ATLS EXAM WITH COMPLETE SOLUTION
field triage scheme step 1:
when to transport to level 1 trauma center?
GCS -
systolic BP -
RR - - answerGCS <13
systolic BP <90
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
,define multiple casualty incident - answermultiple casualty incidents are those in which the
number of patients and the severity of their injuries do not exceed the capability of the facility to
render care. In such cases, patients with life-threatening problems and those sustaining
multiple-system injuries are treated first.
define mass casualty incident - answerIn mass-casualty events, the number of patients and the
severity of their injuries does exceed the capability of the facility and staff. In such cases, patients
having the greatest chance of survival and requiring the least expenditure of time, equipment,
supplies, and personnel are treated first
Where can you assess a central pulse? - answerFemoral or carotid artery.
Make sure you assess bilaterally for quality, rate and regularity.
tourniquets are effective in - answermassive exsanguination from an extremity. However they
carry a risk of ischemic injury.
stop the bleed - answer1. direct pressure to wound
2. pressure dressing
3. compression of artery proximal to injury
4. tourniquet
Tranexamic Acid (TXA) - answerclot promoter. given in patients who are severely injured in the
field in some jurisdictions. Studies demonstrate survival improved with TXA when given within 3
hrs of injury. If given, follow up infusion is given over 8 hrs in the hospital.
What part of GCS correlates best with outcome? - answermotor score.
methods to prevent hypothermia - answer- increase temperature of resuscitation area to minimize
the loss of body heat
- the use of a high flow fluid warmer to heat crystalloid fluids to 39*C (102.2) is recommended.
,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 CO2
hypercarbia - answerhypoventilation
- too much CO2
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
field triage scheme step 1:
when to transport to level 1 trauma center?
GCS -
systolic BP -
RR - - answerGCS <13
systolic BP <90
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
,define multiple casualty incident - answermultiple casualty incidents are those in which the
number of patients and the severity of their injuries do not exceed the capability of the facility to
render care. In such cases, patients with life-threatening problems and those sustaining
multiple-system injuries are treated first.
define mass casualty incident - answerIn mass-casualty events, the number of patients and the
severity of their injuries does exceed the capability of the facility and staff. In such cases, patients
having the greatest chance of survival and requiring the least expenditure of time, equipment,
supplies, and personnel are treated first
Where can you assess a central pulse? - answerFemoral or carotid artery.
Make sure you assess bilaterally for quality, rate and regularity.
tourniquets are effective in - answermassive exsanguination from an extremity. However they
carry a risk of ischemic injury.
stop the bleed - answer1. direct pressure to wound
2. pressure dressing
3. compression of artery proximal to injury
4. tourniquet
Tranexamic Acid (TXA) - answerclot promoter. given in patients who are severely injured in the
field in some jurisdictions. Studies demonstrate survival improved with TXA when given within 3
hrs of injury. If given, follow up infusion is given over 8 hrs in the hospital.
What part of GCS correlates best with outcome? - answermotor score.
methods to prevent hypothermia - answer- increase temperature of resuscitation area to minimize
the loss of body heat
- the use of a high flow fluid warmer to heat crystalloid fluids to 39*C (102.2) is recommended.
,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 CO2
hypercarbia - answerhypoventilation
- too much CO2
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
