ha))ens to hemato rit, normal in )re/nan y: 3hat would you thin7 of a 3BC of 8@6>>> in &ormal6 it an /o u) to ;@6>>> durin/ labor1 a )re/nant woman, That it is always full. 9Gastri em)tyin/ time 3hat should you always assume about a in reases durin/ )re/nan y:. !arly &G tube )re/nant )atientVs stoma h, )la ement re ommended. $m)endin/ res)iratory failure. $t is usually A PaC'; of <@ to G> in a )re/nant )atient around <> due to hy)er*entilation due to may indi ate what, in reased le*els of )ro/esterone.

True or -alseJ All "h ne/ati*e )re/nant trauma )atients should /et "ho/am, 3hen worn orre tly6 seatbelts redu e fatalities by ___K.

True6 unless the in+ury is remote from the uterus 9distal e.tremity in+ury only:. This thera)y should be initiated within L; hours of in+ury. H@0L>K6 with a 8>0fold redu tion in serious in+ury.