ATLS Chapters 1-3

Question Answer
Patients with a GSC of less than ___
8
usually require intubation.
Airway maintenance with CERVICAL
The "A" in ABCD stands for _______.
SPINE PROTECTION
You should assume that any patient in a
multisystem trauma with an altered
level of consciousness or blunt injury Cervical spine injury
above the clavicle has what type of
injury?
Flail chest is invariably accompanied by
pulmonary contusion - do NOT over
______ which can interfere with blood
fluid resuscitate these patients!
oxygenation.
Hypotension is caused by _____ until
hypovolemia
proven otherwise.
1. Level of consciousness (brain
When you don't have/can't get a blood
perfusion), 2. Skin color (ashen
pressure, what are three things to look
face/grey extremities) 3. Pulse
for when evaluating perfusion.
(bilateral femoral - thready/tachy)
Elderly patients have a limited ability to
increase heart rate
______ to compensate for blood loss.
Resuscitation fluids should be warmed
YES - for CRYSTALLOID ONLY (but
39 degrees Celsius (102.2 F). Can you
NOT for blood products).
use a microwave to do this?
Urinary catheters are good for
Blood at urethral meatus, perineal
assessing renal perfusion and volume
ecchymosis, blood in scrotum,
status. List 5 signs of urethral injury
high-riding/non-palpable prostate,
that might prevent you from inserting
pelvic fracture
one.
Which arm should you NOT put a pulse- The arm with a blood pressure cuff
ox on? on it
Name two anatomical things that can
Obesity & intraluminal bowel gas
interfere with doing a FAST scan.
When should radiographs be obtained? During the SECONDARY survey.
How do you get an ample patient A=Allergies, M=Medications,
history? P=PMH/Pregnancy, L=Last meal,
 E=Events/Environment of injury
Why might you want a Bair Hugger for Vasodilation can lead to
a patient who smells of alcohol? hypothermia
What things are you looking for when Blood, high-riding prostate (in
you do a DRE in a trauma? males), and sphincter tone
What should you do for every female Pregnancy test (females of
patient? childbearing age)
Adult patients should maintain UOP of
Adults 0.5 mL/kg/hr, Kids 1.0
at least ___ mL/kg/hr. Kids should have
ml/kg/hr
at least ___ mL/kg/hr.
Preventing hypercarbia is critical in
patients who have sustained a _____ head
injury.
What two places would you LOOK at a
Lips and fingernail beds
patient if you suspect hypoxemia?
Patients may be abusive and belligerent
because of _____, so don't just assume
hypoxia
it's due to drugs, alcohol, or the fact
that they are just inherently a jerk.
Yes, if the phrenic nerves (C3-C5)
Can a patient breathe on their own are spared. This will result in
after complete cervical cord "abdominal" breathing. The
transection? intercostal muscles will be
paralyzed though.
Can you use an OPA (Guedel) in a No, it could make them vomit. An
conscious patient? NPA (trumpet) would be okay.
You can feel the "clicks" as the
distal tip rubs against the
Bougies are typically inserted blindly,
cartilaginous tracheal rings, or it
how do you know you are in the trachea
will deviate right or left when
and not the esophagus?
entering either bronchus (usually
at 50 cm).
What do you NOT want to hear if you Borborygmi - rumbling or gurgling
ascultate a patient after placement of noises suggesting esophageal
an ET tube? insertion.
What is the RSI dose for etomidate? 0.3 mg/kg (usually 20 mg)
What is the RSI dose for sux? 1-2 mg/kg (usually 100 mg)
How does etomidate affect blood It doesn't - at least it SHOULDN'T
pressure? have any significant effect on BP.
Ketamine will increase BP, and
 propofol and thiopental will both
drop BP.
A RSI dose of sux usually lasts about
5
___ minutes.
SUX - patients with severe burns,
What hypnotic/sedative/induction agent crush injuries, hyperkalemia, or
do you NOT want to use for a severely chronic paralytic/neuromuscular
burned patient? diseases should NOT get sux
because of hyperkalemia risk.
Oxygen should flow at 15L for needle
cricothyroidotomy, and have a Y-
Adults 12-14 gauge, kids 16-18
connector for insufflation if possible.
gauge
What size needle do you use for adults?
Kids?
Cricoid cartilage is the only
circumferential support for the upper
trachea in kids, therefore surgical 12
cricothyroidotomy is not recommended
in kids under the age of ___.
In a "normal" patient without significant
chest wall injury or lung disease, needle
cricothyroidotomy can provide 30-45
adequate oxygenation for
approximately ____ minutes.
Chin-lift, jaw-thrust (NOT head-tilt
For a patient with difficulty breathing, while maintaining c-spine
what things might you try before you precautions), OPA (guedel), NPA
provide a surgical airway? (trumpet), LMA, Combitube, ET
tube +/- bougie
A correctly sized OPA will extend
How do you know if an OPA/Guedel is from the corner of the patient's
the correct size for the patient? mouth to the external auditory
canal.
What should do with the balloon on an Inflate it to make sure it doesn't
ET tube/LMA/foley before you insert it? leak - then deflate and insert.
Kid: 3, Woman/small man: 4, Large
What size LMA do you use for kid,
woman/man: 5 (C3,4,5 keep the
woman/small man, large woman/man?
diaphragm alive)
The same size as the infant's
The proper size ET tube for an infant is
nostril or little finger. (Usually size
______.
3 for neonates, 3.5 for infants)
What size cuffed endotracheal tube do
you use for an emergency 5 or 6
cricothyroidotomy?
Use size 3 ET tubes for neonates, 3.5
for infants 0-6 months, and size 4 for
infants 6-12 months. How do you Age/4 + 4 mm = internal diameter
calculate what size ET tube to use for
toddlers and kids?
Shock is defined as an abnormality of
the circulatory system that results in
Neurogenic, cardiogenic,
inadequate organ perfusion and tissue
hypovolemic, septic
oxygenation. What are the 4 different
types?
The most common cause of shock in
hemorrhage
the injured trauma patient is _____.
Approximately ___% of the body's total
blood volume is located in the venous 70
circuit.
Anaerobic metabolism --> can't
make more ATP --> Endoplasmic
Why does shock actually reduce the then mitochondrial damage -->
total volume of circulating blood? lysosomes rupture --> sodium and
WATER enter the cell, which
SWELLS and dies.
NEVER use pressors for
Which vasopressors should you use to hypovolemic shock - use VOLUME
treat hemorrhagic shock? What are the replacement. Pressors will worsen
drug doses? tissue perfusion in hemorrhagic
shock.
Compensatory mechanisms may
preclude a measurable fall in systolic
30
blood pressure until up to __% of the
patient's blood volume is lost.
Any patient who is cool and is
tachycardic is considered to be ______ in shock
until proven otherwise.
The definition of tachycardia depends
on the patient's age. What heart rate is Infants >160, toddlers/preschoolers
considered tachycardic for infants, >140, school age/prebuscent
toddlers/preschoolers, school >120, adults >100
age/prebuscent, and adults?
Elderly patients may not exhibit
tachycardia in response to hypovolemia
They might be on a beta-blocker or
because of limited cardiac response to
have a pacemaker.
catecholamines. Why else might not
they get tachy?
Becks's Triad: JVD, muffled heart
A FAST scan is an excellent way to
sounds, and hypotension (will be
diagnose cardiac tamponade. What
resistant to fluid therapy). Will also
signs suggest tamponade?
likely be tachycardic.
Patients with a tension pneumo and
patients with cardiac tamponade may
Absent breath sounds and
present with many of the same signs.
hyperresonance to percussion over
What findings will you see with a
the affected hemithorax.
tension pneumo that you will NOT see
with tamponade?
Immediate thoracic decompression is
warranted for anyone with absent
Acute respiratory distress &
breath sounds, hyperresonance to
subcutaneous emphysema
percussion, tracheal deviation, ____,
and ____.
Can isolated intracranial injuries cause
NO
neurogenic shock?
70 mL per kg body weight. A 70 kg
How do you calculate total blood
person has about 5 liters of
volume in an adult?
circulating blood. (70*70=4900)
How do you calculate total blood
Body weight in kg x 80-90 mL
volume in an child?
The blood volume of an obese person is
calculated based upon their ______ ideal
weight.
Fluid replacement should be guided by
The patient's response to initial
________, not simply by the initial
replacment
classification (Class I-IV).
Up to 15% Donating 1 pint, or
How much blood volume is lost with ~500 mL of blood is about a 10%
Class I Hemorrhage? volume loss and would qualify as
Class I Hemorrhage!
You don't (usually). Transcapillary
How do you treat a Class I refill and other compensatory
Hemorrhage? mechanisms usually restore blood
volume within 24 hours.
How much blood volume is lost with 15-30% (750-1500 mL in a 70 kg
Class II Hemorrhage? adult)
How do you treat a Class II Usually just crystalloid
Hemorrhage? resuscitation
Subtle CNS changes such as anxiety,
fright, and hostility would be expected
II
in a patient with a Class __
Hemorrhage.
How much blood volume is lost with
30-40% (2000 mL in a 70 kg adult)
Class III Hemorrhage?
A patient with inadequate perfusion, III or IV - These patients almost
marked tachycardia and tachypnea, always require a blood transfusion,
significant mental status change, and a which depends on their response to
measurable fall in systolic blood initial fluid resuscitation. The first
pressure likely has a Class ___ priority is stopping the
Hemorrhage. hemorrhage.
Loss of more than ___% of blood volume
50
results in loss of consciousness.
More than 40%. Unless very
How much blood volume is lost with
aggressive measures are taken the
Class IV Hemorrhage?
patient will die within minutes.
A Class ___ Hemorrhage represents the
smallest volume of blood loss that is
III
consistently associated wiht a drop in
systolic blood pressure.
Up to ______ mL of blood loss is
commonly associated with femur 1500
fractures.
Unexplained hypotension or cardiac
dysrhythmias (usually bradycardia from
gastric distention
excessive vagal stimulation) are often
caused by ______, especially in children.
Adults: 2 liters, Kids: 20 mL/kg
How much crystalloid should you give (may repeat and give as much as
an adult for an initial fluid resuscitation 60 mL/kg but with high reserve in
bolus? For kids? kids, if they're in shock they should
get blood sooner rather than later.
Each mL of blood loss whould be 3
replaced with ___ mL of crystalloid, thus
allowing for replacement of plasma
volume lost into interstitial and
intracellular spaces.
Blood on the floor x four more is a Chest, pelvis, retroperitoneum, and
mnemonic for occult blood loss where? thigh
For children UNDER 1 year of age, UOP
2
should be ___ mL/kg/hr.
Alkalotic - respiratory alkalosis from
Would patients in EARLY hypovolemic tachypnea....followed later by mild
shock be acidodic or alkalotic? metabolic acidosis in the early
phase of shock.
"Rapid responders" whose vital signs
return to normal (and stay there) after
I or II
fluid resuscitation likely have/had a
Class ___ Hemorrhage.
"Transient responders" are associated
II or III
with Class ___ Hemorrhage.
NON-HEMORRHAGIC causes, e.g.
What differential diagnoses should you tension pneumothorax,
always consider for "non-responders" tamponade, blunt cardiac injury,
following fluid resuscitation? MI, acute gastric distention,
neurogenic shock...
Most patients receiving blood
transfusions ____ need calcium don't
replacement.
Created by: satori4all