ADVANCED TRAUMA LIFE SUPPORT EXAM NEWEST 2024 ACTUAL EXAM, Exams of Nursing

Download ADVANCED TRAUMA LIFE SUPPORT EXAM NEWEST 2024 ACTUAL EXAM and more Exams Nursing in PDF only on Docsity! ADVANCED TRAUMA LIFE SUPPORT EXAM NEWEST 2024 ACTUAL EXAM QUESTIONS AND CORRECT DETAILED ANSWERS (VERIFIED ANSWERS) Patients with GSC of less than _____ usually require intubation - ANSWERS,8 The "A" in ABCD stands for ______. - ANSWERS,Airway maintenance with Cervical SPINE protection You should assume that any patient in a multisystem trauma with an altered level of consciousness or blunt injury above the clavice has what type of injury - ANSWERS,Cervical Spine Injury Flail chest is invariably accompanied by _______ which can interfere with blood oxygenation - ANSWERS,pulmonary contusion - do NOT over fluid resuscitate these patients. Hypotension is caused by ______ until proven otherwise. - ANSWERS,hypovolemia When you dont have a BP what are three things to look for when evaluating perfusion? - ANSWERS,1. level of consciousness (brain perfusion 2. Skin color (ashen face/grey extremities) 3. Pulse (bilateral femoral - thready/tachy) Elderly patients have a limited ability to ___________ to compensate for blood loss - ANSWERS,increase heart rate Resuscitation fluids should be warmed to 39 Celsius - ANSWERS,Only for Cyrstalloids, NOT for blood Urinary catheters are good for assessing renal perfusion and volume status. List 5 signs of urethral injury that might precent you from inserting one - ANSWERS,Blood at urethral meatus, perineal ecchymosis, blood in scrotum, high-riding/non-palpable prostate, pelvic fracture Which arm should you NOT put a pulse-ox on? - ANSWERS,The arm with the BP cuff 2 anatomical things that can interfere - ANSWERS,Obesity and intraluminal bowel gas When should radiographs be obtained? - ANSWERS,During the Secondary survey! How do get an ample patient history? - ANSWERS,Allergies Medications PMH/Pregnancy Last meal Events/Environment Why might you want a Bair Hugger for a patient who smells of Alcohol? - ANSWERS,Vasodilation can lead to hypothermia What things are you looking for when you do a DRE in trauma - ANSWERS,Blood, high riding prostate, sphincter tone, What should be done for every female patient - ANSWERS,Pregnancy test Adult patients should maintain UOP of at least _____mL/kg/hr. Kids should have at least ______ mL/kg/hr - ANSWERS,Adults 0.5 mL/kg.hr Kids 1.0 mL/kg/hr Preventing hypercarbia (hypercapnia) is critical in patients who have sustained a _______ injury - ANSWERS,head What two places would you LOOK at a patient if you suspect hypoxemia? - ANSWERS,Lips and fingernail beds Patients may be abusive and belligerent because of ______-, so don't just assume its due to drugs, alcohol, or the fact they they are just inherently a jerk - ANSWERS,hypoxia The most common cause of shock in the injured trauma patient is _________. - ANSWERS,hemorrhage Approximately ___% of the body's total blood volume is located in the venous circuit/ - ANSWERS,70 Why does shock actually reduce the total volume of circulating blood? - ANSWERS,Anaerobic metabolism --> cant make more ATP --> endoplasmic then mitochondrial damage --> lysosomes rupture --> sodium and water enter the cell, which SWELLS and dies Which vasopressors should you use to treat hemorrhagic shock? What are the drug doses - ANSWERS,Never use pressors hypovolemic shock - use VOLUME replacement. Pressors will worsen tissue perfusion in hemorrhagic shock Compensatory mechanisms may preclude a measurable fall in systolic blood pressure until up to ____% of the patient's blood volume is lost. - ANSWERS,30 Any patient who is cool and is tachycardic is considered to be _______until proven otherwise. - ANSWERS,in shock The definition of tachycardia depends on patients age. What heart rate is considered tachycardic for infants, toddlers/PS, schoolage/prepubescent, and adults - ANSWERS,Infants >160 toddlers/PS > 140 schoolage/prepubescent >120 Adults > 100 Elderly patients may not exhibit tachycardia in response to hypovolemia because of limited cardiac response to catecholamines. Why else might they not get tachy? - ANSWERS,On a Beta-Blocker or have a pacemaker A FAST scan in an excellent way to diagnose cardiac tamponade. What signs sugget tamponade - ANSWERS,Beck's Triad: JVD, muffled heard sounds and hypotension (will be resistant to fluid therapy). Will also likely be tachycardic Patients with a tension pneumo and patient with cardiac tamponade may present with many of the same signs. What findings will you see with a tension will you NOT see with tamponade? - ANSWERS,Absent breath sounds and hyperresonance to percussion over the affected hemithorax. Immediate thoracic decompresion is warrented for anyone with absent breath sounds, hyperressonance to percussion, tracheal deviation, _________ and _________ - ANSWERS,Acute respiratory distress & subcutaneous emphysema Can isolated intracranial injuries cause neurogenic shock? - ANSWERS,NO How do you calculate total blood volume in an adult? - ANSWERS,70 mL per kg. A 70 kg person has about 5 L of circulating blood. (70*70) = 4900 mL How do you calculate TBV in child - ANSWERS,BW (kg) X 80-90 mL The blood volume of an obese person is calculated based upon their _________ weight - ANSWERS,ideal Fluid replacement should be guided by __________, not simply by the initial classification (Class I-IV) - ANSWERS,The patient's response to initial replacement How much blood volume is lost with Class I hemorrhage? - ANSWERS,Up to 15% Donating 1 pint, or ~500 mL of blood is about 10% volume lose and would classify as Class I Hemorrhage. Transcapillary refill and other compensatory mechanisms restore blood volume within 24 hours How much blood volume is lost with Class II hemorrhage> - ANSWERS,15-30% (750-1500 mL in a 70 kg adult) How do you treat a Class II hemorrhage - ANSWERS,Usually just crystalloid resuscitation Subtle CNS changes such as anxiety, fright, and hostility would be expected in patient with a Class ____ hemorrhage - ANSWERS,II How much blood volume is lost with Class III hemorrhage? - ANSWERS,30-40% (2000 mL in a 70 kg adult) A patient with inadequate perfusion, marked tachycardia and tachypnea, significant mental status change, and a measurable fall in systolic blood pressure likely has a Class _____ Hemorrhage - ANSWERS,III or IV - these patients requre a blood transfusion, which depends on their response to initial fluid resuscitation. The first priority is stopping the hemorrhage. Loss of more than 50% of blood volume results in loss of consciousness. - ANSWERS,50 How much blood volume is lost with Class IV hemorrhage? - ANSWERS,More than 40%. Unless very aggressive measures are taken the patients will die within minutes A Class _____ Hemorrhage represents the smallest volume of blood lost that is consistently associated with a drop in systolic blood pressure - ANSWERS,III Up to __________ mL of blood loss is commonly associated with femur fractures - ANSWERS,1500 Unexplained hypotension or cardiac dsyrhythmias (usually bradycardia from excessive vagal stimulation) are often caused by ______ especially in children - ANSWERS,gastric distention How much crystalloid should you give an adult for an initial fluid resuscitation bolus? for kids - ANSWERS,Adults: 2 L Kids: 20 mL/kg (may repeat and give as much as 60 mL/Kg but wit high reserve in kids, if they're in shock they should get blood sooner rather than later Each mL of blood loss would be replaced with ____ mL of crystalloid, thus allowing for replacement of plasma volume lot into interstitial and intracellular saces - ANSWERS,3 Blood on the floor x four more is mneumonic for occult blood loss where? - ANSWERS,Chest, pelvis, retroperitoneum, and thigh For children UNDER 1 year of age, UOP should be ______ mL/Kg/Hr - ANSWERS,2 Would patients in EARLY hypovolemic shock be acidodic or alkalotic? - ANSWERS,Alkalotic - respiratory alkalosis from tachypnea .... followed later by mild metabolic acidosis in the early phase of shock A pneumothorax associated with a persistent large air leak after tube thoracostomy suggests a _______ injury. - ANSWERS,tracheobronchial - Use bronchoscopy to confirm, you may need more than one chest tube before definitive operative management. What radiographic findings are suggestive of traumatic aortic disruption? - ANSWERS,Widened mediastinum, obliteration of aortic knob, deviation of trachea to the right, depression of left mainstem bronchus, deviation of esophagus (NG tube) to right, widened paratracheal stripe, fx'd 1st/2nd ribs or scapula. A deceleration injury victim with a left pnuemothorax or hemothorax without rib fractures, is in pain or shock out of proportion to the apparent injury, and has particulate matter in their chest tube may have _________. - ANSWERS,an ESOPHAGEAL RUPTURE - a forceful blow causes expulsion of gastric contents into the esophagus, producing a linear tear in the lower esophagus allowing leakage into the mediastinum. Fractures for the lower ribs (10-12) should increase suspicion for _____ injury. - ANSWERS,hepatosplenic Why are upper torso, facial, and arm plethora with petechiae associated with crush injuries to the chest? - ANSWERS,Temporary compression of the superior vena cava. How does ATLS suggest you should review a chest radiograph? - ANSWERS,Trachea & bronchi, pleural spaces and parenchyma, mediastinum, diaphragm, bones, soft tissues, tubes & lines. You should use a size 16 or 18 gauge 6" needle for pericardiocentesis. How do you insert it? - ANSWERS,Puncture the skin 1-2 cm inferior to the left xiphohondral junction at a 45 degree angle to the skin towards the heart, aiming toward the top of the left scapula. What's a good way to know if you've advanced your needle too far during pericardiocentesis and have entered ventricular muscle? - ANSWERS,ECG Changes - extreme ST-changes, widened QRS, PVCs, etc... Withdrawl needle until ECG returns to baseline. What should you do with your needle after you successfully evacuate blood during pericardiocentesis? - ANSWERS,Lock the stopcock and leave the catheter in place in case it needs to be reevacuated. If possible, use the Seldinger technique to pass a 14 gauge flexible catheter over the guidewire. This is NOT a definitive treatment. For patients with facial fractures or basillar skull fractures, gastric tubes should be inserted ____ before doing a DPL. - ANSWERS,through the mouth You need to do retrograde urethrography PRIOR to foley placement if _____. - ANSWERS,inability to void, unstable pelvic fracture, blood at urethral meatus, scrotal hematoma, perineal ecchymoses, or high-riding prostate. DPL is considered to be __% sensitive for detecting intraperitoneal bleeding. - ANSWERS,98 What are the four places you should look first when doing a FAST scan? - ANSWERS,Mediastinum, hepatorenal fossa, splenorenal fossa, pouch of Douglas. DPL is indicated when a patient with multiple blunt injuries is hemodynamically unstable, especially when they have _____. - ANSWERS,Change in sensorium (brain injury/EtOH or drug intoxication), change in sensation (spinal cord injury), injury to adjacent structures (pelvis, lumbar spine), lap-belt sign (from seatbelt), or if patient is going for long studies (CT, ortho surgery...). What is the only ABSOLUTE contraindication to DPL? - ANSWERS,An existing indication for laparotomy. What are some RELATIVE contraindications to DPL? - ANSWERS,Morbid obesity, advanced cirrhosis, preexisting coagulopathy, and previous abdominal operations (adhesions). When should you use an open SUPRAUMBILICAL approach for a DPL? - ANSWERS,PELVIC FRACTURES (don't want to enter pelvic hematoma) and ADVANCED PREGNANCY (don't want to damage enlarged uterus). When doing a DPL, what INITIAL findings (not from lab) would mandate a laparotomy? - ANSWERS,Free blood (>10 mL) or GI contents (vegetable fiber, bile). If you don't get gross blood upon initial DPL aspiration, what do you do next for an adult? For a child? - ANSWERS,Adult - 1,000 mL warm isotonic crystalloid. Kid - 10 mL/kg You've just put a bunch of fluid in the belly and aspirated more fluid for your DPL. No gross GI contents or anything alarming are present, what QUANTATIVE things would make the DPL positive? - ANSWERS,>100,000 red cells/mm^3, 500 white cells/mm^3, or BACTERIA (on gram stain). Your trauma patient needs an urgent laparotomy, can you take them to the CT scanner first to evaluate injuries? - ANSWERS,No, if they need an emergent laparotomy they are unstable - unstable patients should NOT go to the CT scanner! What are some indications for laparotomy in patients with penetrating abdominal wounds? - ANSWERS,Unstable, GSW, peritoneal irritation, fascial penetration What percentage of stab wounds to the anterior abdomen do NOT penetrate the peritoneum? - ANSWERS,25-33% Does an early normal serum amylase level exclude major pancreatic trauma? - ANSWERS,NO Do you need to operate on anyone with an isolated solid organ injury? - ANSWERS,No - not if they remain hemodynamically stable (Of all patients who are initially thought to havea ISOLATED solid organ injury, <5% will have hollow viscus injury as well). Which is LESS likely to have a life-threating hemorrhage - an open book or closed book pelvic fracture? - ANSWERS,Closed book - the pelvic volume is compressed, so not as much room for blood. Anterior/posterior forces causes _____ book pelvic fractures, and lateral forces cause _____ book fractures. - ANSWERS,AP = Open Book, LATERAL = Closed Book Which are more common, open or closed book pelvic fracturs? - ANSWERS,CLOSED BOOK - 60-70% (Open book 15-20%, vertical shear 5-15%) If a patient with a pelvic fracture is positive for intraperitoneal gross blood, a ex-lap is warranted. What is your next move if that same patient is NEGATIVE for gross intraperitoneal blood? - ANSWERS,Angiography What do you need to do BEFORE you do a DPL? (Other than getting stuff together and surgically prepping, etc...) - ANSWERS,DECOMPRESS BLADDER, DECOMPRESS STOMACH What is "adequate" fluid return when getting DPL fluid back? - ANSWERS,30% Ten percent of all patients with a c-spine fracture have what? - ANSWERS,A second, noncontiguous vertebral column fracture. (So scan the rest of their spine). Attempts to align the spine for the purpose of immobilization on the backboard are not recommended if they _______. - ANSWERS,cause pain Can you clear a c-spine without films? - ANSWERS,Yes, if they are awake, alert, sober, neurological normal, have NO pain, and can flex, extend, and move their head to both sides without pain - you don't need films. Should a quadriplegic or paraplegic patient be put on a hard board? - ANSWERS,Not for more than 2 hours - get them off ASAP. What's a big difference in a physical finding between hypovolemic and neurogenic shock? - ANSWERS,Hypovolemic = usually TACHY, Neurogenic = usually BRADY Partial or total loss of respiratory function may be seen in a patient with a cervical spine injury above ___. - ANSWERS,C6 Why might someone not be able to breathe if they have a long bone fracture - ANSWERS,Fat embolism - uncommon though Abnormal arterial blood flow is indicated by an ABI of ____. - ANSWERS,<0.9 By LOOKING at the patient, what findings might suggest pelvic injury? - ANSWERS,Leg-length discrepancy, rotation (usually external) Crush injuries may result in rhabdomyolysis - casts block flow, also iron is released which forms ROS which then damage cells and impair ability to regulate K+ etc... What can you do to prevent this? - ANSWERS,Volume expansion, and alkalization of urine with bicarb will reduce intratubular precipitation of myoglobin. UOP should be 100 mL/hr until myoglobinuria is cleared. Muscle does not tolerate lack of arterial flow (tourniquet) for more than ___ hours before necrosis begins. - ANSWERS,6 What things increase the risk for tetanus? - ANSWERS,Wounds >6 hours old, wounds contused or abraded, >1 cm deep, from high velocity missiles, due to burns or cold, and significantly contaminated wounds. Should legs be completely straight when splinting? - ANSWERS,No, flexion of 10 degrees recommended to take pressure off neurovascular structures. Any patient with burns covering more than ___% of BSA require fluid resuscitation. - ANSWERS,20 The palmer surface of a patient's hand represents approximately ___% of their BSA. - ANSWERS,1% A high index of suspicion for inhalation injury must be maintained, because patients may not display clinical evidence for up to ___ hours, by this time edema may prevent non-surgical intubation. - ANSWERS,24 Carbon monoxide has ____ times the affinity for oxygen as hemoglobin. - ANSWERS,240 Patients with CO levels less than ___% usually don't have any physical symptoms - ANSWERS,20% Adult head BSA = ___%. - ANSWERS,9 (ENTIRE head front and back = 9) Baby head BSA = __% - ANSWERS,18 (9 front, 9 back) What is the main difference between adult and baby BSA determination for burns? - ANSWERS,Entire head on baby is 18, whereas it's 9 for adults. This difference of 9 is made up by the fact that each side (front/back) on adult = 9, but only 7 for kids. (36 vs 28). Chest BSA = ___%. - ANSWERS,18 Back BSA = ____% - ANSWERS,18 Arm BSA = ___%. - ANSWERS,9 TOTAL (front AND back). Leg BSA for adult = ___%. - ANSWERS,18 TOTAL (9 front, 9 back). Baby front or back of leg BSA =___%. - ANSWERS,7 (TOTAL leg = 14%) If you add up BSA head, chest, back, arms, and legs you get 99% of BSA. What is the remaining 1%? - ANSWERS,Perineum Partial/2nd degree burns extend into the _____ whereas full thickness/3rd degree burns - ANSWERS,Partial - go into dermis, FULL go all the way through dermis and into/beyond SQ tissue For patients with CO poisoning, the ½ life is ___ when breathing room air and ___ breathing 100% oxygen - ANSWERS,4 hours on RA, 40 min on 100% O2 How do you calculate the Parkland formula? (BURNS) - ANSWERS,4 * weight (kg) * percent BSA burned = volume in 24 hours (1st half in 8 hrs, 2nd half over 16 hrs).4*70kg*25 percent = 7 liters in 24 hours. ***Use 25, NOT 0.25)*** Partial or full thickness burns of ___% in patients less than 10 or older than 50 warrants transfer to a burn center. - ANSWERS,10% What percent partial/full thickness burns would qualify a 25 year old for a burn center transfer? - ANSWERS,20% What anatomical positions with partial/full thickness burns warrant burn center transfer? - ANSWERS,Face, eyes, ears, hands, genitalia, perineum, feet, skin overlying joints. Does an inhalation injury warrant transfer to a burn center? - ANSWERS,Yes Should you treat frostbite by soaking body part in water or not? - ANSWERS,YES, 40 degree (104F) for 20-30 min should suffice. Don't warm if there is risk of REFREEZING. Insofar as hypothermia is concerned, patients are not pronounced dead until they are _____ and dead. - ANSWERS,warm