ATLS Flashcards
Primary Survey
A - airway (“what’s your name?” - suction, jaw thrust, +/- intubation)
B - breathing (look at chest wall, auscultate, pulse ox & 10L/min for all)
C - circulation (skin color, pulses, BP, hemorrhage control)
D - disability (brief GCS, pupils, )
E - exposure / environment (take off all clothes –> warm blankets)
AMPLE Hx
A - allergies M - meds P - PMH L - last meal E - events leading up to incident, mechanism of injury
Hx Questions for Blunt v. Penetrating Trauma
Blunt - airbag deployment, seatbelt use, damage to car, speed, position of patient
Penetrating - velocity, how close was shooter, path of bullet
When do you use meds for intubation? Dosing?
If gag reflex intact
.3 mg/kg etomidate
1 mg/kg sux
4 Classes of Shock
I - < 15% loss, no replacement needed
II - 15-30% loss, crystalloids
III - 30-40% loss, control hemorrhage with direct pressure and give pRBCs
(dec UOP, tachy, dec BP, dec LOC)
IV - >40% loss, rapid transfusion and surgery needed
(no UOP)
Indication for Thoracotomy in Hemothorax?
If > 1500 mL blood return when chest tube inserted
CXR Findings Aortic Dissection
Wide mediastinum
L bronchus lower, R bronchus higher
Loss of aortic knob
Indications for Ex Lap
- blunt ab trauma + low BP + pos FAST or peritoneal signs
- GSW to abdomen
- Stab to abdomen + evisceration, abnormal vitals, peritoneal signs OR trans-peritoneal trajectory
- Sig CT findings
- Peritonitis
- Evisceration
- Low BP + wound that penetrates anterior fascia
- Free air, retroperitoneal air, hemi-diaphragm rupture
- Penetrating trauma + blood from stomach, rectum or GU system
Normal ICP
10 mm Hg
CO2 & BP Goals in Head Injury
No > 40, no < 25
Ideal CO2 = 35-40
Systolic BP > 100 50-69 yo
Systolic BP > 110 15-49 yo
GCS
Eyes 1 - spont 2- command 3- open to pain 4 - no opening
Mouth 1- oriented 2- confused 3 - inappropriate 4- incomprehensible 5 - none
Motor 1- commands 2- localize pain 3 - flex from pain 4- decorticate 5 - decerebrate 6 - none
Spinal Level for Neurogenic Shock
Spinal Level for Loss of Resp Function
T6 - disrupts sympathetic chain
C6 - respiratory
Canadian C Spine Rules
High risk - age > 65, dangerous mechanism, paresthesias
(IMAGE IF ANY)
Low risk - ambulating, sitting in ED, simple rear end, delayed onset pain, no midline pain
(EVALUATE ROM - if 45 degrees L and R then no imaging)
NEXUS C Spine Rules
N - neuro def E - ETOH X - extreme distracting injury U - unable to give hx (dec LOC) S - spinal tenderness (midline)
If none then no imaging
Cervical SC Injury on CT
- Vert body or process frax
- Loss of alignment of posterior vert bodies
- Inc distance between spinous processes at 1 level
- Inc pre-vertebral soft tissue space
- Narrow vert canal
Abx for Open Frax
Cefazolin if 10 cm or less
+ Gentamicin if larger, more severe or vascular damage
+ pipercillin tazobactam if still water or farming involved
Tdap Rules
If clean wound … give vax if no primary and booster if > 10 yrs
If dirty wound … give vax/immunoglobulin if no primary and booster if > 5 yrs
Indications for Intubation in Burn Injury
Hoarse, stridor
Burns inside mouth
Difficulty swallowing
Extensive, deep facial burns
Burn SA > 40-50%
Sig edema
Inability to clear secretions or resp fatigue
Dec LOC
Fluid Replacement in Burns (+peds +electrical)
UOP Goals in Burn Resuscitation
2 ml x kg x TBSA
3 ml x kg x TBSA (peds)
4 ml x kg x TBSA (electric)
UOP = .5 mL/kg/hr adults & 1 ml/kg/hr peds
Normal PaCO2 in Preg
30
** so 35-45 may mean impending resp failure
ABC - SBAR
air/breath/circ - interventions done
situation - name/facility/why transfer
background -AMPLE hx, meds given, studies done
assessment / recommendation - include transport details
Indication for Transfer to Burn Center
> 10% TBSA first degree
Any 3rd degree
Face/hands/genitalia/feet/major joints involved
Inhalation Injury
Electrical/chemical burns
Pre-existing condition that will mean longer recovery time (ex - DM)
