ATLS for ME
What is the quickest cause of death in trauma - ANS Hypoxemia
What is the purpose of giving fluids/blood in trauma - ANS To maintain adequate end organ
perfusion
What does L-E-M-O-N stand for - ANS Look for signs of diff intubation
Evaluate the 3-3-2 rule
Mallampati classification
Obstruction of the Airway
Neck mobility is always compromised
What s/s mandate laparotomy - ANS gross blood > 10ml, GI content, Vegetable fibers or bile
Who do you check pelvic stability, how many times, and who do you not check - ANS you check
a stable pt, 1 time. You do not do a pelvic stability check on an unstable pt.
Why are the primary and secondary surveys repeated - ANS They are repeated frequently to
identify any change in the patient's status that indicates the need for additional intervention.
What are the vital signs and LOC that alert you to transfer the pt to a trauma center - ANS GCS
<13
SYS BP <90 mmHg
RR< 10 or >29 bpm (<20 in infant<1 year) or need for vent support
What anatomical injuries alert transfer to the trauma center - ANS -All penetrating injuries to
head, neck, torso, ext proximal to the elbow and the knee.
-Chest wall instability or deformity
-Two or more proximal long-bone fractures
-Crushed, devolved, mangled or pulseless ext.
- amputation proximal to wrist or ankle
-pelvic fracture
-open or depressed skull fracture
-paralysis
What MOIs send the pt directly to the trauma center - ANS Evidence of high-energy impact
-Falls= adults>20ft/6m/2 stories, child >10ft/3m/2-3x ht
-High risk MVC (intrusion incl roof >12in/30cm occupant side, >18/45cm in any side, ejection
from vehicle, death in same passenger compartment, vehicle tele data consistent w/ high ROI
-Auto vs pedestrian thrown/run over or >20mph impact
-Motorcycle crash >20mph
,What special its or system considerations send the pt to the trauma center - ANS Older adults
(>55, BP<110 after 65yo, low impact mech
Children= peds capable trauma center
anticoag
burns
Pregnancy >20wks
EMS provider judgement
Who gets oxygen - ANS everybody= all trauma pts
What are three things you can evaluate in seconds regarding blood volume and CO - ANS LOC
Skin perfusion- red/pink or gray and pale
Pulse- strong or rapid/thready pulse/absent
What are the major areas of Internal hemorrhage - ANS chest, abdomen, retroperitoneum,
pelvis, long bones
T or F: Aggressive and continued volume resuscitation is not a substitute for definitive control of
hemorrhage. - ANS True
Crystalloids administered >1.5 L increase what - ANS the odds ratio of death
When and how should TPA be administered - ANS within 3 hrs of injury as a bolus 1 gm, and
then over an 8 hour period
Primary brain injury results from what; what can prevent a secondary brain injury - ANS
structural effect of the injury to the brain; by maintaining adequate oxygenation and perfusion
are the main goals of initial management.
What assessable measures reflect the adequacy of resuscitation - ANS pulse rate, BP, pulse
pressure, vent rate, ABG, temp, and UO
PEA can indicate what cardiac issues - ANS cardiac tamponade, tension pneumo, and
profound hypovolemia
In the trauma setting, what do low pH and base excess levels indicate - ANS shock
What two things are c/I for foley - ANS blood at the urethral meatus
perineal ecchymosis
When does the secondary survey begin - ANS After the primary survey is complete,
resuscitative efforts are underway, and improvement of the pt's vital fx has been demonstrated
, What mnemonic do you use when the pt is not able to give you their history? - ANS A- Allergies
M-Medications currently used
P-Past illness/pregnancy
L-Last oral intake
E- Events/Environmental related to the injury
When must pts be presumed to have a cervical spine injury and cervical spine motion be
restricted - ANS Pt w/ maxillofacial or head trauma should be presumed to have a cervical
spine injury
Most major cervical vascular injuries are a result of... - ANS penetrating injury
The decision to transport required what - ANS a detailed assessment of the pts injuries and
knowledge of the capabilities of the institution, including equipment, resources, and personnel
To perform effectively, each trauma team should have one member serving as what? what do
they do? - ANS As team leader who supervises, checks and directs assessment; ideally not
directly involved in the assessment itself.
What is a hands off handover - ANS when team members begin working on the pt prior to
handoff to tx obvious life threatening conditions
What is the acronym used for hand off pre-hospital to hospital - ANS Mechanism (and time) of
injury
Injuries found and suspected
Symptoms and Signs
Treatment initiated
Name some early preventable deaths from airway prob - ANS -failure to assess the airway
adequately/or recog need for intervention
-inability to est airway/fail to recog incorrectly placed
-displacement of previous est airway/fail to recog need for vent.
What tiad of clinical signs can present due to laryngeal fractures - ANS 1. hoarseness
2. subq emphysema
3. palpable fracture
Which patients have limited physiological reserve and must be managed w/ extreme care -
ANS obese, peds, elderly, and pts w/ sustained facial trauma
What steps can assist clinicians in identifying objective signs of airway obstruction - ANS 1)
observe for agitation(hypoxia) or obtund (hyper cap). Cyanosis indicates hypoxemia which is a
late sign. Look for retractions and the use of accessory muscles of ventilation. Pulse ox used
early.