ATLS Test Study Guide TEST 4 LATEST VERSIONS REAL EXAM QUESTIONS AND CORRECT ANSWER S |AG, Exams of Nursing

Download ATLS Test Study Guide TEST 4 LATEST VERSIONS REAL EXAM QUESTIONS AND CORRECT ANSWER S |AG and more Exams Nursing in PDF only on Docsity! ATLS Test Study Guide TEST 4 LATEST VERSIONS REAL EXAM QUESTIONS AND CORRECT ANSWER S |AGRADE Order of Initial Assessment - correct answer 1. Preparation -prehospital and hospital 2. Triage 3. Primary Survey- ABCDEs 4. Adjuncts to primary 5. Consider transfer 6. Secondary Survey- head to toe exam and pt history 7. Continue post-resuscitation and re-evalution 8. Definitive care Why should primary and secondary surveys be repeated frequently? - correct answer Identify any change in the patient's status and need for additional intervention Prehospital Phase Preparation - correct answer - notify receiving hospital to allow for mobilization of trauma team to be there when pt arrives - provide airway maintenance, control of bleeding, assess shock, immobilize c-spine/other injuries - transport to the closest facility, preferred trauma center - minimize scene time - obtain report needed for triage at the hospital Hospital Phase Preparation - correct answer - resuscitation area available for patients - proper airway equipment - warmed IV crystalloid solutions - a protocol to summon additional medical equipment - transfers agreements w/ verified trauma centers are established **Consider wearing protection (face mask, gloves, eye care) due to concern for hepatitis and AIDs in patients Triage - correct answer sorting patients based on resources required for treatment and the resources that are actually available - order of patient is based on ABC priorities ATLS Test Study Guide TEST 4 LATEST VERSIONS REAL EXAM QUESTIONS AND CORRECT ANSWER S |AGRADE Multiple Casualties vs Mass Casualties - correct answer multiple: incidents are those in which the number of patients and the severity of their injures DO NOT exceed the capability of the facility mass: the number of patients and severity of their injuries DO exceed the capability of the facility Primary Survey - correct answer Vitals must be assessed quickly and efficiently using the ABCDE method Airway maintenance w/ restriction of c-spine Breathing and Ventilation Circulation w/ hemorrhage control Disability - neurologic status Exposure/Environmental control How can you assess ABCD in a patient in under 10 seconds? - correct answer Identify yourself Ask the patient their name Ask the patient what happened If the patient is able to give an appropriate response during the primary survey what does that mean about their ABCD status - correct answer the patient likely doesn't have an extreme airway or breathing compromise and not a markedly decreased level of consciousness A trauma patient with a known head injury has a compromised airway, do you assess the head trauma or airway - correct answer Airway - clear, suction, administer oxygen, open and secure airway What is important with airway maintenance? - correct answer Restrict the cervical spine, ALWAYS assume a cervical spinal injury exists Airway Maintenance - correct answer assess airway's patency, inspect any form of obstruction including foreign bodies or fractures, suction blood and secretions *if the patient is able to communicate verbally, the airway is likely not compromised --> UNLESS GCS less than 8, then will still likely have to intubate Trauma patient is able to speak so you are not worried about airway compromise, what is a scenario in which you should still be concerned even with verbal communication? - correct ATLS Test Study Guide TEST 4 LATEST VERSIONS REAL EXAM QUESTIONS AND CORRECT ANSWER S |AGRADE When resources for patients with a brain injury are not available, what is the next step? - correct answer Transfer and consult neurosurgery Exposure and Environmental Control - correct answer Carefully and completely undress the patient. Inspect for uncontrolled bleeding and note any obvious injuries. Prevent heat loss. Hypothermia combined with hypotension and acidosis is a potentially lethal combination in the injured patient. Consider: warm blankets, keep ambient temperature warm, warm IVF, forced air warmers, radiant warming lights. Adjuncts to Primary Survery - correct answer - continuous electrocardiology - pulse ox - CO2 monitoring - assessing ventilation rate - ABG measurement - I&O - lactate - imaging: x-ray, FAST, etc. Ventilatory Rate, Capnography, and ABG - part of adjuncts to primary survey - correct answer Measures the adequacy of the patient's respirations -ventilation can be monitored using end tidal CO2 levels - colorimetry, capnometry, or capnography. Endotracheal tubes can be dislodged whenever a patient is moved, capnography can be used to confirm intubation of the airway vs esophagus. However, it does not confirm proper position of the tube within the trachea, end tidal CO2 can be used to avoid hypo or hyperventilation - this reflects cardiac output, it predicts return of spontaneous circulation (ROSC) during CPR In trauma what does a low pH or base excess indicate? - correct answer shock, therefore can use these levels to trend a patient's improvements When are urinary and gastric catheters placed? - correct answer during or following primary survey What is the first step before inserting a catheter during a trauma? - correct answer Examine the perineum and genitalia ATLS Test Study Guide TEST 4 LATEST VERSIONS REAL EXAM QUESTIONS AND CORRECT ANSWER S |AGRADE If there is a urethral injury suspected, what should be done before inserting the catheter? - correct answer perform a retrograde urethrogram (an x-ray with dye, this shows the urethral integrity) What are physical signs that indicate a urethral injury? - correct answer Blood at the meatus or perineal ecchymosis What is contraindicated if there is blood at the urethral meatus or perineal ecchymosis? - correct answer Transurethral bladder catheterization What are the advantages of gastric catheters during trauma? - correct answer decompresses stomach distension, decreases risk of aspiration, and looks for upper GI hemorrhage What does blood in gastric catheter indicate? - correct answer swallowed blood, traumatic insertion, or injury to upper GI tract If a cribriform plate injury is suspected (broken nose) but a gastric catheter is warranted what should you do? - correct answer insert the tube orally to prevent intracranial passage Who are special populations in trauma patients they may warrant special consideration? - correct answer children, pregnant women, older adults, obese patients, and athletes Why are women, older adults, obese patients, and athletes apart of the special population? - correct answer They may have physiologic responses that do not follow expected patterns What is a special consideration for a child with hypovolemia? - correct answer Children have abundant reserve and often show few signs of hypovolemia even after severe depletion. When deterioration does occur - it is precipitous and catastrophic Consider Need for Transfer: what should be done vs not - correct answer Do not delay transfer to perform an in-depth dx evaluation, ONLY undertake testing that enhances the ability to resuscitate, stabilize, and ensure the patient's safe transfer Other than difficulties with airway, what else is an important factor with an obese patient in terms of resuscitation? - correct answer Many obese patients have cardiopulmonary disease, limiting their ability to compensate and rapid fluid resuscitation can exacerbate their underlying comorbidities Why would an athlete cause a need for more concern in a trauma? - correct answer Due to their excellent conditioning, they may not manifest early signs of shock like tachypnea, tachycardia -they also normally have low BP When does the Secondary Survey occur? - correct answer ABCDE of primary survey HAS to be completed first, resuscitative efforts are underway and patient's vital functions are demonstrated ATLS Test Study Guide TEST 4 LATEST VERSIONS REAL EXAM QUESTIONS AND CORRECT ANSWER S |AGRADE What does the Secondary Survey consist of? - correct answer Head to toe evaluation, a complete history and physical exam including reassessment of all vital signs. -each region of the body is examined, seeing potential for any missing injury Secondary survey - what does the history portion include? - correct answer -mechanism of injury, may have to speak to family "AMPLE" - Allergies - Medications - Past illness/pregnancy - Last meal - Events/Environments related to injury What can the mechanism of injury tell you? - correct answer Enhance the physiologic state and provide clues to anticipated injuries, some can be predicted based on the direction and amount of energy of the MOI - Category 1: blunt trauma - Category 2: penetrating trauma Blunt Trauma - correct answer An impact on the body by objects that cause injury without penetrating soft tissues or internal organs and cavities. - important things to note: seat-belt use, steering wheel deformation, direction of impact, what damage occurred to the vehicle, ejection from the vehicle Penetrating Trauma - correct answer Injury caused by objects, such as knives and bullets, that pierce the surface of the body and damage internal tissues and organs. - important things to note: body region, organs in the path, distance from the weapon What complicates a thermal injury? - correct answer Carbon monoxide poisoning What can cause significant heat loss even at moderate temperatures? - correct answer wet clothes, decreased activity, vasodilation caused by alcohol or drugs that compromise the patient's ability to conserve heat Why is it important to ask about any exposure of chemicals, toxins, or radiation in trauma? - correct answer 1. The affect on cardiac, pulmonary, and internal organ dysfunction 2. Danger to healthcare workers ATLS Test Study Guide TEST 4 LATEST VERSIONS REAL EXAM QUESTIONS AND CORRECT ANSWER S |AGRADE What does the role of a team member entail? - correct answer supervises, checks, and directs the assessment - should be trained in ATLS -assigns roles, gets the hospital ready for arrival What is the acronym used for handing over a patient from EMS to hospital trauma team? - correct answer "MIST" -Mechanism of injury -Injuries found and suspected -Symptoms and signs -Treatment initiated What should be done once the patient leaves the ED? - correct answer After Action session, the team addresses technical and emotional aspects of the resuscitation and identifies opportunities What is the quickest killer of injured patients? - correct answer inadequate delivery of oxygenated blood to the brain and other vital organs - supplemental oxygen must be administered o all severely injured trauma patients What can be a subtle but early sign of airway/ventilation compromise? - correct answer tachypnea What is the number one key thing to do for a patient with sustained head injury that need a definitive airway? - correct answer Maintaining oxygenation and preventing hypercarbia Inhalation and facial burn patients are at increased risk for what? - correct answer Respiratory compromise, consider preemptive intubation What do you do if you have a trauma patient who started to vomit during intubation? - correct answer Immediately suction then rotate patient to the lateral position all while keeping the cervical spine stable - vomiting could cause aspiration pneumonia Laryngeal Trauma clinical triad? - correct answer Hoarseness, subcutaneous emphysema, and palpable fracture - can cause acute airway obstruction There is a patient with airway trauma, you try to do an intubation with a flexible endoscope but are unsuccessful. What is the next step? - correct answer Tracheostomy - difficult to perform under emergency conditions and can be associated with profuse bleeding. Therefore, a cricothyroidotomy might be the next best thing. ATLS Test Study Guide TEST 4 LATEST VERSIONS REAL EXAM QUESTIONS AND CORRECT ANSWER S |AGRADE What is noisy breathing a sign of? - correct answer Partial airway obstruction (tracheobronchial injury) that can suddenly become complete - when a patient's level of consciousness is depressed, this detection might be more subtle and the only way to tell is from labored breathing **snoring, gurgling, stridor, dysphonia You observe a trauma patient and they are agitated? Other than the patient being in pain - what do you need to think - correct answer The patient is hypoxic You observe a trauma patient and they are obtunded, what do you need to think of? - correct answer The patient may be hypercarbia (holding onto CO2) What are signs of hypoxia? - correct answer Hypoxia is inadequte oxygenation - you can identify this by nail beds and circumoral skin, however these are LATE findings. - look for retractions and use of accessory muscles - use pulse ox If a patient is belligerent and abusive what should you not assume? - correct answer Intoxication, this could actually mean the patient is hypoxic What patient population is especially sensitive to direct trauma to the chest leading to ventilatory failure? - correct answer Elderly patients and patients with pre-existing pulmonary dysfunction A trauma patient has abnormal ventilation but you see no obvious thoracic or tracheobronchial injury, what are your next thoughts? - correct answer Intracranial injury can cause abnormal breathing and compromise ventilation Cervical spine cord injury can result in respiratory muscle paralysis or paresis Below what cervical spinal injury will maintain diaphragmatic function but lose intercostal and abdominal muscle contribution to respiration? - correct answer C3 If you have a patient who is diaphragmatic breathing/seesaw pattern, what do you suspect? - correct answer A cervical spinal injury below C3, but damage to spinal cord to the intercostal and abdominal muscles but maintains diaphragm breathing - this leads to inefficient respiration -- mismatch and result in respiratory failure ATLS Test Study Guide TEST 4 LATEST VERSIONS REAL EXAM QUESTIONS AND CORRECT ANSWER S |AGRADE 3 Important steps when assessing ventilation - correct answer 1. LOOK for symmetrical chest rise and fall 2. LISTEN for air movement on both sides, tachypnea 3. Use capnography in spontaneously breathing and intubated patients to assess whether ventilation is adequate. In intubated patients it can confirm the tube is positioned within the airway How do you to take off a helmet off a trauma patient? - correct answer This is a two-person procedure: one person restricts cervical spine motion from below while the other person expands the sides of the helmet and removes it What are factors that can predict a difficult airway? - correct answer - C-spine injury - Severe c-spine arthritis - Significant maxillofacial or mandibular trauma - Limited mouth opening - Obesity - Anatomical variations = receding chin, overbite, short muscular neck - Pediatric patients **LEMON: look, evaluate, mallampati, obstruction, neck mobility Can maneuvers during airway establishment aggravate c-spine injury? - correct answer Yes, cervical spine motion must be restricted What difference is there when performing the oropharyngeal airway on adults vs peds patients? - correct answer On adults, the preferred technique is to insert the oral airway upside down until it reaches the soft palate then rotate is 180 degrees - do not use this method on children because you can damage the mouth and pharynx **instead use a tongue blade to depress the tongue **both can cause gagging, if the patient tolerates this they are highly likely to require intubation When would you use a LMA? - correct answer A laryngeal mask airway have been shown to be effective in tx of patients with difficult airways - if endotracheal intubation failed