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ATLS > Chapter 1 - Initial Assessment and Management > Flashcards

Chapter 1 - Initial Assessment and Management Flashcards

1
Q

What are multiple casualties

A

Number of patients and their injuries do not exceed the capabilities of the facility

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2
Q

What are mass casualties

A

Number of patients and the severity of their injuries does exceed the capability of the facility

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3
Q

What happens during the primary survey

A

life-threatening conditions are identified and treated in prioritised sequence - ABCDE

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4
Q

How to you assess the airway

A
  1. clearing the airway
  2. suctioning
  3. administering oxygen
  4. securing the airway
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5
Q

When airway management is required, how do we protect the c-spine

A

The cervical collar is opened and team member manually restricts movement of c-spine

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6
Q

What immediate steps should be taken when a tension pneumothorax is suspected

A

chest decompression - as tension pneumothroax acutely and dramatically compromises ventilation and circulation.

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7
Q

what should every injured patient receive

A

supplemental oxygen

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8
Q

Are there any risks associated with intubating someone who has a simple pneumothorax

A

simple pneumothroax can covert to tension pneumothorax when intubated and positive pressure ventilation started if we have not already decompressed the pneumothroax with a chest tube

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9
Q

Main cause of preventable deaths after injury

A

haemorrhage

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10
Q

3 elements of clinical observation that help assess haemodynamic status

A
  1. level of conciousness. critical impairment of cerebral perfusion
  2. skin perfusion
  3. pulse
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11
Q

how do we manage rapid external blood loss

A

direct manual pressure on the wound. Tourniquets useful in massive exanguination

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12
Q

major areas of internal haemorrhage

A
  • chest
  • abdomen
  • retroperitoneum
  • pelvis
  • long bones
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13
Q

How would you prepare for a patients arrival

A

Prepare equipment necessary to support ABC evaluation.
Oxygen and suction available and checked.
Warm IV fluids.
Aware of institutions capabilities and what to do if needs exceeds

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14
Q

What information is helpful to know before patients arrival into ED

A

Vital signs including GCS
What interventions have been performed
Time of arrival

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15
Q

What is the emphasis during the prehospital phase

A

Airway maintenance, control of external bleeding and shock, immobilisation of the patient and immediate transfer

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16
Q

What are critical aspects of the hospital preparation

A

Resuscitation are for trauma patients
Airway equipment
Warmed IV crystalloids
Protocol to summon additional assistance, prompt radiology and labs
Transfer agreements with major trauma centres

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17
Q

What are important communications from the prehospital team

A

Time of injury
Events related to the injury
Patient history and vital signs
Mechanism of injury

18
Q

What are standard precaution devices

A

Face mask
Eye protection
Water impervious gown
Gloves

19
Q

What adjuncts are used during the primary survey

A 
ECG - continuous
Pulse oximetry
CO2
Ventilation rate assessment
ABG
Urine output
NG
Lactate, X-ray, FAST scan,
20
Q

What condition is associated with the following dysrhythmias

Tachycardia, AF, premature ventricular contractions, ST changes

A

Blunt cardiac injury

21
Q

What condition is associated with the following dysrhythmias

PEa

A

Cardiac tamponade
Tension pneumothorax
Profound hypovolaemia

22
Q

What condition is associated with the following dysrhythmias
Bradycardia, aberrant conduction, premature beats

A

Hypoxia

Hypothermia

23
Q

What is the goal of the primary surgery

A

To identify and treat life threatening injuries in a prioritised sequence based on the effects of the injuryies of the patient physiology, because st first it may not be pooible to identify specific anatomical injuries

24
Q

How can you manage equipment failure

A

Test regularly and keep spare equipment and batteries

25
Q

How can you manage unsuccessful intubation

A

Identify patients with difficult anatomy
Identify your most skilled airway manager
Ensure adequate equipment is available to rescue the failed airways attempt
Be prepared to perform a surgical airway

26
Q

How do you manage progressive airway loss

A

Recognise the dynamic status of the airway
Recognise the injuries that can result in progressive airway loss
Frequently reassess the patient for signs of deterioration of the airway

27
Q

Which patient populations warrant special considerations

A

Children, pregnant women, older adults, obese patients and athletes

28
Q

When do we begin the secondary survey

A

The secondary survey starts once the primary survey is finished, resuscitative efforts are underway and vital signs improvements are seen

29
Q

What is the secondary survey

A

A head to toe assessment of the patient

Full history and physical examination including reassessment of all vital signs

30
Q

What pneumonic can we use to take a history.

A 
AMPLE
Allergies
Medications
Past illnesses / pregnancy
Last meal
Events / environment related to the injury
31
Q

What are the two broad categories of injuries

A

Blunt trauma

Penetrating trauma

32
Q

What is the sequence of the physical examination during the secondary survey

A 
Head
Max fax structures
C spine and neck
Chest
Abdomen and pelvis
Perineum, vagina, rectum
Musculoskeletal system
Neurological examination
33
Q

What is particularly important to examine during head assessment in secondary survey

A

The eyes - oedema can develop later
Visual acuity, pupil size, haemorrhage of conjunctiva or fundi, penetrating injury, contact lenses, lens dislocation, ocular entrapment

34
Q

What should examination of the face include

A

Palpating of all bony structures, assessment of occlusion, intraoral examination and soft tissue assessment

35
Q

What is the acronym for handover

A 
MIST
Mechanism and time of injury
Injuries found and suspected
Symptoms and signs
Treatment initiated
36
Q

What does pulse oximetry measure

A

The saturation of oxygen.

It can be confounded by carboxyhaemoglobin and so should be used with caution in patients with inhalation injuries

37
Q

How can we make the pulse oximetry readings more accurate

A

Place it above the BP cuff

Confirm with ABG findings

38
Q

What X-rays are used during primary survey

A

ONLY chest and pelvis X-rays

39
Q

What specialised diagnostic tests can be performed during the secondary survey to identify specific injuries

A 
X-ray of spine and extremities
CT scans
Contrast URL graphs and angiography
TOE, trans oesophageal ultrasound
Bronchoscopy
OGD
40
Q

how can we help reduce facial odedema

A

minimise it by elevation of the head to trendelenburg position

41
Q

where do we auscletat on the chest and what for

A

high at apex for pneumothorax and at the bases for haemothorax

42
Q

how do we prevent large blood loss in pelvic fractures

A

place a pelvic binder and do not repeatedly or vigorously manipulate the pelvis

ATLS (14 decks)

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