ATLS

Question 1

The best initial treatment for the fetus?

Answer 1

Optimal resuscitation of the mother

Question 2

Who should evaluate pregnant trauma patients?

Answer 2

Qualified surgeon and obstetrician

Question 3

An abrupt decrease in maternal intravascular volume can result in what?

Answer 3

Increase uterine vascular resistance, reducing fetal oxygenation despite reasonably normal maternal vital signs

Question 4

What does PaCO2 of 35 to 40 mmHg indicate?

Answer 4

Impending respiratory failure during pregnancy

Question 5

Which way should uterus be displaced?

Answer 5

Manually to the left to relieve pressure on the IVC

Question 6

When and how should fetal monitoring occur?

Answer 6

Tocodynamometer performed beyond 20 wks gestation

Question 7

When is fetus in jeopardy

Answer 7

minor maternal injury can jeopardize fetus

Question 8

When should patient receive Rh immunoglobulin

Answer 8

All pregnant Rh-negative trauma patients, unless injury is remote from uterus (i.e., isolated distal extremity)

Question 9

Indicators that suggest presence of intimate partner violence:

Answer 9

• 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

Question 10

Cut off for blood loss (Class II to Class III)

Answer 10

1500mL

Question 11

Blood loss in % blood volume for shock

Answer 11

30%

Question 12

Pulse rate (BPM) cut off

Answer 12

120

Question 13

Respiratory rate cut off (Class II to Class III)

Answer 13

RR 30

Question 14

Urine output cut off (Class II to Class III)

Answer 14

<15mL/hr

Question 15

CNS/mental status during shock

Answer 15

anxious, confused

Question 16

Initial fluid replacement

Answer 16

Crystalloid and blood

Question 17

Corticospinal tract

Answer 17

Posterolateral segment

Ipsilateral motor power

Test by: voluntary muscle contraction or involuntary response to painful stimuli

Question 18

Spinothalamic tract

Answer 18

Anterolateral aspect

Contralateral pain & temp

Test by: pinprick and light touch

Question 19

Dorsal Columns

Answer 19

Posteromedial aspect

Ipsilateral proprioception, vibration, light-touch

Test by: position sense in the toes and fingers, or vibration sense using tuning fork

Question 20

Indications for transferring to a burn center:

Answer 20

• 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