ATLS Ch 1-2 Flashcards by tcarlso 3

under what GSC score is transport indicated for a trauma pt?

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Under what SBP should you transport a trauma pt?

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What RR indicates the need to transport for a trauma pt?

under 10 or over 29

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Falls of over how high indicate the need to transport a pt? (adult and child)?

Adult = 20 ft
Child = 10

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Motorcycle crash over how many mph indicate the need for transport?

20 mph

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Blows above what anatomic boundary should make you suspect cervical spine injury?

Calvicle

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In whom should you assume cervical trauma?

AMS
Injury above the clavicle
Multi-system trauma

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Why must you be careful when intubating a patient with neck trauma, in regard to their breathing?

May worsen a laryngeal laceration

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What three clinical signs give a good indication of circulation?

LOC
Skin color
Pulse

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What are the determinants of the flow of IVFs in a tube?

Internal diameter of the tubing, and inversely to its length

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EKG changes in a patient with thoracic trauma may indicate what?

Cardiac contusion

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What are the three major signs of urethral injury?

Blood at the meatus
Perineal ecchymosis
High-riding prostate

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What lab test always follows intubation?

ABG

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What tubes go into a trauma patient?

Two large bore IVs or central line
NG or OG
Foley
(art line)

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When should you never insert something into the nose?

If you suspect cribiform plate fracture

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What hand should the pulse ox never go on?

The one with the BP cuff

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Normalization of hemodynamics in injured patients requires more than a normal blood pressure. What else?

Good peripheral perfusion

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When does the secondary survey begin?

After ABCDEs, and normalization of vital functions has been demonstrated

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What are the components of the AMPLE mnemonic?

Allergies
Medications
Past illness/pregnancy
Last meal
Events

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What information is important to obtain in a burn injury patient?

Where burn occurred (open or closed

- What was burned

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What are the two major reasons it is important to know if a patient is exposed to hazardous/poisonous material?

treat patient

- prevent harm to healthcare team

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What things should be assessed for with the eyes in a head trauma pt?

Visual acuity
Pupillary size
Hemorrhage
Penetrating injury
Contact lenses
Lens dislocation
Ocular entrapment

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Why should you remove contact lenses from a patient?

Will causes problems with edema

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Once a penetrating injury to the neck passes what anatomic structure should ED physicians no longer try to explore the wound?

Platysma

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What is a major complication and emergent threat to life that may be present in neck trauma pts?

Expanding hematoma leading to airway obstruction

Why is it necessary to listen for a carotid bruit in patients with neck trauma?

Assess for carotid injury and risk for a hematoma

Where is auscultation performed to detect a PTX and a hemothorax?

PTX = upper air fields | Hemothorax =Lower air fields

Unexplained hypotension in a trauma patient is what until proven otherwise?

Intraabdominal or intrapelvic bleed

All women with a pelvic fracture should had what exam performed?

Vaginal

Where does ecchymosis appear with pelvic fractures?

Iliac wings Pubis Scrotum/labia

Who should rock the pelvis to assess for stability?

Orthopedic surgeon

Patients with head trauma and deteriorating mental status should first have what assessed, prior to calling the neurosurgeon for management of an intracranial bleed?

ABCDEs

Why should intubation be performed as quickly as possible in head trauma pts?

Intubation increases ICP

Why must a patient with a c=spine injury always be on a backboard?

If lower body is free to move, c-spine will too

Why must a trauma patient be continuously re-evaluated?

New findings if waking up or deterioration if missed injury

What is the maintenance urinary output rate in adults and children?

``` Adults = 0.5 mL/kg/h Children = 1 mL/kg/h ```

What are the three major things to check with the diability part of the ABCDEs?

GSC score Pupils lateralizing signs

What is the appropriate action if a trauma patient begins to vomit?

Suction and lay in the lateral position

What is the clinical triad of a larynx injury?

Hoarseness SQ emphysema Palpable fracture

Agitation and obtundation respectively may be signs of what in trauma patients?

``` Agitation = hypoxia Obtundation = hypercarbia ```

Abusive and belligerant patients may have what underlying issue?

Breathing compromise

True or false: all trauma patients receive oxygen

True

What is the appropriate way to remove a helmet from a trauma patient?

One person maintains neck stabilization, while the other removes the helmet

What are the components of the LEMON mnemonic?

- Look externally - Evaluate 3-3-2 rule - Mallampati - Obstruction - Neck mobility

Is the mallampati done with the tongue proturiding or kept in?

Protuding

What are the four major indications for placing a definitive airway?

- Severe maxillofacial fractures - Risk for obstruction - Risk for aspiration - Unconcious

True or false: getting a defintive airway always takes priority over clearing the c-spine

If no immediate need, then can clear the c-spine first. Otherwise airway problems must always be resolved first

What is the BURP maneuver in attempting to visualize the vocal cords?

Backward, upward, and rightward pressure on the larynx

True or false: any time an intubated patient is moved, you need to check if their ET tube is in place

True

True or false: it is advisable to lower very high BG levels in patients with stroke

True, but only if greater than 185

What is the role of anti epileptics in a stroke?

Given to prevent recurrent seizures, but only if one occurs--not given prophylactically

What is the one time dose of IV labetalol given to emergently lower BP in cases of stroke tPA candidate?

10-20 mg IV over 1-2 minutes. may repeat once

How often should blood pressure be monitored after tPA administration?

- q15 minutes for first hour - q30 minutes for next 6 hours - q1 hour for next 16 hours

What is the infusion rate of IV labetalol?

10 mg IV followed by 2-5 mg/min

What are the 5 Hs?

``` Hypovolemia Hypoxia Hydrogen Ions Hypo/hyperthermia Hypo/hyperkalemia ```

What are the 5 Ts?

``` Tension PTX Tamponade Toxins Thrombosis, cardiac Thrombosis, pulmonary ```

If you have a biphasic defibrillator and it does not say what the recommended Joules are, what should you set it to?

Max dose for all doses

What is the rate by which survival declines at a witnessed arrest with and without CPR?

``` With = 4% Without = 10% ```

What is the dose and max dose of IV lidocaine for cardiac arrest?

1 mg/kg IV, to a max of 3 mg/kg IV

What is the dose of MgSO4?

1-2 g IV/IO diluted in 10 mL, given over 5 minutes

What is the normal range for central venous oxygenation?

60-80%

If you have a central line in and are able to measure central venous oxygenation during an arrest, what is the goal ScvO2?

Above 30%

If waveform capnography slopes downward, what issue may be present?

Emphysema ot PTX

If waveform capnography has an irregular peak early on, what could be wrong?

Airway issue

What do capnography waveforms appear like with asthma?

slow rising "hills" rather than boxes

True or false: insertion of a central line into a non-compressible vessel is an absolute contraindication to fibrinolytic therapy

False--relative

What is the general process of administering drugs via the IV route during cardiac arrest?

Give in bolus, follow with 20 mL of NS, and raise extremity

True or false: anything that is given via the IV route in cardiac arrest can be given via the IO route

True

What is the dose of drugs given via the ET route, as compared to the IV route?

Why must CPR be stopped when giving drugs via the ET route?

Drugs may regurgitate back up the ET tube

What is the standard procedure to prepare an IV drug for ET route?

dilute in 1 mL of sterile water or saline

What is the dose of etomidate for RSI?

0.3 mg/kg

What is the dose of succinylcholine for RSI?

1-2 mg/kg (usual dose is 100 mg)

What gauge needle is used for a needle cricoidotomy?

12-14

What is the O2 flow rate when using a needle cricoidotomy?

15 L/min

When using a needle for needle cricoidotomy, how long should you occuld and release the Y connector to simulate breathing?

Breathe in for 1 second, breathe out for 4

How long can needle cricoidotomy be used to ventilate patients? Why not for longer?

30-45 minutes | CO2 is not fully exhaled with this so will build

What diseases preclude the use of a needle cricoidotomy?

No pulmonary disease or chest injury

What flow rates should be used with a needle cricoidotomy if there is suspected glottic obstruction? Why?

5-7 L/min to reduce barotrauma to the lungs

What is the lower age limit for a surgical cricoidotomy, and why?

12 because there is not enough cartilaginous support before this age, and significant damage may occur

What factors limit the reliability of pulse ox?

Anemia Poor peripheral circulation Methemoglobinemia

How do you appropriately size an oropharyngeal airway?

Measure corner of mouth to the earlobe

Why will a SpO2 monitor report a different result compared to the calculated result from a PaO2 on an ABG?

ABG will not take into account pH, temperature, or other factors