Advanced Trauma Life support (ATLS) Exam Questions and Answers (Latest Update 2024), Exams of Nursing

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Advanced Trauma Life support (ATLS) Exam Questions and Answers (Latest Update 2024) definition of; - multiple casualties - mass casualties - Correct 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 - Correct Answer ✅J (Osborn) wave clinicians can quickly assess A, B, C and D in a trauma pat (10 sec assessment), how? - Correct Answer ✅identify themselves, asking pat for his or her name, and asking what happened GCS - Correct Answer ✅ Advanced Trauma Life support (ATLS) Exam Questions and Answers (Latest Update 2024) laryngeal fracture, triad of clinical signs - Correct Answer ✅- hoarseness - subcutaneous emphysema - palpable fracture laryngeal trauma, triad of clinical signs - Correct Answer ✅- hoarseness - subcutaneous emphysema - palpable fracture laryngeal trauma, method for securing airway - Correct Answer ✅- intubation (flexible endoscopic intubation) - emergency tracheostomy, followed by operative repair - cricothyroidotomy Advanced Trauma Life support (ATLS) Exam Questions and Answers (Latest Update 2024) how do we prevent this? - Correct Answer ✅- monitor pat RR and work of breathing - ABG or VBGs - continuous capnograms LEMON assessment for difficult intubation - Correct Answer ✅L= look externally E= evaluate 3-3-2 rule M= Mallampati O= obstruction N= neck mobility Advanced Trauma Life support (ATLS) Exam Questions and Answers (Latest Update 2024) indications for a definitive airway - Correct Answer ✅ what is the 3-3-2 rule during intubation? - Correct 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 - Correct Answer ✅I- soft palate, uvula, fauces, pillars entirely visible II- soft palate, uvula, fauces partially visible III- soft palate, base of uvula visible Advanced Trauma Life support (ATLS) Exam Questions and Answers (Latest Update 2024) IV- hard palate only visible airway decision scheme (algorithm for determining appropriate route of airway management) - Correct Answer ✅ chin-lift maneuver - Correct Answer ✅ jaw-thrust maneuver - Correct Answer ✅ alternative technique for inserting oral airway - Correct Answer ✅ i-gel supraglottic airway - Correct Answer ✅ example of a laryngeal mask airway - Correct Answer ✅ term; Advanced Trauma Life support (ATLS) Exam Questions and Answers (Latest Update 2024) laryngeal manipulation which can aid in visualizing the vocal cords during intubation - Correct Answer ✅BURP - backward, upward, rightward pressure on thyroid cartilage intubation through an intubating laryngeal mask (ILMA) - Correct Answer ✅ insertion of GEB designed to aid in difficutl intubations - Correct 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 - Correct Answer ✅used when vocal cords cannot be visualized on direct laryngoscopy Advanced Trauma Life support (ATLS) Exam Questions and Answers (Latest Update 2024) needle cricothyroidotomy - Correct Answer ✅performed by placing catheter over needle or over wire using the Seldinger technique surgical cricothyroidotomy - Correct Answer ✅ approximate PaO2 versus O2 Hb sat levels - Correct Answer ✅ most common cause of shock in trauma patients - Correct Answer ✅hemorrhage cardiac output, diagram - Correct Answer ✅ stroke volume is classically determined by 3 factors - Correct Answer ✅- preload - myocardial contractility - afterload hemorrhage has what effect on preload? - Correct Answer ✅diminishes it Advanced Trauma Life support (ATLS) Exam Questions and Answers (Latest Update 2024) preload is determined by what factors? - Correct 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 - Correct 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? - Correct Answer ✅locating and stopping source of bleeding, Advanced Trauma Life support (ATLS) Exam Questions and Answers (Latest Update 2024) - 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 - Correct 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? - Correct Answer ✅>95% gastric dilation often occurs in trauma patients, especially children, Advanced Trauma Life support (ATLS) Exam Questions and Answers (Latest Update 2024) how do we solve this problem? - Correct Answer ✅consider decompressing stomach by inserting nasal or oral tube and attaching it to suction initial fluid therapy, usual dose - Correct Answer ✅1L for adults 20 ml/kg for pediatric pat < 40 kg adequate volume replacement during fluid resuscitation should produce UO of approx - Correct 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 - Correct Answer ✅- rapid - transient - minimal or no response Advanced Trauma Life support (ATLS) Exam Questions and Answers (Latest Update 2024) massive transfusion, definition - Correct Answer ✅> 10 units pRBCs in first 24h or > 4 units in 1 hour tension ptx - Correct Answer ✅ the most common cause of tension ptx - Correct Answer ✅mechanical positive pressure ventilation in pat with visceral pleural injury needle decompression for tension ptx, recent evidence supports placing the needler where? - Correct Answer ✅5th IC space slightly anterior to midaxillary line site of chest tube insertion - Correct Answer ✅5th intercostal space, just anterior to MAL open pneumothorax diagram - Correct Answer ✅ Advanced Trauma Life support (ATLS) Exam Questions and Answers (Latest Update 2024) associated with cardiac tamponade term; rise in venous pressure with inspiration when breathing spontaneously - Correct Answer ✅Kussmaul sign (true paradoxical venous pressure abnormality Ω cardiac tamponade) algorithm for management of traumatic circulatory arrest - Correct Answer ✅ thoracic spine fractures may be classified into four broad categories - Correct Answer ✅- anterior wedge compression injuries - burst injuries - Chance fractures Advanced Trauma Life support (ATLS) Exam Questions and Answers (Latest Update 2024) - fracture-dislocations 8 potentially lethal injuries which should be identified and managed during the secondary survey (thoracic trauma) - Correct Answer ✅- simple ptx - htx - flail chest - pulmonary contusion - blunt cardiac injury - traumatic aortic disruption - traumatic diaphragmatic injury - blunt esophageal rupture Advanced Trauma Life support (ATLS) Exam Questions and Answers (Latest Update 2024) thoracic trauma, primary survey; life-threatening injuries, examples - Correct Answer ✅- airway obstruction - tracheobronchial tree injury - tension ptx - open ptx - massive htx - cardiac tamponade - traumatic circulatory arrest tracheobronchial tree injury; - clin features - dx Advanced Trauma Life support (ATLS) Exam Questions and Answers (Latest Update 2024) - multiple PVCs, unexplaines sinus tach, Afib, BBB (right), ∂ ST segment - monitor first 24h some radiographic signs of blunt aortic injury in the chest - Correct Answer ✅ diaphragmatic rupture, x-ray - Correct Answer ✅ typical clinical setting of esophageal injury - Correct 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 anterior abdomen borders - Correct Answer ✅area between; - costal margins superiorly - inguinal lig and pubic symphysis inferiorly - AAL laterally Advanced Trauma Life support (ATLS) Exam Questions and Answers (Latest Update 2024) area of the thoracoabdomen - Correct 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 - Correct Answer ✅area between AAL and PAL from 6th IC space to iliac crest term; area between AAL and PAL from 6th IC space to iliac crest - Correct Answer ✅flank what abdominal areas contain the retroperitoneal space? - Correct Answer ✅flank and back retroperitoneal space, important contents - Correct Answer ✅- abd. aorta Advanced Trauma Life support (ATLS) Exam Questions and Answers (Latest Update 2024) - IVC - most of duodenum - pancreas - kidneys - ureters - post. aspect of ascending colon and descending colon - retroperitoneal components of pelvic cavity term; injury in which there is a differential movement of fixed and mobile parts of the body - Correct Answer ✅deceleration injuries stab wounds most commonly injure what abd. organs and gunshot wounds? - Correct Answer ✅- liver 40% Advanced Trauma Life support (ATLS) Exam Questions and Answers (Latest Update 2024) - discrepancy in limb length - rotational deformity of a leg without obvious fracture pelvic fractures and hemorrhagic shock management algorithm - Correct Answer ✅ indications for laparotomy in pat with penetrating abdominal wounds include - Correct Answer ✅- hemodynamic abnormality - 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; - Correct Answer ✅- thoracoscopy Advanced Trauma Life support (ATLS) Exam Questions and Answers (Latest Update 2024) - laparoscopy - DPL - CT indications for laparotomy - Correct 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 pelvic binder - Correct Answer ✅ pelvic fractures and hemorrhagic shock, management algorithm - Correct Answer ✅ overview of cranial anatomy - Correct Answer ✅ overview of meninges - Correct Answer ✅ uncal herniation, diagram - Correct Answer ✅ Advanced Trauma Life support (ATLS) Exam Questions and Answers (Latest Update 2024) classical sign of of uncal herniation - Correct Answer ✅ipsilateral pupillary dilation Ω contralateral hemiparesis normal ICP for pat in resting state - Correct Answer ✅approx 10 mmHg define the Monro-Kellie Doctrine - Correct Answer ✅total volume of intracranial contents must remain constant, because the cranium is a rigid container incapable of expanding a MAP of ____ to ____ mmHg is "autoregulated" to maintain a constant CBF - Correct Answer ✅50-150 mmHg mathematical definition of CPP - Correct Answer ✅CPP = MAP-ICP GCS definition for; - coma or severe brain injury (SBI) Advanced Trauma Life support (ATLS) Exam Questions and Answers (Latest Update 2024) anticoagulation reversal in pat with traumatic brain injury - Correct 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? - Correct Answer ✅mannitol, if euvolemic 1g/kg bolus over 5 min, and transport immediately to CT or direct to op room NEXUS criteria and mnemonic - Correct Answer ✅ Canadian C-spine rule (CCS) - Correct Answer ✅ the most common c1 fracture - Correct Answer ✅jefferson fracture example of a Jefferson fracture - Correct Answer ✅ term respective syndrome; Advanced Trauma Life support (ATLS) Exam Questions and Answers (Latest Update 2024) - 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 resulting in a facial impact. - Correct 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 - Correct Answer ✅anterior cord syndrome Advanced Trauma Life support (ATLS) Exam Questions and Answers (Latest Update 2024) 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). - Correct Answer ✅Brown-Sequard syndrome hangman's fracture is associated with fracture of what vertebra? - Correct Answer ✅C2 (Axis) (pars interarticularis) term; transverse fracture through the vertebral body - Correct Answer ✅chance fracture Advanced Trauma Life support (ATLS) Exam Questions and Answers (Latest Update 2024) pressure measurements may aid in dx compartment syndrome after trauma, Sx treatment - Correct Answer ✅fasciotomy peripheral nerve assessment of upper extremities - Correct Answer ✅ peripheral nerve assessment of lower extremities - Correct Answer ✅ join and ligament injuries, management - Correct Answer ✅immobilize joint injuries, serial reassess vascular and neuro status of limb distal to injury Sx consult recognizing shock, what should be evaluated? - Correct Answer ✅- RR Advanced Trauma Life support (ATLS) Exam Questions and Answers (Latest Update 2024) - pulse rate and character - skin perfusion - pulse pressure tension ptx, immediate treatment - Correct Answer ✅ american burn life support (ABLS) indications for early intubation include; - Correct Answer ✅ current consensus guidelines regarding fluid resuscitation in burn victims - Correct Answer ✅Parkland; 2 ml of Ringer x kg x %TBSA for 2nd and 3rd degree burns initiate; Advanced Trauma Life support (ATLS) Exam Questions and Answers (Latest Update 2024) - 1/2 in first 8h - 1/2 in subsequent 16h rule of nines in adult - Correct Answer ✅ rule of nines in children - Correct Answer ✅ burn resuscitation fluid rates and target UO by burn type and age (diagram) - Correct Answer ✅ how can we calculate the optimal ETT depth (in cm) in children? - Correct Answer ✅3x appropriate tube size eg. 4.0 ETT would be positioned 12 cm from gums depths of burns, different types - Correct Answer ✅superficial (first-degree) burns - eg. sunburn, erythema and pain, no blister Advanced Trauma Life support (ATLS) Exam Questions and Answers (Latest Update 2024) how can we calculate optimal endotracheal tube dpeth in cm in a child? - Correct Answer ✅3x appropriate tube size (eg. 4.0 ETT would be positioned at 12 cm from gums) oral airway in a child, how should it be inserted? - Correct 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 - Correct 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 - Correct Answer ✅ Advanced Trauma Life support (ATLS) Exam Questions and Answers (Latest Update 2024) C1 rotary subluxation injury is most often seen in what pat group? - Correct Answer ✅children the most common odontoid fracture - Correct Answer ✅type II odontoid fractures mnemonic or common causes of deterioration in intubated patients - Correct Answer ✅dont be a DOPE Dislodgement Obstruction Ptx Equipment failure most common cause of pediatric cardiac arrest - Correct Answer ✅hypoxia Advanced Trauma Life support (ATLS) Exam Questions and Answers (Latest Update 2024) systemic responses to blood loss in pediatric patients - Correct Answer ✅ normal vital functions by age group - Correct Answer ✅ volume resuscitation flow diagram for pediatric patients with normal and abnormal hemodynamics - Correct Answer ✅ the most common immediately life-threatening injury in children - Correct Answer ✅tension ptx pediatric verbal score - Correct Answer ✅ pediatric emergency care applied research netwoerk (PECARN) criteria for head CT - Correct Answer ✅A - children < 2 yrs B - children > 2 yrs baby milestones - Correct Answer ✅ Advanced Trauma Life support (ATLS) Exam Questions and Answers (Latest Update 2024) term; life threatening condition including; 1- > 40 degree core temp 2- involvement of CNS Ω dizziness, confusion, irritability, aggressiveness, apathy, disorientation, seizures, coma 3- SIRS with MOF - Correct Answer ✅heat stroke C-1 SALT triage categories - Correct Answer ✅ critical events in an integrated response to an active shooter event are represented by what acronym? - Correct Answer ✅THREAT Threat supression Hemorrhage control Rapid extrication Assessment by medical providers Advanced Trauma Life support (ATLS) Exam Questions and Answers (Latest Update 2024) Transport to definitive care stop the bleed campaign - Correct Answer ✅ ATLS-OE - Correct Answer ✅ trauma team composition - Correct Answer ✅team leader (senior doctor experienced in trauma management) airway manager (provider skilled i airway management) airway assistant second provider two nurses Advanced Trauma Life support (ATLS) Exam Questions and Answers (Latest Update 2024) additionally: scribe/coordinator, transporters/technicians/nursing assistants, radiology support, specialist (neurosurgeon, orthopedic surgeon, vascular surgeon) MIST mnemonic as a handover tool in a time-pressured environment to ensure safe transfer of info without loss of important details - Correct Answer ✅Mechanism Injuries sustained Signs Treatment and travel MIST correctly sized OPA (oropharyngeal airway) extends from corner of pat's mouth to - Correct Answer ✅earlobe Advanced Trauma Life support (ATLS) Exam Questions and Answers (Latest Update 2024) neurological level of injury sensory level of injury - Correct 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 - Correct Answer ✅C5 algorithms for avoiding radiographic evaluation for c-spine fracture in trauma patients - Correct Answer ✅National emergency x-radiography utliization study (NEXUS) low risk-criteria (NLC) Canadian C-spine rule (CCR) Advanced Trauma Life support (ATLS) Exam Questions and Answers (Latest Update 2024) extraglottic or supraglottic devices, role of these? - Correct 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 - Correct Answer ✅- C5 Advanced Trauma Life support (ATLS) Exam Questions and Answers (Latest Update 2024) - C6 - C7 - C8 - T4 - T8 key spinal nerve segments and areas of innervation, sensorium if; umbilicus symphysis pubis medial aspect of calf Advanced Trauma Life support (ATLS) Exam Questions and Answers (Latest Update 2024) - 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 - 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 Advanced Trauma Life support (ATLS) Exam Questions and Answers (Latest Update 2024) - burn injury in pat. who will require special social, emotional, or rhehab intervention once increment in french size - Correct Answer ✅= 1/3 mm abdominal trauma in a child, when should you perform a prompt laparotomy to control hemorrhage? - Correct Answer ✅if child's hemodynamic condition cannot be normalized and the diagnostic procedure performed is positive for blood term; rheostatic - Correct Answer ✅a resistor for regulating a current by means of variable resistances abruptio placentae; clinical signs Advanced Trauma Life support (ATLS) Exam Questions and Answers (Latest Update 2024) diagnosis - Correct Answer ✅vaginal bleed (70%), uterine tenderness, frequent contractions, uterine tetany, uterine irritability uterine US, CT uterine rupture, clinical signs - Correct Answer ✅abd. tenderness, guarding, rigidity or rebound tenderness abdominal fetal lie, easy palpation of fetal parts signs of retrobulbar hemorrhage with compartment syndrome - Correct Answer ✅- decreased vision - elevated eye pressure - asymmetrical proptosis (eye bulge) - resistance to retropulsion - tight eyelids against the globe (rock-hard eye)