Chapter 22 Flashcards
What is the most critical concept of ATLS?
Treat the greatest threat to life first
What is the ABCDE mnemonic?
Airway establishment or maintenance with cervical spine protection
Breathing/ensuring adequate ventilation
Circulation/hemorrhage control and maintenance of adequate perfusion pressure
Disability/neurologic status
Exposure/environmental control/injury identification
When should C-spine injury be presumed?
In who sustains injury from a blunt trauma mechanism, any trauma pt who displays an altered LOC, or suffers multiple system trauma
What is a simple way to assess an intact airway?
Asking a simple question
If the pt can speak in sentences with a clear voice, airway is patent
When does a patent airway need to be established and maintained?
Hoarse Stridorous Cannot speak Has garbled speech Does not follow commands
What are considered fractures of the upper airway?
Facial bones
Mandible
Larynx
Trachea
What should occur airway-wise in the obtunded trauma pt?
Jaw-thrust, chin-lift maneuvers, or naso/oropharyngeal airways alleviate obstruction from pharyngeal tissues or the tongue
How is supplemental oxygen applied in an obtunded pt?
Up to 6 L via NC or up to 12 L via NRB
When should a definitive airway be obtained?
If there is any doubt about the pt’s ability to maintain a patent airway and/or ventilate
Or if their GCS is 8 or less
When should an airway device be exchanged for an endotracheal tube?
Trauma pts who present with emergently placed rescue airway devices, such as a laryngeal mask airway (LMA) or an esophageal tracheal combitube
When should an early cricothyroidotomy be performed?
If the airway is not obtainable via other ways, such as in trauma pts with severe obesity, severe maxillofacial bleeding, or facial features
What should occur after the airway is secured?
The function of the chest wall, diaphragm and lungs must be investigated
How is ventilation determined clinically?
Gas exchange at the nose and mouth Chest excursion Palpation Percussion Auscultated breath sounds Capnometry ABG GCS
When can false-positive readings occur in end-tidal CO2?
If the pt recently ingested a CO2-containing beverage like soda or recently received positive pressure ventilation via a BVM
Why should a CXR be obtained after endotracheal intubation?
To confirm appropriate endotracheal tube position within the thoracic inlet, at least 2 cm above the carina, and also to identify chest pathology
Presentation of a tension pneumo
May be present in an unstable pt with unilateral breath sounds, contralateral tracheal deviation, and a significant drop in end-tidal CO2
DDx of PEA
Tension pneumo Tamponade, cardiac Toxins (drug overdose) Thrombosis, coronary Thrombosis, pulmonary embolism Hypothermia Hypoxia Hyper/hypokalemia Hydrogen ion acidosis Hypo/hyperglycemia
What is the most common cause of preventable postinjury death?
When can it be suspected?
Hemorrhage Shock-like sx, including: Altered LOC Skin pallor Rapid, thready pulse
Control of external hemorrhage
Use direct manual pressure
Compression of the proximal palpable pulse either digitally or with a tourniquet
When should one suspect the presence of occult hemorrhage?
In the chest and abdominal cavities, in the soft tissues surrounding a long bone fracture, or in the retroperitoneum of the hypotensive trauma pt
Tx of hemorrhage
A minimum of two large-bore IV catheters should be established, and warm lactated Ringer’s should be administered rapidly
In PEA, who is a poor candidate for a thoracotomy?
Blunt trauma pts
How should pulses be evaluated?
Centrally (carotid or femoral)
Peripherally (radial and dorsalis pedis)
Bilaterally
For quality, rate, and regularity
Pulse-wise, when are pts usually normovolemic?
Pts with full, slow regular pulses, unless they are medicated with beta-adrenergic blockade
