ATLS Flashcards
The best initial treatment for the fetus?
Optimal resuscitation of the mother
Who should evaluate pregnant trauma patients?
Qualified surgeon and obstetrician
An abrupt decrease in maternal intravascular volume can result in what?
Increase uterine vascular resistance, reducing fetal oxygenation despite reasonably normal maternal vital signs
What does PaCO2 of 35 to 40 mmHg indicate?
Impending respiratory failure during pregnancy
Which way should uterus be displaced?
Manually to the left to relieve pressure on the IVC
When and how should fetal monitoring occur?
Tocodynamometer performed beyond 20 wks gestation
When is fetus in jeopardy
minor maternal injury can jeopardize fetus
When should patient receive Rh immunoglobulin
All pregnant Rh-negative trauma patients, unless injury is remote from uterus (i.e., isolated distal extremity)
Indicators that suggest presence of intimate partner violence:
- Injuries inconsistent with hx
- Diminished self-image, depression, SI
- Self-abuse
- Frequent ED or doctor’s visits
- Sxs of substance abuse
- Partner insists on being present for interview and exam and monopolizes discussion
Cut off for blood loss (Class II to Class III)
1500mL
Blood loss in % blood volume for shock
30%
Pulse rate (BPM) cut off
120
Respiratory rate cut off (Class II to Class III)
RR 30
Urine output cut off (Class II to Class III)
<15mL/hr
CNS/mental status during shock
anxious, confused
Initial fluid replacement
Crystalloid and blood
Corticospinal tract
Posterolateral segment
Ipsilateral motor power
Test by: voluntary muscle contraction or involuntary response to painful stimuli
Spinothalamic tract
Anterolateral aspect
Contralateral pain & temp
Test by: pinprick and light touch
Dorsal Columns
Posteromedial aspect
Ipsilateral proprioception, vibration, light-touch
Test by: position sense in the toes and fingers, or vibration sense using tuning fork
Indications for transferring to a burn center:
- Partial-thickness and full-thickness burns greater than 10% of BSA
- Partial-thickness and full-thickness burns involving the face, eyes, ears, hands, feet, genitalia, and perineum, as well as those that involve skin overlying major joints
- Full-thickness burns of any size in any age group
- Significant electrical burns, including lightning injury (significant volumes of tissue beneath the surface can be injured and result in acute renal failure and other complications)
- Significant chemical burns
- Inhalation injury
- Burn injury in patients with preexisting illness that could complicate treatment, prolong recovery, or affect mortality
- Any patient with a burn injury who has concomitant trauma poses an increased risk of morbidity or mortality, and may be treated initially in a trauma center until stable before being transferred to a burn center
- Children with burn injuries who are seen in hospitals without qualified personnel or equipment to manage their care should be transferred to a burn center with these capabilities
- Burn injury in patients who will require special social and emotional or long-term rehabilitative support, including cases involving suspected child maltreatment and neglect
