EM Trauma 10 (ATLS 1)

Question 1

main components of prehospital phase in trauma

Answer 1

airway maintenance
control of external bleeding and shock
immobilization of the patient
immediate transport to the closest appropriate facility, preferably a verified trauma center

Question 2

things to be done to every injured patient

Answer 2

Supplemental oxygen
“Every injured patient should receive supplemental oxygen.” (?)

Question 3

Injuries identified in the secondary survey

Answer 3

simple pneumothorax
simple hemothorax
fractured ribs
flail chest
pulmonary contusion

Question 4

elements of circulation that yield important information within seconds

Answer 4

level of consciousness
skin perfusion
pulse

Question 5

remarks on fluid resuscitaiton

Answer 5

usual dose is 1L for adults or 20mL/kg for children

one study showed that crystalloid resuscitaiton of more than 1.5L independently increased the odds ratio of death

Question 6

it is recommended to warm fluids to this temperature

Answer 6

39C
When fluid warmers are not available, a microwave can be used to warm crystalloid fluids, but NOT blood products

Question 7

remarks on cervical trauma

Answer 7

most major cervical vascular injuries are the result of penetrating injury

wound that extend through the platysma should NOT be explored manually, probed with instruments, or treated by individuals in the ED who are not trained to manage such injuries

Question 8

things to communicate in handover of trauma patients

Answer 8

MIST
Mechanism (and time) of injury
Injuries found and suspected
Symptoms and signs
Treatment initiated

Question 9

the most important early assessment measure for airway and breathing

Answer 9

talking to the patient and stimulating a verbal response
a positive, appropriate verbal response with a clear voice indicates that the patient’s airway is patent, ventilation is intact, and brain perfusion is sufficient

Question 10

triad of laryngeal fracture

Answer 10

hoarseness
subcutaneous emphysema
palpable fracture

Question 11

describe stridor

Answer 11

crowing sounds

Question 12

remarks on cervical cord injuries

Answer 12

injuries below C3 level result in maintenance of the diaphragmatic function but loss of the intercostal and abdominal muscle contribution to respiration

Question 13

LEMON rule

Answer 13

Look externally (large incisors, tongue, small mouth, facial trauma)
Evaluate for 3-3-2 rule
incisor opening distance ≥3 FB
hyoid-mental distance ≥3 FB
thyroid notch to floor of mouth ≥2 FB
Mallampati 3-4
Obstruction (e.g. epiglottitis, retropharyngeal abscess, trauma)
Neck mobility (limited)

Question 14

first priority of airway management

Answer 14

ensure continued oxygenation while restricting cervical spinal motion

Question 15

remarks on OPA

Answer 15

do not use 180 degree method in children; instead use a tongue depressor

patients who tolerate OPA are highly likely to require intubation

Question 16

remarks on cricoid pressure

Answer 16

can reduce the risk of aspiration, although it may also reduce the view of larynx

Question 17

remarks on BURP

Answer 17

backward, upward, rightward pressure on the thyroid cartilate
aids in visualizing the vocal cords

Question 18

remarks on surgical cricothyroidotomy

Answer 18

not recommended for children <12 y/o

Question 19

remarks on neurogenic shock

Answer 19

results from extensive injury to the cervical or upper thoracic spinal cord caused by a loss of sympathetic tone and subsequent vasodilation

shock does not result from an isolated brain injury unless the brainstem is involved, in which case the prognosis is poor

a narrowed pulse pressure is NOT seen in neurogenic shock

the faliure of fluid resuscitation to restore organ perfusion and tissue oxygenation suggests either continuing hemorrhage or neurogenic shock

Question 20

define shock

Answer 20

an abnormality of the circulatory system that results in inadequate organ perfusion and tissue oxygenation

Question 21

remarks on pulse pressure

Answer 21

in shock, there is a release of endogenous catecholamines that increases peripheral vascular resistance, which in turn increases DBP and reduced PP

Question 22

remarks on recognition of shock

Answer 22

any injured patient who is cool to touch and is tachycardic should be considered to be in shock until proven otherwise

relying solely on SBP as an indicator of shock can delay its recognition as loss of up to 30% of blood volume can occur without a measurable fall in SBP

Question 23

remarks on blunt cardiac injury

Answer 23

suspect a blunt cardiac injury when the mechanism of injury to the thorax involve rapid deceleration

all patients with blunt thoracic trauma need continuous ECG monitoring to detect injury patterns and dysrhythmias

Question 24

remarks on blood volume

Answer 24

adults: 7% of ideal body weight
pedia: 8-9% of ideal body weight

Question 25

remarks on class IV hemorrhage

Answer 25

considered a preterminal event
unless aggressive mesaures are taken, the patient will die within minutes
blood transfusion is required

Question 26

lethal triad in trauma

Answer 26

hypothermia
coagulopathy
acidosis

Question 27

remarks on vascular access in trauma

Answer 27

two large-caliber (minimum of 18-gauge in adult) peripheral IV catheters
-most desirable site for peripheral are forearms and antecubital veins

Question 28

remarks on central lines

Answer 28

obtain CXR to document position of the line and evaluate for a pneumothorax or hemothorax

Question 29

where to look for other sources of ongoing blood loss?

Answer 29

abdomen/pelvis
retroperitoneum
thorax
extremities

Question 30

most comon cause of poor response to fluid therapy

Answer 30

an undiagnosed source of bleeding

Question 31

role of the team leader in shock patients

Answer 31

identify and control site of hemorrhage
ensure rapid IV access
activate MTP early to avoid lethal triad of coaguloapathy, hypothermia, and acidosis