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ATLS Written Review FINAL EXAM 200 QUESTIONS & DETAILED ANSWERS (WELL VERIFIED) ALREADY GRADED A+
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What is the primary goal of treating TBI? How is this done? **- CORRECT ANSWER
** preventing secondary brain injury. This is done by maintaining blood pressure and providing adequate profusion. After managing ABCDEs of TBI what MUST be identified if present? How is this done? - CORRECT ANSWER >>> mass lesion that requires surgical evacuation is critical! this is done with CT. NOTE: obtaining a CT should not delay patient transfer to trauma center. Which brain lobes do the following hold:
What layer of the meninges splits into two leaves as specific sites to enclose large venous sinuses? What do these sinuses do? - CORRECT ANSWER >>> dura mater. these sinuses provide major venous drainage from the brain. What is the midline sinus of of the brain that splits into two sinuses: bilateral transverse and sigmoid sinus? What side are these bigger on? - CORRECT ANSWER >>> The main sinus enclosed by the dura major is the midline superior sagital sinus. This splits into the sigmoid and bilateral transverse sinuses which are larger on the right side. What are the arteries that lie between the skull and the dura mater (epidural space)? - CORRECT ANSWER >>> meningeal arteries. What is the most commonly injured meningeal artery and where is it located? - CORRECT ANSWER >>> middle meningeal artery. Located over the temporal fossa T/F: the arachnoid mater is fused to the dura mater? - CORRECT ANSWER >>> FALSE: not attached. This produces a potential space for a subdural hematoma In a subdural hematoma, what is the cause? - CORRECT ANSWER >>> injury to bridging veins that extend from brain surface to the sinuses within the dura. _______ fills the space between the arachnoid and pia mater? - CORRECT ANSWER >>> CSF. this cushions the brain and spinal cord. What location of brain hemorrhage is frequently seen in brain contusion or injury to major blood vessels at base of brain? - CORRECT ANSWER >>> subarachnoid.
what part of the brain most commonly herniates through the tentorial notch? - CORRECT ANSWER >>> Uncus (medial part of temporal lobe) does weakness occur on the same or opposite side of the uncal herniation? **- CORRECT ANSWER
** OPPOSITE. the corticospinal tract of the midbrain is compressed and then crosses at the foramen magnum. state: Ipsilateral/contralateral ____ pupillary dilation associated with _____ hemiparesis is the classic sign of uncial herniation.
- CORRECT ANSWER >>> ipsi contra average ICP is _____ mmHg. - CORRECT ANSWER >>> 10 The monro-kellie doctrine states that the total volume of intracranial contents must remain constant, because the cranium is ___ - CORRECT ANSWER >>> a rigid, non expandable container. The monro-kellie doctrine states that _____ and _____ may be compressed out of the skull providing a degree of buffering. - CORRECT ANSWER >>> CSF and venous blood. Once the CSF and venous blood reach a certain level of displacement the ICP rapidly increases. What is the equation for CPP (cerebral perfusion pressure)? **- CORRECT ANSWER
** CPP=MAP-ICP
in TBI, Every effort should be made to reduce ______, while normalizing ____, ___, and _____. - CORRECT ANSWER >>> ICP MAP, oxygenation, intravascular volume What GCS ranges for the following classes:
** Use the best possible because this will be the best predictor of outcome Basilar fractures of the skull usually require what type of imaging? - CORRECT ANSWER >>> this requires CT with bone-window setting. What are the typical clinical signs of basilar skull fractures? **- CORRECT ANSWER ** 1.periorbital ecchymosis (raccoon eyes)
What is the imaging protocol for a patient with cerebral contusion? **- CORRECT ANSWER
** get CT at presentation. then get another within 24 hours to assess for coalesced hematoma. What factors would require a CT in minor brain injury? - CORRECT ANSWER >>> 1. suspected open skull frac
2 episode vomitting
** Airway and breathing. rapid deterioration may occur. hypoventilation and hypercapnia may ensue requiring intubation. close monitoring in ICU is required. What should immediately follow the secondary survey in major/severe brain injury? - CORRECT ANSWER >>> CT. REMEMBER: CT should never delay patient transfer
When assessing ABCDE of severe brain injury, when does DPL or FAST come before neuro exam?
- CORRECT ANSWER >>> if the systolic blood pressure cannot be brought above 100, DPL or FAST is done first as to assess source of hypotension Spinal cord injury has what result in blood pressure? - CORRECT ANSWER >>> hypotension. This may also occur in terminal brain injury with medullary failure What needs to be cleared before Doll's eye testing is conducted? - CORRECT ANSWER >>> cervical spine must cleared. What tests should be performed before sedation? - CORRECT ANSWER >>> GCS and pupillary rxn A midline shift of _____mm or greater on the CT is indicative of need for neurosurgery to evacuate the clot or contusion causing the shift - CORRECT ANSWER >>> 5mm What type of fluids should be used? - CORRECT ANSWER >>> hypertonic (ringers lactate or normal saline). NO GLUCOSE. What electrolyte abnormality is associated with brain edema and must be monitored? - CORRECT ANSWER >>> hyponatremia What are the physiologic consequences of PaCO2 >45? PaCO2 <30? - CORRECT ANSWER >>> f PaCO2 >45 = vasodilation = inc ICP PaCO2 <30 (hyperventilation) = constriction = ischemia What is the preferred PaCO2 in brain injury? - CORRECT ANSWER >>> 35 mm Hg
What clinical signs are the criteria for brain death? - CORRECT ANSWER >>> GCS of 3, nonreactive pupil, absent brainstem reflexes, no spontaneous ventilatory effort
Which vertebrae is most susceptible to injury? - CORRECT ANSWER >>> Cervical. NOTE: in peds this accounts for only 1% of vertebral injury What nerve and cervical spine level would cause apnea and results in death in 1/3 of patient with upper cervical spine injury - CORRECT ANSWER >>> phrenic nerve C At what age do cervical spine differences begin to normalize? at what age does cervical spine look like that of an adult? - CORRECT ANSWER >>> marked differences in cervical spine occur until age 8 and steadily decline until age 12 when they are similar When a dislocation-fracture of the vertebrae occurs, almost always the result is _____. - CORRECT ANSWER >>> complete spinal cord injury T/F: the thoracolumbar junction is extremely strong and rarely incurs injury? - CORRECT ANSWER >>> FALSE: the flexible thoracic meeting the rigid lumbar make this area a common place for injury (15% of all spinal injuries) At what levels do the spinal cord begin and end? - CORRECT ANSWER >>> begins at foramen magnum at terminal end of the medulla oblongata and end at L What is sacral sparing? - CORRECT ANSWER >>> this is a sign of incomplete spinal cord injury where some sensation below an injury to spinal cord is preserved. In the case of sacral sparing, sensation and rectal sphincter tone is preserved. What function does the dorsal column have? What tests can be done to assess function? - CORRECT ANSWER >>> position, vibration, light touch, all from same side of body.
What should be used when vocal chords cannot be visualized on direct laryngoscopy? - CORRECT ANSWER >>> gum elastic bougie. in place when you feel clicks. can be inserted blindly beyond epiglottis What is the acronym BURP? - CORRECT ANSWER >>> backward, upward and rightward pressure used in external laryngeal manipulation with orotracheal intubation what is the most common life threatening injury in children? - CORRECT ANSWER >>> tension pneumothorax What is the most common acid-base disturbance in the injury child and what is it caused by? - CORRECT ANSWER >>> Respiratory acidosis caused by hypoventilation. What are the options to establish an airway when bag-mask ventilation and attempts at orotracheal intubation fail for a child? - CORRECT ANSWER >>> LMA, or intubating LMA, or needle cricothyroidotomy.
What would be expected on ABG abnormalities for pulmonary contusion? **- CORRECT ANSWER
** PaO2 <65 mm Hg (sat <90) would suggest need for intubation and in the presence of flail chest is more suggestive t/f vomitus in the posterior oropharynx suggests esophageal intubation. **- CORRECT ANSWER ** false. signs include: epigastric fullness, absent end title CO2, absent breath sounds, audible borborygmi sounds over abdomen t/f: major head injury rarely causes shock by itself - CORRECT ANSWER >>> true What are the vital signs to be expected when ICP increases? **- CORRECT ANSWER ** decreased respirations and HR, increased systolic and pulse pressure Urethral injury should be suspected in the presence of what three things? - CORRECT ANSWER >>> 1. blood at the meatus
** examine the rectum and perineum What is the best guide for adequate fluid resuscitation in a burn patient? - CORRECT ANSWER
What three X-ray views are most important for a person with multiple trauma? - CORRECT ANSWER >>> c-spine, chest, pelvis Pulse oximetry provides information about _____ and ____ but does not provide information about ____ - CORRECT ANSWER >>> 1. O2 sat
What are the symptoms of central cord syndrome? - CORRECT ANSWER >>> disproportionate motor strength loss greater in upper extremities than lower with varying degree of sensory loss.(the arms and hands are most severely affected) What are the symptoms of Brown-Sequard syndrome? - CORRECT ANSWER >>> Think of a cut from anterior to posterior of the cord.