ATLS Flashcards
There are more than ___________ MVC deaths worldwide per year.
1 million
Describe the trimodal distribution of death from trauma.
The first peak is the first seconds to minutes after the injury. This is from severe traumas and patients likely cannot be saved.
The second peak is the minutes to hours after the injury. These are from delayed consequences of the trauma, such as bleeding, hematomas, and swelling.
The third peak is days to weeks after the trauma. This is from the secondary effects of trauma, like wound infection.
ATLS is supervised by ____________.
the American College of Surgeons
What are the primary and secondary surveys?
Primary: ABCDEs
Secondary: full HPI and PE, labs, images (x-rays, CTs, and USs)
What are the duties of prehospital providers in a trauma?
- Airway and breathing
- Control of hemorrhage
- Immobilization
What information should you obtain from EMS in a trauma?
- Mechanism of injury
- Blood on scene
- Vitals and GCS
- Interventions done by EMS
- Access
- Immobility
- ETA
Review ABCDE.
Airway: maintain a patent airway, intubate if otherwise
Breathing: maintain adequate respiration, support if otherwise
Circulation and hemorrhage: control bleeding, identify cardiac causes of death, and identify dehydration
Disability: assess for neurologic damage that may require immediate immobilization and NSGY management
Exposure: look for missed things (on the body) and control temperature with warm blankets
How should you begin the ABCDE?
Introduce yourself, ask the patient’s name, and ask them to tell you what happened. If they answer correctly and without stridor or other airway sounds then you know they are breathing and their airway is patent. You can simultaneously get them hooked up to monitors and begin your assessment of their BC portion.
What do you need to do for the “D” part of the primary survey?
- GCS
- Pupillary exam
- UE motor function
- LE motor function
The only x-rays obtained in the primary survey are _______________.
chest and pelvis
There are two main kinds of trauma: _____________.
blunt and penetrating trauma
Thermal and toxic injuries are other types but are less common.
What types of injuries do you need to worry about in an electrical trauma?
- Arrhythmia
- Rhabdomyolysis
- Compartment syndrome
What kinds of non-burn injuries do you need to worry about in a burn patient?
Occult blunt trauma
The person may have sustained blunt trauma while escaping a fire or with a blunt trauma that involved a burn.
In the secondary survey, you need to auscultate for _________ bruits.
carotid
Neck trauma can cause dissection.
In each exam of the secondary survey, you need to do what?
- Inspect
- Palpate (crepitus, tenderness, drop offs)
- Auscultate (breath sounds, heart sounds)
Note: if you see any superficial lacerations or hematomas, check for puncture/penetration.
Place a ____________ when you’re concerned for pelvic fracture.
pelvic binder
Worse injuries typically occur in what type of MVC?
(Side impact or front impact)
Side impact
Define definitive airway.
An endotracheal intubation that is secured (cuff inflated, confirmed by CXR, and secured in place)
How do you know if a patient is at risk of airway compromise?
Talk to them and examine their head and neck.
If they can talk to you without worrisome sounds (stertor, stridor, or hoarseness) and they are not showing AMS, then you can rule out AMS and some mechanical causes of airway compromise. You then examine their head, next, and oropharynx for signs of injury (like hematoma, deformity, or bleeding) that might indicate other causes of airway compromise.
Why do you need to look and feel for maxillofacial fractures in assessing the airway?
Loss of bony support structures can cause loss of airway, particularly with bag-masking
Go through the look, listen, feel for airway assessment.
Look for the following:
- Symmetrical chest rise
- Presence/absence of retractions
- Hematomas or puncture wounds to the head and neck
- Maxillofacial deformity
- Midline trachea
- Tachypnea
Listen for the following:
- Gurgling, stertor, stridor, hoarseness
- Bilateral lung fields equal and clear
Feel for the following:
- Crepitus of the chest and neck
- Maxillofacial fractures
- Deep masses that might suggest developing hematomas
What are three things you do to confirm proper airway placement?
- Look for positive capnography
- Listen for symmetric breath sounds
- CXR
It is important to identify which type of shock trauma patients have because _______________.
while hemorrhagic shock is most common, they can also have obstructive (from PTX, tamponade, or PE that could have caused or been caused by the trauma), neurogenic (from a spinal cord injury), or even septic/anaphylactic/cardiogenic (if this preceded the trauma)
Hemorrhage induces shock by ____________.
reducing preload