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ATLS
atls course flashcards
87
Medical
Post-Graduate
06/13/2013

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Cards

Term
What is the leading cause of death in ages 0-40 in developed countries?
Definition
Trauma
Term
What do you say during the test as you enter and approach the patient?
Definition
"I have universal precautions for myself and my team"
Term
Fisrt examination of the patient?
Definition
"What is your name?"

If the patient can answer, you have examined the airway, breathing and circulation. A patient who can complain is a healthy patient.
Term
Why do patients need early gastric decompression?
Definition
1. Trauma patients aren't usually fasting for you, and are aspiration risks.
2. They may have been bag-ventilated in the field, and gotten a lot of air forced into their stomaches. This air can cause vagal over stimulation.
Term
What are the AMPLE components to a history?
Definition
Allergies
Medications
Past illnesses/Pregnancy
Last meal
Events/environment/mechanism

This is 'key' history. Get what you can...
Term
How do you diagnose a mid-face fracture?
Definition
Grab the incisors and pull.
Term
Trauma patient has horseness? What are you worried about?
Definition
Pneumothorax. Subcutaneous air could have migrated up to the neck and be irritating the vocal cords/nerves.
Term
3 PE signs of pelvic (not urethral) injury:
Definition
1. Pain on palpation
2. Unstable pelvis
3. Unequal leg length
Term
Airway: what do you do first?
Definition
Jaw thrust-chin lift.
Term
What 3 pieces of evidence do we need to verify that the cuff is inflated below the vocal cords?
Definition
1. bilateral breath sounds
2. CO2 return
3. CXR showing ET tube ~ 4 cm above the carina
Term
In a difficult airway, what non-definitive adjunct may be helpful?
Definition
A super-glottic device.
Term
What is shock?
Definition
From the book: "an abnormality of the circulatory system that results in inadequate organ perfusion and tissue oxygenation." 9th edition.
Term
What is the most common cause of shock in the trauma patient?
Definition
Hemorrhage. (= hypovolemic shock)
Term
Pt comes to the trauma bay, he/she is cool and tachycardic. What is his/her diagnosis?
Definition
Shock until proven otherwise.
Term
What determines how much resuscitation you give?
Definition
The patient's response.
Term
What are the resuscitation guidelines for pedi patients?
Definition
20 ml/kg of crystalloid

10 ml/kg of blood product
Term
What blood loss volume is your threshold for giving blood products?
Definition
1500 ml. Less than 1500 ml is still class I and II shock.
Term
What stage shock do you see a decrease in blood pressure?
Definition
Stage III shock, when the pt has lost between 1500 and 2000 ml of blood.
Term
What mental status can you expect in stage III shock?
Definition
anxious and confused.
Term
Book: If you believe your patient has a tension pneumothorax, do you wait for radiologic confirmation?
Definition
No.
Term
What are 6 life threatening thoracic trauma injuries identifed on primary survey?
Definition
1. Airway obstruction
2. Tension pneumothorax
3. Open pneumothorax
4. Flail chest and pulmonary contusion
5. Massive hemothorax
6. Cardiac tamponade
Term
8 only slightly less life threatening injuries identified on secondary survey (thoracic)?
Definition
1. Simple pneumo
2. Hemothorax
3. Pulmonary contusion
4. Tracheobronchial tree injury
5. Blunt cardiac injury
6. Traumatic aortic disruption
7. Traumatic diaphragmatic injury
8. Blunt esophageal rupture
Term
What should you always do during airway assessment that involves removing the C collar?
Definition
Look at the trachea for deviation.
Term
How can you tell between tension pneumo and tamponade?
Definition
**Tension pneumo will have no breath sounds on one side, while a tamponade should still have breath sounds**

Also, a tension pneumo should be hyperresonant, and have a deviated trachea contralateral to the decreased breath sounds.

Tamponade: May have distended neck veins, may have a pericardial rub. Good luck with that...
Term
Dr. Jackson, the patient needs an ER thoracotomy! Will you do it??
Definition
NO! I have not had sufficient training. ER thoracotomies are only indicated when a surgeon with the appropriate training is performing them.
Term
What is the least likely mechanism of injury to benefit from an ER thoracotomy?
Definition
blunt trauma
Term
Why is the patient with flail chest in danger?
Definition
Because underneath the flail chest is probably a massive pulmonary contusion. Alveoli that are full of blood and inflammation cannot participate in gas exchange, leading to hypoxia and hypercapnia.
Term
Congradulations! You put your first chest tube in! What are you going to do now?
Definition
Get a CXR, and then start over at ABCDE.
Term
You put your chest tube in but there is still a pneumo!! DDx?
Definition
1. Tracheobronchial tree injury
2. Air leak
3. Tube not working for some reason, check system.
Term
Your blunt trauma patient is not responding with resuscitation. Fast, DPL, and CT have ruled out bleeding. What could it be?
Definition
Blunt cardiac injury. You can diagnose this with echo, and if it is present just give it time to heal. Though you may need ionotropes until then...
Term
So, you have a widened mediastinum and aortic capping (no distinct aortic knob). What should you look at to further your hypothesis of aortic disruption?
Definition
Look for L mainstem bronchus depression.
Term
What are adjuncts used in the secondary survey of the chest?
Definition
1. CXR (may have been done as a part of the primary survey work up)
2. ABG
3. Pulse ox
4. ECG monitoring
Term
Cause of prevenatble death after truncal trauma?
Definition
Unrecognized abdominal and pelvic injuries.
Term
What space do we always forget about that is really a bitch?
Definition
The retroperitoneum
Term
4 common blunt trauma abd/pelvic injuries:
Definition
Liver
Spleen
Small bowel
Pelvic
Term
True or False? Gunshot wounds damage tissue by kinetic energy.
Definition
True. This is why there is increased damage around the track as compared to stab wounds.
Term
True or False? You can look at entry and exit wounds and get a general sense of the organs involved in the injury.
Definition
False. You don't know where that bullet been.
Term
Four patients that get a lap:
Definition
1. Free air under the diaphragm.
2. Diaphragmatic rupture
3. Peritonitis
4. Violation of the peritoneal cavity
Term
Pt rolls in to the trauma bay. Fast is positive, and they are hemodynamically unstable. What next?
Definition
Ex Lap.
Term
Pt rolls in to the trauma bay. CT shows SMA extrav, and they are hemodynamically unstable. What next?
Definition
Ex Lap
Term
What is the FAST not very good at detecting?
Definition
small bowel, pancreas, or diaphragm injuries
Term
What can a DPL help you diagnose?
Definition
small bowel injuries
Term
When would you give your patient rectal as well as IV contrast in the trauma bay?
Definition
When you suspect colon injury. This might be in the case of flank ecchymoses.
Term
Unstable pelvis in a rural hospital. What do you do?
Definition
Bind the pelvis tightly with a sheet. Binding the thighs and ankles can also help.
Term
What GCS is a trigger for intubation?
Definition
8
Term
Hypertension and closed head injury:
Definition
early sign of herniation?
Term
You get a CXR that shows your ER intubation is 4 cm above the carina. Can you congradulate yourself yet?
Definition
No. You must also have end tidal CO2, and bilateral breath sounds.
Term
What is the COD in shock?
Definition
Multi-organ failure
Term
What metabolic disturbance can you get with normal saline resuscitation?
Definition
Hyperchloremic metabolic acidosis. Apparently all that chloride dilutes the bicarb. Hmm.
Term
A 33 wk pregnant pt is admitted s/p MVC. Her PaCO2 is 40. That's normal, right?
Definition
Wrong. As pregnancy progresses, women have a permissive hypocapnia because they have an increased respiratory rate. In a very pregnant patient, a PaCO2 of 40 is hypercapnia.
Term
How do you get the baby off the IVC?
Definition
Turn the woman onto her left side.
Term
Why do we put long bone injuries into traction?
Definition
To minimize bleeding. (No clue why that works.)
Term
Limb threatening injuries are characterized by:
Definition
1. Vascular compromize
2. Severely crushed tissue
3. Impending compartment syndrome
Term
Pt has frostbite. What do you do?
Definition
Rapid rewarming with moist heat.
Term
Your pediatric patient needs a surgical airway, what is the best way to do that?
Definition
Needle cricoidostomy with jet insufflation.
Term
You just placed an ET tube in your rural ER. Pt has been approved for transfer. You don't have to wait on anything but your ______ before transfer.
Definition
CXR confirming tube placement. You cannot transfer a patient with a bad intubation.
Term
What are the categories of the GCS?
Definition
Eye opening, verbal response, and best motor response
Term
What are the EYE terms?
Definition
eye is 1-4. No response is one, opening to pain is 2, opeing to speech is 3, spontaneous opening is 4.
Term
What are the VERBAL scores?
Definition
no verbal is 1
incomprehensible sounds are 2
inappropriate words are 3
confused conversation is 4
Oriented is 5
Term
What are the MOTOR scores?
Definition
none is a 1
extension (decerebrate) is 2
abnormal flexion (decorticate) is 3
Flexion withdrawal to pain is 4
localization of pain is 5
obeying commands is 6
Term
Two things that have to happen with transfer:
Definition
1. The referring and receiving doctor must talk
2. Appropriate resuscitation like personel and blood products must be sent along with the transfered patient.
Term
Who gets Rhogam?
Definition
All pregnant Rh-negative trauma patients should receive Rh immunoglobulin therapy unless their injury is remote from the uterus.
Term
True or false? Because of their increased intravascular volume, pregnant patients can lose a significant amount of blood without damage to themselves or the fetus.
Definition
False. Bc of the increased intravascular volume, they can lose a lot of blood before their vital signs reflect that loss. Thus, the fetus may be in distress and the placenta deprived of vital perfusion while the mother's condition and vital signs appear stable.
Term
True or false? An elevated white count is worrisome in a pregnant patient.
Definition
False. Pregnant patients may have a low grade elevated WBC count. If it is 27k, no that's not normal, but 12 or 13k should not sound the alarm bells.
Term
How low can a normal PaCO2 be in a pregnant woman?
Definition
25-30 mmHg says this book. Dang.
Term
Do kids get as many laps as adults?
Definition
No. Kids are better at healing with non-op treatment. Though, if they are unstable or non-responders to resuscitaiton, and there is evidence of bleeding, they should get an operation.
Term
What is the most common immediately life threatening injury in children?
Definition
Tension pneumothroax. The mobility of mediastinal structures makes a child more susceptible to this process.
Term
What is that tape that you lay out next to the pedi trauma patient?
Definition
The Broselow Pediatric Emergency Tape. It has rapid determination of weight based on length, appropriate fluid volumes, drug doses, and equipment size.
Term
What is the rule of nines?
Definition
The adult body is is generally divided into surface areas of 9% each and or fraction or multiples of 9%
Term
Does the rule of nines work for children?
Definition
Kind of. The infant's or young child's head represents a larger proportion of the surface area, and lower extremities represent a smaller proportion than the adult.
Term
Don't forget internal injuries just bc a pt is burned.
Definition
Associated injuries can be sustained while the victim is attemting to escape, there can also be blast injuries.
Term
What do you always think about with a burn patient???
Definition
INHALATION INJURY. You should intubate them.
Term
Chemical burns require:
Definition
Immediate removal of clothing to prevent further injury, as well as copious irrigation.
Term
How much resuscitation do burn patients need?
Definition
2-4 ml LR/kg/%BSA of deep partial-thickness and full thickness burns durin the first 24 hours to maintain adequate circuating blood volume. Calculate your number, give it with the first half to be delivered in the first 8 hours, and watch urine output. If your UOP is fine, your resuscitation is fine. If UOP does not respond, increase your resuscitation.
Term
Outside the OR, hemorrhage control is best effected by:
Definition
well-aimed direct pressure.
Term
A doppler ankle/brachial index of less than ____ is indicative of an abnormal arterial flow 2/2 injury or peripheral vascular disease.
Definition
0.9. It means that there is significantly less flow in the legs than the arms.
Term
True or false? All patients with open fractures should be treated with intravenous abx as soon as possible.
Definition
True
Term
3 important spinal tracts of ATLS:
Definition
the corticospinal tract
the spinothalamic tract
the dorsal columns
Term
What do we call no demonstrable sensory or motor function below a certain spinal level?
Definition
A complete spinal cord injury. As we know from Downton Abbey, during the first weeks after injury, this diagnosis cannot be made with certainty, because of the possibility of spinal shock.
Term
Where is the corticospinal tract?
Definition
In the posterolateral segment
Term
What does the corticospinal tract do?
Definition
Controls motor power on the ipsilateral body.
Term
Where is the spinothalamic tract?
Definition
In teh anterolateral cord
Term
What does the spinothalami tract do?
Definition
transmits pain and temperature from the contralateral body.
Term
And the dorsal columns?
Definition
These are located in the posteromedial aspect of the cord, and control proprioceptive and light-touch information from the ipsilateral body.
Term
________ shock results from impairment of the descending sympathetic pathways in the cervical or upper thoracic spinal cord.
Definition
Neurogenic. This condition results in the loss of vasomotor tone and in sympathetic innervation to the heart.
Term
Classic sign of uncal herniation?
Definition
Ipsilateral pupillary dilation a/w contralateral hemiparesis.
Term
How many times do you scan the head?
Definition
Twice in pts with cerebral contusions, second scan within 24 hours. We need to make sure that it is not evolving.
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