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ATLS EXAM WITH DETAILED VERIFIED ANSWERS (100% CORRECT ANSWERS)
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"In the elderly population, what is decreased physiological reserve? - CORRECT ANSWER
aging is characterized by impaired adaptive and homeostatic mechanisms that caused an increased susceptibility to the stress of injury. Insults tolerated by the younger population can lead to devastating results in elderly patients."
"In the elderly population, what are risk factors for falls? - CORRECT ANSWER advanced age,
physical impairment, history of previous fall, medication use, dementia, unsteady gait, and visual, cognitive impairment" "True or False? Mortality associated with small to moderate sized burns in older adults remains
high - CORRECT ANSWER True"
"Spilled hot liquids on the leg, which in younger patients may re-epithelialize due to an adequate
number of hair follicles, will result in a full thickness burn in older patients. - CORRECT
ANSWER this is true"
"Airway-patients may have dentures that may loosen or obstruct the airway. If dentures are not
obstructing the airway, leave them in place for what? - CORRECT ANSWER bag mask
ventilation, as it improves mask fitting." "Functional changes in pulmonary system include decreased elastic recoil, reduced residual
capacity, decreased gas exchange and decreased cough reflex - CORRECT ANSWER thus they
are at increased risk for respiratory failure, increased risk for pneumonia, and poor tolerance to rib fractures" "Functional changes in renal system include loss of renal mass, decreased GFR, and decreased
sensitivity to ADH and aldosterone - CORRECT ANSWER resulting in drug dosing for renal
insufficiency, decreased ability to concentrate urine, increased risk for AKI and urine flow may be normal with hypovolemia"
"True or false: Arthritis can complicate the airway and cervical spine. Patients can have multilevel degenerative changes affecting disk spaces and posterior elements associated with severe
central canal stenosis, cord compression, and myelomalacia - CORRECT ANSWER true"
"In elderly population, due to their changes in pulmonary system, placing a gauze between gums and cheek to achieve seal when using bag valve mask ventilation is okay. In addition, because
aging causes a suppressed heart rate response to hypoxia...... - CORRECT ANSWER respiratory
failure may present insidiously in older adults."
"what 2 factors place elderly patients at risk for intracranial hemorrhage? - CORRECT ANSWER
aging causes dura to become more adherent to the skull increasing risk of injury and older patients are on anticoagulant and antiplatelet medications." "Loss of subcutaneous fat, nutritional deficiencies, chronic medical conditions place elderly
patients as risk for hypothermia and complications for immobility. - CORRECT ANSWER Rapid
evaluation and when possible early liberation from spine boards and cervical collars will minimize complications." "True or False: Fall prevention is the mainstay of reducing the mortality associated with pelvic
fractures. - CORRECT ANSWER true"
"Common mechanisms of injury include falls, MVC, burns, and penetrating injuries - CORRECT
ANSWER common injuries in the elderly include rib fractures, TBI, pelvic fractures"
"The best initial treatment for the fetus is to provide optimal resuscitation of the mother. True or
False? - CORRECT ANSWER True. Also if xray examination is indicated during the pregnant
patient's treatment, it should not be withheld because of the pregnancy." "An abrupt decrease in maternal intravascular volume can result in a profound increase in uterine
vascular resistance reducing fetal oxygenation despite reasonably normal maternal vital signs. -
CORRECT ANSWER this is true"
"Physiological anemia of pregnancy - CORRECT ANSWER A smaller increase in red blood cell
volume can occur resulting in a decreased hematocrit level. Thus, in late pregnancy a hematocrit of 31-33% is normal."
"Using a shoulder restraints in conjunction with a lap belt reduces the likelihood of direct and indirect fetal injury, presumably because the shoulder belt dissipates deceleration forces over a
great surface area and helps prevent the mother from flexing forward over the gravid uterus. -
CORRECT ANSWER the deployment of air bags in vehicles does not appear to increase
pregnancy specific risks. Using lap belt alone allows for forward flexion and uterine compression with possible uterine rupture or placental abruption. Lap belt worn too high over uterus may produce uterine rupture."
"Failure to displace the uterus to the left side in a hypotensive pregnant patient - CORRECT
ANSWER logroll all patients appearing clinically pregnant (second and third trimester) to the left
15-30 degrees and elevate the right side 4-6 inches and support with a bolstering device to maintain spinal motion restriction and decompression of the vena cava." "Due to increases intravascular volume, pregnant patients can lose a significant amount of blood before tachycardia, hypotension, and other signs of hypovolemia occur. Thus, what do stable vital
signs in a pregnant patient indicate about the fetus? - CORRECT ANSWER The fetus may be in
distress and the placenta deprived of vital perfusion while the mother's condition and vital signs appear stable. Administer crystalloid fluid resuscitation and blood to support the physiological hypervolemia of pregnancy. vasopressers should be an absolute last resort in restoring maternal blood pressure as they further reduce uterine blood flow, resulting in fetal hypoxia." "Perform continuous fetal monitoring with a tocodynamometer beyond 20-24 weeks of
gestation. - CORRECT ANSWER Patients with no risk factors for fetal loss should have
continuous monitoring for 6 hours, whereas, patients with risk factors for fetal loss or placental abruption should be monitored for 24 hours. RISK FACTORS ARE: heart rate > 110, an injury severity score >9, evidence of placental abruption, fetal heart rate >160 or less than 120, ejection during MV, and motorcycle or pedestrian collisions" "REMEMBER: maternal bicarbonate is low during pregnancy to compensate for respiratory
alkalosis. - CORRECT ANSWER 17-22 in pregnant patient. (non pregnant patient is 22-28)"
"Fetal heart rate is a sensitive indicator of maternal blood volume status and fetal well being. -
CORRECT ANSWER normal range for fetus is 120-160. abnormal heart rate, repetitive
decelerations, absence of accelerations or beat to beat variability and frequent uterine activity can be signs of impending maternal and or fetal decompensation (hypoxia or acidosis) and should prompt immediate obstetrical consultation."
"If a DPL is to be placed in a pregnant trauma patient, place the catheter above the umbilicus using the open technique. Be alert to uterine contractions which suggest early labor and tetanic
contractions which suggest placental abruption. - CORRECT ANSWER evidence of ruptured
chorioamniotic membranes include amniotic fluid in vagina evidenced by a pH of 4.5" "Bleeding in 3rd trimester may indicate placental abruption and impending death of the fetus, a
vaginal exam is vital - CORRECT ANSWER however, avoid repeating vaginal examination, CT
abdominal imaging can be done and radiation doses less than 50mGy are not associated with fetal anomalies or higher risk of fetal loss."
"Admission to hospital for pregnant patients: - CORRECT ANSWER vaginal bleeding, uterine
irritability, abdominal tenderness, pain or cramping, evidence of hypovolemia, changes in or absence of fetal heart tones and or leakage of amniotic fluid" "With extensive placental separation or amniotic fluid embolization, widespread consumptive coagulopathy can emerge rapidly causing depletion of fibrinogen, other clotting factors, and
platelets. - CORRECT ANSWER immediately perform uterine evacuation and replace platelets,
fibrinogen, and other clotting factors."
"As little as 0.01mL of RH+ blood will sensitize 70% of Rh- women. - CORRECT ANSWER All
pregnany RH negative trauma patients should receive RH immunoglobulin therapy unless injury is remote from the uterus (isolated distal extremity injury)"
"Factors that increase the risk of upper airway obstruction are: - CORRECT ANSWER increasing
burn size and depth, burns to the head and face, inhalation injury, associated trauma, and burns inside the mouth. Airway can become obstructed form direct injury such as inhalation injury, but also from massive edema resulting from burn injury."
"Indications for early intubation in burn patients: - CORRECT ANSWER full thickness
circumferential neck burns, signs of airway obstruction, extent of the burn > 40%, burns inside the mouth, difficulty clearing secretions or swallowing, decreased level of consciousness," "Patient with inhalation injury are at risk for bronchial obstruction from secretions and debris and
they may require bronchoscopy. - CORRECT ANSWER Make sure to place an adequately sized
airway tube"
lines with cross incision at the clavicular line and the junction of the thorax and abdomen usually relieve this problem. relieve circulatory compromise in a circumferentially burned limb by eschartomy and these escharotimies are not needed within the first 6 hours."
"Partial thickness burns are painful when air currents pass over the burned surface. - CORRECT
ANSWER gently cover the burn with clean sheets will decrease the pain and deflect air currents.
Do not break blisters or apply an antiseptic and application of cold compress can cause hypothermia. DO not apply cold water to a burn patient." "electrical burns are more serious than they appear on the body surface and extremities,
particularly the digits. - CORRECT ANSWER current can travel inside blood vessels and nerves
and can cause local thrombosis and nerve injury. So a severe electrical injury usually results in contracture of the affected extremity." "A clenched hand with a small electrical entrance wound should alert the clinician that a deep soft
tissue injury is likely much more extensive than is visable to the naked eye - CORRECT
ANSWER true. patients with severe electrical injuries require fasciotomies. Electricity can cause
forced contraction of muscles, doctors need to examine patient for skeletal and muscular damage, especially for fractures of the spine and rhabdomyolysis"
"How do you dissolve a tar burn? - CORRECT ANSWER Use mineral oil"
"Abuse and burns - CORRECT ANSWER circular burns and burns with clear edges and unique
patterns may reflect cigarette burns or iron. Burns on the sole of the feet usually suggest child was placed in hot water. A burn on the posterior aspect of the LE and buttocks"
"Patient with electrical burn can develop for acute renal failure - CORRECT ANSWER
remember these burns can cause serious muscle damage without showing signs outright. Test urine for hemochromogen and administer proper volume. Assess for compartment syndrome and attach EKG leads as electrical injury can cause arrhythmias." "Frostbite is due to freezing of tissue with intracellular ice crystal formation, microvascular
occlusion, and subsequent tissue anoxia. - CORRECT ANSWER first degree: hyperemia and
edema are present w/o skin necrosis second degree: large clear vesicles accompany the hyperemia and edema with partial thickness skin necrosis. third degree frostbite: full thickness skin necrosis including muscle and bone with later necrosis
treatment is circulating water at constant 40 degrees C or 104F until pink color and perfusion return in 20-30 minutes." "In frostbite injury, warming large areas can result in reperfusion syndrome, with acidosis, hyperK
and local swelling. - CORRECT ANSWER therefore monitor the patient's cardiac status and
peripheral perfusion during rewarming." "Sympathetic blockade agents and vasodilating agents have shown to be effective in altering the
progression of acute cold injury - CORRECT ANSWER false"
"hypothermia is a core temp below 36C or 96.8F - CORRECT ANSWER hypothermia can
worsen coagulopathy and affect organ function."
"Rhabdomyolysis can lead to metabolic acidosis, hyperK, hypoC, and DIC. - CORRECT ANSWER
Myoglobin induced renal failure can be prevented with intravascular fluid expansion, alkalinization of the urine by IV administration of Bicarbonate and osmotic diuresis."
"For MSK trauma, loss of sensation in a stocking or glove distribution is an early sign of.... -
CORRECT ANSWER early sign of vascular impairment"
"Knee dislocations can reduce spontaneously and may not present with any gross external or
radiographic anomalies until a physical exam of is joint is perfromed. - CORRECT ANSWER an
ankle brachial index of less than 0.9 indicates abnormal arterial flow secondary to injury or peripheral vascular disease" "Blanched skin associated with fractures and dislocations can lead to soft tissue necrosis. The purpose of promptly reducing this injury is to prevent pressure necrosis of the lateral left ankle
soft tissue - CORRECT ANSWER the only reason to forgo an xray exam before treating a
dislocation or fracture is the presence of vascular compromise or impending skin breakdown, often seen with fracture dislocations of the ankle"
"Treat all patients with open fractures as soon as possible with iv antibiotics - CORRECT
ANSWER cephalosporins are necessary for all open fractures"
"operative revascularization to an avascular extremity is important to treat emergently. -
CORRECT ANSWER muscle necrosis begins where there is a lack of blood flow for 6 hours. is
there is an associated fracture deformity, correct it by gently pulling the limb out to length,
"Laryngeal Trauma presents as hoarseness, subcutaneous emphysema, and palpable fracture -
CORRECT ANSWER true. sounds of airway obstruction and include snoring, gurgling, stridor,
hoarseness, cyanosis, agitation"
"LEMON assessment for difficult airway - CORRECT ANSWER Look, evaluate 3-3-2 rule,
mallampati, obstruction, neck mobility" "Do not give a nasopharyngeal airway to someone suspected of having a cribriform plate fracture.
- CORRECT ANSWER also do not give nasotracheal intubation to patients with basillar skull
fracture" "A tube placed in the trachea with the cuff inflated below the vocal cords and the tube connected
to oxygen enriched assisted ventilation and airway secured in place. - CORRECT ANSWER
definitive airway" "patients use the gum elastic bougie when vocal cords cannot be visualized on direct
laryngoscopy. - CORRECT ANSWER using the GEB has allowed for rapid intubation of nearly
80% of prehospital patients in whom laryngoscopy was difficult. A GEB inserted into the esophagus will pass its full length without resistance"
"Reliable ways to detect proper intubation - CORRECT ANSWER proper placement of the tube
is suggested but not confirmed:
- hearing equal breath sounds bilaterally
- detecting no borborygmi (rumbling or gurgling noises) in the epigastrium. the presence of this with inspiration suggestion esophageal intubation and warrants removal of tube
- A CO2 detector ideally capnograph or colorimetric CO2 monitoring device. If CO2 is not detected in exhaled air, then esophageal intubation has occurred.
- Proper position of the tube is best confirmed via chest xray" "definitive control of hemorrhage and restoration of adequate circulating volume are the goals of
treating hemorrhagic shock. - CORRECT ANSWER never give vasopressors as the first line
treatment as they worsen tissue perfusion. most injured patients who are in hemorrhagic shock require early surgical intervention or angioembolization to reverse the shock state. The presence of shock in a trauma patient warrants the immediate involvement of a surgeon." "An injured patient who is cool to the touch and is tachycardic should be considered to be in shock until proven otherwise. Massive blood loss may only produce a slight decrease in HCT/Hgb.
- CORRECT ANSWER relying solely on BP as an indicator of shock can delay recognition of the
condition b/c compensatory mechanisms can prevent measurable fall in systolic pressure until up
to 30% of the patient's blood volume is loss. A narrowed pulse pressure suggests significant blood loss and involvement in compensatory mechanisms. tachycardia is diagnosed as > 100 in adults
160 in infants 140 in preschool aged children 120 in children from school age to puberty." "Tachycardia, muffled heart sounds, dilated engorged neck veins, hypotension and insufficient
response to fluid therapy is what? - CORRECT ANSWER cardiac tamponade, which is
commonly caused by penetrating thoracic trauma, but can result from blunt injury to the thorax. Definitive treatment is operative intervention as pericardiocentesis is temporary measure. Tension pneumothorax differs because it presents with distended neck veins and hypotension as well as absent breath sounds and hyperresonant percussion" "Acute respiratory distress, subcutaneous emphysema, absent unilateral breath sounds,
hyperresonance to percussion, and tracheal shift supports the diagnosis of???? - CORRECT
ANSWER tension pneumothorax. needle or finger decompression temporarily relieves this life
threatening condition and follow this with a chest tube" "isolated intracranial injuries do not cause shock, unless the brainstem is injured. A narrowed
pulse pressure is not seen in neurogenic shock. - CORRECT ANSWER The classic presentation
of neurogenic shock is hypotension (due to loss of sympathetic tone) without tachycardia. A narrowed pulse pressure is not seen in neurogenic shock. The failure of fluid resuscitation to restore organ perfusion and tissue oxygenation suggest either continuing hemorrhage or neurogenic shock"
"Less than 15% blood loss. no change in HR, BP, pulse pressure, RR, urine output. - CORRECT
ANSWER this is class 1 hemorrhage and requires monitoring with base deficit of 0- -2"
"15-30% blood loss. increase in heart rate. decrease in pulse pressure. BP, RR, urine output do not
change - CORRECT ANSWER class II hemorrhagic shock. possible need for blood products, but
mostly crystalloid fluid and base deficit of -2 to -6. anxiety, fear" "31-40% blood loss. heart rate increase, respiratory rate increase, blood pressure decrease, pulse
pressure decrease, urine output and GCS decrease - CORRECT ANSWER class III and this is the
least amount of blood loss that consistently causes a drop in systolic blood pressure. blood products needed and base deficit is -6 to -10"
"what are these signs and symptoms describing? chest pain, air hunger, tachypnea, respiratory distress, tachycardia, hypotension, tracheal deviation away from side of injury, unilateral absence of breath sounds, neck vein distention, cyanosis (late manifestation), hyperresonance on
percussion - CORRECT ANSWER tension pneumothorax. initially, you can do a needle
decompression or finger thoracostomy. place tube in afterwards" "pain, difficulty breathing, tachypnea, decreased breath sounds on affected side, and noisy
movement of air through chest wall injury - CORRECT ANSWER these are signs and symptoms
of an open pneumothorax. sterile occlusive dressing large enough to overlap the wound's edges and tap it securely on 3 sides"
"Causes of Pulseless Electrical Activity - CORRECT ANSWER hypovolemia, hypokalemia,
hyperkalemia, hypoglycemia, hypothermia, toxins, cardiac tamponade, tension pneumothorax, thrombosis" "Massive hemothorax is suggested when a patient is in shock and has decreased breath sounds or
dullness to percussion on one side of the chest with collapsed neck veins - CORRECT ANSWER
chest tube at the fifth intercostal space at the midaxillary line and you get a return of 1500mL or 1/3 or more of the patient's blood in the chest, that indicated the need for urgent thoracotomy. persistent need for blood is an indication for a thoracotomy. color of the blood is a poor indicator of the necessity for thoracotomy." "muffled heart sounds, hypotension, and distended necks veins may not always be present in cardiac tamponade. Kussmaul's sign (rise in venous pressure with inspiration when breathing spontaneously) is a true paradoxical venous pressure abnormality that is associated with
tamponade - CORRECT ANSWER The presence of hyperresonance on percussion indicated
tension pneumothorax whereas presence of bilateral breath sounds is cardiac tamponade. FAST can identify cardiac tamponade. if FAST is unavailable, use echo or pericardial window. definitive treatment is surgery so thoracotomy or sternotomy."
"potentially life threatening injuries that should be identified on secondary survey - CORRECT
ANSWER simple pneumothorax, hemothorax, flail chest, pulmonary contusion, blunt cardiac
injury, traumatic aortic disruption, traumatic diaphragmatic injury, esophageal rupture" "pulmonary contusion can occur with rib fractures and flail chest (two or more adjacent ribs
fractured in two or more places). - CORRECT ANSWER initial treatment includes humidified
oxygen, adequate ventilation, and cautious fluid resuscitation. definitive treatment includes pain control, adequate oxygenation"
"Blunt cardiac injury can present with hypotension, dysrhythmias, EKG changes, premature ventricular contractions, unexplained sinus tachycardia, AFib, bundle branch block, elevated central venous pressure without any obvious cause may indicate right ventricular dysfunction
secondary to contusion. - CORRECT ANSWER cardiac troponins can be diagnostic in an MI but
have little role in diagnosing blunt cardiac injury. patients with a blunt injury to the heart diagnosed by conduction abnormalities are at increased risk for sudden dysrhythmias and need to be monitored for 24 hours." "Traumatic aortic disruption- most survive if they have an incomplete laceration near the ligmentum arteriosum. commonly caused by vehicle collision or fall from a great height. have a
high index of suspicion if history has decelerating force. - CORRECT ANSWER Look for widened
mediastinum on chest xray, obliteration of the aortic knob, deviation of the trachea to the right, depression of the L mainstem bronchus, elevation of R mainstem bronchus, deviation of the esophagus to the right, left hemothorax, presence of the pleural or apical cap, fractures of the first or second rib or scapula, widened paraspinal interface, widened paratracheal stripe." "In a traumatic aortic rupture, heart rate and blood pressure control can decrease the likelihood
of rupture. - CORRECT ANSWER definitive treatment is surgery."
"Diaphragmatic injury-displaced bowel, stomach, and nasogastric tube on left side. - CORRECT
ANSWER The appearance of peritoneal lavage fluid in the chest tube also confirms diagnosis"
"esophageal injury- clinical picture is a patient with a left pneumothorax or hemothorax without a rib fracture who has received a severe blow to the lower sternum or epigastrum and is in pain or
shock out of proportion to the apparent injury - CORRECT ANSWER presence of mediastinal
air also suggests diagnosis and definitive treatment is direct repair of the injury." "injuries to the retroperitoneal structures are difficult to recognize because they occur deep
within the abdomen and may not initially present with signs or symptoms of peritonitis. -
CORRECT ANSWER the retroperitoneal space is NOT sampled by DPL or FAST"
"physical exam findings suggestive of a pelvic fracture include: - CORRECT ANSWER ruptured
urethra, scrotal hematoma or blood at the urethral meatus, discrepancy in limb length and rotational deformity of a leg w/o obvious fracture. use pelvic binder that is centered at the greater trochanters rather than over the iliac crests."
"signs of urethral injury include: - CORRECT ANSWER blood at the uretheral meatus,
ecchymosis or hematoma of the scrotum and perineum. Palpation of the prostate gland is NOT a reliable sign of urethral injury.
"Duodenal injuries- a bloody gastric aspirate or retroperitoneal air on abdominal CT or radiograph
should raise suspicion - CORRECT ANSWER classically seen in unrestrained drives involved in
frontal-impact MVC and patients who sustain direct blows to the abdomen from bicycle handlebars." "Any early normal serum amylase level or an elevated amylase level does not conclude pancreas
injury - CORRECT ANSWER "
"uncal herination - CORRECT ANSWER ipsilateral pupillary dilation associated w/contralateral
hemiparesis and loss of pupillary response to light"
"ICP - CORRECT ANSWER normal is 10. > 22 has poor outcomes. increased ICP decreases
cerebral perfusion pressure. monroe kellie doctrine states that total volume of intracranial contents must remain constant because cranium is a rigid container incapable of expanding."
"CPP= MAP -ICP - CORRECT ANSWER a MAP of 50-150 is autoregulated to maintain a constant
cerebral blood flow. GCS of 8 or less= severe brain injury GCS of 9-12= moderate GCS of 13-15= mild"
"Indications for CT scanning - CORRECT ANSWER GCS < 15 at 2 hours after injury
suspected open or depressed skull fracture any sign of basilar skull fracture emesis more than 2 episodes age > 65 anticoagulant use LOC > 5 minutes amnesia before impact"
"Goals of treatment of brain injury - CORRECT ANSWER systolic BP > 100
temp 36- Glucose 80- Hgb > 7 PaCO2 35- ICP 5- pulse ox > 95 NA 135-145"
"TBI treatment - CORRECT ANSWER IV fluids & hypertonic saline (do not give hypotonic fluids
or glucose containing fluids because this can harm the injured brain) Avoid hyponatremia reversal of anticoagulants Hyperventilation to keep PaCO2 at 35-temporizing measure Mannitol-do not give to patients with hypotension"
"reversal agents: - CORRECT ANSWER aspirin/plavix: platelets
warfarin: FFP, vitamin K, Prothrombin Complex Heparin or LMWH: Protamine Sulfate Direct thrombin inhibitors: Idarucizumab Rivaroxaban: N/A"
"Neurogenic shock - CORRECT ANSWER loss of vasomotor tone and sympathetic innervation
to the heart. Injury T6 and above can cause impairment of the sympathetic pathways. We get hypotension and bradycardia. Neurogenic shock is not reversed with fluid resuscitation alone. Vasopressors may be required. spinal shock refers to the loss of muscle tone (flaccid) and reflexes immediately after injury"
"Central cord syndrome - CORRECT ANSWER loss of function in upper extremities > lower
extremities occurring after a hyperextension injury, forward fall resulting in facial impact."
"Anterior Cord Syndrome - CORRECT ANSWER injury to the motor and sensory pathways in
the anterior part of cord. paraplegia and bilateral loss of pain and temp. However, position, vibration, and deep pressure sense are preserved (sensations from dorsal columns). commonly due to cord ischemia"
"Brown-Sequard Syndrome - CORRECT ANSWER results from hemisection of the spinal cord.
Ipsilateral motor loss and loss of position sense and contralateral loss of pain and temp"
"Pre-existing conditions that affect morbidity and mortality include: - CORRECT ANSWER
cirrhosis, coagulopathy, COPD, ischemic heart disease, DM"
"What is the most common mechanism of injury in the elderly? - CORRECT ANSWER Fall.
Nonfatal falls are common in women and fractures are common in women who fall. Falls are the most common cause of TBI." "Most of elderly traffic fatalities occur in the daytime and on weekends and typically involve other
vehicles. Why? - CORRECT ANSWER Older people drive on more familiar roads and at lower
speeds and tend to drive during the day. Older people have slower reaction time, a larger blind spot, limited cervical mobility, decreased hearing, and cognitive impairment." "When preforming rapid sequence intubation, the dose of benzos, barbiturates, and other sedatives should be reduced to what percentage to minimize the risk of cardiovascular
depression? - CORRECT ANSWER 20-40%"
"Functional changes in cardiac system include declining function, decreased sensitivity to catecholamines, atherosclerosis of coronary vessels, increased afterload, fixed heart rate (beta
blockers) - CORRECT ANSWER this results in lack of classic response to hypovolemia, risk for
cardiac ischemia, elevated BP at baseline, and increased risk of dysrythmias." "Functional changes to MSK include loss of lean body mass, osteoporosis, changes in joints and
cartilage, c spine degenerative changes and loss of skin elastin and subcutaneous fat - CORRECT
ANSWER resulting in increased risk for fractures, decreased mobility, difficulty for oral
intubation, risk of skin injury, increased risk for hypothermia, challenges in rehabiliation" "Functional changes in Endocrine system include decreased production and response to thyroxin
and decreased dehydroepiandrosterone (DHEA) - CORRECT ANSWER resulting in occult
hypothyroidism, relative hypercortisone states and increased risk of infection" "Age related changes in the cardiovascular system place the elderly trauma patient at significant
risk for being inaccurately categorized as hemodynamically stable. - CORRECT ANSWER
Elderly patients have a fixed heart rate and fixed cardiac output, thus, their response to hypovolemia will involve increasing their systemic vascular resistance. Furthermore, since older patients have HTN, an acceptable BP may truly reflect a hypotensive state. A systolic BP of 110 is to be utilized as the threshold for identifying hypotension in patients 65 and older."
"Do no equate blood pressure with shock in older patients - CORRECT ANSWER BP in older
patients may look normal due to the medications they are on. Use lactate and base deficit to evaluate for evidence of shock" "poor hygiene, dehydration, oral injury, contusions affecting the inner arms, inner thighs, palms, soles, scalp, ear, nasal bridge and temple injury from being struck while wearing glasses, contact
burns and scalds. These are all signs of.......? - CORRECT ANSWER Elder maltreatment. The
presence of physical findings of maltreatment should prompt a detailed history. if history conflicts with findings, immediately report findings to authorities." "True of false: early activation of the trauma team may be required for elderly patients who do
not meet traditional criteria for activation - CORRECT ANSWER True. A simple injury such as
an open tibia fracture in a frail elderly patient may become life threatening."
"What happens as the uterus enlarged and the bowel is pushed cephalad. - CORRECT
ANSWER When the uterus enlarges it pushes the bowel cephalad and the uterus lies in the
upper abdomen. As a result, the bowel is somewhat protected from blunt abdominal trauma, whereas the uterus and its contents (fetus and placenta) become more vulnerable. Uterus remains intrapelvic until 12 weeks and then at 20 weeks it is at the umbilicus, and at 34-36 weeks it reaches the costal margin." "Amniotic fluid can cause amniotic fluid embolism and disseminated intravascular coagulation
following trauma if fluid enters maternal intravascular space. True or False - CORRECT
ANSWER True"
"By the third trimester, what is the complication of trauma to the pelvis of the mother? -
CORRECT ANSWER by the third trimester, the uterus is large and thin walled. In vertex
presentation, fetal head is usually in the pelvis and the remainder of the fetus is exposed above the pelvic brim. Pelvic fractures in late gestation can result in skull fracture or intracranial injury to the fetus. Also we can have a placental abruption due to its little elasticity and vulnerability to sheer forces." "During pregnancy the heart rate increases to a maximum of 10-15 beats per minute over
baseline by the third trimester. - CORRECT ANSWER this heart rate must be considered when
interpreting a tachycardic response to hypovolemia." "Blood pressure falls 5-15 mm Hg in systolic and diastolic pressures during second trimester,
although it returns to near normal levels at term. - CORRECT ANSWER some women
experience hypotension when placed in the supine position due to the compression of teh inferior vena cava."
"hypertension in the pregnant if accompanied by proteinuria may represent what? - CORRECT
ANSWER pre-eclampsia."
"Minute ventilation increases primarily due to an increase in tidal volume. Hypocapnia (30 mm
Hg) is common in late pregnancy - CORRECT ANSWER Monitor ventilation in late pregnancy
