ATLS

Question 1

What does the ‘c’ refer to in cABCDE?

Answer 1

Stabilise C-spine and stop massive catastrophic haemorrhage.

Question 2

What are the steps of ‘A’ in cABCDE?

Answer 2

1. Ask the patient how they are, if they respond then move to B.
2. Assess for airway obstruction - swelling, gurgling, snoring, choking, stridor, flail chest.

Question 3

How do you respond to airway obstruction?

Answer 3

1. Head tilt/chin lift
2. Jaw thrust in c-spine trauma
3. Remove foreign object, suction secretions
4. Guedel OP/NPA especially in seizure
5. If it persists - escalate (ENT, anaesthetics)

Question 4

What are the steps of ‘B’ in cABCDE?

Answer 4

1. Give 100% oxygen if hypoxic
2. Resp rate, sats, tracheal deviation
3. Inspect, palpate, percuss, auscultate chest

Question 5

What could a dullness on auscultation of the chest in an emergency represent?

Answer 5

Pleural effusion, collapse, consolidation

Question 6

What could reduced sounds on auscultation of the chest in an emergency represent?

Answer 6

Collapse, pneumothorax, pleural effusion

Question 7

What could a wheeze on auscultation of the chest in an emergency represent?

Answer 7

Bronchospasm

Question 8

What could crackles on auscultation of the chest in an emergency represent?

Answer 8

Pulmonary oedema, fibrosis, consolidation

Question 9

What is the next step in management if the respiratory effort is poor?

Answer 9

1. Get help
2. Manual ventilation via bag-valve mask
3. Naloxone in opioid toxicity

Question 10

What is the next step in management in a tension pneumothorax?

Answer 10

Immediate needle aspiration

Question 11

What is the next step in management in widespread wheeze?

Answer 11

Check for anaphylaxis, if not then give bronchodilators.

Question 12

When do you aim for sats between 88-92%?

Answer 12

Chronic T2RF

Question 13

What are the steps of ‘C’ in cABCDE?

Answer 13

1. Check colour and temperature of hands
2. Capillary refill time
3. Palpate radial and carotid pulses
4. Blood pressure
5. JVP
6. Auscultate heart sounds
7. ECG
8. 2 large bore IV cannulas - routine bloods and cross match

Question 14

What are the signs for shock and how do you manage it?

Answer 14

1. Increased CRT, cold peripheries, thready pulse, tachycardia, hypotension.
2. Give fluid challenge unless evidence of pulmonary oedema.

Question 15

What are the recommendations for fluid challenge (ml/kg) in these three scenarios?

1. Poor urine output
2. Low blood pressure
3. Congestive heart failure and poor urine output

Answer 15

1. 10
2. 20
3. 5

Question 16

What is the management of a massive haemorrhage?

Answer 16

1. 1:1:1 of packed RBC, FFP, and platelets
2. Reverse warfarin with IV vitamin K and PTCC
3. Consider tranexamic acid

Question 17

What is the management of VT?

Answer 17

Synchronised DC shock

Question 18

What is the management of bradycardia?

Answer 18

1. Give atropine 0.5-3mg

2. If no response - get help, transcutaneous pacing or IV adrenaline

Question 19

What are the steps of ‘D’ in cABCDE?

Answer 19

1. Capillary blood glucose
2. ABG
3. GCS/AVPU
4. Pupillary reflexes

Question 20

How is a CBG of <3 managed?

Answer 20

1. Send blood for formal lab glucose

2. Give immediate IV dextrose

Question 21

What is the pharmaceutical cause of bilateral pinpoint pupils?

Answer 21

Opioid intoxication

Question 22

What is the pharmaceutical cause of bilateral dilated pupils?

Answer 22

Cocaine, amphetamine, TCA, atropine

Question 23

What could to cause of a unilateral fixed pupil be?

Answer 23

Raised ICP or CN III palsy

Question 24

What are the steps of ‘E’ in cABCDE?

Answer 24

1. Body temperature
2. Fully expose body - bleeding, injuries, rashes, jaundice, medic alert bracelet, DVT, leg swelling
3. Examine abdomen
4. Bowels and water works
5. Allergies, meds, PMHx

Question 25

What should you do during cABCDE if an abnormality was noted at any stage?

Answer 25

Repeat cABCDE