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ATLS (2025) EXAM WITH DETAILED &
VERIFIED| COMPLETE SOLUTIONS |
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field triage scheme step 1: when to transport to level 1 trauma center? GCS - systolic BP - RR - - answerGCS <13 systolic BP < RR <10 or >29 [ <20 in infants <1 yr] (OR need for ventilatory support) when adults fall > feet or meters (2 stories) you should transport to trauma center
- answer>20 feet or 6 meters (2 stories) when children fall > feet or meters you should transport to trauma center - answer>10 feet or 3 meters (2-3x height of child) high risk mvc qualities - answer- intrusion, including roof: >12 inches (30cm) occupants side
- intrusion >18 inches (45cm) on any side
- ejection
- death in same passenger compartment
- vehicle telemetry data consistent with high risk of injury
- auto vs pedestrian/bicyclist thrown, run over or with significant (>20mph) impact
- motorcycle crash >20mph
When fluid warmers are not available, a microwave can be used to warm crystalloid fluids but it should never be used to warm blood products. When urethral injury is suspected, confirm urethral integrity by performing a before the catheter is inserted. - answerretrograde urethrogram How do you monitor the adequacy of a patient's respirations? - answerVentilatory rate, capnography, (end tidal carbon dioxide levels), ABG measurements. End tidal CO2 can be detected using? - answercolorimetry, capnometry, or capnography — a noninvasive monitoring technique that provides insight into the patient's ventilation, circulation, and metabolism. End tidal CO2 can also be used for tight control of ventilation to avoid hypoventilation and hyperventilation. It reflects and is used to predict - answercardiac output and is used to predict return of spontaneous circulation (ROSC) during CPR. ex) >30 = ROSC likely ex) <10 = bad CPR AMPLE - answerAllergies Medications Past illnesses/pregnancy Last meal Events/Environment of injury ** part of 2ndary survey
secondary survey - answerThe secondary survey is a head-to-toe evaluation of the trauma patient — that is, a complete history and physical examination, including reassessment of all vital signs Desirable urinary output for adults - answerFor adult patients, maintenance of urinary output at 0.5 mL/kg/h is desirable. Desirable urinary output for peds >1 yr - answerIn pediatric patients who are older than 1 year, an output of 1 mL/kg/h is typically adequate. Define a definitive airway - answerA definitive airway is defined as a tube placed in the trachea with the cuff inflated below the vocal cords, the tube connected to a form of oxygen-enriched assisted ventilation, and the airway secured in place with an appropriate stabilizing method. hypocarbia - answerhyperventilation
- insufficient CO hypercarbia - answerhypoventilation
- too much CO an agitated pt can suggest .... .. - answerhypoxia take away: abusive and belligerent pt may be hypoxic. do not assume intoxication! an obtunded pt can suggest - answerhypercarbia Cervical spinal cord injury can result in respiratory muscle paresis or paralysis. The more the injury, the more likely there will be respiratory impairment. - answerproximal
therefore more difficult to intubate. Mallampati Score - answerI - soft palate, fauces, uvula, tonsillar pillars II - soft palate, fauces and uvula III - soft palate and base of uvula IV - soft palate not visible. hard palate only visible. The first priority of airway management is - answerto ensure continued oxygenation while restricting cervical spinal motion.
- Clinicians accomplish this task initially by positioning (i.e., chin-lift or jaw-thrust maneuver) and by using preliminary airway techniques (i.e., nasopharyngeal airway). If an endotracheal tube cannot be inserted and the patient's respiratory status is in jeopardy, clinicians may attempt ventilation via - answera laryngeal mask airway or other extraglottic airway device as a bridge to a definitive airway.
- If this measure fails, they should perform a cricothyroidotomy. What is the preferred technique for Oropharyngeal airway insertion? - answerThe preferred technique is to insert the oral airway upside down, with its curved part directed upward, until it touches the soft palate. At that point, rotate the device 180 degrees, so the curve faces downward, and slip it into place over the tongue patients who tolerate an oropharyngeal airway are - answerlikely to need intubation is an LMA a definitive airway? - answerthe LMA does not provide a definitive airway, and proper placement of this device is difficult without appropriate training. What are the 3 types of definitive airway? - answer1. orotracheal tube, 2. nasotracheal tube
- surgical airway (cricothyroidotomy and tracheostomy).
If clinicians decide to perform orotracheal intubation, what technique is preferred? - answerthe three-person technique with restriction of cervical spinal motion is recommended what is the preferred route taken to protect the airway? - answerorotracheal intubation What can reduce thee risk of aspiration during intubation? - answercricoid pressure.
- this maneuver may also reduce the view of the larynx What can aid in visualizing the vocal cords during intubation? - answerBURP! Laryngeal manipulation by backward, upward, and rightward pressure (BURP) on the thyroid cartilage can aid in visualizing the vocal cords.
- when the addition of cricoid pressure compromises the view of the larynx, this maneuver should be discontinued or readjusted. Additional hands are required for administering drugs and performing the BURP maneuver. Problematic airway, what can you use to assist intubation? - answerEschmann tracheal tube introducer (aka gum elastic bougie ; GEB) When do clinicians use GEB? - answerwhen vocal cords cannot be visualized on direct laryngoscopy How do you confirm tracheal position with GEB placement? - answerby feeling clicks as the distal tip rubs along the cartilaginous tracheal rings. A GEB inserted into the esophagus will pass its full. length without resistance. After confirming position of GEB, pass a lubricated endotracheal tube over the bougie beyond the vocal cords. Proper placement of an endotracheal tube is suggested — but not confirmed — by - answer- hearing equal breath sounds bilaterally
and requires less time to perform than an emergency tracheostomy. Oxygenated inspired air is best provided via .... - answera tight-fitting oxygen reservoir face mask with a flow rate of at least 10 L/min. PaO2 level of 90 corresponds with what O2 saturation? - answer100% PaO2 level of 60 corresponds with what O2 saturation? - answer90% PaO2 level of 30 corresponds with what O2 saturation? - answer60% PaO2 level of 27 corresponds with what O2 saturation? - answer50% Tachycardia is diagnosed when the heart rate is greater than 160 BPM in an - answerinfant Tachycardia is diagnosed when the heart rate is greater than 140 BPM in - answera preschool-aged child Tachycardia is diagnosed when the heart rate is greater than 120 BPM in - answerchildren from school age to puberty Tachycardia is diagnosed when the heart rate is greater than 100 BPM in - answeradults Elderly patients may not exhibit tachycardia with shock because they - answerhave a limited cardiac response to catecholamine stimulation or they have concurrent use of medications, such as ß-adrenergic blocking agents. A narrowed pulse pressure suggests significant blood loss and involvement of compensatory
mechanisms. The release of increases peripheral vascular resistance, which in turn increases diastolic blood pressure and reduces pulse pressure. - answerendogenous catecholamines The classic presentation of neurogenic shock is - answerhypotension without tachycardia or cutaneous vasoconstriction. Although it can vary considerably, adult blood volume is approximately % of body weight
- answer7% ex) a 70kg male has a circulating blood volume of approximately 5L. Although it can vary considerably, child blood volume is approximately % of body weight - answer8-9% Name that class of hemorrhage!
- Person donated 1 unit of blood - answerClass I <15% approximate blood loss really no signs base deficit: 0 to - 2 mEq/L Base excess is the quantity of base (HCO3- in mEq/L) that is above or below the normal range in a body. A negative number is called a and indicates - answerbase deficit and indicates metabolic acidosis. Name that class of hemorrhage
- HR: tachycardic
- BP: normal or decreased
- Pulse pressure: decreased
- Urine output: normal
- GCS: normal
- Base deficit: 0 to - 2 mEq/L - answerClass I Name that class of hemorrhage
- HR: tachycardic
- BP: normal
- Pulse pressure: decreased
- RR: normal
- Urine output: normal
- GCS: normal
- Base deficit: - 2 to - 6 mEq/L - answerClass II MILD Name that class of hemorrhage
- HR: VERY tachycardic
- BP: decreased
- Pulse pressure: decreased
- RR: increased
- Urine output: decreased/none
- GCS: decreased
- Base deficit: - 10 mEq/L or less - answerClass IV SEVERE Name that class of hemorrhage
- EBL 15 - 30% - answerClass II
Name that class of hemorrhage
- EBL >40% - answerClass IV Name that class of hemorrhage
- EBL 30 - 40% - answerClass III Name that class of hemorrhage
- EBL <15% - answerClass I What are the two ways major soft tissue injuries and fractures compromise the hemodyanmic status of a patient? - answer1. Blood loss into the site itself
- Edema that occurs. Tissue edema is the result of shifts in fluid primarily from the plasma into the extravascular, or extracellular, space as a result of alterations in endothelial permeability. Such shifts produce an additional depletion in intravascular volume. Gastric Dilation in the trauma patient - answer- often occurs especially in children.
- can cause unexplained hypotension or cardiac dysrhythmia, usually bradycardia from excessive vagal stimulation.
- In unconscious patients, gastric distention increases the risk of aspiration of gastric contents, a potentially fatal complication.
- management: decompress the stomach by inserting a nasal or oral tube and attaching it to suction. Poiseuille's Law & catheters - answerthe rate of flow is proportional to the fourth power of the radius of the cannula and inversely related to its length. Hence, short large caliber peripheral IVs are preferred for the rapid infusion of fluid rather than
Blood products cannot be stored in a warmer but they can be heated by - answerpassage through an IV warmer Define MTP - answerdefined as > 10 units of pRBCs within the first 24 hours of admission or more than 4 units in 1 hour. Massive fluid resuscitation with the resultant dilution of platelets and clotting factors, as well as the adverse effect of hypothermia on platelet aggregation and the clotting cascade, contributes to in injured patients. - answercoagulopathy PT, PTT. and PLT count are valuable baseline studies to obtain within especially in those with history of coagulation disorders or those who take medications that alter coagulation - answerfirst hour Equating Blood pressure to Cardiac Output - answeris a big no-no. Ohm's law (V = I × R). (BP = CO x SVR/afterload) An increase in blood pressure should not be equated with a concomitant increase in cardiac output or recovery from shock. For example, an increase in peripheral resistance with vasopressor therapy, with no change in cardiac output, results in increased blood pressure but no improvement in tissue perfusion or oxygenation. Accurate way to measure core temperature - answeresophageal or bladder Lethal Triad - answer1. Metabolic acidosis
- Coagulopathy
- Hypothermia Blast injuries & thoracic cavity: - answercommonly produce severe injury at air-fluid interfaces
Incomplete expansion of the lung and continued large air leak after placement of a chest tube suggests. - answera tracheobronchial injury *** Placement of more than one chest tube may be necessary to overcome the significant air leak. Bronchoscopy confirms the diagnosis. Tension Pneumothorax - answer The most common cause of tension pneumothorax is - answermechanical positive- pressure ventilation in patients with visceral pleural injury. Successful needle decompression converts tension pneumothorax to - answera simple pneumothorax. Open Pneumothorax - answerLarge injuries to the chest wall that remain open can result in an open pneumothorax, also known as a sucking chest wound. sucking chest wound - answer How to treat open pneumothorax - answerFor initial management of an open pneumothorax, promptly close the defect with a sterile dressing large enough to overlap the wound's edges. Any occlusive dressing (e.g. plastic wrap or petrolatum gauze) may be used as temporary measure to enable rapid assessment to continue. Tape it securely on only three sides to provide a flutter-valve effect. Define Massive Hemothorax - answerrapid accumulation of more than 1500 mL of blood or one-third or more of the patient's blood volume in the chest cavity. Hemothorax: The immediate return of 1500 mL or more of blood generally indicates the need for
- Widened paraspinal interfaces
- Presence of a pleural or apical cap
- Left hemothorax
- Fractures of the first or second rib or scapula Traumatic diaphragmatic ruptures are more commonly diagnosed on the side. - answerleft side why? Perhaps because the liver obliterates the defect or protects it on the right side, whereas the appearance of displaced bowel, stomach, and/or nasogastric (NG) tube is more easily detected in the left chest. note: most commonly diagnosed. =/= occurs. How does blunt trauma lead to diaphragmatic rupture? - answerlarge radial tears lead to herniation how does penetrating trauma lead to diaphragmatic rupture? - answerthis produces small perforations that can remain asymptomatic for years If a laceration of the left diaphragm is suspected, a can be inserted. - answera gastric tube can be inserted
- If the gastric tube appears in the thoracic cavity on the chest film, the need for special contrast studies is eliminated. What ribs sustain most of the effects of blunt trauma? - answermiddle ribs 4 - 9
Fractures to lower ribs (10-12) should raise suspicion for injury - answerhepatosplenic What is in the retroperitoneal space - answer- abdominal aorta
- inferior vena cava
- most of the duodenum
- pancreas
- kidneys and ureters
- the posterior aspects of the ascending colon and descending colon
- the retroperitoneal components of the pelvic cavity. Injuries to the retroperitoneal visceral structures are difficult to recognize because they occur deep within the abdomen and may not initially present with signs or symptoms of peritonitis. In patients who sustain blunt trauma, the organs most frequently injured are .... - answerthe spleen (40% to 55%) the liver (35% to 45%) the small bowel (5% to 10%). Stab wounds and low-energy gunshot wounds cause tissue damage by. - answerlacerating and tearing. High-energy gunshot wounds transfer more kinetic energy, causing increased damage surrounding the track of the missile due to ... - answertemporary cavitation. In the case of shotguns, what determines the severity of injuries incurred? - answerthe distance between the shotgun and the patient determines the severity of injuries incurred.
