Trauma Management: Principles and Protocols, Exams of Nursing

Download Trauma Management: Principles and Protocols and more Exams Nursing in PDF only on Docsity! Atls Exam With 100% Correct Verified Answers 2024 A 19 year old man hiking in the forest fell 10 feet through at rotten plan on an old wooden bridge to the rocky stream below. He was transported to the ED within 30 mins complaining of chest pain. He is hypotensive on arrival to the ED. What do you do? A. 2L bolus crystalloid B. Send to OR C. 1L bolus crystalloid D. CT chest/abd/pelvis - Correct Answer-D. 1L bolus crystalloid In a severely injured patient, the risk of coagulopathy is high. Which of the following is correct: A. TXA should no be reduced after the initial bolus B. Resuscitative measures can increase the risk of coagulopathy C. To decrease the risk of coagulopathy you must keep the patient cool. D. TXA can be given within the first 4hrs of injury E. Patient's taking anticoagulation are not at any higher risk in trauma - Correct Answer- B. Resuscitative measures can increase the risk of coagulopathy Which of the following patients would not require radiographic evaluation per the Canadian C-Spine rules? A. 12 y/o boy who fell from 3.5 feet B. 68 y/o man who was ambulatory at the scene C. 42 y/o women rear ended by a city bus D. 35 y/o woman with delayed onset of neck pain who can actively rotate her neck 45 degrees left and right E. 23 y/o man with midline cervical spine tenderness - Correct Answer-D. 35 y/o woman with delayed onset of neck pain who can actively rotate her neck 45 degrees left and right In a patient with hemorrhagic shock, a base deficit of -4 would indicate what class of shock? A. Class 1 B. Class 2 C. Class 3 D. Class 4 E. Base deficit does not correlate with shock - Correct Answer-B. Class 2 At what class of hemorrhagic shock would the GCS decrease? A. Class 1 B. Class 2 C. Class 3 D. Class 4 E. A change in GCS would indicate neurogenic shock not hemorrhagic shock - Correct Answer-C. Class 3 Mildly hypotensive patient, tachycardia, BP normalizes after 1 L fluid bolus but begins to drop again. What do you do? A. Give 2nd litre bolus of crystalloid B. Start transfusing blood C. Transfer to higher level of care D. Obtain CT to determine source of bleeding E. Place a swan gantz catheter for more inverse monitoring - Correct Answer-B. Start transfusing blood Which of the following is true in the management of the potentially coagulopathic patient: A. Thromboelastography can take 2-3 hrs in some labs and should not done in the patients needing transfer B. Permissive hypothermia allows for a mild level of hypothermia to decrease risk of coagulopathy C. Patients given TXA in the field should get a follow up dose of 2g given as a rapid infusion over 30 mins D. Baseline PLTs PT/INR and PTT should be checked with the first 4hrs following arrival in the ED E. Rotational thromboelastometry is a point of care test that may be useful in guiding the treatment of this patient - Correct Answer-E. Rotational thromboelastometry is a point of care test that may be useful in guiding the treatment of this patient A 26 year old women was hit by a van while walking across a busy intersection. She has an obvious broken right femur and 3 broken ribs on the right side. She requires a blood transfusion. Which of the following is true: A. >4u pRBC in 1 hr is considered a massive transfusion B. Everyone requiring massive transfusion should receive calcium supplementation C. <12u PRBC in 24 hrs would no be considered a massive transfusion D. The ACS had developed a universal MTP that should be adopted by all trauma centres E. Type O plasmas is given when uncross matched plasma is needed - Correct Answer- A. >4u pRBC in 1 hr is considered a massive transfusion Subdural hematoma have a ___ shape on CT - Correct Answer-crescentic Pediatric considerations in airway - Correct Answer-Vocal cords are more anterior = harder to visualize. Trachea is shorter = easier to intubate right main stem is the tube is advanced too far Base deficient of 6-10 is what stage of shock - Correct Answer-3 MCC of shock is - Correct Answer-Hypovolemia HR and MAP targets for dissecting aortic aneurysm - Correct Answer-HR <80 MAP 60-70 Two medications used to control HR and MAP in a dissecting aortic aneurysm - Correct Answer-Beta block - esmolol CBB - nicardipine PaCO2 goal for when hyperventilating to control ICP - Correct Answer-30-35 Secondary brain injury is due to - Correct Answer-Hypovolemia and hypoxia 3 methods to control ICP - Correct Answer-Hyperosmolar agents, sedation, hyperventilation Patients with a GCS of ____ should be intubate - Correct Answer-<9 Urine output goals for adults - Correct Answer-0.5 ml/kg/hr Urine output goals for children - Correct Answer-1 ml/kg/hr Size of chest tube for hemothorax - Correct Answer-28-32 Fr CPP = - Correct Answer-MAP-ICP MAP = - Correct Answer-diastolic pressure + 1/3 pulse pressure CT Head rules - Correct Answer-ADGSSAV: Amnesia >30 minutes Dangerous MOI GCS <15 after 2 hours Suspected basal skull # Suspected depressed skull # Age >65 Vomiting >1 episode 4 Indications for a definitive airway - Correct Answer-A. Inability to maintain an airway by other means or impending airway compromise (inhalation injury, facial #, retropharyngeal hematoma) B. Inability to maintain oxygenation by face mask or apnea C. Cerebral hypoprofusion causing obtundation or combativeness D. GCS <9 indicating that the patient can't protect their own airway Life threatening conditions to look for on CXR - Correct Answer-Pneumo/hemo thorax Tension pneumo/hemo thorax Mediastinal widening for dissecting aortic aneurysms Cardiac widening for tapenade Pulmonary contusions # including rib, vertebrae, clavicle, scapula, humeral Ruptured diaphragm 3 high risk factors for Canadian C spine rules that require radiography - Correct Answer- Age => 65 Dangerous MOI Paraesthesias in extremities 5 low risk factors for Canadian C spine rules - Correct Answer-Simple rear-end MVC Sitting position in ED Delayed onset of neck pain Ambulatory at any time Absence of midline c-spine tenderness