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A comprehensive set of questions and answers related to advanced trauma life support (atls) principles and procedures. It covers key concepts such as the trimodal death distribution, the platinum half hour, the primary and secondary surveys, and the management of shock. Valuable for students and professionals in the medical field who are preparing for atls certification or seeking to enhance their knowledge of trauma care.
Typology: Exams
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What is the trimodal death distribution and what are the mortality rates? - Answers- Timing of death resulting from trauma First peak = Immediately = 50% within minutes Fatal disruption of big vessels, heart, lungs Massive blood loss or neuro injury 2nd peak = Early = 30% within first few hours Mostly neuro injury 3rd peak = Later = 20% within days-weeks after initial injury Multiple system organ failure and sepsis What's the biggest risk to EMS? - Answers- Accidents
T = treatment What is the platinum half hour? - Answers- Time you are left "half hour" once the patient gets to the trauma center and begins to be treated Make every second count Time is not your friend What is the order of an initial evaluation of a trauma patient? - Answers- Primary survey ATLS/history/vital signs Resuscitation Secondary survey Definitive treatment or transfer to appropriate trauma center What is performed between primary and secondary survey in addition to obtaining a brief medical history and vital sings, that is the standard of care for trauma patients? - Answers- ATLS - advance trauma life support
A = airway B = breathing C = circulation: D = disability: E = exposure When do most trauma patients die? How do you prevent trauma deaths? - Answers- Most die immediately within first 10 minutes d/t primary injury to major organs, massive blood loss, etc Prevention with education w/anticipatory guidance What is trauma care versus critical care? What is the golden hour? - Answers- Trauma care = saves patients from early trauma mortality Critical care = avert later trauma mortality Golden hour: The time the patient gets injured until definitive care at the trauma center (1st hour of trauma)
What should we oxygenate with? When do we insert a chest tube? What kind of chest tube? Where? - Answers- Oxygenate with 100% O Insert a chest tube for tracheal injury, flail chest, or sucking chest wound w/decreased breath sounds. Use a 28-32 French. At the 5th ICS midaxillary line How do you stop a bleed? What type of IVs do you insert? What solution? When is it contraindicated? - Answers- Use the DEPT pneumonic: Direct pressure Elevation Pressure point Tourniquet **can use sphygmomanometer - > best tourniquet Start two LARGE bore IVs (14 gauge catheter) Infuse 1 L of Ringer's lactate in 70kg adult (3:1 ratio crystalloids replacement for unit of blood loss) C/I with closed head injury In order to avoid hemorrhagic shock what do we give? What's important to evaluate in the blood? If the patient is bleeding is in shock what do we use? What are they at risk for with a massive transfusions? - Answers- Give blood products early
What's the most common dysrhythmia seen in trauma patients? What should we think if they go from sinus tachy to sinus Brady? What do we want to monitor? - Answers- Sinus tachy Tachy-Brady = pre-arrest - > patient is in shock Monitor BP, HR< and pulse quality When we do a quick neuro assessment what is AVPI? What about Glasgow coma score? When we we intubate? - Answers- AVPU: A=alert V = verbal response P = pain response U = unresponsive GCS = eyes, verbal motor score E+V+M = 3-15 score Monitor change in mental status Intubate at 8 **best motor response is most significant How do we score eye opening on GCS? - Answers- 4 = spontaneous 3 = eyes open to voice 2 = eyes open to pain 1 = no opening How do we score verbal response on GCS? - Answers- 5 = normal conversation/oriented 4 = disoriented/confused conversation 3 = words, but not coherent/inappropriate 2 = no words, only sounds or incomprehensible 1 = none How do we score motor response on GCS? - Answers- 6 = normal/obeys commands 5 = localizes to pain 4 = withdraws to pain 3 = decorticate flexion posture 2 = decerebrate extension posture 1 = none/flaccid What is important about exposure/environmental control? - Answers- Completely undress and expose patient Don't forget to turn patient over and check the back via log roll Reward the patient - > warm or heat fluids
Place a finger or tube in every orifice - > if there isn't any available orifice we create one How do we reassess resuscitation? Contraindications? What do we do if patient deteriorates? - Answers- Is there a tube in every orifice? NG tube and foley Create new ones? IVs and chest tube insertion Pericardiocentesis Diagnostic peritoneal lavage (DPL) Beware of C/I Ex: if pt is leaking from the nose, NO NG TUBE Ex: if part has blood at tip of meatus, do not place Foley catheter - possible urethra transaction If patient deteriorates repeat primary survey Where is definitive care for the trauma patient? Vital signs - how many? Different MOI? - Answers- In the OR Vital signs - one set is never enough. Don't rely on automatic BP cuff - look for shock signs and symptoms MOI - blunt or penetrating. Have high Index of suspicion What is the first change with shock? Order of Head to toe survey for physical exam? What are we looking for? - Answers- Mental status IPAA = inspect, palpate, percuss, auscultate EXCEPT IAPP = inspect, auscultate, palpate, percuss Looking for: BBSD = bleeding, bruising, swelling and deformity LACS = lacerations, abrasions, confusions, swelling Important labs for trauma patients? - Answers- Baseline and ABGs Type and cross blood HCT - unreliable indicator of vascular status BUN/Creat Electrolytes Calcium in massive transfusion What are the radiologic exams for a trauma patient? - Answers- Initial XR - C-spine, CXR, Pelvis
Only to radiology suite if they are stable, monitored, and accompanied by trauma team member FAST (focused assessment by sonography for trauma) = quick and cost effective non- invasive method for evaluation of trauma in resuscitation area via US What is in the tertiary survey? - Answers- Re-evaluate and reassess patient
How does tension pneumothorax lead to death? - Answers- A tension pneumothorax essential acts as an internal one-way valve - allowing air into the chest cavity but not out. This results in pressure on the mediastinum, thus decreasing venous return to the heart and eventual cardiac arrest. What are the signs of a tension pneumothorax? - Answers- engorged neck veins Reduced lung expansion deviation of trachea to opposite side Hyper-resonant chest decreased breath sounds on affected side Management of tension pneumothorax? - Answers- needle decompression in 2nd intercostal space then insertion of chest drain (definitive management) Management of open pneumothorax - Answers- Three-sided dressing and then insertion of chest drain What is a flail chest? - Answers- 2 or more rib fractures in 2 or more places, thus resulting in separation of a segment of the thoracic cage Clinical sign of flail chest - Answers- Paradoxical movement of this part of the chest wall - indrawing on inspiration and outwards movement on expiration Beck's triad is a constellation of findings indicative of cardiac tamponade. What are they? - Answers- hypotension jugular venous distention muffled heart sounds Management of cardiac tamponade - Answers- pericardiocentesis under ultrasound guidance What is the lethal triad of trauma? - Answers- coagulopathy hypothermia metabolic acidosis Classification of cardiogenic shock based on % blood loss - Answers- Class 1 - < Class 2 - 15 - 30 Class 3 - 30 - 40 Class 4 - > Classification of cardiogenic shock based on pulse - Answers- Class 1 - < Class 2 - 100 - 120 Class 3 - 120 - 140 Class 4 - >
Classification of cardiogenic shock based on BP? - Answers- Class 1- 2 - normal BP Class 3- 4 - low BP