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ATLS > ATLS > Flashcards

ATLS Flashcards

1
Q

Massive haemothorax

A

> 1500ml
Or
1/3 pt blood volume

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2
Q

Indications for thoracotomy

A

> 1500ml initially
Or
200ml/he for 2-4h

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3
Q

Tx aortic aneurysm

A

HR<80, MAP 60-70
Labetalol infusion
Cardiothoracic surgeon

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4
Q

Seatbelt sign likely injuries

A

Chance #
Intestinal injury

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5
Q

Types pelvic #

A

AP compression
- open book
Lateral
Vertical shear
- consider vertical traction
Combined

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6
Q

Language centre location

A

Left hemisphere
- all right handed
- 85% left handed

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7
Q

Dysphasia usually seen with x weakness

A

Right side weakness

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8
Q

Cause of blown pupil - Raised IOP

A

Parasympathetic fibres compressed
On oculomotor nerve
Tentorial herniation

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9
Q

Signs uncal herniation

A

Ipsilateral pupil blown
Contra lateral weakness

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10
Q

CPP=

A

CPP=MAP-ICP

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11
Q

Cerebral Autoregulation range

A

50-150mmHg

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12
Q

Moderate brain injury definition

A

GCS 9-12

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13
Q

BP aim for brain injury

A

sBP >110
Or
sBP> 100
— If 50-70yo

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14
Q

Mannitol dose

A

1g/kg

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15
Q

Mannitol contraindication

A

Hypotension

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16
Q

5% NaCl dose

A

50-100ml
(?max 5ml/kg)

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17
Q

Test; Spinal tracts
Back to front

A

Dorsal column
- position
Corticospinal
- power
Spinothalamic
- contralateral pinprick

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18
Q

Diaphragm innervation

A

C3,4,5
Keeps diaphragm alive

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19
Q

Dermatomes

A

C6 thumb
C8 little finger
T4 nipple
T10 umbilicus
L5 web space 1st/2nd toe
S1 lateral foot
S4/5 perianal

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20
Q

Central cord syndrome Sx

A

Weakness
Upper > lower

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21
Q

Anterior cord synd Sx

A

Paraplegia
Bilateral loss pain and temp
Intact; pressure/vibration/proprioception

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22
Q

Brown sequard syndrome Sx

A

Ipsilateral motor loss
Contralateral pain and temp

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23
Q

Tube size burns patients

A

Size 8
For bronchoscopy

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24
Q

COHb >x suggest inhalation injury

A

> 10%

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25
Q

Significant burn
Adult v child/elderly

A

Adult > 20%
>10% child or elderly

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26
Q

Fluids for significant burn

A

2ml x kg x %TBSA
- 3ml paed
- 4ml electrical burn
1/2 over 8h
Then adjust to U/O

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27
Q

Partial thickness burn
Superficial v deep

A

Superficial
- wet and painful
Deep
- dry, no pain, no blanch

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28
Q

Chest eschatotomy

A

Anterior axillary line
Cross at
- clavicle line
- abdo/thorax

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29
Q

Hypothermia define and severe

A

<36C
Severe <32C

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30
Q

DOPE

A

Dislodgement
Obstruction
PNX
Equipment

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31
Q

Lethal triad

A

Hypothermia
Acidosis
Coagulopathy

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32
Q

Paed pseudosubluxation

A

C2 on C3
Normal variant

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33
Q

Important pre-existing conditions

A

Cirrhosis
Coagulopathy
COPD
IHD
DM

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34
Q

Hypotension >65 yo

A

sBP<110

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35
Q

RSI in elderly

A

Reduce dose 20-40%

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36
Q

Trauma: Middle age or older consider

A

Medical event triggering trauma

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37
Q

Rhesus negative pregnant trauma

A

Rh Ig within 72h
?>12w

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38
Q

Fetal heart tone
how, Normal, bad

A

Doppler by 10w gestation
Normal 120-160bpm
Bad: absent accelerations

39
Q

Tocodynamometer from

A

20/40

40
Q

Test amniotic fluid in vagina

A

pH>4.5

41
Q

Define definitive airway

A

Tube in trachea
Cuff up
Below vocal cords
O2 supply

42
Q

Laryngeal # Sx

A

Hoarseness
Surgical emphysema
Palpable #

43
Q

LEMON

A

Look
Evaluate 3-3-2
Malampati
Obstruction
Neck mobility

44
Q

See saw breathing consider

A

below C3

Normal diaphragm
Loss of abdominal and intercostal

45
Q

3-3-2 rule

A

3cm incisors
3cm chin hyoid
2cm floor to thyroid

46
Q

Mallampati

A

2: partial uvula/fauces
3: base uvula
4: hard palate only

47
Q

Suxamethonium contraindication

A

High K, crush injuries

48
Q

Sats > 95% =~x pO2

A

9

49
Q

Neurogenic v spinal shock

A

Neurogenic
- injury >T6
- disrupt sympathetic outflow

Spinal (concussion)
- temporary LMN signs

50
Q

Effects on stroke volume

A

Preload
Contractility
After load

51
Q

Cardiac output =

A

CO= HR x stroke volume

52
Q

High Peripheral vascular resistance causes

A

Raised dBP and reduced pulse pressure

53
Q

Tachycardia in age groups

A

Infant > 160
Pre school > 140
Children > 120
Adults > 100

54
Q

Multiple vs mass casualty

A

Multiple
- does not exceed capabilities
Mass
- exceeds capabilities

55
Q

Major haemorrhage locations

A

On the floor and 4 more
Chest, AP, retroP, femurs

56
Q

Urine output per age

A

Adult = 0.5ml/hr
Paed = 1ml/hr
Infant = 2ml/hr

57
Q

Secondary survey

A

Head to toe
Look, feel; bone, joints, pulses
- Eyes (VA, remove contacts)
- Ears (haemotymp)
CN, PN
Active/passive movements
Stable joints; ligaments

58
Q

Jefferson #

A

Most common C1 #
Axial load
Burst #
Displaced lateral masses

59
Q

Chance #

A

Transverse # through vertebral body

60
Q

Hangman’s #

A

Posterior c2 #
Hyper extension

61
Q

C1 rotatory subluxation

A

Presents with torticollis
Can be minimal trauma

62
Q

Canadian c spine
Vs
Nexus

A

Canadian
- scan if; age>65, dangerous mechanism, paraesthesia, unable to rotate

Nexus
- scan if central pain

63
Q

Resp dysfunction from spinal injury

A

Above C6
Diaphragm C3,4,5

64
Q

Ankle/brachial index

A

sBP ankle/ sBP arm
>0.9 is normal

65
Q

Expected Tourniquet time over 1 h

A

Single attempt at releasing

66
Q

Rhabdomyolysis complications

A

High K
Low pH
Low Ca
DIC
Renal failure

67
Q

Pulse pressure=

A

sBP-dBP
(Force per contraction)

68
Q

Consider angio embolisation

A

In pelvic or abdo bleeds

69
Q

Paed IVF bolus volume

A

10-20ml/kg

70
Q

Class 2 vs class 3 shock

A

2: 15-30% blood loss
- decrease pulse pressure
- base excess -2 to -6

3: 30-40% blood loss
- increase HR
- decrease urine and GCS
- base excess -6 to - 10

71
Q

Female ?

A

?pregnant

72
Q

Define massive transfusion

A

> 10unit RBC w/I 24h
Or
4 unit in 1h

73
Q

Ohms law

A

BP= CO x after load

74
Q

Reduce posterior clavicle disloc.

A

Extend shoulders
Or
Grasp with clamp

75
Q

R/O in Breathing primary survey

A

Tension
Open PNX
Massive haemothorax

76
Q

When open PNX start sucking

A

Over 2/3 diameter trachea

77
Q

Consider Tracheobronchial injury

A

High air leak after placing chest drain
My require multiple chest drains

78
Q

Initial A to E report

A

C - immobilise
A - patent, tube, depth, CO2
B - Sats on %, RR
- look, feel, listen
C - BP, HR,
- look, feel: skin, pulse
- abdo, pelvis, femur
D - GCS, pupils, BG, lateralise
E - temp, expose, log roll

79
Q

A to E treatments

A

C - block
A - suction, O2, BVM, RSI, tube
B - Thoracostomy; needle, drain
- NG tube, sedation
C - tourniquet, p binder
- IV/IO, TXA
- level 1, blood/FFP
- splint, catheter
D - head up, NaCl, mannitol
- RSI, CO2
E - bait hugger, warm Fluid

80
Q

Surgical airway procedure

A

Scalpel (10), bougie, tube (6)
Left of patient
Gloves, clean
Laryngeal handshake - 3 finger
Transverse incision, twist 90
Bougie 90 then twist
Tube, twist
Cuff up
CO2

81
Q

RSI, ETT

A

Hx: AMPQT
Anaesthetic Hx
Exam: LEMON
Checklist: SPEEDBOMB
1:1:1, 1:1, 1
Cricoid, BURP
Cuff up
Cricoid off
CO2
Sedation and vent

82
Q

Needle decompression

A

CEPAC
18-12G
Paed 2nd IC space mid clav
Adult 4/5th IC space mid axillary
Clean
+|- syringe of water
Place canula

83
Q

Finger/tube thoracostomy

A

Kit: 28-33Fr, prepare underwater seal
4/5th IC space mid axillary
Gloves and gown
Clean; chlorhex
LA; 1%, 15ml, Ketamine
3cm incision
Finger and Spencer wells
Over rib, pop, widen, sweep
Clamp tube x2
Connect ? Swinging
Suture I-0 silk, dressing
CXR

84
Q

Needle cricothyrotomy

A

3ml syringe, 7.5mm ETT, BVM
12-18G canula
Left of pt
Gloves and clean
Laryngeal handshake: 3 finger
Syringe water
Aspirate and advance 45deg
Place canula
1 s inflation, 4 s expiration

85
Q

C spine XR report

A

AABCDE
Adequacy; C7, T1
Alignment
- ant vertebral, ant spinal, post spinal, spinous process
Bone
Cartilage
Dens
Extra axial soft tissue
- 7mm @ C3
- 3cm @ C7

86
Q

Hot debrief

A

Summarise
Things that went well
Opportunities
- equipment
Points to action
- family, cold debrief

87
Q

Feedback points

A

Situational awareness
Team work
Leadership
Decision making
Task management
- delegate, prioritise

88
Q

BVM ventilation. Steps

A

Select proper mask size
Connect oxygen
Ensure patent airway (+/- OP airway)
C or V grip (1 or 2 handed)
Ventilate
Observe chest rise/misting
Ventilate every 5 sec

89
Q

Dialogue feedback; form

A

What specific challenges did you encounter
Explore; How did you
- anyone else had similar situation?
Close; Q,S,T

90
Q

Phases learning

A

Remember
Apply
Evaluate

91
Q

Teaching phases ESDC

A

Environment;
- equipment, lighting, lay out
Set;
- introduce, roles, learning objectives, prior experience
Dialogue
- teaching part
Closure
- questions, summarise, terminate

92
Q

Asking questions for phases of learning

A

Remember: ask fact
Apply: ask for application
Evaluating:
- ask why, opinion, experiences, preferences
Synthesis: ask to solve problem

93
Q

Reasons for intubation

A

Airway patency; occlusion/ injury
Airway protection; blood, vomit
Respiratory failure

ATLS (2 decks)

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