Approach to Trauma Flashcards
What are the general steps of ATLS?
- ABCDEs
- Log roll
- X-ray and FAST
- Secondary survey
- Resuscitation and stabilization
What are the hemodynamic effects of a tension pneumothorax?
Increases pressure in the thoracic cavity, thereby decreasing preload
What is the needle used for a needle thoracostomy?
14-16 gauge
Where is the appropriate site for a needle thoracostomy?
Midclavicular line in the second intercostal space, over the neurovascular bundle
What is the size of the tube used in the placement of a chest tube?
36 french
What SBP is needed to feel a radial pulse?
80 mmHg
What SBP is needed to feel a femoral pulse?
60 mmHg
What SBP is needed to feel a carotid pulse?
60 mmHg
What is the relative HR for classes 1-4 of hemorrhagic shock?
1 = Normal-fast
2 = normal-fast
3. Fast
4. Fast
What is the relative BP for classes 1-4 of hemorrhagic shock?
1= normal 2 = normal-low 3 = low 4 = low
What is the percent blood loss for classes 1-4 of hemorrhagic shock?
1 = less than 15% 2 = 15-30% 3 = 30-40% 4 = 40%+
What is the type of fluids given for classes 1-4 of hemorrhagic shock?
1 = NS 2 = NS 3 = NS+blood 4 = NS+blood
What are the components of the AVPU scale?
Alert
Voice responsive
Pain responsive
Unresponsive
What is assessed with the disability part of the ABCDEs?
Level of alertness (GSC)
Brief neuro function
What sort of neuro exam should be done for the D part of the ABCDEs?
- Wiggle toes, fingers,
- Assess eyes
- sensation in arms and legs
- log roll and anal tone
What are the components of the visual portion of the GSC scale?
4 = spontaneously 3 = loud voice 2 = to pain 1 = none
What are the components of the verbal portion of the GSC scale?
5 = oriented 4 = confused 3 = Inapprop words 2 = Incomprehensible sounds 1 = no sounds
What are the components of the motor portion of the GSC scale?
6 = obeys commands 5 = Localizes to pain 4 = withdraws from pain 3= flexes 2= extends 1 =none
What are the standard x-rays to obtain in a trauma pt?
CXR and pelvis
What are the components of the secondary survey in the ATLS?
History (SAMPLE)
PE
What are the components of the AMPLE mnemonic?
Allergies Medications Past history Last meal Events
What are the major things to look for in the head part of the PE for ATLS?
Battle’s signs
Raccoon’s eyes
Hemotympanum
What are 0-5 grading for strength?
0 = paralyzed 1 = palable/visible contraction 2 = FROM with gravity eliminated 3 = FROM against gravity 4= FROM, but weak 5 = FROM, strong
What are the major things to look for in the neck part of the PE for ATLS?
- Tracheal deviation, hematoma
- SQ emphysema
- Pulses
What are the components of the NEXUS criteria? (4)
- Alert, non-intoxicated
- No midline TTP
- No distracting injury
- No sensory/motor deficit
What are the four general components of the PE for the chest in ATLS?
Inspect
Palpate
Percuss
Auscultate
How will a tracheobronchial tree disruption present?
- SQ emphysema
- Lung fails to reinflate after chest tube placement
If a lung fails to inflate after a chest tube is placed, what should be suspected?
Tracheobronchial disruption
What happens to a pt with a pulmonary contusion after fluids are given? What is the treatment?
- Causes pulmonary edema
- Hold off on fluids and given oxygen
What is the presentation and treatment of a cardiac contusion?
EKG abnormalities
FIx them
How should a pelvic fracture be treated?
Sheets wrapped around and tightened. Pelvic binder.
What should be assess for in the perineum, rectum, and genital area in the ATLS secondary survey?
- Hematomas
- Blood are the urethral meatus
- Sphincter tone
- High riding prostate
What should be assessed for in the arm/leg region of the ATLS secondary survey?
- Ensure neurovascularly intact
- Compartment syndrome
What are the labs, besides a type and cross, that should be obtained in a trauma pt?
CBC CMP ABG UA EKG EtOH
