ADVANCED TRAUMA LIFE SUPPORT EXAM NEWEST EXAM 2024 | ALL QUESTIONS AND CORRECT ANSWERS, Exams of Nursing

Download ADVANCED TRAUMA LIFE SUPPORT EXAM NEWEST EXAM 2024 | ALL QUESTIONS AND CORRECT ANSWERS and more Exams Nursing in PDF only on Docsity! ADVANCED TRAUMA LIFE SUPPORT EXAM NEWEST EXAM 2024 | ALL QUESTIONS AND CORRECT ANSWERS | ALREADY GRADED A+ | PROFESSOR VERIFIED A patient arrives to the trauma bay intubated and there are absent breath sounds over the left hemithorax, where should you place your decompression needle? ------CORRECT ANSWER---------------This may NOT be a pneumothorax, for intubated patients always suspect a right main-stem before attempting needle decompression. Where would you insert a large caliber needle to decompress a tension pneumo ------CORRECT ANSWER---------------2nd IC space in the midclavicular line of affected hemithorax For an open pneumothorax, (sucking chest wound) air passes preferentially through the chest wall defect (least resistance) if the diameter of the defect is at least ___ the diameter of the trachea. ------CORRECT ANSWER-------- -------2/3 Flail chest results from multiple rib fractures - by definition this would be ___ or more ribs, fractured in ___ or more places. ------CORRECT ANSWER---------------2 or more ribs fractured in 2 or more places Both tension pneumothorax and massive hemothorax are associated with decreased breath sounds on auscultation, so you can tell which it is by _______. ------CORRECT ANSWER---------------Percussion - hyperresonant with pnuemo, dull with hemothorax. If a patient doesn't have JVD, does this mean they don't have a tension pneumo or tamponade? ------CORRECT ANSWER---------------No, they might have a massive internal hemorrhage and be hypovolemic. By definition, how much blood is in the chest cavity to call it a "massive hemothorax"? ------CORRECT ANSWER---------------1500 mL or 1/3 or more of the patient's total blood volume. (Some also define it as continued blood loss of 200 mL/hr for 2-4 hours- but ATLS does NOT use this rate for any mandatory treatment decisions). What size chest tube might you use to evacuate a massive hemothorax? --- ---CORRECT ANSWER---------------#38 French - inserted at the 4th or 5th intercostal space, just anterior to the midaxillary line. What is Kussmaul's sign? ------CORRECT ANSWER---------------A rise in venous pressure with inspiration while breathing spontaneously, and is a true paradoxical venous pressure abnormality associated with cardiac tamponade. How well do CPR compressions work on someone with a penetrating chest injury and hypovolemia? ------CORRECT ANSWER---------------"Closed heart massage for cardiac arrest or PEA is INEFFECTIVE in patients with hypovolemia." Patients with PENETRATING thoracic injuries who arrive pulseless, but with myocardial electrial activity, may be candidates for an ED thoacotomy. ANSWER---------------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? ------CORRECT ANSWER---------------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. ------CORRECT ANSWER----- ----------through the mouth You need to do retrograde urethrography PRIOR to foley placement if _____. ------CORRECT ANSWER---------------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. ------CORRECT ANSWER---------------98 What are the four places you should look first when doing a FAST scan? --- ---CORRECT ANSWER---------------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 _____. ------ CORRECT ANSWER---------------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? ------CORRECT ANSWER---------------An existing indication for laparotomy. What are some RELATIVE contraindications to DPL? ------CORRECT ANSWER---------------Morbid obesity, advanced cirrhosis, preexisting coagulopathy, and previous abdominal operations (adhesions). When should you use an open SUPRAUMBILICAL approach for a DPL? --- ---CORRECT ANSWER---------------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? ------CORRECT ANSWER---------------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? ------CORRECT ANSWER---------------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? ------CORRECT ANSWER--------------->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? ------CORRECT ANSWER--------------- 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? ------CORRECT ANSWER---------------Unstable, GSW, peritoneal irritation, fascial penetration What percentage of stab wounds to the anterior abdomen do NOT penetrate the peritoneum? ------CORRECT ANSWER---------------25-33% Does an early normal serum amylase level exclude major pancreatic trauma? ------CORRECT ANSWER---------------NO Do you need to operate on anyone with an isolated solid organ injury? ------ CORRECT ANSWER---------------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? ------CORRECT ANSWER---------------Closed book - the pelvic volume is compressed, so not as much room for blood. When should radiographs be obtained? ------CORRECT ANSWER------------ ---During the Secondary survey! How do get an ample patient history? ------CORRECT ANSWER--------------- Allergies Medications PMH/Pregnancy Last meal Events/Environment Why might you want a Bair Hugger for a patient who smells of Alcohol? ----- -CORRECT ANSWER---------------Vasodilation can lead to hypothermia What things are you looking for when you do a DRE in trauma ------ CORRECT ANSWER---------------Blood, high riding prostate, sphincter tone, What should be done for every female patient ------CORRECT ANSWER---- -----------Pregnancy test Adult patients should maintain UOP of at least _____mL/kg/hr. Kids should have at least ______ mL/kg/hr ------CORRECT ANSWER---------------Adults 0.5 mL/kg.hr Kids 1.0 mL/kg/hr Preventing hypercarbia (hypercapnia) is critical in patients who have sustained a _______ injury ------CORRECT ANSWER---------------head What two places would you LOOK at a patient if you suspect hypoxemia? -- ----CORRECT ANSWER---------------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 ------CORRECT ANSWER---------------hypoxia Can a patient breath on their own after complete cervical cord transection -- ----CORRECT ANSWER---------------Yes if the phrenic nerves (C3-C5 are spared. This will result in 'abdominal' breathing. The intercostal muscles will be paralyzed though Can you use an OPA (Guedel) in a conscious patient ------CORRECT ANSWER---------------No, it could make them vomit. An NPA (trumpet) would be okay. Bougies are typically inserted blindly, how do you know you are in the trachea and not the esophagus? ------CORRECT ANSWER---------------You can feel the clicks as the distal tip rubs against the cartilaginous tracheal rings, or it will deviate right or left when entering either bronchus (at 50 cm) What do yo NOT want to hear if you auscultate a patient after placement of an ET tube? ------CORRECT ANSWER---------------Borborygmi - rumbling or gurgling noices suggest esophageal insertion. What is the RSI dose for etomidate ------CORRECT ANSWER--------------- 0.3 mg/kg (usually 20 mg) What is the RSI dose for succinylcholine ------CORRECT ANSWER----------- ----1-2 mg/kg (usually 100 mg) How does etomidate affect blood pressure ------CORRECT ANSWER-------- -------it doesnt -it shouldnt have any effect on BP. Ketamine will increase BP, and propofol and thiopental will both drop BP. A RSI dose of succinylcholine usually lasts about ___ minutes ------ CORRECT ANSWER---------------5 What hypnotic/sedative/induction agent do you NOT want to use for a severely burned patient? ------CORRECT ANSWER---------------Sux - patients with severe burns, crush injuries, hyperkalemia, or chronic paralytic/neuromuscular disease should NOT get Sux because of hyperkalemia risk O2 should flow at 15L for needle cricothyroidotomy, and have a Y connector for insufflation if possible. What size needle do you use for adults? Kids? ------CORRECT ANSWER---------------Adults: 12-14 gauge kids: 16-18 gauge Which vasopressors should you use to treat hemorrhagic shock? What are the drug doses ------CORRECT ANSWER---------------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. ------ CORRECT ANSWER---------------30 Any patient who is cool and is tachycardic is considered to be _______until proven otherwise. ------CORRECT ANSWER---------------in shock The definition of tachycardia depends on patients age. What heart rate is considered tachycardic for infants, toddlers/PS, schoolage/prepubescent, and adults ------CORRECT ANSWER---------------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? ------CORRECT ANSWER---------------On a Beta- Blocker or have a pacemaker A FAST scan in an excellent way to diagnose cardiac tamponade. What signs sugget tamponade ------CORRECT ANSWER---------------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? ------CORRECT ANSWER------- --------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 _________ ------CORRECT ANSWER---------------Acute respiratory distress & subcutaneous emphysema Can isolated intracranial injuries cause neurogenic shock? ------CORRECT ANSWER---------------NO How do you calculate total blood volume in an adult? ------CORRECT ANSWER---------------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 ------CORRECT ANSWER--------------- BW (kg) X 80-90 mL The blood volume of an obese person is calculated based upon their _________ weight ------CORRECT ANSWER---------------ideal Fluid replacement should be guided by __________, not simply by the initial classification (Class I-IV) ------CORRECT ANSWER---------------The patient's response to initial replacement How much blood volume is lost with Class I hemorrhage? ------CORRECT ANSWER---------------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> ------CORRECT ANSWER---------------15-30% (750-1500 mL in a 70 kg adult) How do you treat a Class II hemorrhage ------CORRECT ANSWER----------- ----Usually just crystalloid resuscitation Subtle CNS changes such as anxiety, fright, and hostility would be expected in patient with a Class ____ hemorrhage ------CORRECT ANSWER---------------II How much blood volume is lost with Class III hemorrhage? ------CORRECT ANSWER---------------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 ------CORRECT ANSWER-- -------------III or IV - these patients requre a blood transfusion, which Most Patients receiving blood transfusions ___________ need calcium replacement ------CORRECT ANSWER---------------dont How should you position the patient before placing a subclavian or IJ line? - -----CORRECT ANSWER---------------Supine, head down 15 degrees to distend neck neck veins and prevent embolism, only turn head away is C- spine has been cleared first. How long can you keep and IO line in ------CORRECT ANSWER-------------- -Intraosseous infusions should be limited to emergency resuscitation and should be discontinued as soon as other venous access is obtained Where do you want to make an incision for a saphenous vein cutdown and how long should your incisions be? ------CORRECT ANSWER---------------1 cm superior, 1 cm anterior to medial malleolus. 2.5 cm transverse incusion through the skin and SQ, careful to not to inure the vessel. What do you need to do BEFORE you do a DPL? (Other than getting stuff together and surgically prepping, etc...) ------CORRECT ANSWER------------ ---DECOMPRESS BLADDER, DECOMPRESS STOMACH What is "adequate" fluid return when getting DPL fluid back? ------ CORRECT ANSWER---------------30% A blown pupil in a patient with a traumatic injury is caused by compression of which nerve? ------CORRECT ANSWER---------------Superficial parasympathetic fibers of the CN III (occulomotor). What is a "normal" ICP in the resting state? ------CORRECT ANSWER------- --------10mm Hg (Pressures >20, particularly if sustained, are associated with poor outcomes). The Monro-Kellie Doctrine describes compensatory mechanisms inside the calvarium to stabilize pressure - what are the 2 main/first ones? ------ CORRECT ANSWER---------------Venous Blood & CSF (decreased in equal volumes, when this is exhausted, herniation can occur and brain perfusion will likely be inadequate). Patients with a GCS of 3-8 meet the accepted definition of "coma" or "severe brain injury." What are the GCS scores for "minor" and "moderate" brain injury? ------CORRECT ANSWER---------------Minor = 13-15, Moderate = 8-12 When calculating GCS and there is right/left assymetry in the motor response - which one do you use? ------CORRECT ANSWER--------------- The "BEST" response. (Better predictor than worst response) What signs might you see if a patient has a basillar skull fracture? ------ CORRECT ANSWER---------------PERIORBITAL ECCHYMOSIS (raccoon eyes), RETROAURICULAR ECCHYMOSIS (Battle sign), and otorrhea/rhinorrhea. What do you need to know about the GCS ------CORRECT ANSWER-------- ------- What things might require a person with MINOR brain injury get admitted? - -----CORRECT ANSWER---------------Abnormal CT (or no scan available), penetrating head injury, prolonged LOC, worsening LOC, moderate to severe HA, significant drug/alcohol intoxication, skull fx, oto/rhinorrhea, nobody at home to watch, GCS stays <15, focal neuro deficits. What would you want to do if a patient with a minor brain injury fails to reach a GCS of 15 within 2 hour post injury, had LOC >5 min, are older than 65, emesis x 2, or had retrograde amnesia >30 minutes ------ CORRECT ANSWER---------------CT scan - Everything but the 30 min amnesia makes them HIGH risk for neurosurgical intervention (as would a basillar skull fx). What 2 things do you need to do first for everyone with a MODERATE brain injury (according to ATLS algorithm)? ------CORRECT ANSWER------- --------CT scan, admit to faciolity capable of definitive neurosurgical care (Moderate = GCS 9-12) High levels of CO2 will cause cerebral vasculature to _____. ------ CORRECT ANSWER---------------Dilate (to increase blood flow) - so you might want to HYPERventilate people with brain injuries. Ideally, you want to wait to perform a GCS on a person with SEVERE brain injury until what? ------CORRECT ANSWER---------------BP is normalized Should a quadriplegic or paraplegic patient be put on a hard board? ------ CORRECT ANSWER---------------Not for more than 2 hours - get them off ASAP. What's a big difference in a physical finding between hypovolemic and neurogenic shock? ------CORRECT ANSWER---------------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 ___. ------CORRECT ANSWER---------------C6 Why might someone not be able to breathe if they have a long bone fracture ------CORRECT ANSWER---------------Fat embolism - uncommon though Abnormal arterial blood flow is indicated by an ABI of ____. ------CORRECT ANSWER---------------<0.9 By LOOKING at the patient, what findings might suggest pelvic injury? ------ CORRECT ANSWER---------------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? ------CORRECT ANSWER---------------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. ------CORRECT ANSWER---------------6 What things increase the risk for tetanus? ------CORRECT ANSWER--------- ------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? ------CORRECT ANSWER---------------No, flexion of 10 degrees recommended to take pressure off neurovascular structures. Any patient with burns covering more than ___% of BSA require fluid resuscitation. ------CORRECT ANSWER---------------20 The palmer surface of a patient's hand represents approximately ___% of their BSA. ------CORRECT ANSWER---------------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. ------CORRECT ANSWER------ ---------24 Carbon monoxide has ____ times the affinity for oxygen as hemoglobin. ---- --CORRECT ANSWER---------------240 Patients with CO levels less than ___% usually don't have any physical symptoms ------CORRECT ANSWER---------------20% Adult head BSA = ___%. ------CORRECT ANSWER---------------9 (ENTIRE head front and back = 9) Baby head BSA = __% ------CORRECT ANSWER---------------18 (9 front, 9 back) What is the main difference between adult and baby BSA determination for burns? ------CORRECT ANSWER---------------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 = ___%. ------CORRECT ANSWER---------------18 Back BSA = ____% ------CORRECT ANSWER---------------18 Arm BSA = ___%. ------CORRECT ANSWER---------------9 TOTAL (front AND back). Leg BSA for adult = ___%. ------CORRECT ANSWER---------------18 TOTAL (9 front, 9 back). The normal systolic BP in kids can be estimated by what? ------CORRECT ANSWER---------------90 mm Hg + (age x 2) How do you estimate a child's total circulating volume? ------CORRECT ANSWER---------------80 mL/kg When shock in a child is suspected, how much fluid do you give them? ----- -CORRECT ANSWER---------------20 mL/kg warm crystalloid May need to repeat up to 3 times (60 mL/kg) then consider blood products. Optimal UOP for infants is ___ mL/kg/hr. ------CORRECT ANSWER---------- -----2 (1.5 for younger kids, and 1.0 for older kids) How much warmed crystalloid should be used for a DPL in kids? ------ CORRECT ANSWER---------------10 mL/kg (up to 1000 mL) What would you see in an infant that would make you suspect very severe brain injury despite normal LOC? ------CORRECT ANSWER--------------- Bulging fontanelles - these allow tolerance for expanding masses/swelling... What is a possible mistake about a blood pressure of 120/80 in a 87 year old man? ------CORRECT ANSWER---------------Assuming that normal blood pressure = normovolemia. Many geriatric patients have uncontrolled hypertension, and if their normal systolic is 180, then 120/80 is relative HYPOtension for them. How well do geriatric patients do with non-operative management of abdominal injuries compared to younger people? ------CORRECT ANSWER---------------Not as well - the risks of non-operative management are often worse than the risks of surgery. Why would geriatric patients be MORE susceptible to head bleeds when there is increased space around a shrinking brain to protect them from contusion? ------CORRECT ANSWER---------------Atrophic brains = stretching of the parasagittal bridging veins, making them more prone to rupture upon impact. Plasma volume increases during pregnancy, what happens to hematocrit? - -----CORRECT ANSWER---------------Decreases - dilution by plasma (31- 35% is normal in pregnancy) What would you think of a WBC of 15,000 in a pregnant woman? ------ CORRECT ANSWER---------------Normal, it can go up to 25,000 during labor! What should you always assume about a pregnant patient's stomach? ------ CORRECT ANSWER---------------That it is always full. (Gastric emptying time increases during pregnancy). Early NG tube placement recommended. A PaCO2 of 35 to 40 in a pregnant patient may indicate what? ------ CORRECT ANSWER---------------Impending respiratory failure. It is usually around 30 due to hyperventilation due to increased levels of progesterone. True or False: All Rh negative pregnant trauma patients should get Rhogam? ------CORRECT ANSWER---------------True, unless the injury is remote from the uterus (distal extremity injury only). This therapy should be initiated within 72 hours of injury. When worn correctly, seatbelts reduce fatalities by ___%. ------CORRECT ANSWER---------------65-70%, with a 10-fold reduction in serious injury. A midline shift of greater than ___ often indicates the need for neurosurgical evacuation of the mass/blood. ------CORRECT ANSWER----- ----------