Download ATLS Exam Study Cards: Trauma Management & Injury Assessment and more Exams Nursing in PDF only on Docsity!
ATLS Study Cards (2025) Exam With
Detailed & Verified | With 100% Complete
Solutions | 100% Confirmed Latest
Update…Grade A+ | 100% Guaranteed
Success
Glasgow Coma Scale Chance fracture - Answer- Transverse fracture through vertebra. In children usually associated with enterc disruption. Seen in motor vehicle accidents involving only lap belt. May be associated with retroperitoneal and Abdominal visceral injuries. Anterior hip dislocation - Answer- Flexed, abducted, externally rotated. Burst fracture - Answer- Associated with vertebral-axial compression injuries Posterior hip dislocation - Answer- Flexed, aDDucted, internally rotated Anterior shoulder dislocation - Answer- Squared off appearance Posterior shoulder dislocation - Answer- Lock in internal rotation. Ankle dislocation - Answer- Most are Externally rotated, with a prominent medial malleolus. FULL thickness (3rd degree) burn - Answer- Dark or white and leathery. Translucent white as well. Painless and generally "dry" Does not blanch with pressure. Very little swelling of burned tissue. Principle Life saving measures for patients with burn injuries include - Answer- - Establishing airway control
- Stopping the burning. process
- Intravenous access Factors that increase the risk for upper AIRWAY OBSTRUCTION in burns include: - Answer- - Burns to the head and face
- Burn size and depth
- Burns inside the mouth Partial thickness burn - Answer- Red remodeled appearance with associated swelling and blister formation. May have weeping or wet appearance and is painfully hypersensitive even to air current.
Signs and symptoms and history that suggest INHALATION INJURY include: - Answer-These patients should be intubated. Inhalation injury is an indication for transfer to a burn center.
Antibiotics are not indicated empirically unless infection develops later. Persisted ACIDEMIA in burn victims may reflect... - Answer- Cyanide poisoning. (Cyanide is a naturally occurring toxin that may be inhaled in a confined space fire). Hypothermia Severe hypothermia - Answer- Core temperature of 36 degrees centigrade Temperature below 32 degrees centigrade Definition of frostbite. - Answer- Freezing of tissue with intracellular ice crystal formation, microvascular occlusion, subsequent tissue anoxia. First degree frostbite - Answer- Hyperemia and edema without skin necrosis Second-degree frostbite - Answer- Large clear vesicle formation accompanies hyperemia and edema with partial thickness skin necrosis 3rd degree frostbite - Answer- Full thickness and subcutaneous necrosis occurs, commonly with hemorrhage and vesicle formation. Although a compartment pressure > systolic blood pressure is required to lose a pulse distal to in extremity burn, a pressure of what was in the compartment may lead to muscle necrosis - Answer- 30 mm Hg. If a pressure of greater than 30 mm Hg in a burned extremity is present, eschatotomy is indicated. Difference between fasciotomy and eschatotomy - Answer- Compartment syndrome is also present with circumferential chest and abdominal burns, which lead to increased peak inspiratory pressures. Eschatotomy in circumferential chest and abdominal burns. - Answer- We are generally not needed before the first 6 hours after a burn. Gastric tube placement in burn victims. - Answer- Place of burn involves more than 20% of total BSA. Alkali burns to the eyes require how many hours of continuous irrigation - Answer- 8 hours. Electrical burns. - Answer- Can cause thrombosis and entry to nerves, and digits are especially prone to injury. Patients with electrical injuries frequently require fasciotomies because of the degree of deep tissue injury and should be transferred to a burn center.
Immediate ELECTRICAL burn treatment measures. - Answer- Attention to airway and breathing, IV line placement, ECG monitoring, and placement of an indwelling Foley catheter. Rhabdomyolysis and subsequent metabolic acidosis are common complications. Criteria for transfer of a burn victim to a burn center. - Answer- Estimating WEIGHT in kilograms for a child - Answer- (2× AGE) + 10 Infant blood volume estimate - Answer- 80 ml/kg Child blood volume estimate - Answer- 70 ml/kg. IO needle size: Infant Child - Answer- 18 gauge 15 gauge Packed red blood cell volume transfusion for a child - Answer- 10 mL/ kilogram Pediatric verbal score - Answer- Impacted fractures - Answer- Demonstrate no false motion of the humorous when the shoulder is rotated gently from a flexed elbow. Nonimpacted Fractures - Answer- Generally experience pain on movement of the arm. Generally require hospitalization for orthopedic consultation and often operation Fundal height in pregnancy - Answer- The amniotic fluid may cause amniotic fluid EMBOLISM and DIC following trauma if the fluid gains access to maternal intravascular space. Physiologic changes in pregnancy - Answer- 1.Physiologic changes in pregnancysmall increase in rent till volume resulting in a decrease in hematocrit.
- Elevation and WBC as high as 25,000.
- Mild elevation in clotting factors. Bleeding and clotting times are unchanged, however.
- Arterial pH 7.40-7.
- PaCO2: 25 - 30mmHg
- Bicarbonate space 17 - 22
collision: Bent steering wheel, Knee imprint dashboard Bulls eye fracture windshield - Answer- Cervical spine fracture Anterior flail chest Myocardial contusion Pneumothorax Traumatic aortic disruption Fractured spleen or liver Posterior fracture/dislocation of hip and/or knee Side impact automobile collision - Answer- Contralateral next sprain Cervical spine fracture Lateral flail chest Pneumothorax Traumatic aortic disruption Diaphragmatic rupture Fractured spleen/liver and/or Fracture of kidney, pelvis or acetabulum Rear impact automobile collision - Answer- Cervical spine injury Soft tissue neck injury Ejection from automobile - Answer- Ejection from the vehicle precludes meaningful prediction of injury patterns. Patient at greater risk from virtually all injury mechanisms. Motor vehicle impact with pedestrian. - Answer- Head injury Traumatic aortic disruption Blunt force to the neck or Traction injury from a shoulder harness restraint - Answer- Can cause carotid disruption dissection or thrombosis. Symptoms may develop late Auscultation of chest - Answer- Auscultate high on the anterior chest for PNEUMOTHORAX and at the posterior basis for detection of HEMOTHORAX Distended neck veins - Answer- Seen in Cardiac Tampanode or Tension Pneumothorax. Abdominal injury Patients with unexplained hypotension, neurological injury, impaired sensorium secondary to alcohol and/or other drugs, and equivocal or normal findings - Answer- Should be considered candidates for DPL, or FAST. If hemodynamically stable, CT scan of the abdomen
Any increase in intracranial pressure can REDUCE cerebral perfusion pressure, and lead to secondary brain injury. - Answer- Complete cervical cord transection which SPARES the phrenic nerve, C3 and C4, results in... - Answer- Results in quadriplegia and ABDOMINAL breathing but paralysis of the intercostal muscles. Assisted ventilation may be required. Size of plastic cannula for cricothyroidotomy for jet insufflation - Answer- 12 to 14 gauge; 8.5 cm length LMA sizes - Answer- 3 for small female 4 for large female 5 for large male RANGES FROM 1 FOR NEONATE 5 FOR ADULTS Consider Use when you cannot extend the neck (c-collar in place) Laryngeal tube airway - Answer- Use when you cannot extend the c-spine (c-collar) CO2 capnography - Answer- Yellow indicates adequate CO2 levels, violet: too low Definition of Shock - Answer- Abnormality of the circulatory system resulting in inadequate organ perfusion and tissue oxygenation. Hemorrhage is the most common cause of shock in the injured/trauma patient. Earliest signs of shock - Answer- Tachycardia and cutaneous vasoconstriction. Tachycardia an infant - Answer- Greater than 160 beats per minute Tachycardia in a preschool child - Answer- Greater than 140 beats per minute Tachycardia in a school age to puberty - Answer- Greater than 120 beats per minute Tachycardia in an adult - Answer- Greater than 100 beats per minute. Significance of narrowed pulse pressure - Answer- Significant blood loss and involvement of compensatory mechanisms. What percent of body weight in kilograms represents the circulating blood volume of an adult (in liters). - Answer- 7%. Example, a 70 kilogram man's total circulating volume is 70 × 7% which equals 4900 ml. Class hemorrhage and hemodynamic effects. - Answer-
Definition of massive transfusion of pack RBC: - Answer- Greater than 10 units attack with blood cells in the first 24 hours of admission. Preferred temperature of packed red blood cells or peritoneal or thoracic cavity crystalloid solutions for hypothermia - Answer- 39 degrees centigrade Most common cause of poor response to IV fluids in the setting of shock. - Answer- Undiagnosed source of bleeding. Central venous pressure - Answer- Reflects right heart function. May not represent left heart function in patients with primary myocardial dysfunction or abnormal pulmonary circulation. Conditions to consider if a patient does not respond to fluid therapy - Answer- Unrecognized fluid loss, Ventilatory problems Tension pneumothorax Cardiac tamponade Hypoadrenalism Neurogenic shock Massive hemothorax findings on physical exam - Answer- Tracheal deviation FLAT neck veins (due to heavy blood loss) Percussion dullness Absent breath sounds Distended neck veins are seen in what two conditions - Answer- Cardiac tamponade Tension pneumothorax Conditions to consider in transient responders in the setting of shock. - Answer- 1. Hemorrhagic: Bleeding within the abdomen, pelvis, retroperitoneum, extremity fracture, or obvious external bleeding.
- Nonhemorrhagic: Tension pneumothorax or cardiac tamponade NONresponder to IV fluids. Diagnostic consideration - Answer- Blunt cardiac injury. Intraosseous needle size. - Answer- 18 gauge spinal needle with stylet. Physical signs suggesting a pelvic fracture on physical exam - Answer- Scrotal hematoma, Blood at the urethral meatus Perineal hematoma, Leg length difference
Mobile or high-riding prostate gland, Gross or occult blood in the stool. Accurate lines of the sacrum - Answer- To treat an open book fracture of the pelvis - Answer- Life-threatening thoracic injuries that need to be addressed in the primary survey - Answer- Airway obstruction Tension pneumothorax Open pneumothorax Flail chest and pulmonary contusion Massive hemothorax Cardiac tamponade Most common cause of tension pneumothorax - Answer- Mechanical ventilation with positive pressure ventilation in patients with visceral pleural injury Flail chest - Answer- Flail chest radiograph - Answer- Initial treatment of flail chest - Answer- Adequate ventilation, humidified oxygen, fluid resuscitation. Later, analgesia. Short Term intubation and ventilation may be necessary. Local nerve block preferred over IV narcotics. MASSIVE hemothorax definition - Answer- > 1500 milliliters of blood or one third or more of the patient's total blood volume in the chest cavity. Neck veins can be distended (if concomitant tension pneumothorax) or flat (if blood loss results in hypovolemia). Treatment of MASSIVE hemothorax - Answer- Restoration of blood volume (crystalloid then type specific blood) and decompression of the chest cavity. 36 or 40 French chest tube required MASSIVE Hemothorax. Indications for thoracotomy: - Answer- If Greater than 1500 ml of fluid is immediately evacuated. Less than 1500 milliliters of fluid evacuated but continued blood loss of 200 milliliters per hour for 2 to 4 hours Beck's triad in cardiac tamponade - Answer- Venous pressure elevation, decline in arterial pressure, muffled heart tones.
History of a severe blow to the LOWER sternum or epigastrium. Pain or shock out of proportion to the apparent injury. Particulate matter in the chest tube after blood begins to clear. Presence of mediastinal air. Treatment of blunt esophageal rupture - Answer- Wide drainage of the pleural space and mediastinum, with direct repair of the injury through thoracotomy. Causes of subcutaneous emphysema - Answer- Blast injury. Airway injury. Lung injury. The emphysema itself is generally not treated but underlying causes need to be addressed and treated. Fractures involving ribs 1 through 3, sternum, scapula and clavicle can be associated with - Answer- Great vessel trauma or airway obstruction. Pneumothorax. Pulmonary contusion. Middle rib fracture, 4 through 9, can be associated with - Answer- Pneumothorax hemothorax pulmonary contusion. Fracture involving ribs 10 through 12 can be associated with - Answer- Hepatosplenic trauma Mediastinal widening - Answer- Great vessel injury Sternal fracture Thoracic spine injury. Mediastinal air - Answer- Esophageal disruption Tracheal injury Pneumoperitoneum. Air fluid level in the chest - Answer- Hemopneumothorax or diaphragmatic rupture. Disrupted diaphragm - Answer- Indicates adominal visceral injury X-ray findings in diaphragmatic ruptured - Answer- Elevation, irregularity or obliteration of diaphragm. Mass like density above the diaphragm. Air or contrast containing stomach or bowel above diaphragm. Pleural effusion.
Fracture of the scapula - Answer- Great vessel injury, airway injury, pulmonary contusion. Sternal fractures are associated with - Answer- Myocardial contusion Great vessel injury Pericardiocentesis needle, size - Answer- 15 - 18 gauge, 15 centimeters length. Current of energy pattern that occurs in pericardiocentesis - Answer- Extreme ST wave changes Widened and enlarged QRS complex. Organs contained within the retroperitoneum - Answer- Duodenum, pancreas, kidneys and ureters; posterior aspect of the ascending and descending colon, part of the pelvic cavity. Relative contraindications to DPL - Answer- Coagulopathy, obesity, previous abdominal operations, liver cirrhosis. DPL - Answer- Positive test:
- greater than 100, RBCs/ cubic mm
- 500 WBCs
- Gram stain positive for bacteria. Evaluation of penetrating (such as knife wound) trauma to the abdomen and the thoracoabdominal region. - Answer- Serial physical exam or DPL. Generally manage more selectively but approximately 30% associated with intraperitoneal injury. Management of gunshot wounds to the abdomen - Answer- Most are managed by laparotomy. Indications for laparoscopy in PENETRATING abdominal wound - Answer- - Any hemodynamically abnormal patient
- Gunshot wound with transperitoneal trajectory
- signs of peritoneal irritation
- signs of fascial penetration. Management options for flank and back stab wounds and gunshot wounds. - Answer- Initially, serial physical exams if patient is asymptomatic except for local pain
(GCS 13 - 15) when the following are seen: - Answer- *GCS of less than 15 two hours after injury *Suspected open or depressed skull fracture *Any signs of basilar skull fracture *Vomiting more than 2 episodes *Age more than 65 years *Loss of consciousness more than five minutes *More than 30 minutes amnesia before impact *Dangerous mechanism of trauma Management of moderate brain injury GCS 9- 12 - Answer- CT scan of the head in all cases Admission to intensive care unit for frequent neurologic checks repeat CT scan. (10 to 20% of these patients deteriorate and lapse into coma) Management of patients with severe brain injury GCS 3 - 8 - Answer- *CT Scan and admit to neurosurgical ICU *Therapeutic agents if needed including mannitol, hypertonic saline, moderate hyperventilation: PaO2 of ~35mmHg. *Repeat CT scanning as needed. *Intubation. A midline shift of 5 millimeters or greater on CT scan of the brain - Answer- Indicate the need for surgery to evacuate the blood clot or contusion causing the shift Indication for the use of Mannitol (1gm/kg) - Answer- Acute neurologic deterioration such as development of a dilated pupil, loss of consciousness, or hemiparesis in a severe head trauma patient. Patient must be euvolemic. Three main factors linked to a high incidence of late epilepsy in post traumatic patients - Answer- Seizures occurring within the first week Intracranial hematoma Depressed skull fracture. Diagnosis of brain death criteria - Answer- *GCS score of 3 *Nonreactive pupils *Absent brainstem reflexes (Doll's eyes, corneal, gag reflexes) *No spontaneous ventilatory effort on formal apnea testing NEUROGENIC shock is rare in spinal cord injuries below this level. - Answer- T6. Injury to this cervical spine level results in paralysis of the diaphragm - Answer- C thru C5 segments.
Injury to the lower cervical upper thoracic spine results in paralysis of what muscles? - Answer- The intercostal muscles Definition of neurological level when discussing spinal cord injuries. - Answer- The segment of spinal cord that has normal sensory and motor function on both sides of the body. Central cord syndrome - Answer- commonly in hyperextension injuries in elderly with cervical spondylosis. Weakness in UE > LE, possibly loss of local pain/temperature. The motor fibers of the cervical segments are topographically arranged toward the center of the cord. Arms and hands are there for more severely affected. Anterior cord syndrome - Answer- Paraplegia and dissociated sensory loss with a loss of pain and temperature sensation. Dorsal column function is preserved. Poorest prognosis of the incomplete injuries. Brown-Sèquard syndrome - Answer- ipsilateral motor paralysis and loss of touch/vibration and contralateral loss of pain and temperature. Usually a result of a penetrating trauma. Atlanto-occipital dislocation - Answer- Not Common - < 1% all acute C/S injuries. Caused by severe traumatic flexion. Most patients die from traumatic brain injury. Atlas fracture - Answer- 40% of Atlas fractures are associated with fractures of the AXIS Occurs by strong vertical forces (e.g. Blow to head top or diving in shallow pool) fracturing the lateral masses and rupturing the transverse ligament. A fracture of the ring is a Jefferson fracture. Usually not associated with spinal cord injuries but are unstable. C1 rotary subluxation - Answer- Patient population: children & patients with rheumatoid arthritis. Patient presents with persistent rotation of the head. Axis Fractures - Answer- fractures of odontoid, forceful flexion or extensio Hangman's Fracture - Answer- fracture of both pedicles of C2 due to extreme hyperextension (incredibly unstable as dens pushes against brainstem). Involves the posterior elements of c2. The pars interarticularis C2 fractures. - Answer- Most are odontoid or hangman fractures. 20% of C2 fractures do not involve other one of these, however. C2 because of its unique anatomy is very susceptible to fractures.
Femur fracture can be associated with - Answer- Femoral neck fractures posterior hip dislocation Fracture / dislocation of the elbow can be associated with - Answer- Brachial artery injury Median, mode, and radial nerve injury. Posterior knee dislocation can be associated with - Answer- Femoral fracture Posterior hip dislocation Need this location or displaced tibial plateau fracture can be associated with - Answer-Popliteal artery and nerve injuries. Calcaneal fracture can be associated with - Answer- Spine injury or fracture, fracture dislocation of the hind foot, to be a plateau fracture. Open fractures can be associated with - Answer- 70% incidence of associated non skeletal injury. Any deformed or dislocated joints should be splinted and x-rayed before testing for stability. - Answer- Assess the neurovascular status of any extremity before applying a splint Do not force realign a deformed extremity with a normal pulse. - Answer- Alternatively, place extremity in a splint if normally aligned. If malaligned, the extremity needs to be realigned and then splinted. Characteristics of pediatric trauma - Answer- Motor vehicle associated injuries are the most common cause of death in children of all ages. Most serious pediatric trauma is blunt trauma that a bowl of the brain. As a result apnea, hypoventilation and hypoxia after five times more often. Multisystem injury is the rule and should be presumed. Internal organ damage is often noted without overlying bony fractures. Use of atropine for drug assisted intubation. - Answer- Should be reserved for infants only. Crycothyroidomy in infants and small children - Answer- Is rarely indicated Up to 30% diminution in circulating blood volume may be required to manifest a decrease in the child systolic blood pressure. - Answer- Hypotension in a child represents a state of decompensated shock and indicates severe blood loss of greater than 45% of circulating blood volume.
Vital functions for pediatric population - Answer- Characteristics of chest trauma in children. - Answer- Mediastinal structures are mobile.; pneumomrdiastinum is rare abdominal tension pneumothorax is most common life threatening injury. Chest tube placement is required but thoracotomy is generally not needed in children. Rib fractures are rare. The present, indicates significant energy impact. Typical characteristics of paediatric abdominal trauma. - Answer- Most pediatric internal injuries occurred as a result of blunt trauma. The presence of shoulder or lap belt marks increases likelihood of intraabdominal injuries. FAST should not be relied upon as the sole diagnostic tool in pediatric abdominal trauma. If a small amount of interim nominal through it is found and the child is hemodynamically normal a CT scan should be obtained. Most pediatric patients have self in a minute intra-abdominal injuries and no hemodynamic abnormalities. Diagnostic peritoneal lavage volume in pediatric patients - Answer- 10 milliliters per kilogram. A DPL or FAST exam that is positive for blood alone does not mandate laparotomy in a child who was hemodynamically normal, or who stabilizes rapidly with fluid resuscitation. Laparotomy is indicated if child's hemodynamic condition cannot be normalized Characteristics of pediatric head trauma. - Answer- Subarachnoid space is relatively small and offers less protection to the brain because there is less buoyancy. parenchymal damaged structurally is more common. Outcome in children suffering severe brain injury less than three years of age is worse than a similar injury in an older adult. Hypovolemia is a single worse risk factor for secondary brain injury in children. An infant who is not in a coma but who has bulging fontanelle or suture diastasis should be treated as having a more severe injury. Impact seizures, that occurs shortly after a brain injury, are more common in children and are usually self-limited.
