Intro To Advanced Trauma Life Support (ATLS) Exam, Exams of Nursing

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Intro To Advanced Trauma Life Support

(ATLS) Exam With 100% Correct And

Verified Answers 2024

What is the trimodal death distribution and what are the mortality rates? - Correct Answer-Timing of death resulting from trauma First peak = Immediately = 50% within minutes Fatal disruption of big vessels, heart, lungs Massive blood loss or neuro injury 2nd peak = Early = 30% within first few hours Mostly neuro injury 3rd peak = Later = 20% within days-weeks after initial injury Multiple system organ failure and sepsis What's the biggest risk to EMS? - Correct Answer-Accidents -usually while responding emergently to other accidents How is evidence based medicine implemented in trauma? - Correct Answer-American college of surgeons requires that every level 1 trauma center has to have National trauma registry that collects information and basic data points on their patients National trauma registry assesses data to see whats the best care, treatment and who's at risk and then studies are created to help better perform care on our patients When do most trauma patients die? How do you prevent trauma deaths? - Correct Answer-Most die immediately within first 10 minutes d/t primary injury to major organs, massive blood loss, etc Prevention with education w/anticipatory guidance What is trauma care versus critical care? What is the golden hour? - Correct Answer-Trauma care = saves patients from early trauma mortality Critical care = avert later trauma mortality Golden hour: The time the patient gets injured until definitive care at the trauma center (1st hour of trauma)

-most commonly die from neurologic injury In trauma, treat the [...] before [...] if the patient is unstable. What is not your friend? What is the process of death on a cellular level? - Correct Answer-Treat the PATIENT before the DIAGNOSIS TIME IS NOT YOUR FRIEND Cells die -> tissue dies -> organs die -> patient becomes septic (hemorrhage or hypovolemic) and develops multi organ dysfunction syndrome (MODS) ->organ failure (kidney, liver, respiratory) How are morbidity and mortality prevented during the second peak? - Correct Answer- By avoidance of secondary injury d/t hypoxia, hemorrhage or inadequate tissue perfusion Is most trauma an accident? How can we view as preventable vs non-preventable? How can we prevent? - Correct Answer-NO Preventable = MVC (motor vehicle crash) Non-preventable = MVA (motor vehicle accident) aka it implies that car crashes are not- preventable We prevent by educating patients on trauma prevention WEAR YOUR SEATBELTS->seatbelts are not as confining as wheel chairs Who oversees EMS and hand off to trauma team? What is the pneumonic to remember? - Correct Answer-Trauma leader MIST: M=mechanism of injury - EMS shows you picture to demonstrate the extent of trauma I= injuries found and suspected - by EMS during primary and secondary survey. Other than time theres not a lot EMS can do for trauma victim S= signs and symptoms T = treatment What is the platinum half hour? - Correct Answer-Time you are left "half hour" once the patient gets to the trauma center and begins to be treated Make every second count Time is not your friend What is the order of an initial evaluation of a trauma patient? - Correct Answer-Primary survey ATLS/history/vital signs

Resuscitation Secondary survey Definitive treatment or transfer to appropriate trauma center What is performed between primary and secondary survey in addition to obtaining a brief medical history and vital sings, that is the standard of care for trauma patients? - Correct Answer-ATLS - advance trauma life support -ensures most immediate life-threatening conditions are actively identified and treated in order to enhance survival What is a good history pneumonic? When should vital signs be done? - Correct Answer- AMPLE A=allergies - ask multiple times M=medications P = PMH and pregnancy L = last meal E = events and environment related to injury -Mechanism of injury. Need high index of suspicion based on MOI After the history, but get multiple vital signs taken at different times to see if patient is getting better, staying the same or getting worse Patients at risk of hypothermia what is a sign of shock? - Correct Answer-They are cold and clammy as they go into shock Secondary survey includes what? Is an absolute diagnosis needed to treat critical injuries? - Correct Answer-Head to toe exam Some patients wont have 2dary survey if they go to the OR NO absolute diagnosis isn't needed, immediately resuscitate If patient is unstable - they need to go to OR What's important about the initial evaluation of a trauma patient in the primary survey? How long should primary survey take? - Correct Answer-ABCDEs A = airway B = breathing C = circulation: D = disability: E = exposure If you find a life threatening injury during primary survey stop and treat the patient This usually is performed simultaneously Should take 30-60 seconds

How do we maintain airway? What is the intubation of choice? What is important at this step? - Correct Answer-maintain airway with C-spine protection -chin lift, jaw thrust, modified jaw thrust -not in MVC Endotracheal tube is intubation of choice Make sure you immobilize C-spine and don't apply traction What should we oxygenate with? When do we insert a chest tube? What kind of chest tube? Where? - Correct Answer-Oxygenate with 100% O Insert a chest tube for tracheal injury, flail chest, or sucking chest wound w/decreased breath sounds. Use a 28-32 French. At the 5th ICS midaxillary line How do you stop a bleed? What type of IVs do you insert? What solution? When is it contraindicated? - Correct Answer-Use the DEPT pneumonic: Direct pressure Elevation Pressure point Tourniquet **can use sphygmomanometer -> best tourniquet Start two LARGE bore IVs (14 gauge catheter) Infuse 1 L of Ringer's lactate in 70kg adult (3:1 ratio crystalloids replacement for unit of blood loss) C/I with closed head injury In order to avoid hemorrhagic shock what do we give? What's important to evaluate in the blood? If the patient is bleeding is in shock what do we use? What are they at risk for with a massive transfusions? - Correct Answer-Give blood products early -packed RBCs, Platelets, FFP 1st thing to evaluate = CBC, HCT and type and cross If patients bleeding and in shock use O pos blood, for females give O neg to prevent erythroblastosis fetalis At risk for DIC How much urine output should we expect for adult and child? - Correct Answer-Adult =

50 cc/hour or 0.5 cc/kg/hour Child > 1 yo = 1 cc/kg/hour

How can we quickly assess for signs of perfusion? - Correct Answer-Radial pulse means their pressure is around 80mmHg Femoral pulse means 70 mmHg Carotid pulse means 60 mmHg What's the most common dysrhythmia seen in trauma patients? What should we think if they go from sinus tachy to sinus Brady? What do we want to monitor? - Correct Answer-Sinus tachy Tachy-Brady = pre-arrest -> patient is in shock Monitor BP, HR< and pulse quality When we do a quick neuro assessment what is AVPI? What about Glasgow coma score? When we we intubate? - Correct Answer-AVPU: A=alert V = verbal response P = pain response U = unresponsive GCS = eyes, verbal motor score E+V+M = 3-15 score Monitor change in mental status Intubate at 8 **best motor response is most significant How do we score eye opening on GCS? - Correct Answer-4 = spontaneous 3 = eyes open to voice 2 = eyes open to pain 1 = no opening How do we score verbal response on GCS? - Correct Answer-5 = normal conversation/oriented 4 = disoriented/confused conversation 3 = words, but not coherent/inappropriate 2 = no words, only sounds or incomprehensible 1 = none How do we score motor response on GCS? - Correct Answer-6 = normal/obeys commands 5 = localizes to pain 4 = withdraws to pain 3 = decorticate flexion posture 2 = decerebrate extension posture

1 = none/flaccid What is important about exposure/environmental control? - Correct Answer-Completely undress and expose patient Don't forget to turn patient over and check the back via log roll Reward the patient -> warm or heat fluids Place a finger or tube in every orifice -> if there isn't any available orifice we create one How do we reassess resuscitation? Contraindications? What do we do if patient deteriorates? - Correct Answer-Is there a tube in every orifice? NG tube and foley Create new ones? IVs and chest tube insertion Pericardiocentesis Diagnostic peritoneal lavage (DPL) Beware of C/I Ex: if pt is leaking from the nose, NO NG TUBE Ex: if part has blood at tip of meatus, do not place Foley catheter - possible urethra transaction If patient deteriorates repeat primary survey Where is definitive care for the trauma patient? Vital signs - how many? Different MOI? - Correct Answer-In the OR Vital signs - one set is never enough. Don't rely on automatic BP cuff - look for shock signs and symptoms MOI - blunt or penetrating. Have high Index of suspicion What is the first change with shock? Order of Head to toe survey for physical exam? What are we looking for? - Correct Answer-Mental status IPAA = inspect, palpate, percuss, auscultate EXCEPT IAPP = inspect, auscultate, palpate, percuss Looking for: BBSD = bleeding, bruising, swelling and deformity LACS = lacerations, abrasions, confusions, swelling Important labs for trauma patients? - Correct Answer-Baseline and ABGs

Type and cross blood HCT - unreliable indicator of vascular status BUN/Creat Electrolytes Calcium in massive transfusion What are the radiologic exams for a trauma patient? - Correct Answer-Initial XR - C- spine, CXR, Pelvis Only to radiology suite if they are stable, monitored, and accompanied by trauma team member FAST (focused assessment by sonography for trauma) = quick and cost effective non- invasive method for evaluation of trauma in resuscitation area via US What is in the tertiary survey? - Correct Answer-Re-evaluate and reassess patient -airway status -O2, ventilation, pulse OX, ABG -vital signs -hemodynamics status (fluid I/O, NG output, foley output) -12 lead EKG Definitive care is in the OR what do we have to remember? - Correct Answer-Ex-Lap = diagnostic and therapeutic Is patient unstable? If yes - to OR asap for laparoscopy and/or laparotomy Transfer to higher level of care? Consults/meds Minor procedures Admit and write orders for floor/ICU Discharge home with follow up and pt edu, address trauma prevention and health promotion