ATLS principles Flashcards

Question

Life saving measures in burns

Answer 1

Identify and manage inhalation injury Stop the burning (remove clothing and jewellery, cold water, wash chemicals) IV lines

Answer 2

Hemodynamic abnormality in abdominal trauma Clinical evidence of intraperitoneal bleeding Positive FAST scan Positive DPL Gunshot wound (high velocity, trams abdominal, close range shotgun, peppering) Peritoneal irritation (indicating rupture of hollow viscus) Signs of fascial penetration Positive finding on wound exploration Evisceration Gastrointestinal or genitourinary bleeding Free air, retroperitoneal air, rupture of hemidiaphragm Positive finding on CT

Answer 3

History Body surface area affected Depth of burns

Answer 4

Adults - rule of 9: head, each upper limb, anterior lower limb, posterior limb - 18%: anterior torso, posterior torso - 1%: perineum Kinders - rule of 9: anterior head, posterior head, each upper limb - 18%: anterior torso, posterior torso (each butt cheek 2.5%) - 7%: anterior lower limb, posterior lower limb Inhalation injury - 10-20%

Answer 5

1st degree: erythema, pain, no vesicles 2nd degree: erythema or mottled, swelling and vesicles, wet and exudative, painfully sensitive 3rd degree: dark, leathery, dry, waxy white, mottled, translucent, painless

Answer 6

Primary survey: - inhalation injury - chemical injury to lungs - CO poisoning - fluids: 2-4ml/kg/%BSA, half in first 8hrs after injury, half in next 16hrs Secondary survey: - physical examination - documentation - baseline investigations (CXR, FBC, U&E, glucose, HbCO, compat, ABG, BhCG) - wound care - antibiotics as indicated - analgesia - tetanus prophylaxis - nasogastric tube - peripheral circulation (remove constricting clothing and jewelry, assess peripheral perfusion, escharotomy and fasciotomy as indicated)

Answer 7

Airway: position, alternative insertion of oropharyngeal airway contraindicated, atropine prior intubation, needle cricothyroidotomy Breathing: increased risk of barotrauma (tidal volume 6-8ml/kg); smaller chest tube and needle for decompression Circulation: occult intracranial or intraabdominal hemorrhage, subtle signs of shock, increased compensatory ability, 20ml/kg fluid boluses, 10ml/kg RBCs, intraosseous infusion, urine output Disability: increased compliance of bones means fewer fractures Thermoregulation: increased surface area

Answer 8

Dislodgement of endotracheal tube Obstruction of endotracheal tube Tension pneumothorax Equipment failure

Answer 9

``` 5 - appropriate words, social smile, fixes and follows 4 - cries, but consolable 3 - persistently irritable 2 - restless, agitated 1 - none ```

Answer 10

Oxygen saturation monitor applied 2 wide bore lines, Ringers lactate IVI at maximum speed Arterial blood gas collected ECG monitor connected Logroll, rectal and perineal examination. While logrolling, a rapid secondary survey of the back can be performed Remove all clothing and then cover Urinary catheter if perineum intact Nasogastric (or orogastric) tube if required Analgesia and sedation X-ray chest (all cases) and pelvis(in blunt trauma) Repeat the Primary Survey to re-evaluate the response to resuscitation

Answer 11

Patient fully awake and orientated (co-operative) No abnormal neurology related to spinal trauma No discomfort/pain related to spinal column No distracting injury in the vicinity, e.g. above clavicle, paraspinal area No tenderness, step-deformities, bruising or induration over spine Collar and other immobilizing devices removed, and patient capable of gently moving each element without any discomfort or new neurology If it: CT or X-ray (lateral, AP, and open mouth)

Answer 12

``` Liver, spleen, kidney Small bowel rupture Diaphragm rupture Duodenum and pancreas Bladder rupture Retroperitoneal hematoma ```

Answer 13

Liver Small bowel Colon Diaphragm

Answer 14

SBP < 70mmHg GCS < 8 Burns inhalation injury Clinically compromised airway

Answer 15

Chest drains >1.5L initially Chest drains >200ml/h for 4 hours Chest drains >100ml/h for 10 hours Repeat CXR reveals persistent hemothorax

Answer 16

Circumferential burns - neurovascular compromise (escharotomy) CO inhalation - monitor CO level, 100% oxygen, intubate and ventilate Chemical burns - brush dry chemicals off, rinse wet chemicals Electrical burns - rhabdomyolysis, demyelinisation, fractures, and arrhythmia

Answer 17

``` Injured Walking Breathing Resp rate Circulation (pulse, capillary refill) ``` Green - walking Red - only breathing with airway manoeuvre, RR > 30 or 120, capillary refill >2 seconds Yellow - not walking, but not red

Answer 18

GCS Resp rate SBP Green - SBP >90 - RR 10-30 - GCS 13-15 Yellow - ONE of - SBP 75-90 - RR > 30 - GCS 9-12 Red - not green or yellow

Answer 19

``` MAP > 90 Normovolemia PO2 80-100 SATS > 95 PCO2 30-35 Mannitol Temp 35-37 Phenytoin No steroids Early enteral feeding Sucralfate DVT prophylaxis (NB brain bleeds) Pressure sore prevention Drain mass lesions +/- ICP monitoring ```

Answer 20

Life threatening - unstable pelvic fracture - major arterial hemorrhage - crush syndrome Limb threatening - open fractures - joint injuries - vascular injuries - compartment syndrome - neurological injury Other - contusion and laceration - fracture - joint injury

Answer 21

Look, feel and move - assess skin, bone, muscle, neurovascular, and joints ``` Adjuncts: Pelvic X-rays X rays of injured limbs U/S for large hematomas Assess perfusion Full neurological examination Differential Doppler pressures Compartment pressures Angiography and arteriography ```

Answer 22

400ml saline | 1000iu heparin

Answer 23

No bubbling for 24 hours | Draining les than 150ml per day

Answer 24

``` >2 cm lung collapse Respiratory distress General anesthetic Positive pressure ventilation Transfer ```