ATLS POST EXAMS WITH ACTUAL CORRECT QUESTIONS , Exams of Nursing

Download ATLS POST EXAMS WITH ACTUAL CORRECT QUESTIONS and more Exams Nursing in PDF only on Docsity! ATLS POST EXAMS WITH ACTUAL CORRECT QUESTIONS AND VERIFIED DETAILED ANSWERS LATEST UPDATE 2023-2024 ALREADY GRADED A+ 100% GUARANTEED PASS!! After being involved in a motor vehicle crash, a 25-year-old man is brought to a hospital that has surgery capabilities available.. Computed tomography of the chest and abdomen shows an aortic injury and splenic laceration with free abdominal fluid. His blood pressure falls to 70 mm Hg after CT. The next step is: perform an exploratory laparotomy What statements regarding abdominal trauma in the pregnant patient is TRUE? Leakage of amniotic fluid is an indication for hospital admission. The first maneuver to improve oxygenation after chest injury is: administer supplemental oxygen A 25-year-old man, injured in a motor vehicular crash, is admitted to the emergency department. His pupils react sluggishly and his eyes open to pressure. He does not follow commands, but he does moan periodically. His right arm is deformed and does not respond to pressure; however, his left hand reaches purposefully toward the stimulus. Both legs are stiffly extended. His GCS score is: 9 A 20-year-old woman who is at 32 weeks gestation, is stabbed in the upper right chest. In the emergency department, her blood pressure is 80/60 mm Hg. She is gasping for breath, extremely anxious, and yelling for help. Breath sounds are diminished in the right chest. The most appropriate first step is to: perform needle or finger decompression of the right chest What findings in an adult is most likely to require immediate management during the primary survey? respiratory rate of 40 breaths per minute The most important, immediate step in the management of an open pneumothorax is: placement of an occlusive dressing over the wound The following are contraindications for tetanus toxoid administration: history of neurological reaction or severe hypersensitivity to the product A 56-year-old man is thrown violently against the steering wheel of his truck during a motor vehicle crash. On arrival in the emergency department he is diaphoretic and complaining of chest pain. His blood pressure is 60/40 mm Hg and his respiratory rate is 40 breaths per minute. What best differentiates cardiac tamponade from tension pneumothorax as the cause of his hypotension? breath sounds Bronchial intubation of the right or left mainstem bronchus can easily occur during infant endotracheal intubation because: The trachea is relatively short. A 23-year-old man sustains 4 stab wounds to the upper right chest during an altercation and is brought by ambulance to a hospital that has full surgical capabilities. His wounds are all above the nipple. He is endotracheally intubated, closed tube thoracostomy is performed, fluid resuscitation is initiated through 2 large-caliber IVs. FAST exam does not reveal intraabdominal injuries. His blood pressure now is 60/0 mm Hg, heart rate is 160 beats per minute, and respiratory rate is 14 breaths per minute (ventilated with 100% O2). 1500 mL of blood has drained from the right chest. The most appropriate next step in managing this patient is to: urgently transfer the patient to the operating room A 39-year-old man is admitted to the emergency department after an automobile collision. He is cyanotic, has insufficient respiratory effort, and has a GCS score of 6. His full beard makes it difficult to fit the oxygen facemask to his face. The most appropriate next step is to: restrict cervical motion and attempt orotracheal intubation using 2 people A patient is brought to the emergency department after a motor vehicle crash. He is conscious and there is no obvious external trauma. He arrives at the hospital completely immobilized on a long spine board. His blood pressure is 60/40 mm Hg and his heart rate is 70 beats per minute. His skin is warm. What do you expect to see with the patient? Flaccidity of the lower extremities and loss of deep tendon reflexes are expected. What is the most effective method for initially treating frostbite? Moist heat A 32-year-old man's right leg is trapped beneath his overturned car for nearly 2 hours before he is extricated. On arrival in the emergency department, his right lower extremity is cool, mottled, insensate, and motionless. Despite normal vital signs, pulses cannot be palpated below the right femoral artery and the muscles of the lower extremity are firm and hard. During the management of this patient, what is most likely to improve the chances for limb salvage? surgical consultation for right lower extremity fasciotomy A patient arrives in the emergency department after being beaten about the head and face with a wooden club. He is comatose and has a palpable depressed skull fracture. His face is swollen and ecchymotic. He has gurgling respirations and vomitus on his face and clothing. The most appropriate step after providing supplemental oxygen and elevating his jaw is to: suction the oropharynx A 22-year-old man sustains a gunshot wound to the left chest and is transported to a small community hospital no surgical capabilities are available. In the emergency department, a chest tube is inserted and A 40-year-old woman who was a restrained driver in a motor vehicle crash is evaluated in the emergency department. She is hemodynamically normal and found to be paraplegic at the level of T10. What precaution should be taken during evaluation and management? Log rolling using 4 people is a safe approach to restrict spinal motion when moving her. A trauma patient presents to your emergency department with inspiratory stridor and a suspected c- spine injury. Oxygen saturation is 88% on high-flow oxygen via a nonrebreathing mask. The most appropriate next step is to: restrict cervical motion and establish a definitive airway When applying the Rule of Nines to infants The head is proportionally larger in infants than in adults A healthy young male is brought to the emergency department following a motor vehicle crash. His vital signs are a blood pressure of 84/60, pulse 123, GCS 10. The patient moans when his pelvis is palpated. After initiating fluid resuscitation, the next step in management is: placement of a pelvic binder What situations requires Rh immunoglobulin administration to an injured woman? positive pregnancy test, Rh negative, and has torso trauma A 22-year-old female athlete is stabbed in her left chest at the third interspace in the anterior axillary line. On admission to the emergency department and 15 minutes after the incident, she is awake and alert. Her heart rate is 100 beats per minute, blood pressure 80/60 mm Hg, and respiratory rate 20 breaths per minute. A chest x-ray reveals a large left hemothorax. A left chest tube is placed with an immediate return of 1600 mL of blood. The next management step for this patient is: prepare for an exploratory thoracotomy A 6-year-old boy walking across the street is struck by the front bumper of a sports utility vehicle traveling at 32 kph (20 mph). What's true about this patient? A pulmonary contusion may be present in the absence of rib fractures. Adjuncts used during the primary survey ECG Pulse ox CO2 monitoringV Ventilatory rate ABGs Foleys (UOP) Gastric catheter FAST or eFAST DPL Urinary output is sensitive for Patient's volume status and renal perfusion "Golden hour" The time from injury to definitive care, during which treatment of shock and traumatic injuries should occur because survival potential is best; also called the Golden Period. Leading cause of trauma deaths worldwide MVCs Trimodal death distribution 1st: seconds to minutes of injury (apnea) 2nd: minutes to several hours (EDH, SDH, liver lac, pelvic fractures, spleen ruptures) 3rd: several days to weeks after injury (sepsis and multi-organ failure) An 18-year-old male was the unrestrained driver in a MVC involving contact with a tree, He is being transported to the ED by ambulance after a prolonged extrication process. He is receive oxygen by mask and IVF via one large-bore IV, and he is immobilized on a long spine board. How would you prepare for arrival of this patient? Airway equipment for possible intubation IV equipment to place a second IV and get blood work Lab/Xray available Monitor equipment ready Notify blood bank and have transfusion protocol available Consider appropriate transfer AMPLE hx Allergies Medications currently used Past illnesses/Pregnancy Last meal Events/Environment related to the injury Blunt trauma MOI Seatbelt use Steering wheel deofrmation Presence/activation of airbags Direction of impact Damage to vehicle Patient position Ejection from vehicle? Penetrating trauma MOI Body region Velocity of weapon Caliber Heat loss can occur at moderated temperatures 59 to 68 F (15-20 C) Prehospital phase should include what interventions and considerations? Airway maintenance Breathing support Control of bleeding and shock Immobilization Immediate transport to closest appropriate facility Hospital preparation for trauma Resuscitation area Airway équipement Warmed IV crystalloid solution Monitoring devices Protocol for requesting additional assistance Transfer agreements Primary survey Airway maintenance with restriction of cervical spine motion Breathing Circulation Disability Exposure/Environmental control Patients with maxillofacial or head trauma should be presumed to have A cervical pine injury and cervical spine motion must be restricted PITFALL: equipment failure Test regularly Ensure spare equipment and batteries are readily available PITFALL: unsuccessful intubation Identify patients with difficult anatomy Identify the most experienced/skilled airway manager on team Ensure appropriate equipment is available Be prepared to prefer a surgical airway PITFALL: progressive airway loss Children Pregnant females Elderly Obese individuals Athletes Why is info about mechanism of injury so important? The patient's condition is greatly influenced by MOI. It can enhance the understanding of the patient's condition and anticipated injuries Possible adjuncts to secondary survey X-rays of spine and extremities CT scans of head, chest, abdomen, spine Contrast urography and angiography TEE Bronchoscopy Esophagoscopy Frontal impact MVC Cervical spine fracture Flail chest Myocardial contusion Pneumothroax Traumatic aortic disruption Fractured spleen or liver Posterior fracture/dislocation hip/knee Head injury Facial fractures Side impact MVC Contralateral neck sprain Head injury Cervical spine fracture Flail chest Pneumothorax Traumatic aortic disrution Diaphragmatic rupture Fractured spleen/liver/kidney Fractured pelvis or acetabulum Rear impact MVC Cervical spine injury Head injury Soft tissue injury to neck MVC vs pedestrian Head injury Traumatic aortic disruption Abdominal visceral injuries Fractured lower extremities/ pelvis Fall from heigh Head injury Axial spine injury Abdominal visceral injuries Fractured pelvis or acetabulum Bilateral LE fractures Anterior stab wound Cardiac tamponade Hemothorax Pneumothorax Hemopneumothorax Left stab wound Left diaphragm injury Spleen injury Hemopneumothoax Abdomen stab wound Visceral injury Extremity GSW Neurovascular injury Fractures Compartment syndrome Thermal burns Eschar on extremities or chest Electrical burns Cardiac arrhythmias Myonecrosis Compartment syndrome Inhalation burns CO poisoning Upper airway swelling Pulmonary edema What is your first step when a patient condition changes? ABCDEs What's the importance of meticulous record keeping? Crucial during patient assessment and management because often more than one clinician cares for an individual patient and allows those to evaluate the patient's needs and clinical status What info should be provided to the receiving facility for a transferring patient? As much info as possible! Event of injury, patient exam, treatments done, responses of treatments, tests and results, and possible injuries What key information should prehospital providers obtain and report to the receiving hospital? Events associated with injury What patient sign can be quickly observed to assess a patient's hemodynamic status? Skin perfusion Definitive airway A tube placed in the trachea with the cuff inflated below the vocal cords, the tube connected to a form of oxygen-enriched assisted ventilation and the airway secured in place with an appropriate stabilizing method What's critical management for trauma patients, especially those with sustained head injuries? Maintaining oxygenation and printing hypercarbia Triad of largyneal fracture Hoarseness Subcutaneous emphysema Palpable fracture In a conscious trauma patient, airway adequacy can quickly be assessed by Talking to the patient-- A positive verbal response with clear voice indicated patent airways, ventilation, and brain perfusion What can conform a suspected laryngeal fracture? CT scan For a patient who is gurgling, initial assessment for ventilation should include A 24-year-old male arrives in ED already intubated. He has significant crepitus of the right chest wall and diminished breath sounds. You place a chest tube and note a large amount of bubbling in the water seal chamber. His O2 saturation remains at 85% and he has goodCO2 return on capnography. The most likely cause of his low oxygen saturation is Tracheobronchial tree injury Most injuries to the tracheobronchial tree occur where? Within 2.5 cm from the carina Do the vast majority of thoracic injuries (blunt and penetrating) require operative intervention? No, most are treated with technical procedures Airway thoracic injuries Airway obstruction (laryngeal injury, posterior dislocation of clavicular head, or penetrating trauma) Tracheobronchial tree injury Breathing thoracic injuries Tension pneumothorax Open pneumothorax Massive hemothorax Circulation thoracic injuries Massive hemothorax Cardiac tamponade Traumatic circulatory arrest What's the most common cause of a tension pneumothorax? Mechanical positive-pressure ventilation in patients with a visceral pleural inury Where is the ideal location for needle decompression of a tension pneumothorax? 5th intercostal space, slightly anterior to midaxillary line What do you need to remember when treating an open pneumothorax? Place a dressing on the site and only secure is on 3 sides so air can escape, then place a chest tube Massive hemothorax Accumulation of >1500 ml of blood in one side of chest Causes of PEA? Hypovolemia Hypoxia Hydrogen acidosis Hypo/hyperkalemia Hypoglycemia Hypothermia Toxins Tamponade Tension pneumo Thrombosis Indications of a thoracotomy Immediate return of > 1500 ml of blood or significant bleeding Persistent blood transfusions Penetrating anterior chest wounds medial to the nipple line Posterior wounds medial to the scapula A 26-year-old male sustained a posterior stab wound. Blood and bubbling are coming from the wound. Open pneumothorax A 46-year-old male sustained a gunshot wound to the chest Massive hemothorax A 65-year-old female who takes warfarin was involved in a MVC. She initially presented complaining of sternal pain. BP deteriorated to 90/60 after arriving to the ED Cardiac tamponade Eight life-threatening injuries during the secondary survey? Simple pneumothorax Hemothorax Flail chest Pulmonary contusion Blunt cardiac injury Traumatic aortic disruption Traumatic diaphragmatic injury Blunt esophageal rupture A patient with a simple pneumothorax May be watched for progression if pneumothorax is small (<15%) and patient is stable and does not require transfer A 38-year-old male presents to the ED after a head-on, high-speed collision. His vitals are HR 130, BP 156/90, RR 20, and O2 sat 92% on 15L of O2. His voice is raspy and he complains of chest pain that radiates to his back. A CXR shows a widened mediastinum, obliteration of the aortic notch, and depression of the left mainstream bronchus. You should Administer agents to manage his pain and lower his HR and BP (aortic disruption) What's a characteristic that is shared by all traumatic aortic disruption survivors? Contained hematoma A 36-year-old female was involved in an altercation, sustaining a knife wound to the chest, below the left nipple. She is mildly short of breath with an oxygen sat of 92%. BP is 115/80. Simple pneumothorax A 56-year-old male archer was riding a horse when it bucked and the saddle struck him in the chest wall. You note paradoxical chest wall movement on the left anterior chest. CXR is negative. Flail chest due to costochondral disruption What would confirm a diaphragmatic injury in a patient? Presence of NGT What is a common finding associated with traumatic asphyxia? Upper torso, facial, and arm plethora with petechiae secondary to acute temporary compression of SVC. Massive swelling and cerebral edema may be present. Why are rib fractures in older adults a more significant concern than in young patients? The incidence of PNA and mortality is doubled in older patients Pulmonary contusion/flail chest is best treated by? A 12-year-old male complains of LUQ tenderness and L shoulder pain 8 hours after playing rugby. ABCDE are normal. Circulatory assessment remains normal. Abdominal exam reveals mild LUQ TTP without peritoneal signs. FAST demonstrated fluid in the hepatorenal space and the plenorenal recess. What's the appropriate next step? Observation A 29-year-old woman is the restrained driver in a head-on collision. Airbags deployed. ABCDE are normal. The patient complains of lower abd and back pain. A lower abd contusion is present and associated with tenderness. There is no evidence of diffuse peritonitis. Your institution has NOT surgical capabilities. What's the most appropriate treatment plan? The patient should be urgently transferred for surgical intervention A 50-year-old male arrives to the ED following fall of 26'. He hs gurgling respirations and is not responsive to voice. VS are BP 80/5-, RR 30, HR 138, O2 sat is undetectable. Your hospital does not have surgical capabilities. The first step in management is Application of oxygen and securing an airway A 25-year-old ale arrives at the ED following a motorcycle crash. BP is 80/60, HR 140. Airway and breathing are controlled. There are no open wounds. The abd is not distended. Both legs are externally rotated but soft. The pelvis is tender. The scrotum is swollen and ecchymotic. While vascular access is obtained, what the next most appropriate step? Application of a pelvic binder A 45-year-old male with a BMI of 48 was working in an industrial plant when 2 pieces of wood flew off a sa and struck him in the abdomen and right chest. CXR demonstrates rib fractures. What's true about this scenario? Despite multiple imaging studies, detection of intestinal and retroperitoneal injuries may be difficult Your institution does not have surgical capabilities. You have intubated a 25-year-old man who was in a rollover MVC. You have also placed bilateral chest tubes for pneumothoraxes. The patient's SBP is continually < 90 and HR > 140. Potential therapy and evaluation includes Activation of massive transfusion protocol, application of pelvic binder, and CXR What's the primary goal of treatment for patient's with suspected TBIs? To prevent secondary brain injury by ensuring adequate oxygenation and maintain BP that's sufficient to perfuse the brain Cerebral perfusion pressure (CPP) MAP - ICP A 23-year-old male fell from a bike, striking his head on the curb. He was not wearing a helmet. The patient has a 10 cm laceration to the temporal-parietal region of the left scalp. He is initially able to say hi name. VS are HR 115, BP 100/60, oxygen sat 88%, GCS initially 12. 2 hours after transfer to a local hospital, he has sonorous respirations, a HR of 120, BP 100/70, and GCS of 6. What the initial priorities in the management of this patient? Airway protection with a subglottic device Oxygenation to prevent hypoxia Maintain SBP > 100 mmHg A 23-year-old male fell from a bike, striking his head on the curb. He was not wearing a helmet. The patient has a 10 cm laceration to the temporal-parietal region of the left scalp. He is initially able to say hi name. VS are HR 115, BP 100/60, oxygen sat 88%, GCS initially 12. 2 hours after transfer to a local hospital, he has sonorous respirations, a HR of 120, BP 100/70, and GCS of 6. What are the signs that the patient's injury is progressing? Decreased GCS indicates worsening intracranial pathology with possible intracranial HTN and impending herniation A 78-year-old ale is found down in the bathroom with a large left scalp laceration from striking the corner of the sink. He arrives in the ED with a BP 180/90, HR 60, dilated, non-responsive right pupil. The most likely finding on the patient's CT scan will be Illustrtive of impending uncle hernia associated with Cushing response (high BP + bradycardia)-- associated with a large subdural hematoma with midline shift Intracranial mass effect is defined by the Monro-Kellie Doctrine A trauma patient opens her eyes, moans, and withdraws from pain. What is her GCS score? Eye opening: 2 Verbal response: 2 Best motor response: 4 Total = 8 A 48-year-old female falls from a balcony. She was witnessed striking her head on the steps after an ~8' fall. The patient briefly lost consciousness and is found confused, lying at the bottom of the steps. Her eyes are open, and she is rubbing her forehead. The most important finding related to this patient's long-term outcome is GCS score A 56-year-old male repeats questions, his eyes are open, and he moves to command GCS 14 A 17-year-old female was struck by a vehicle while crossing the road. Upon arrival she is moaning, her eyes open, and she withdraws to painful stimuli GCS 8 A 82-year-old female was found home by family. Her eyes are closed, she extends to pain, and is not speaking GCS 4 A 63-year-old male fell off a ladder. Witnesses report loss of consciousness. His eyes open to voice, he localizes to pain, and has garbled speech GCS 11 What types of intracranial hemorrhage can be identified on CT scan? Epidural Sudural Intra-ventricular Subarachnoid Intra-parenchymal What CT scan findings are indicative of severe head injury that may require intervention? Midline shift (> 5mm), loss of definition of the basil cisterns, and severe skull fractures with intrusion into the brain matter A 70-year-old female falls at home and strikes her head on the bathtub. She is found down by her granddaughter ~6 hours later. GCS is 8: eye opening 2, verbal 2, motor 4. She is intubated for airway protection upon arrival in the trauma bay. What preexisting patient characteristics should you consider that may affect this patient's outcome? Current anti platelet therapy, beta blockade, and anticoagulation What is the purpose of intubation in a comatose patient? Prevent hypoxia and secondary brain injury occurs with a protection of the airway Ancillary studies to confirm brain death? EEG: no activity at high gain CBF studies Cerebral angiography Diagnosing brain death GCS = 3 Nonreactive pupils Absent brainstem reflexes (oculocephalic corneal, doll's eyes, and no gag reflex) No spontaneous ventilatory effect on formal apnea testing Absence of confounding factors such as alcohol or drug intoxication or hypothermia What are the initial management options for mild brain injury? Monitoring isnt' required but know long-term effects can manifest over time Chance fracture What's the appropriate treatment for a C6 vertebral body fracture Spinal immobilization and IVFs, followed by vasopressors if patient remains bradycardic after fluids A patient with a known cervical spine fracture who is being transferred from a rural hospital to definitive care should be transported in which way? Semi-regid collar and head restraint Patients with cerviacl fractures above C6 require special consideration prior to transportation due to? Potential progression to respiratory failure A 35-year-oldman was ejected from a MV. On arrival, his VS are BP 80/40, HR 110,RR 24, GCS 15. Airway and breathing are intact. He complains of severe back pain, has no sensation below umbilicus, has lower thoracic tenderness, and is unable to move LE. Chest and pelvic X-rays are normal. Along with IVFs, what is most appropriate treatment for this patient's hypotension? Although this patient likely has a spinal cord injury, perform a FAST exam or DPL to r/o other etiology. An elderly female falls and sustains a hyperextension injury to her neck. Her exam demonstrated decreased strength in UE compared to LE. What is the cause of her unusual neurologic findings? Central cord syndrome What's the most common location of all spinal injuries? C5 A 40-year-old M involved in a MVC is evaluated in a rural hospital without spine surgical capacity. The patient has a clear C-spine fracture at C4 on plain film and the inability to move any extremities and sensation limited to supraclavicular region. He is having difficulty breathing with a RR 30. BP 80/40 and HR 50. What should be performed prior to transfer? Crystalloid bolus, initiate pressers, intubate, and then transfer patient once he is hemodynamically stable Potentially life threatening extremity injuries Marjor arterial hemorrhage Bilateral femoral fractures Crush syndrome Rhabdomyolysis can lead to Metabolic acidosis Hyperkalemia Hypocalcemia Disseminated intravascular coagulation (DIC) A 38-year-old female restrained driver is involved in a high-speed, head-on collision with a truck. Following a prolonged extrication, she noted to have deformity of her right thigh. On arrival, her VS are HR 120, BP 90/50, RR 22, GC 15. 2 large bore IVs are inserted in UE. VS are now HR 13- BP 80/40, RR 24, GCS 14. CXR, pelvis X-ray, and FAST are negative. You suspect the source of hypotension is a femur fracture and bilateral tibial shaft fractures. How much blood loss would you expect from this patient's extremity injuries and what's the best way to control it? A femur fracture can result in blood loss up to 2 L and each tibial fracture can cause up to 1.5 L of blood loss. Fracture immobilization is the best control. How should femur and tibial shaft fractures be stabilized? A traction splint should NOT be used. Tibial fracture should be placed in a long leg splint. A femur and tibial fracture should be placed in a long leg posterior splint. Open fractures should be covered with moist saline gauze before placed in splint. Neurovascular exams should be performed before and after splint placement Extremity bleeding control order 1) Manual pressure to the wound 2) Pressure dressing 3) Compression of the artery proximal to the injury 4) Tourniquet application Cold, pale, pulseless extremity Interrupted arterial blood supply Rapidly expanding hematoma Significant vascular injury Tourniquet use 1) Tightening tourniquet until bleeding stops 2) Ensure arterial inflow is occluded 3) Document time of application 4_ Obtain immediate surgical consult and transfer patient, if necessary 5) If time to surgery is prolonged in stable patient, consider one attempt to deflate tourniquet 6) If tourniquet use if prolonged, consider chose of life over limb An ABI < ___ indicates abnormal arterial flow secondary to injury or PVD. < 0.9 All open fractures and open joint injuries require Up to date tetanus vaccine IV antibiotics (1st generation cephalosporin) Abnormal motion through a joint segment Tendon or ligament rupture Absent spontaneous extremity movement in unconscious patient Neurologic and/or muscular impairment Swollen extremity in region of major muscle group Crush injury with impending compartment syndrome Pale or white distal extremity Lack of arterial blood flow Diagnosis of an open fracture is made based on? Physical exam and x-ray What's high risk for compartment syndrome? Ischemia repercussion injury to enclosed muscle Crush injury Tight dressing or cast How is an open joint injury confirmed? CT or saline/dye injection When does muscle necrosis begin? When there is a lack of arterial blood flow for more than 6 hours A 38-year-old female restrained driver is involved in a high-speed, head-on collision with a truck. Following a prolonged extrication, she noted to have deformity of her right thigh. On arrival, her VS are HR 120, BP 90/50, RR 22, GC 15. 2 large bore IVs are inserted in UE. VS are now HR 13- BP 80/40, RR 24, GCS 14. CXR, pelvis X-ray, and FAST are negative. You suspect the source of hypotension is a femur fracture and bilateral tibial shaft fractures. Transfer is initiated. What antibiotics and at what dose should be given tot he patient? Cefazolin 3g + ciprofloxacin or gentamicin What does splinting accomplish in patients with musculoskeletal trauma? Control blood loss, prevent further neuromuscular compromise and soft tissue injury, and reduce the patient's pain A 25-year-old male presents after a motorcycle crash. VS are BP 128/70, HR 124, GCS 15. He complains of R leg pain. On exam, the patient is found to have proximal right thigh deformity. Distal pulses intact. What's the best initial magement of this patient's symptoms? Splint the extremity and administer a small dose of an IV narcotic, like fentanyl When should IV antibiotics be given to patients with open fractures? Edema from the inflammatory response to the burn and reduced elasticity of burned skin (increased pressure in the underlying soft tissue) How cana circumferential burn injury affect muscle tissue? Can cause the pressure from burn edema to build to the point that it compromises tissue perfusion, similar to compartment syndrome How is burn resuscitation affected when the patient also has an injury causing hemorrhage? Control bleeding and resuscitate the patient per standard ATLS protocol for hemorrhagic shock before starting burn resuscitation In what situation is it not advisable to immediately wash off chemicals with irrigation? Not until airway has been assessed and secured and when the chemical is a powder (brush off before irrigation) What are two interventions for treating rhabdomyolysis? Increase IVF to target UOP of 100 ml/hr which washes out the myoglobin before it settles Administer mannitol which acts as a free radical scavenger and osmotic diuretic therefore increasing UOP and washing out myoglobin A 20-year-old is brought to ED after his shovel hits a 14,000 volt underground wire and he suffers an electrical contact injury to his arms. He is covered in powdered cement from the work site. How should be be initially treated? Establish ABCs Brush powder off before irrigating Monitor due to electrical injuries later manifesting If a burn patient's urine were reddish-brown in color, what would change in your burn resuscitation? Signifying myoglobinuria secondary to rhabdomyolysis should be treated with aggressive IVF and possible mannitol What's the difference between active and passive rewarming? Passive involves placing the patient in an environment that reduces heat loss and relies on patient's intrinsic thermoregulartory mechanisms Active involves supplying a heat source (warm IVFs, warmed packs of high vascular flow and initiating circulatory bypass) Why is the issue of iatrogenic hypothermia important? Shown to increase trauma related mortality, which is preventable A 35-year-old female is brought into the hospital after being lost for two days while snowmobiling in -30 C weather. She has a core body temperature of 30 C and her toes are frozen. How and when should rewarming start Immediate active rewarming A 35-year-old female is brought into the hospital after being lost for two days while snowmobiling in -30 C weather. She has a core body temperature of 30 C and her toes are frozen. How should the toes be thawed? Moist rewarming The most significant difference between burn and other traumatic injuries is? In a burn injury, the full extent of the injury may not be evidence immediately In an adult patient with suspected inhalation injury, it is important to? Use an ETT larger than 7.5 in an adult to enable clearance of secretions Burn shock is a result of? Interstitial loss due to inflammation The immediate treatment of electrical injury consists of? Maintaining UOP of 100 ml/hr What're the leading causes of unsuccessful resuscitation in pediatric patients with severe trauma? Failure to secure a compromised airway Failure to support breathing Failure to recognize and respond to intra-abdominal and intracranial hemorrhage A 3-year-old falls 10 meters out of an apartment window onto pavement. He does not open his eyes, moans incomprehensibly, and extending abnormally when stimulated. The patient is unresponsive on arrival to the ED, and pupils are unequal. He has blood coming from his right ear, is breathing rapidly, and is pale, with mottled extremities. VS are BP 74/57,HR 156, RR 49. What steps and maneuvers would you use to manage this patient's airway? Maintain airway with chin-lift and jaw-thrust with assisted ventilation using bag mask with placement of laryngeal mask or ETT A 3-year-old falls 10 meters out of an apartment window onto pavement. He does not open his eyes, moans incomprehensibly, and extending abnormally when stimulated. The patient is unresponsive on arrival to the ED, and pupils are unequal. He has blood coming from his right ear, is breathing rapidly, and is pale, with mottled extremities. VS are BP 74/57,HR 156, RR 49. Is this child in shock? Yes (tachycardia, mottled extremities, and hypotension) indicates significant compromise, likely due to bleeding but other etiology must be ruled out. Trauma triad of death Hypothermia Acidosis Coagulopathies A 5-year-old boy is struck by a car and brought to the ED. He is lethargic but withdraws from painful stimuli. VS are BP 90, HR 160, RR 40, and oxygen sat 85%. The best option for establishing vascular access after experienced nurses have failed to obtain PIV on two attempts is? Placement of intraosseous device into proximal tibia When treating a severely injured child, it is very important to rapidly establish the patient's weight in order to determine equipment size, drug doses, and resuscitation volumes. What are options for estimating weight quickly or determining appropriate equipment size? Asking parent or caregiver Using a length-based pediatric resuscitation tape Using the formula (2 x age in years + 10) Common causes of deterioration in intubated patients Dislodgement Obstruction Pneumothorax Equipment failures Classifications of responses of children to fluid resuscitation Responders: stabilized by crystalloid fluid OR crystalloid and blood resuscitation Transient responders: install response to crystalloid and blood, but then deteriorates Nonresponders: doesn't respond to crystalloid or blood infusion A 3-year-old falls 10 meters out of an apartment window onto pavement. He does not open his eyes, moans incomprehensibly, and extending abnormally when stimulated. The patient is unresponsive on arrival to the ED, and pupils are unequal. He has blood coming from his right ear, is breathing rapidly, and is pale, with mottled extremities. The patient is intubated and IV access is obtained. He's given crystalloid and blood with good response. HR 110 and BP 90/60. CXR shows pulmonary contusions. What are the priorities in evaluating a small child with multi system trauma? ABCDE Why do children commonly develop pulmonary contusions following trauma, even in absence of rib fractures? Ribs of children are primarily cartilaginous therefore bend and allows transmission of kinetic energy to underlying lung rather than absorbing and dissipating energy by fracturing ribs What's the most common immediately lift-threatening injury in children? Tension pneumothorax What visceral injuries are more common in children? Blunt pancreatic injuries Small bowel perforations near ligament of Treitz Mesenteric and small bowel avulsions Delirium Dementia Pain medication Sedatives Increase ICP Decreased cerebral perfusion pressure Geriatric trauma patients are at greater risk of mortality from rib fractures than younger individuals because they? Are at a greater risk of developing pneumonia An elderly patient is transferred from a long-term care facility after being found down. In addition to a hip fracture, you find the patient is wearing soiled clothes and a soiled diaper, has dry mucus membranes, and tenting skin. You should evaluate the patient for? Elder maltreatment Compared to a younger patient, a geriatric trauma patient with a pelvic fracture is more likely to? Require blood transfusions The removal of spine boards early is particularly important in geriatric patients because? Patients are at increased risk of pressure ulcers The best initial treatment for pregnant trauma patients is? Resuscitate the mother and consult surgeon and obstetrician A 35-year-old woman who appears to be in the second trimester of pregnancy is brought to the ED following a MVC. She is unconscious and immobilized on a long spine board. How might the patient's pregnant affect the performance of the primary survey? The priorities are the same: ABCDE. Care must be taken to interpret VS. In addition to VS and GCS score, what information would be helpful to obtain in order to evaluate pregnant trauma patients? Additional scene information: whether/how the patient was restrained and MOI A 22-year-old female in the 3rd trimester of her pregnancy presents after MVC. Her VS are BP 100/70, HR 120,RR 22. FHR found to be 90. What statement about FHR is correct? This is abnormally low FHR likely presents impair oxygen flow to the fetus from the placental vasculature (sensitive to catecholamine surge during trauma causing increased uterine vascular resistance and decreased fetal oxygenation) What's true about hypervolemia associated with pregnancy? Cardiac output increased by 1-1.5 L/min after the 10th week of pregnancy due to the increase in plasma volume and decrease in vascular resistance Healthy pregnant patients can lose _____ ml of blood before exhibiting signs and symptoms of hypovolemia 1200-1500 ml of blood Lab values changed during pregnany Elevated WBC (12000-25000) Mildly elevated fibrinogen and other clotting factors Shortened PT and PTT (bleeding and clotting times unchanged) Decreased Hct (32-42%) While supine, vena cava compression can cause? Decrease cardiac output by 30% because of decreased venous return from the lower extremities A 35-year-old woman who appears to be in the second trimester of pregnancy is brought to the ED following a MVC. VS are RR 28, HR 130, BP 110/50, GCS 7. What are the first steps in primary survey in this patient? Establish definitive airway and stabilize cervical spine Placing a orogastric tube may be advised as it's likely to reflux gastric contents If the patient becomes hypotensive, elevate the patient's right side to displace uterus off IVC A 35-year-old woman who appears to be in the second trimester of pregnancy is brought to the ED following a MVC. VS are RR 28, HR 130, BP 110/50, GCS 7. What lab and radiologic tests should be ordered? CMP, CBC, blood gas, toxicology, coagulation, Rh status, UA (If Rh- then administer Rh immunoglobulin) Imaging to r/o brain, spine, and abdominal injuries The ability to palpate fetal extremities on the abdominal exam of a pregnant trauma patient is indicative of? Uterine rupture A 33-year-old woman who is 28 weeks pregnant by dates presents with a 4 cm stab wound to the left chest superior and lateral to the nipple. Her BP is 78/40, HR 14-, RR 30. She is awake and talking but confused, pale, and diaphoretic. Her oxygen sat is 92% on 15 L. She has markedly decreased breath sounds on left, dullness to percussion, and active air exchange via the open wound in her chest. What's the appropriate next step? Rapid decompression of the left chest with tube thoracotomy accompanied by occlusive dressing of the stab wound Kleihauer-Betke test Maternal blood smear allows evaluation of amount of fetal blood in maternal circulation if large fetomaternal transfusion is suspected Main causes of fetal death of pregnant trauma patients are? Maternal shock Maternal death Abruption placentae IVF in pregnancy Patients requiring larger fluid requirements when hypotensive avoid dextrose Antiemetics in pregnancy Metocloperamide Ondansetron Antibiotics in pregnancy Ceftriaxone Clindamycin (if PCN allergy) SBP > 160 or DBP > 110 in pregnancy Labetalol 10-20 mg IV bolus Seizures in pregnancy Eclamptic: Mg Sulfate 4-4 g IV load over 15-20 m Non-eclamptic: lorazepam 1-2 mg/min IV What precautions should be taken while a pregnant trauma patient is undergoing CT scan? Monitoring VS, if she becomes hemodynamically unstable, remove the patient During brain and spine imaging, the abdomen should be shielded While assessment and management of a pregnant mother continues, what steps should be taken to evaluate the fetus? Monitoring fetal heart tones frequently (monitoring for fetal distress and abnormal fetal heart tones) Early obstetrical consult A 34-year-old in her 3rd trimester of pregnancy was found unconscious in her backyard. She apparently fell from a second-story porch. EMD reports seizure activity. VS BP 174/90, HR 118, GCS. Which test might help determine if the patient's seizure activity is due to eclampsia? Urine test for protein What's true regarding serum fibrinogen levels in pregnant patients? A normal serum fibrinogen level late in pregnancy may indicated early disseminated intravascular coagulation