Eye opening response 4. Spontaneously 3. To speech 2. To pain 1. No response Verbal response 5. Oriented x3 4. Confused 3. Inappropriate words 2. Incomprehensible sounds 1. No response Motor response 6. Obeys command 5. Moves to localized pain 4. Flex to withdraw from pain 3. Abnormal flexion 2. Abnormal extension 1. No response

ATLS 1 Flashcards by Olle Bladin

Base excess and lactate in shock?

Low BE (Base deficit), high lactate

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Hemorrhage classes, 1-4, what can you say about them in regards of blood loss and intervention?

Loss of 1 unit of blood. 0-15%. Monitoring, perhaps crystalloids.
15-30%. Thin pulses. Base deficit -2 to -6. Tachycardia, tachypnea, tube nervous signs (fear). Requires crystalloids.
31-40%. Possibly required blood transfusion. Inadequate perfusion. Severe tachycardia and tachypnea. Significant changes mental status. Decreased systolic BP. Base deficit -6 to -10.
> 40%. Preterminal event, dies in minutes. Super low BT. Pale. No urine. Base deficit < -10.

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Blood volume = how many percent of ideal weight in adults? Higher or lower in children?

7%. 70kg male => 5l. Slightly higher in children.

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Look for blood on floor and four more. Which four?

Pelvis, thorax, extremities, retropeitoneum/abdomen

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Normal urinary output in adults, children and infants

0.5ml/kg/h adults
1ml/kg/h children
2ml/kg/h infants

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Patient responds to bolus crystalloids then deteriorates, what to do?

Blood transfusion, plan for surgical hemorrhage control

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Indications for thoracotomy

> 1500ml from chest tube.
Continuation of bleeding.
Penetrating anterior chest wounds medial to mamilla or penetrating wounds medial to scapula.
Persistent need for transfusion.

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What is Kussmaul sign on cardiac tamponade?

Paradoxical filling of jugular veins on inspirations.

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Differentiate cardiac tamponade and tension pneumothorax

Breath sounds.

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Needle decompression tension pneumothorax, where?

5th intercostal room slightly anterior to mid axillary line

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Pulseless electrical activity can be present in?

Cardiac tamponade, tension pneumothorax, extreme hypovolemia

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Treatment cardiac tamponade?

Thoracotomy/sternotomy.

Cardiocentesis if surgery unavailable, not definitive treatment. Fluid resucitation in preparation for surgery.

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Algorithm for traumatic cardiac arrest

CPR => No rosc => Bilateral chest decompression => No rosc => Thoracotomy (release tamponade if present), clamp bleeding vessels.. Give epinephrine 1mg somewhere along the line early.

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Placement of more than one chest tube?

Incomplete expansion of lung and continued air leakage suggest tracheobronchial injury and may require additional chest tubes to overcome leak.

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List a bunch of indications for operation - abdominal injury

Hemodynamically unstable + suspected abdominal injury
Free air
Diaphragm injury
Intraperitoneal bladder rupture
Peritonitis
Blood per gastric/rectal/urethral

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Glasgow coma scale

Eye opening response

Spontaneously
To speech
To pain
No response

Verbal response

Oriented x3
Confused
Inappropriate words
Incomprehensible sounds
No response

Motor response

Obeys command
Moves to localized pain
Flex to withdraw from pain
Abnormal flexion
Abnormal extension
No response

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What is Monro-Kellie doctrine?

ICP and cerebral hemodynamics. A “mass” will displace venous volume and CSF => pressure will remain stable until compensatory mechanisms cannot withstand.

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Severity of head injury according to GCS

Severe - GCS 8 or less
Moderate - GCS 9-12
Mild - GCS 13-15

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CT scan findings that may require surgical intervention

Midline shift, loss of definition of basil cisterns, severe fractures with intrusion to brain matter

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Who not hyperventilate brain injuries?

Hyperventilation => Hypocarbia => Vasoconstriction => Ischemia

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At what levels shall Co2 be kept in head injuries and what’s the issue with hypo and hypercarbia?

Remain at Co2 4.7 kPa
Hypocarbia => vasoconstriction => ischemia.
Hypercarbia => dilation of blood vessels => High ICP

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What does mannitol do and when shall it not be used? How much over what period of time?

Lowers ICP. Do not give to hypovolemic pat (diuretic). Give 1g/kg 20% solution over 20min.

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Epidural/subdural hematoma results in widening of ipsilateral or contralateral pupil?

Ipsilateral pupil widening

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Dermatomes for sensory response on 2ndary survey, suspected spinal injury

C5 - Deltoid
T4 - Nipple line
T10 - Umbilicus
L4 - Medial aspect of calf
L5 - Medial aspect of feet
S1 - Lateral aspect of feet
S4/S5 - Rectal

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Myotome exams on 2ndary survey, suspected spinal injury

``` C5 - Deltoid C6 - Elbow flexion C7 - Triceps C8 - Wrist T1 - Spread fingers L2 - Hip flexure L3/L4 - Loft lower legs off bed L5 - Knee flexion + push down on the gas S1 - Toes to nose ```

Central cord syndrome?

Greater loss of strength in upper limbs than lower

Anterior cord syndrome?

Paraplegia and loss of pain and temp

Brown-Séquard syndrome?

Ipsilateral muscle loss, contralateral sensation loss

Before applying splints for skeletal injury, check what?

Neurology and vascular status.. Check after applying as well.

Extremities.. On primary or 2ndary survey?

Life threatening on primary, otherwise secondary.

Systematic review musculoskeletal status

Palpate through all extremities, torso and pelvis, ask to move, check temp, sensation and pulses.

Use traction on combined femur + tibia/fibula fracture?

Nah, can cause neural damage

Presence of vascular compromise or sin breakdown in fractured limb, x-ray or treat injury?

Treat injury

All burns trapped in environment, what should be assumed? Treatment?

CO-poisoning. Provide O2 100% mask. Monitor carboxyhemoglobin levels.

Burn. Simple measure to prevent edema (neck, chest)

Elevate 30 degrees

Pitfall IV lines in burn patients

May dislodge due to edema, use long catheters, re evaluate.

Initial fluid resuscitation in burns according to Parkland formula. Any difference in electrical burns?

2ml lactated ringer * body weight * % of area burned. First half over 8h, 2nd half over 16h. Adjust according to urinary output. 4ml for electrical burns.

Rule of 9 in estimation of burn area

``` Head/neck - 9% Arm - 9% each Thorax and upper back - 9% each Abdomen and lower back - 9% each Legs - 9% front + 9% back each Genital area - 1% ```

Types of burns

Superficial - erythema Superficial partial thickness - Moist erythema, possible blisters, blanches to touch Deep partial thickness - Dry. Not painful, possible blister, does not blanch to touch. Full thickness - Dry, leather, painless, waxy

Why cover burns?

Prevents infection, less pain

Management of frostbite

Stop tissue freezing. Moist heat. Warm fluids per os and IV. Warm objects in groin. 40C circulating water. Analgetics. Monitor heart. Do not use dry heat.

Reperfusion syndrome? What to monitor etc

Acidosis. Hyperkalemia. Local swelling. Monitor heart.

Normal systolic blood pressure in children (formula)

90 + 2*age upper limit. | 70 + 2*age lower limit.

Weight estimation children

Age*2 + 10

Step by step airway management in children

``` Reverse sniffing position Jaw thrust Clear secretions Preoxygenation Oral airway (do not use unless unconscious) Use tongue repressor ```

Deterioration in intubated patients nemonic

``` DOPE D Dislodgement of tube O Obstruction (suction or replace tube) P Pneumothorax E Equipment failure ```

Rely not on blood pressure to determine shock in children, but rather?

BP may be normal until 30% blood loss. Rely on tachycardia and reduced skin perfusion.

Urine output goals in children

Infants 1-2ml/kg/h Children 1ml/kg/h Teens 0.5ml/kg/h

Is hypotension in a trauma child bad?

Yes.. May indicate blood loss of 40%. If penetrating or blunt abdominal trauma => op.

``` Early reversal of anticoagulation.. ASA, plavix Warfarin Heparin DOAK ```

Antiplatelets (ASA, plavix) - Platelets Warfarin - Plasma + vitamin K Heparin - Protamine sulfate DOAK - Ocpex (prothrombin complex concentrate)

How to interpret a normal PCo2 in pregnant lady?

May indicated respiratory difficulties, should be lower.

Is there reason to worry about the fetus in normotensive pregnant lady?

Yes. Hypotension may occur later. Fetal distress can occur earlier.

Heartrate in fetus, what is normal?

120-160bpm. Absence of accelerations is a sign of hypoxia. You want increased HR for about 15 beats - ie accelerations

Blood samples in pregnancy, how are the following affected? | Hematocrit, WBC, pH, Bicarbonate, PCo2, Fibrinogen, PO2

``` Hematocrit - Lower WBC - Lower pH - Higher Bicarbonate - Lower PCo2 - Lower Fibrinogen - Higher PO2 - Higher ```

Fibrinogens role in pregnancy trauma?

Should be higher, if normal value - can indicate intravascular coagulation

Eclampsia can mimic head injury, consider eclampsia when:

Seizures, hypertension, peripheral edema, proteinuria, hyperreflexia.

Signs abruptio placentae

Vaginal bleeding, pain, uterine tenderness, contractions, uterine irritability

Signs uterine rupture

Guard, abnormal fetal lie, Easy palpation fetal parts, inability palpate fundus.

Give Rh immunoglobulin to mother when?

Determine RH status ASAP. Give immunoglobulin if mother is RH NEGATIVE.

When screen for intimate partner violence and malpractice?

Always, interview patient alone.

Gastric tube in all intubated patients?

Yes

When initiate transfer? Before, under or after resuscitation?

Under resuscitation

How to report patient to receiving caregiver?

ABC SBAR

ATLS 1 Flashcards

(63 cards)