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Advanced Trauma Life Support Keys Q&A 2024.
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Advanced Trauma Life Support Keys Q&A2024
Patients with GSC of less than _____ usually require intubation - ANS-8
The "A" in ABCD stands for ______. - ANS-Airway maintenance with Cervical SPINE
protection
You should assume that any patient in a multisystem trauma with an altered level of
consciousness or blunt injury above the clavice has what type of injury - ANS-Cervical
Spine Injury
Flail chest is invariably accompanied by _______ which can interfere with blood
oxygenation - ANS-pulmonary contusion - do NOT over fluid resuscitate these patients.
Hypotension is caused by ______ until proven otherwise. - ANS-hypovolemia
When you dont have a BP what are three things to look for when evaluating perfusion? -
ANS-1. level of consciousness (brain perfusion
2. Skin color (ashen face/grey extremities)
3. Pulse (bilateral femoral - thready/tachy)
Elderly patients have a limited ability to ___________ to compensate for blood loss -
ANS-increase heart rate
Resuscitation fluids should be warmed to 39 Celsius - ANS-Only for Cyrstalloids, NOT
for blood
Urinary catheters are good for assessing renal perfusion and volume status. List 5 signs
of urethral injury that might precent you from inserting one - ANS-Blood at urethral
meatus, perineal ecchymosis, blood in scrotum, high-riding/non-palpable prostate,
pelvic fracture
Which arm should you NOT put a pulse-ox on? - ANS-The arm with the BP cuff
2 anatomical things that can interfere - ANS-Obesity and intraluminal bowel gas
,When should radiographs be obtained? - ANS-During the Secondary survey!
How do get an ample patient history? - ANS-Allergies
Medications
PMH/Pregnancy
Last meal
Events/Environment
Why might you want a Bair Hugger for a patient who smells of Alcohol? -
ANS-Vasodilation can lead to hypothermia
What things are you looking for when you do a DRE in trauma - ANS-Blood, high riding
prostate, sphincter tone,
What should be done for every female patient - ANS-Pregnancy test
Adult patients should maintain UOP of at least _____mL/kg/hr. Kids should have at least
______ mL/kg/hr - ANS-Adults 0.5 mL/kg.hr
Kids 1.0 mL/kg/hr
Preventing hypercarbia (hypercapnia) is critical in patients who have sustained a
_______ injury - ANS-head
What two places would you LOOK at a patient if you suspect hypoxemia? - ANS-Lips
and fingernail beds
Patients may be abusive and belligerent because of ______-, so don't just assume its
due to drugs, alcohol, or the fact they they are just inherently a jerk - ANS-hypoxia
Can a patient breath on their own after complete cervical cord transection - ANS-Yes if
the phrenic nerves (C3-C5 are spared. This will result in 'abdominal' breathing. The
intercostal muscles will be paralyzed though
Can you use an OPA (Guedel) in a conscious patient - ANS-No, it could make them
vomit. An NPA (trumpet) would be okay.
Bougies are typically inserted blindly, how do you know you are in the trachea and not
the esophagus? - ANS-You can feel the clicks as the distal tip rubs against the
cartilaginous tracheal rings, or it will deviate right or left when entering either bronchus
, (at 50 cm)
What do yo NOT want to hear if you auscultate a patient after placement of an ET tube?
- ANS-Borborygmi - rumbling or gurgling noices suggest esophageal insertion.
What is the RSI dose for etomidate - ANS-0.3 mg/kg (usually 20 mg) What
is the RSI dose for succinylcholine - ANS-1-2 mg/kg (usually 100 mg)
How does etomidate affect blood pressure - ANS-it doesnt -it shouldnt have any
effect on BP. Ketamine will increase BP, and propofol and thiopental will both drop BP.
A RSI dose of succinylcholine usually lasts about ___ minutes - ANS-5
What hypnotic/sedative/induction agent do you NOT want to use for a severely burned
patient? - ANS-Sux - patients with severe burns, crush injuries, hyperkalemia, or chronic
paralytic/neuromuscular disease should NOT get Sux because of hyperkalemia risk
O2 should flow at 15L for needle cricothyroidotomy, and have a Y connector for
insufflation if possible. What size needle do you use for adults? Kids? - ANS-Adults:
12-14 gauge
kids: 16-18 gauge
Cricoid cartilage is the only circumferential support for the upper trachea in kids,
therefore surgical cricothyroidotomy is not recommeded for kids under the age of
________. - ANS-12
In a 'normal' patient without significant chest wall injury or lung disease, needle
cricothyroidotomy can provide adequate oxygenation for approximately ______ minutes
- ANS-30-45
For a patient with difficulty breathing, what things might you try before you provide a
surgical aurway - ANS-Chin Lift, jaw-thrust (NOT head-tilt while maintaining c-spine
precautions), OPA (guedel), NPA (trumpet), LMA, Combitube, ET tube +- bougie
How do you know if an OPA/Guedel is the correct size for the patient? - ANS-A correctly
sized OPA will extend from the corner of the patients mouth to the external auditory
canal.
What should you do with the balloon on an ET tube/LMA/foley before you insert it? -
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