ATLS Written Exam Review -with 100% verified solutions 2024-2025-tutor verified.docx, Exams of Nursing

Download ATLS Written Exam Review -with 100% verified solutions 2024-2025-tutor verified.docx and more Exams Nursing in PDF only on Docsity! ATLS Written Exam Review -with 100% verified solutions 2024-2025-tutor verified What is the primary goal of treating TBI? How is this done? preventing secondary brain injury. This is done by maintaining blood pressure and providing adequate profusion. After managing ABCDEs of TBI what MUST be identified if present? How is this done? mass lesion that requires surgical evacuation is critical! this is done with CT. NOTE: obtaining a CT should not delay patient transfer to trauma center. Which brain lobes do the following hold: 1. anterior fossa: 2. middle fossa: 3. posterior fossa: 1. anterior fossa: frontal lobes 2. middle fossa: temporal lobes 3. posterior fossa: lower brainstem and cerebellum What are the 3 layers of the meninges? dura mater, arachnoid mater, pia mater What does the dura mater adhere firmly to? the skull. it is tough and fibrous What layer of the meninges splits into two leaves as specific sites to enclose large venous sinuses? What do these sinuses do? dura mater. these sinuses provide major venous drainage from the brain. What is the midline sinus of of the brain that splits into two sinuses: bilateral transverse and sigmoid sinus? What side are these bigger on? The main sinus enclosed by the dura major is the midline superior sagital sinus. This splits into the sigmoid and bilateral transverse sinuses which are larger on the right side. What are the arteries that lie between the skull and the dura mater (epidural space)? meningeal arteries. What is the most commonly injured meningeal artery and where is it located? middle meningeal artery. Located over the temporal fossa T/F: the arachnoid mater is fused to the dura mater? FALSE: not attached. This produces a potential space for a subdural hematoma In a subdural hematoma, what is the cause? injury to bridging veins that extend from brain surface to the sinuses within the dura. _______ fills the space between the arachnoid and pia mater? CSF. this cushions the brain and spinal cord. What location of brain hemorrhage is frequently seen in brain contusion or injury to major blood vessels at base of brain? subarachnoid. The monro-kellie doctrine states that _____ and _____ may be compressed out of the skull providing a degree of buffering. CSF and venous blood. Once the CSF and venous blood reach a certain level of displacement the ICP rapidly increases. What is the equation for CPP (cerebral perfusion pressure)? CPP=MAP-ICP in TBI, Every effort should be made to reduce ______, while normalizing ____, ___, and _____. ICP MAP, oxygenation, intravascular volume What GCS ranges for the following classes: 1. Minor 2. Moderate 3. Severe 1. 13-15 2. 9-12 3. 3-8 What nerve palsy may occur with basilar skull fracture? seventh nerve. A GCS of ___ is accepted definition of coma? 8 or less How do you assess a GCS of someone with asymmetric responses? Use the best possible because this will be the best predictor of outcome Basilar fractures of the skull usually require what type of imaging? this requires CT with bone-window setting. What are the typical clinical signs of basilar skull fractures? 1.periorbital ecchymosis (raccoon eyes) 2. retroauriculor ecchymosis (battle sign) 3. CSF leak from nose or ears 4. 7th or 8th CN dysfunction (facial paralysis and hearing loss) What should be a primary consideration for any patient with a skull fracture, especially a linear skull fracture? hematoma. linear skull fracture increases likelihood of intracranial hematoma by about 400x What mechanism is common with diffuse axonal injury and what is the likely outcome? these injury often occur with high velocity or deceleration injures. They appear as diffuse cerebral hemorrhage often between grey and white matter. These are associated with variable but often poor outcomes. Epidural hematomas often occur in the _____ area of the skull and result from a tear of the _______ arteries. temporal middle meningeal artery What is the classic presentation of a epidural hematoma? a lucid interval between time of injury and neurologic a deterioration. What are more common brain injury: epidural or subdural? subdural 30% epidural 0.5% Subdural hematoma occur from tear of _________. bridging vessels of the cerebral cortex Contusion occur in ___% of TBI. They often occur in _____ or ______ lobes of brain. They may coalesce to form ______ in as many as 20$%. 20-30% frontal or temporal intracerebral hematoma. A midline shift of _____mm or greater on the CT is indicative of need for neurosurgery to evacuate the clot or contusion causing the shift 5mm What type of fluids should be used? hypertonic (ringers lactate or normal saline). NO GLUCOSE. What electrolyte abnormality is associated with brain edema and must be monitored? hyponatremia What are the physiologic consequences of PaCO2 >45? PaCO2 <30? f PaCO2 >45 = vasodilation = inc ICP PaCO2 <30 (hyperventilation) = constriction = ischemia What is the preferred PaCO2 in brain injury? 35 mm Hg If ICP is rapidly increasing, what can be done while preparing for craniotomy? hyperventilation. NOTE: this must be monitored closely and is only done very short periods at a time Does hypertonic saline lower ICP in hypovolemia? Does mannitol lower ICP in hypovolemia? No NO After administration of mannitol what should be monitored closely? ICP! mannitol has a substantial rebound effect on ICP What is the role of muscle relaxants (vecuronium or succinylcholine) in seizures with TBI? NONE. these may mask tonic-clonic seizures and prevent anticonvulsant intervention (30-60 min of seizure = secondary brain injury) What meningeal tear would a CSF leakage of a head laceration indicate? dural tear What is the treatment of any intracranial mass lesion? Must be evacuated by neurosurgeon. transfer if not available. for a penetrating object such as an arrow or screw driver into the skull, test should be performed and what should be done with the object? need CT, Xray for trajectory, and angiography. leave the object in place. Removing the object lead to fatal vascular injury. What clinical signs are the criteria for brain death? GCS of 3, nonreactive pupil, absent brainstem reflexes, no spontaneous ventilatory effort Which vertebrae is most susceptible to injury? Cervical. NOTE: in peds this accounts for only 1% of vertebral injury What nerve and cervical spine level would cause apnea and results in death in 1/3 of patient with upper cervical spine injury phrenic nerve C1 At what age do cervical spine differences begin to normalize? at what age does cervical spine look like that of an adult? marked differences in cervical spine occur until age 8 and steadily decline until age 12 when they are similar When a dislocation-fracture of the vertebrae occurs, almost always the result is _____. complete spinal cord injury T/F: the thoracolumbar junction is extremely strong and rarely incurs injury? All EXCEPT pulmonary contusion What is the initial bolus for fluid resuscitation when a small child is in shock? 20mL/kg ringers lactate What are the chest tube blood volume output parameters that would require a thoracotomy? >1500mL immediatley evacuated OR 200mL/hr for 2-4hrs NOTE: thoractomy is not indicated unless a surgeon qualified by training and experience is present How can one determine the appropriate tube depth for pediatric intubation? ETT tube size x 3 Ex: 4.0 ETT would be properly positioned at 12 cm from the gums In pediatrics: once past the glottic opening, the ETT should be positioned __ to ___ cm below the level of the vocal cords and then carefully secured. 2-3 cm Fluid resuscitation of an infant begins with _______(amount and type). And then progresses to ______. (amount and type) 20mL/kg Ringers lactate. (may give up to three of these boluses initially) For the third bolus consider PRBCs at 10mL/kg For a patient who is not breathing what intervention is indicated? orotracheal intubation What should be used when vocal chords cannot be visualized on direct laryngoscopy? gum elastic bougie. in place when you feel clicks. can be inserted blindly beyond epiglottis What is the acronym BURP? backward, upward and rightward pressure used in external laryngeal manipulation with orotracheal intubation what is the most common life threatening injury in children? tension pneumothorax What is the most common acid-base disturbance in the injury child and what is it caused by? Respiratory acidosis caused by hypoventilation. What are the options to establish an airway when bag-mask ventilation and attempts at orotracheal intubation fail for a child? LMA, or intubating LMA, or needle cricothyroidotomy. -needle-jet insufflation is an appropriate temporizing technique for oxygenation but does not provide adequate ventilation. NOTE: surgical cric is RARELY indicated for infants an small children. usually it is an adoption when the cricothyroid membrane is easily palpable around the age of 12. A local area of frost bite should be rewarmed with what temperature and in what waY? 40C (104F) should be done in whirlpool. not dry heat. What is the main utility of ECG during resuscitation? detecting rhythm abnormalities What does PaCO2 of 35-40 mmHg indicate in late pregnancy? impending respiratory failure. hypocapnia (around 30) is typical in late pregnancy due to inc tidal volume. Other than maternal death, what is the leading cause of fetal death? Symptoms? abruptio placentae (70%) suggested by vaginal bleeding, uterine tenderness, uterine contractions, uterine tetany, and irritability of uterus (contracts when touched) What type of monitoring should be initiated in fetus of gestation age >20 wks What is the physiology behind neurogenic shock? loss of vascular tone What is another name for Central Venous Pressure? When is it elevated? Basically the same as Right atrial pressure. -Elevated in cardiac failure, tamponade, tension pneumo, disrupted thoracic aorta. What would be expected on ABG abnormalities for pulmonary contusion? PaO2 <65 mm Hg (sat <90) would suggest need for intubation and in the presence of flail chest is more suggestive t/f vomitus in the posterior oropharynx suggests esophageal intubation. false. signs include: epigastric fullness, absent end title CO2, absent breath sounds, audible borborygmi sounds over abdomen t/f: major head injury rarely causes shock by itself true What are the vital signs to be expected when ICP increases? decreased respirations and HR, increased systolic and pulse pressure Urethral injury should be suspected in the presence of what three things? 1. blood at the meatus 2. perineal ecchymosis 3. high riding or non-palpable prostate What test is used to confirm the integrity of the urethra before a catheter is inserted? retrograde urethrogram What physical exam is essential before passing a urethral catheter examine the rectum and perineum What is the best guide for adequate fluid resuscitation in a burn patient? urine output adults: 0.5mL/kg/hr >30kg: 1mL/kg/hr NOTE: parkland is only for estimating and should be adjusted in accordance with urinary output. fluids should not be slowed at 8 hours if urine output is not adequate The LEAST likely cause of a depressed level of consciousness in the multisystem injured patient is a. shock. b. head injury. c. hyperglycemia. d. impaired oxygenation. e. alcohol and other drugs. c hyperglycemia. For a patient bleed profusely from a wound not he medial thigh where should pressure be applied? pressure should b applied directly to the wound. Do not apply pressure to the proximal femoral artery at the groin What is one characteristic shared by all SURVIVORS of traumatic aortic disruption? contained hematoma What does x ray showing widened mediastinum and obliteration of the aortic knob suggest? traumatic aortic disruption What is the sensitivity and specificity of CT in aortic disruption? around 100%. NOTE: CT angiography should only be used to further identify site of disruption (not an initial test) What three X-ray views are most important for a person with multiple trauma? c-spine, chest, pelvis