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

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Advanced Trauma Life support (ATLS) 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 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 objective signs of airway obstruction - Correct Answer - agitation (hypoxia), obtunded (hypercarbia), cyanosis (hypoxemia), use of accessory mm - noisy breathing (obstructed), snoring, gurgling, stridor (partial occlusion), hoarseness (functional laryngeal obstruction) - abusive and belligerent (hypoxic) term; referring to flaccidity and loss of reflexes that occur immediately after spinal cord injury, after a period of time, spasticity ensues - Correct Answer spinal shock neurogenic shock, 2 types of medications which may be useful - Correct Answer - vasopressors - atropine seesaw pattern of breathing, typically indicates what damage? - Correct Answer injury to cervical spinal cord below C3 -> maintenance of diaphragmatic function but loss of IC and abd. mm contribution to resp. (abdominal breathing or diaphragmatic breathing) examples of ventilation compromise causes if clearing airway does not improve pat's breathing - Correct Answer - pain with breathing - intracranial injury - cervical spinal cord injury failure to recognize inadequate ventilation, 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 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 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, volume repletion will allow recovery from shock state only when bleeding has stopped other clinical components to observe when looking for shock, except SBP - Correct Answer - pulse rate - pulse character - RR - skin perfusion - PP examples of radiology for finding the sources of potential blood loss - Correct Answer - CXR - pelvic x ray (PXR) - abd. assessment with FAST or diagnostic peritoneal lavage (DPL) - bladder catheterization in trauma, causes for cardiogenic shock - Correct Answer - blunt cardiac injury - cardiac tamponade - air embolus - rarely MI clinical signs of cardiac tamponade - Correct Answer tachycardia, muffled heart sounds, dilated and engorged neck veins with hypotension and insuff. response to fluid therapy classic presentation of neurogenic shock - Correct Answer hypotension without tachycardia or cutaneous vasoconstriction narrowed PP is not seen in neurogenic shock signs and symptoms of hemorrhage by class, diagram - Correct Answer classes of hemorrhage, relate; - individual who donated 1 unit of blood - 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 - 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, 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 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 dressing for treatment of open ptx - Correct Answer describe; - tension ptx - open ptx - simple ptx - Correct Answer - "one-way valve" air leak from lung or through chest wall - sucking chest wound, in large injuries to the chest wall which remain open - air enters parietal space, thorax completely filled by lungs, but air in pleural space disrupts cohesive forces between pleurae and allows lung to collapse. simple ptx diagram - Correct Answer massive hemothorax diagram - Correct Answer most common causes of blunt cardiac injuries (mechanisms of injuries) - Correct Answer - motor vehicle crash Ω (50%) - pedestrian struck by vehicles - motorcycle crashes - falls from heights greater than 6 m blunt cardiac injury, clinically significant sequelae ECG findings most commonly seen management if detected blunt injury by conduction abnormalities - Correct 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 - 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 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 - 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% - small bowel 30% - diaphragm 20% - colon 15% - small bowel, 50% - colon 40% - liver 30% - abd. vascular structures 25% physical exam findings suggestive of pelvic fracture include; - Correct Answer - evidence of ruptured urethra (scrotal hematoma or blood at urethral meatus) - discrepancy in limb length - rotational deformity of a leg without obvious fracture - lower extremity neuro abnormalities or open wounds in flank, perineum, vagina or rectum term; an invasive emergency procedure used to detect hemoperitoneum and help determine the need for laparotomy following abdominal trauma. A catheter is inserted into the peritoneal cavity, followed by aspiration of intraperitoneal contents, often after their dilution with crystalloid. - Correct Answer diagnostic peritoneal lavage FAST RUQ, free fluid, kidney and liver - Correct Answer abdominal trauma DPL vs FAST vs CT, when is which indicated? - Correct Answer signs of pelvic fracture - Correct Answer - evidence of ruptured urethra - 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 - 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 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 potentially life-threatening extremity injuries include for example; - Correct Answer - major arterial hemorrhage - bilateral femoral fractures - crush syndrome myoglobin induced renal failure can be prevented by what medical means? - Correct Answer - IV fluid expansion - alkalinization of urine by IV bicarbonate and osmotic diuresis common joint dislocation deformities - Correct Answer ankle/brachial index of less than ___ indicates abnormal arterial flow secondary to injury or peripheral vascular disease - Correct Answer 0.9 open fractures and open joint injuries, management - Correct Answer - ASAP IV ab, weight-based dosing - remove gross contamination and particulates from wound ASAP and cover with moist sterile dressing - immobilization after accurately describing wound and determining Ω soft-tissue, circulatory and neuro status - Sx consult IV antibiotic weight-based dosing guidelines for open fractures - Correct Answer signs and symptoms of compartment syndromes - Correct Answer clinical diagnosis of compartment syndrome - Correct 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 - 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 - 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; - 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 partial-thickness burns - superficial partial thickness, moist, painfully hypersensitive, potentially blistered, homogenously pink, blanch to touch - deep partial thickness, drier, less painful, potentially blistered, red or mottled in appearance, do not blanch full-thickness burn - leathery, skin may appear translucent or waxy white, painless dry superficial partial-thickness burn injury - Correct Answer deep partial-thickness burn diagram - Correct Answer deep partial-thickness burn pic - Correct Answer full-thickness burn pic - Correct Answer frostbite classification - Correct Answer 1st degree - hyperemia and edema present without skin necrosis 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 warming strategies in trauma, algorithm - Correct Answer 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 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 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 OPA device will prevent what? - Correct Answer obstruction from tongue adjuncts to primary survey and resusictation, examples - Correct Answer - ECG - vital signs - ABGs - capnography and pulsoximetry - imaging (CT, FAST, eFAST, DPL) - urinary/gastric catheters - urinary output adjuncts are used selectively proper initial assessment and management, diagram - Correct Answer initial assessment, diagram - Correct Answer traumatic circulatory arrest, algorithm - Correct Answer flail chest and pulmonary contusion, treatment - Correct Answer indications for CT in ATLS - Correct Answer identifying abdominal, retroperitoneal and pelvic injuries for hemodynamically normal patients without indication for laparotomy definitions; motor level injury 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) 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 - C6 - C7 - C8 - T4 - T8 key spinal nerve segments and areas of innervation, sensorium if;