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ADVANCED TRAUMA LIFE SUPPORT ATLS EXAM QUESTIONS

AND ANSWERS | 2024/25 UPDATE

60 minutes after injury to treat after the 60 mins morbidity and mortality significantly increases after 1st year of life injury is most frequent cause of death in babies too 31%-48% - CORRECT ANSWERS golden hour rib fractures on child

of left posterior 8th rib - CORRECT ANSWERS

•Performs Trauma Series - Lat C Spine, CXR, Pelvis

•Acts as liaison with CT suite. - CORRECT ANSWERS radiographer role in trauma team leader- most important stand back and keep overview of whats happening in the room and helicopter ODP- support anaesthetics nurse x scribe- wirtting whats happening radiographer •Team Leader •Anaesthetic SpR •Cardiac/Thoracic Surgeon •A & E Consultant/SpR •Orthopaedic SpR - CORRECT ANSWERS trauma team (not important)

airway management cervical spine control- any signs there breathing or snoring is bad sign of upper airway obstruction sokve with head tilt chin lift snoring will stop. they need a patent airway to breath breathing & ventilation - check lungs are rising and falling equally good depth volume listen to breath sounds or absent breath sounds on one side due to pnemothorax listen with stethoscope. if you hear crackles- fluid purcusion- use two fingers to look for a echo looking for hyper resenant- sign of pnemothorax if dull then its fluid. are they using accesory muscles struggling to breath -asthmatic or see saw effect with abdomen probe on finger to look at oxygen saturation should be breath 94-90% oxyegen saturaton of room air circulation -check for pulse of corotid pulse not just radial as they may be in shcok so blood pressure cant suport organs so shut down so cant feel radial pulse well so feel for corotid pulse and blood pressure. capilary re fill test good way to test if pt has shut down- press finger for 5 seconds finger should pink up within 2 seconds if not shut down haemorrage control - 5 liters circulating volume if you lose one litre you'll be out of it. disability - awareness is key. GCS can be replaced with- avpue if easier - measure are u alert b responsive to voice do they respond to pain u- unconcious e-exposure - any rashes bleeding wounds - CORRECT ANSWERS primary survery ABCD Not Breathing/Occasional gasps?• call for help then start CPR •Call Resuscitation Team - 2222 •Commence CPR 30:2 Adult (15:2 Child/Infant) 30 compressions to 2 ventilations at a rate of 120 per minute bag valve mask for ventilations 85-90% oxygen given •Change CPR provider after every 2 minutes MAX! - CORRECT ANSWERS Basic life support •Ventricular Fibrillation - VF!

•Pulseless Ventricular Tachycardia •Asystole •Pulseless Electrical Activity - PEA - CORRECT ANSWERS types of cardial arrest use weight of child to calculate amount of drugs to give and how to use a defibulator etc. calculations done before child arrives on helicopter - CORRECT ANSWERS before peadatric trauma arrives arrives head injury - ct throacic injury - suspected physical injury •Peripheral Trauma - RTA, bouncy castles, trampolines, electric scooters parents heavy on trampoline can injure child - CORRECT ANSWERS common peadeatric trauma and imaging and moi Ventricular fibrillation heart becomes ishcemic myocardial cells fire randomly not all at once heart shakes dosnt pump no blood pressure wont be asked to learn this image as its acc a video can be due shown to be VF due to catheters in right and less coronary artery giving contrast and contrast came out of coronary sinus (vein) circulation of heart filled with contrast and not blood so heart is hypoxic lacking in oxygen. shock pt to solve - defibulation - CORRECT ANSWERS Ventricular fibrillation heart beating so fast not giving itself a chance to fill with blood heart isnt allowing itself to fill with blood before going out again blood pressure falls and results in cardiac arrest even if VT still has pulse if sustained end up in vf good example is stompign on foot pump too fast

shock pt to solve - defibulation - CORRECT ANSWERS Ventricular Tachycardia heart has electricity in vt and vf and defib stops heart and biphaser defib gives double shock Synoatrial SA node kicks in to restore normal rythm and starts heart agao - CORRECT ANSWERS defibulation •Asystole - absence of electricity in heart so cant cure with defib as heart already stopped

•Pulseless Electrical Activity - PEA looks on ecg there is a pulse but there isnt - caused by: Hypoxia- loss of 02, Hypovolaemia-losss of circulating volume, Hypothermia, Hyperkalaemia/calcaemia- electrolyte imbalance Toxins- recrational drugs , Thrombus, Tension Pnuemothorax, Tamponade, or others! - CORRECT ANSWERS Non-Shockable Rhythms are they breathing? agonal gasps- accosional random breathing should be breathing 12-20 breaths a minute normally alseep 12 breaths a min over 20 is inceased respiratory rate due to a issue dont tell someone when cheking their breathing rate - CORRECT ANSWERS what is normal breathing rate? and name for random accasional breathing? tension pnemothroax midline shift from right side over to left tracheal deveaition away from effected side and diaphram drops comprimises venous circulation back to heart due to shift - CORRECT ANSWERS valves

chambers 3 left ventricle 22- right ventricle 8 left atrium - not usually seen on chest xray 19 right atrium left side posterior and higher right ventricle more on left side right heart border is right atrium - CORRECT ANSWERS label heart •Blunt trauma - crush/deceleration - caridac up check right side more anterior so more chnace of survival to trauma to right side of heart as it isn't as thick lower pressure not going as far to pump. cardicac chamber can cuase tamponade blood in pericaridal sack acts as constrictive band heart cant relax in diastoyle needs a needle blood aspiration •Penetrating trauma -Knives, bullets never take a knife or anything out as its blocking the hole it has caused Iatrogenic- medically caused somthing staff have done -Complications of arterial/venous punctures, Insertion of PPM or Chest Drain, Surgical Trauma for example putting a pace making in puncturing when putting valves ext in could cause subcalvian puncture into subclavian vein - CORRECT ANSWERS thoracic trauma cardiac tamponade - CORRECT ANSWERS

cardiac tamponade - large heart - CORRECT ANSWERS cardiac tamponade on ct in need of a needle aspiration to get it out - CORRECT ANSWERS penetrating trauma by knife to heart to right ventricle - CORRECT ANSWERS cxr ct if pt haemodynamicaly stable blood pressure stable - CORRECT ANSWERS throaxic trauma imaging options prev to xray: when brochial stent put in trauma caused pt not haemodynamically stable at time of chest xray had surgical emphysema put chest drains in after on right side of chest this xray shows: also been a pnemothroax on left but drains cause it to then be tension pnemothroax thoracic cavity filled with air that cant escape every time they take a breath in diaphram has inverted depressed on left endotracheal tube has moved to the right treatment pop baloon of air in the thoracic cavity to release the air then put chest drains in. - CORRECT ANSWERS •ET Tube •ECG Leads •Intercostal Drains •NG tubes- trauma pt always has one in place to aspirate any contents you can get back to prevent vomiting which can cause pt to aspirate drown in vomit and cause death

want to decompress stomach dont want it fill with air and bring diaphram up want lungs to have proper inflation - CORRECT ANSWERS tubes seen on chest xray •Fractures •Pneumothoraces •Haemothoraces •Pleural Effusions •Lung Injury - CORRECT ANSWERS pathologies seen on chest xray •Arterial puncture •Seldinger technique, •Guide wire •Introducer sheath •Catheter traditional angiography - risky could cause damage aorta can disect - CORRECT ANSWERS angiography is to see complications? Venous puncture into antecubital fossa ct angiography easy and get to see whole aorta safer than traditional angiography - CORRECT ANSWERS ct angiography aorta Vascular Dissection can be caused by angiography or deceleration of a vehicle A separation of the layers of the vessel wall caused by - A tear in the diseased intima directly exposing the underlying media to the pulse pressure of intraluminal blood. 3 layers inner - intima then media then adventitia - not spelt right

disection - rip in intema so blood can flow into normal lumen but also through intema and media which is bad thorax - deceleration injuries, vehicle suddenly stopping tethered two places in thorax ligamentum nksn and diaphram aorta is free on a large area vehicle stops then you stop the organs stop this whipping of aorta can cuase rippping of intima media/ aortic disection - CORRECT ANSWERS aorta Vascular Dissection Axial CT showing dissection of descending aorta (tennis ball appearance above vertebrae.) brighter contrast in true lumen grey contrast in false lumen going down between intim and lumen on image intima flap flops over oculde true lumen vessels like renal artery aorta provides blood to their blood flow will be comprimised so acute serious issue - CORRECT ANSWERS Sagital view of complete descending aortic dissection. T - True lumen, I - Intima, - F false lumen ct angiography sagital view of aorta dissection - type b decsending. black line intima can also see false lumen decending disection not usually survivable - CORRECT ANSWERS 1.The false lumen may compress the true lumen. 2.The false lumen may become the channel that supplies blood to an organ. 3.The intimal flap may impair flow into branch vessels. 4.Rupture. 5.Aneurysmal late dilatation.

6.Initial 1% mortality per hour. Usually due to retrograde extension into pericardium causing tamponade, severe AR, or rupture into pleural space. - CORRECT ANSWERS consequences of arotic dissection Cross sections of pelvis showing fracture of right ileum - CORRECT ANSWERS Cross sections of pelvis showing disruption of acetabulum on right side on image see shattered pelvic around acetabulum see left acetabulum and femoral head on right hand side - CORRECT ANSWERS Topogram (scout) of trauma patient's CT case study: •Off-Road motorbike Collision with a Landrover - CORRECT ANSWERS Fluoro image of fracture through acetabulum rta motorbike got hit by landrover - CORRECT ANSWERS Axial view demonstrating faint tennis ball dissection appearance. aorta trasncted intima ripped comprimised blood flow rta motorbike got hit by landrover - CORRECT ANSWERS Saggital view showing to areas of horizontal dissection or transections aorta trasncted intima ripped comprimised blood flow rta motorbike got hit by landrover - CORRECT ANSWERS

Fluoro view of fractured right femur this was missed on ct orginally as it wasnt low enough leg was white and one biggest than other rta motorbike got hit by landrover - CORRECT ANSWERS Fluoro view of fractured right femur under traction trasnverse nail put through femur for treatment to put the traction on rta motorbike got hit by landrover - CORRECT ANSWERS angiogram of right femoral artery to prove he had circulation rta motorbike got hit by landrover - CORRECT ANSWERS TEVAR- Thoracic EndoVascular Aortic Repair of proximal descending aorta with stent in situ and pigtail catheter stent put in through femoral artery to help blood flow rta motorbike got hit by landrover - CORRECT ANSWERS CXR showing Right chest drain, right central catheter, endo tracheal tube, and aortic stent (circle at the arch) ng tube seen stent seen rta motorbike got hit by landrover - CORRECT ANSWERS

Right hip view showing K nail in femur and acetabular repair femur and pelvis plated rta motorbike got hit by landrover - CORRECT ANSWERS Right femur from knee up after surgery rta motorbike got hit by landrover - CORRECT ANSWERS case study 4 year old getting photo taken stone collapsed onto the child Initial traumatic amputation of left hand at the level of carpal bones Successful reattachment with pins - CORRECT ANSWERS 15 year old RTA playing 'chicken' with friends hit @ 60 mph Coronal view and axial view of face showing fluid in maxillary sinuses and disruption of Right zygoma. Axial view of chest showing bilateral chest drains (circles) and residual pneumothorax on Left side Fractured left wrist Zygoma blow out fracture sinus full of blood fluid Fractures around face Fractured ribs - CORRECT ANSWERS •An anaphylactic reaction is an exaggerated response of a previously sensitised individual to foreign antigenic material symptoms in order of how they happen and acronym finding faint friends flushing is itchy rash

****ing facial swelling brilliant brochioconstriction veronicas vomiting dad diarrhoea howeled hypovolaemia (collapse) - CORRECT ANSWERS anaphylaxis what it is and treatment