Advanced Trauma Life Support (ATLS) Correctly Defined Terms 2023\2024 Update, Exams of Nursing

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Advanced Trauma Life support (ATLS) Correctly Defined Terms 2023\2024 Update definition of; - multiple casualties - mass casualties - Answer - incidents in which nr of pat and severity of injuries do not exceed capability of facility to render care - nr of pat and severity of their injuries exceed capability of facility and staff term; upward deflection after QRS complex in a patient with hypothermia - Answer J (Osborn) wave clinicians can quickly assess A, B, C and D in a trauma pat (10 sec assessment), how? - Answer identify themselves, asking pat for his or her name, and asking what happened Advanced Trauma Life support (ATLS) Correctly Defined Terms 2023\2024 Update GCS - Answer Glasgow Coma Scale laryngeal fracture, triad of clinical signs - Answer - hoarseness - subcutaneous emphysema - palpable fracture laryngeal trauma, triad of clinical signs - Answer - hoarseness - subcutaneous emphysema - palpable fracture laryngeal trauma, method for securing airway - Answer - intubation (flexible endoscopic intubation) Advanced Trauma Life support (ATLS) Correctly Defined Terms 2023\2024 Update failure to recognize inadequate ventilation, how do we prevent this? - Answer - monitor pat RR and work of breathing - ABG or VBGs - continuous capnograms LEMON assessment for difficult intubation - Answer L= look externally E= evaluate 3-3-2 rule M= Mallampati O= obstruction N= neck mobility Advanced Trauma Life support (ATLS) Correctly Defined Terms 2023\2024 Update indications for a definitive airway - Answer what is the 3-3-2 rule during intubation? - Answer relationships; - distance between incisor should be at least 3 finger breadths - distance between hyoid bone and chin should be at least 3 finger breadths - distance between thyroid notch and floor of mouth should be at least 2 finger breadths Mallampati classifications - Answer I- soft palate, uvula, fauces, pillars entirely visible II- soft palate, uvula, fauces partially visible Advanced Trauma Life support (ATLS) Correctly Defined Terms 2023\2024 Update III- soft palate, base of uvula visible IV- hard palate only visible airway decision scheme (algorithm for determining appropriate route of airway management) - Answer chin-lift maneuver - Answer jaw-thrust maneuver - Answer alternative technique for inserting oral airway - Answer i-gel supraglottic airway - Answer example of a laryngeal mask airway - Answer Advanced Trauma Life support (ATLS) Correctly Defined Terms 2023\2024 Update laryngeal manipulation which can aid in visualizing the vocal cords during intubation - Answer BURP - backward, upward, rightward pressure on thyroid cartilage intubation through an intubating laryngeal mask (ILMA) - Answer insertion of GEB designed to aid in difficutl intubations - Answer The GEB is lubricated and placed in back of the epiglottis with the tip angled toward the front of the neck. B. It slides under the epiglottis and is maneuvered in a semiblind or blind fashion into the trachea. C. Placement of the GEB into the trachea may be detected by the palpable "clicks" as the tip passes over the cartilaginous rings of the trachea. Eschmann tracheal tube introducer (ETTI) also known as gum elastic bougie - Answer used when vocal cords cannot be visualized on direct laryngoscopy Advanced Trauma Life support (ATLS) Correctly Defined Terms 2023\2024 Update needle cricothyroidotomy - Answer performed by placing catheter over needle or over wire using the Seldinger technique surgical cricothyroidotomy - Answer approximate PaO2 versus O2 Hb sat levels - Answer most common cause of shock in trauma patients - Answer hemorrhage cardiac output, diagram - Answer stroke volume is classically determined by 3 factors - Answer - preload - myocardial contractility - afterload hemorrhage has what effect on preload? - Answer diminishes it Advanced Trauma Life support (ATLS) Correctly Defined Terms 2023\2024 Update preload is determined by what factors? - Answer - venous capacitance - volume status - ∂ mean VSP and RAP the venous system can be considered a reservoir, or capacitance, system in which volume of blood is divided into 2 components, describe them - Answer 1- component representing volume of blood that would remain in capacitance circuit if pressure in the system were zero, doesn't contrbiute to mean SVP 2- venous volume contributing to SVP blood loss depletes this component of venous volume and reduces pressure gradients, with lower venous returns the most effective method of restoring adequate CO, endo-organ perfusion and tissue oxygenation is to restore venous return to normal by what means? - Answer locating and stopping source of bleeding, Advanced Trauma Life support (ATLS) Correctly Defined Terms 2023\2024 Update - uncomplicated hemorrhage for which crystalloid resuscitation is required - complicated hemorrhagic state in which at least crystalloid infusion is required and perhaps also blood replacemenet - preterminal event, unless aggressive measures are taken, pat will die within minutes, blood transfusion is required - Answer - class 1 hemorrhage - class 2 hemorrhage - class 3 hemorrhage - class 4 hemorrhagic shock, initial ABCDE, suppl O2 should maintain O2 sat over what value? - Answer >95% gastric dilation often occurs in trauma patients, especially children, Advanced Trauma Life support (ATLS) Correctly Defined Terms 2023\2024 Update how do we solve this problem? - Answer consider decompressing stomach by inserting nasal or oral tube and attaching it to suction initial fluid therapy, usual dose - Answer 1L for adults 20 ml/kg for pediatric pat < 40 kg adequate volume replacement during fluid resuscitation should produce UO of approx - Answer 0.5 ml/kg/h in adults 1 ml/kg/h in pediatric patients potential patterns of response to initial fluid admin can be divided into 3 groups - Answer - rapid - transient Advanced Trauma Life support (ATLS) Correctly Defined Terms 2023\2024 Update - minimal or no response massive transfusion, definition - Answer > 10 units pRBCs in first 24h or > 4 units in 1 hour tension ptx - Answer the most common cause of tension ptx - Answer mechanical positive pressure ventilation in pat with visceral pleural injury needle decompression for tension ptx, recent evidence supports placing the needler where? - Answer 5th IC space slightly anterior to midaxillary line site of chest tube insertion - Answer 5th intercostal space, just anterior to MAL open pneumothorax diagram - Answer Advanced Trauma Life support (ATLS) Correctly Defined Terms 2023\2024 Update explain Kussmaul sign - Answer rise in venous pressure with inspiration when breathing spontaneously associated with cardiac tamponade term; rise in venous pressure with inspiration when breathing spontaneously - Answer Kussmaul sign (true paradoxical venous pressure abnormality Ω cardiac tamponade) algorithm for management of traumatic circulatory arrest - Answer thoracic spine fractures may be classified into four broad categories - Answer - anterior wedge compression injuries - burst injuries Advanced Trauma Life support (ATLS) Correctly Defined Terms 2023\2024 Update - Chance fractures - fracture-dislocations 8 potentially lethal injuries which should be identified and managed during the secondary survey (thoracic trauma) - Answer - simple ptx - htx - flail chest - pulmonary contusion - blunt cardiac injury - traumatic aortic disruption Advanced Trauma Life support (ATLS) Correctly Defined Terms 2023\2024 Update - traumatic diaphragmatic injury - blunt esophageal rupture thoracic trauma, primary survey; life-threatening injuries, examples - Answer - airway obstruction - tracheobronchial tree injury - tension ptx - open ptx - massive htx - cardiac tamponade - traumatic circulatory arrest tracheobronchial tree injury; Advanced Trauma Life support (ATLS) Correctly Defined Terms 2023\2024 Update ECG findings most commonly seen management if detected blunt injury by conduction abnormalities - Answer - hypotension, dysrhythmias, and/or wall-motion abnormality on 2D echo - multiple PVCs, unexplaines sinus tach, Afib, BBB (right), ∂ ST segment - monitor first 24h some radiographic signs of blunt aortic injury in the chest - Answer diaphragmatic rupture, x-ray - Answer typical clinical setting of esophageal injury - Answer typically pat with left ptx or htx without rib fracture who has received a sever eblow to lower sternum or epigastrium and is in pain or shock of proportion to apparent injury Advanced Trauma Life support (ATLS) Correctly Defined Terms 2023\2024 Update anterior abdomen borders - Answer area between; - costal margins superiorly - inguinal lig and pubic symphysis inferiorly - AAL laterally area of the thoracoabdomen - Answer area inferior to nipple line anteriorly and infrascapular line posteriorly superior to costal margins encompass: liver, spleen, diaphragm, and stomach anatomical location of the flank - Answer area between AAL and PAL from 6th IC space to iliac crest term; Advanced Trauma Life support (ATLS) Correctly Defined Terms 2023\2024 Update area between AAL and PAL from 6th IC space to iliac crest - Answer flank what abdominal areas contain the retroperitoneal space? - Answer flank and back retroperitoneal space, important contents - Answer - abd. aorta - IVC - most of duodenum - pancreas - kidneys - ureters - post. aspect of ascending colon and descending colon - retroperitoneal components of pelvic cavity term; Advanced Trauma Life support (ATLS) Correctly Defined Terms 2023\2024 Update abdominal trauma DPL vs FAST vs CT, when is which indicated? - Answer signs of pelvic fracture - Answer - evidence of ruptured urethra - discrepancy in limb length - rotational deformity of a leg without obvious fracture pelvic fractures and hemorrhagic shock management algorithm - Answer indications for laparotomy in pat with penetrating abdominal wounds include - Answer - hemodynamic abnormality Advanced Trauma Life support (ATLS) Correctly Defined Terms 2023\2024 Update - gunshot wound with a transperitoneal trajectory - signs of peritoneal irritation - signs of peritoneal penetration (eg. evisceration) evaluation options for pat without indications for immediate laparotomy, but with possible injuries to the diaphragm and upper abd. structures include; - Answer - thoracoscopy - laparoscopy - DPL - CT indications for laparotomy - Answer also; - blunt or penetrating abd. trauma with aspiration of GI contents, vegetable fibers, or bile from DPL, or aspiration of 10 cc or more of blood in hemodynamically abnormal patients Advanced Trauma Life support (ATLS) Correctly Defined Terms 2023\2024 Update pelvic binder - Answer pelvic fractures and hemorrhagic shock, management algorithm - Answer overview of cranial anatomy - Answer overview of meninges - Answer uncal herniation, diagram - Answer classical sign of of uncal herniation - Answer ipsilateral pupillary dilation Ω contralateral hemiparesis normal ICP for pat in resting state - Answer approx 10 mmHg define the Monro-Kellie Doctrine - Answer total volume of intracranial contents must remain constant, because the cranium is a rigid container incapable of expanding Advanced Trauma Life support (ATLS) Correctly Defined Terms 2023\2024 Update indications for CT scan in pat with mild TBI - Answer algorithm for management of moderate brain injury (MBI) - Answer algorithm for initial management of severe brain injury (SBI) - Answer goals of treatment of brain injury; clinical, labs, and monitoring parameters - Answer anticoagulation reversal in pat with traumatic brain injury - Answer acute neurological deterioration, such as when a pat under obs develops a dilated pupil, has hemiparesis, or loses consciousness - is a strong indication for what medication? - Answer mannitol, if euvolemic 1g/kg bolus over 5 min, and transport immediately to CT or direct to op room Advanced Trauma Life support (ATLS) Correctly Defined Terms 2023\2024 Update NEXUS criteria and mnemonic - Answer Canadian C-spine rule (CCS) - Answer the most common c1 fracture - Answer jefferson fracture example of a Jefferson fracture - Answer term respective syndrome; - characterized by a disproportionately greater loss of motor strength in the upper extremities than in the lower extremities, with varying degrees of sensory loss. This syndrome typically occurs after a hyperextension injury in a patient with preexisting cervical canal stenosis. The mechanism is commonly that of a forward fall Advanced Trauma Life support (ATLS) Correctly Defined Terms 2023\2024 Update resulting in a facial impact. - Answer central cord syndrome term syndrome; results from injury to the motor and sensory pathways in the anterior part of the cord. It is characterized by paraplegia and a bilateral loss of pain and temperature sensation. However, sensation from the intact dorsal column (i.e., position, vibration, and deep pressure sense) is preserved. associated with ischemia of anterior cord - Answer anterior cord syndrome term syndrome; results from hemisection of the cord, usually due to a penetrating trauma. In its pure form, the syndrome consists of ipsilateral motor loss (corticospinal tract) and loss of position sense (dorsal column), associated with contralateral loss of pain and temperature sensation beginning one to two levels below the level of injury (spino-thalamic tract). - Answer Brown-Sequard syndrome Advanced Trauma Life support (ATLS) Correctly Defined Terms 2023\2024 Update - Sx consult IV antibiotic weight-based dosing guidelines for open fractures - Answer signs and symptoms of compartment syndromes - Answer clinical diagnosis of compartment syndrome - Answer based on history of injury and physical signs, coupled with high index of suspicion pressure measurements may aid in dx compartment syndrome after trauma, Sx treatment - Answer fasciotomy peripheral nerve assessment of upper extremities - Answer Advanced Trauma Life support (ATLS) Correctly Defined Terms 2023\2024 Update peripheral nerve assessment of lower extremities - Answer join and ligament injuries, management - Answer immobilize joint injuries, serial reassess vascular and neuro status of limb distal to injury Sx consult recognizing shock, what should be evaluated? - Answer - RR - pulse rate and character - skin perfusion - pulse pressure Advanced Trauma Life support (ATLS) Correctly Defined Terms 2023\2024 Update tension ptx, immediate treatment - Answer american burn life support (ABLS) indications for early intubation include; - Answer current consensus guidelines regarding fluid resuscitation in burn victims - Answer Parkland; 2 ml of Ringer x kg x %TBSA for 2nd and 3rd degree burns initiate; - 1/2 in first 8h - 1/2 in subsequent 16h rule of nines in adult - Answer rule of nines in children - Answer Advanced Trauma Life support (ATLS) Correctly Defined Terms 2023\2024 Update 2nd - large, clear vesicle formation accompanying hyperemia and edema with partial- thickness skin necrosis 3rd - full-thickness and SC tissue necrosis occurs, commonly with hemorrhagic vesicle formation 4th - full-thickness skin necrosis, including bone and muscle with later necrosis the most common cause of death and disability in childhood - Answer injury positioning for airway maintenance in a child - Answer how can we calculate optimal endotracheal tube dpeth in cm in a child? - Answer 3x appropriate tube size Advanced Trauma Life support (ATLS) Correctly Defined Terms 2023\2024 Update (eg. 4.0 ETT would be positioned at 12 cm from gums) oral airway in a child, how should it be inserted? - Answer dont rotate, insert oral airway gently and directly into the oropharynx, using a tongue blade to depress the tongue simple technique to gauge the ETT size needed for a specific patient is to - Answer approx dπ of child's external nares or tip of child's smallest finger and use a tube with a similar dπ algorithm for drug-assisted intubation/rapid sequence intubation in pediatric patients - Answer C1 rotary subluxation injury is most often seen in what pat group? - Answer children the most common odontoid fracture - Answer type II odontoid fractures Advanced Trauma Life support (ATLS) Correctly Defined Terms 2023\2024 Update mnemonic or common causes of deterioration in intubated patients - Answer dont be a DOPE Dislodgement Obstruction Ptx Equipment failure most common cause of pediatric cardiac arrest - Answer hypoxia systemic responses to blood loss in pediatric patients - Answer normal vital functions by age group - Answer Advanced Trauma Life support (ATLS) Correctly Defined Terms 2023\2024 Update ASA classification - Answer degrees of hypothermia - Answer mild - 35-32 mod - 32 - 30 severe < 30 staging and management of accidental hypothermia - Answer area of greatest flexion and extension of the cervical spine - Answer C5-C6 warming strategies in trauma, algorithm - Answer term; life threatening condition including; Advanced Trauma Life support (ATLS) Correctly Defined Terms 2023\2024 Update 1- > 40 degree core temp 2- involvement of CNS Ω dizziness, confusion, irritability, aggressiveness, apathy, disorientation, seizures, coma 3- SIRS with MOF - Answer heat stroke C-1 SALT triage categories - Answer critical events in an integrated response to an active shooter event are represented by what acronym? - Answer THREAT Threat supression Hemorrhage control Rapid extrication Assessment by medical providers Transport to definitive care Advanced Trauma Life support (ATLS) Correctly Defined Terms 2023\2024 Update stop the bleed campaign - Answer ATLS-OE - Answer trauma team composition - Answer team leader (senior doctor experienced in trauma management) airway manager (provider skilled i airway management) airway assistant second provider two nurses additionally: scribe/coordinator, transporters/technicians/nursing assistants, radiology support, specialist (neurosurgeon, orthopedic surgeon, vascular surgeon) Advanced Trauma Life support (ATLS) Correctly Defined Terms 2023\2024 Update proper initial assessment and management, diagram - Answer initial assessment, diagram - Answer traumatic circulatory arrest, algorithm - Answer flail chest and pulmonary contusion, treatment - Answer indications for CT in ATLS - Answer identifying abdominal, retroperitoneal and pelvic injuries for hemodynamically normal patients without indication for laparotomy definitions; motor level injury Advanced Trauma Life support (ATLS) Correctly Defined Terms 2023\2024 Update neurological level of injury sensory level of injury - Answer - lowest key muscle with that has muscle strength grade of at least 3 - most caudal segment of the spinal cord that has a normal sensory and motor function on both sides of the body - the most caudal segment with normal sensory function most common level of c-spine fracture - Answer C5 algorithms for avoiding radiographic evaluation for c-spine fracture in trauma patients - Answer National emergency x-radiography utliization study (NEXUS) low risk-criteria (NLC) Canadian C-spine rule (CCR) Advanced Trauma Life support (ATLS) Correctly Defined Terms 2023\2024 Update extraglottic or supraglottic devices, role of these? - Answer - managing pat who require an advanced airway adjunct, but in whom intubation has failed or is unlikely to succeed key spinal nerve segments and areas of innervation, sensorium if; - area of deltoid - thumb - middle finger - little finger - nipple - xiphisternum - Answer - C5 Advanced Trauma Life support (ATLS) Correctly Defined Terms 2023\2024 Update - S3 - S4, S5 musculoskeletal trauma, primary survey and resuscitation of pat. with potentially life-threatening extremity injuries, examples - Answer - major arterial hemorrhage and traumatic amputation - bilateral femur fractures - crush syndrome (traumatic rhabdomyolysis) appropriately sized endotracheal tube (ETT) in a burn victim, effots should be made for what sizes? - Answer adults: > 7.5 mm ID Advanced Trauma Life support (ATLS) Correctly Defined Terms 2023\2024 Update children: > 4.5 mm ID riteria for transfer of patients to burn centers by American Burn Association - Answer - partial-thickness burns on greater than 10% TBSA - burns Ω face, hands, feet, genitalia, perineum, and major joints - 3rd degree burns in any age group - electrical burns, including lightning injury - chemical burns - inhalation injury - burn injury in pat with preexisting medical disorders Ω complicated management Advanced Trauma Life support (ATLS) Correctly Defined Terms 2023\2024 Update - any pat. with burns and concomitant trauma in which the burn injury poses greatest risk of morbidity or mortality - burned children in hospitals without qualified personnel or equipment for the care of children - burn injury in pat. who will require special social, emotional, or rhehab intervention once increment in french size - Answer = 1/3 mm abdominal trauma in a child, when should you perform a prompt laparotomy to control hemorrhage? - Answer if child's hemodynamic condition cannot be normalized and the diagnostic procedure performed is positive for blood term;