ATLS POST TEST QUESTIONS AND ANSWEERS 2024, Exams of Medicine

Download ATLS POST TEST QUESTIONS AND ANSWEERS 2024 and more Exams Medicine in PDF only on Docsity! ATLS Cheat Sheet IMPORTANT CONCEPTS Initial Assessment It is conducted in order to identify and treat imminent life threats and prevent complications. In a real-life setting, there will be multiple simultaneous activities occurring in order to resuscitate and stabilize the patient. Not necessarily linear. A B C D E A - airway + c-spine control ‣ 1st line - head tilt/chin lift ‣ 2nd line - Guedel airway or nasopharyngeal ‣ 3rd line - laryngeal face mask ‣ 4th line - intubation using an endotracheal tube ‣ 5th line - tracheostomy if failed intubation ‣ 6th line - cricothyroidotomy if all else has failed B - Breathing ‣ palpation of the chest in all quadrants ‣ auscultation for breath sounds- axillae ‣ a mobile chest x-ray should be performed with pelvic and lateral neck x-ray at the earliest opportunity ‣ oxygen target 94-98% (COPD patients 88-92%) C - circulation + exsanguinating external hemorrhage ‣ assess HR, BP, Peripheral circulation ‣ gain IV access- 2 large bore cannulas ‣ FAST scan Control of catastrophic hemorrhage ‣ Stop bleeding - Tourniquets, pressure, splinting. ‣ Replace volume - You start with a hypotensive resuscitation with fluids which means you don’t drive up their blood pressure to normal- too much watery blood will dislodge any clots made to stop the bleeding. ‣ Restore Hb - Blood products. ‣ Address underlying cause. D - disability E - exposure ‣ assessment of consciousness GCS ‣ BM ‣ risk of hypothermia Airway and Ventilation Management Advanced Trauma Life Support (ATLS) defines a definitive airway as a cuffed endotracheal tube, achieved either by orotracheal intubation, nasotracheal intubation, cricothyrotomy, or tracheostomy. Induction Agents and Muscle Relaxants An ideal induction agent should have the following properties: ‣ rapid onset ‣ minimal adverse effects (hemodynamic instability) ‣ improves intubating conditions ‣ provides sedation and decrease awareness DA Algorithm in Trauma Patients ‣ The basic ASA standards of monitoring should be adhered to. ‣ Supplemental oxygen should be delivered throughout the intubation attempt, if possible. ‣ The best airway management approach should be considered (awake fiberoptic intubation (AFOI), DL, VAL, invasive techniques, preserving or ablation of spontaneous respirations, etc.). ‣ Primary and alternative airway management plans should be developed. ‣ The latest 2022 ASA practice guidelines for the management of the difficult airway specifically emphasize limiting the number of intubation attempts. Thoracic Trauma A widely used mnemonic for the 6 killer conditions to think of, and actively search for, during the primary survey is ATOM-FC: Airway obstruction or disruption ‣ high flow oxygen 15 L/min via non-rebreather mask ‣ will need bronchoscopy/thoracotomy Tension pneumothorax ‣ high flow oxygen to maintain the SpO2 target ‣ immediate needle thoracocentesis or finger thoracostomy ‣ proceed to formal intercostal catheter after needle decompression Open pneumothorax ‣ high flow oxygen to maintain the SpO2 target ‣ cover with occlusive 3-sided dressing to form a ‘flutter valve’ ‣ will need formal exploration prior to closing Massive haemothorax ‣ high flow oxygen to maintain the SpO2 target ‣ treat with rapid restoration of blood volume combined with concurrent drainage of the thorax ‣ hemostatic resuscitation ‣ thoracotomy Flail chest ‣ high flow oxygen to maintain the SpO2 target ‣ analgesia ‣ respiratory monitoring and support Cardiac tamponade ‣ high flow oxygen 15L/min via non-rebreather mask ‣ lower the pulse rate to decrease aortic shear forces by commencing beta- blockade then commence GTN infusion