ATLS study cards With Complete Solution
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.
,Rule of nines - adult -Answer- The palm represents 1% of the body total surface area.
Symptoms of carbon monoxide poisoning and respective levels -Answer- PaO2 does
not reliably predict carbon monoxide poisoning because a CO partial pressure of only 1
mmm Hg results in a hemoglobin CO level of 40% or greater.
Carbon monoxide has how many times greater affinity for hemoglobin than oxygen -
Answer- 240 times.
It displaces the oxyhemoglobin desaturated curve to the LEFT.
Two criteria required for the diagnosis of smoke inhalation injury -Answer- -Exposure to
a combustible agent
-Signs of exposure to smoke in the lower airway, below the vocal cords, by
bronchoscopy.
Performing this action will help reduce neck and chest wall edema in patients with burn
and inhalation injury. -Answer- Elevation of the head and chest by 30 degrees.
IV fluid administration formula for burn victims -Answer- Indicated in burns involving
over 20% of the body surface area.
*(2-4 mL/kg of LR/NS) (weight in kg) (% area of burn); give 1/2 of this volume in first 8
hours. Remainder in over 16 hours.
Large caliber, at least 15 gauge intravenous line should be introduced.
Pitfalls for IV fluid requirements for burn victims. -Answer- These patients require
greater fluid requirements: ~immolation injury
~pediatric burn victims
~concomitant blunt or crush
injuries.
Basic rules regarding IV fluids administration in burn victims -Answer- IV fluid Rate
should not be based on the time of actual injury.
In very small children, less than 10 kilograms, it may be necessary to add glucose to the
IV fluids to avoid hypoglycemia.
Any adjustment in IV fluid rate should be based on urine output. In an adult, urine output
above 0.5 ml/ kilogram should result in reduction of IV fluid rate.
Initial treatment of frostbite/ cold injuries -Answer- Place injured part in circulating water
and a constant 40 degrees centigrade until pink color and perfusion return, usually
within 20 to 30 minutes.
, 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.
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.
,Rule of nines - adult -Answer- The palm represents 1% of the body total surface area.
Symptoms of carbon monoxide poisoning and respective levels -Answer- PaO2 does
not reliably predict carbon monoxide poisoning because a CO partial pressure of only 1
mmm Hg results in a hemoglobin CO level of 40% or greater.
Carbon monoxide has how many times greater affinity for hemoglobin than oxygen -
Answer- 240 times.
It displaces the oxyhemoglobin desaturated curve to the LEFT.
Two criteria required for the diagnosis of smoke inhalation injury -Answer- -Exposure to
a combustible agent
-Signs of exposure to smoke in the lower airway, below the vocal cords, by
bronchoscopy.
Performing this action will help reduce neck and chest wall edema in patients with burn
and inhalation injury. -Answer- Elevation of the head and chest by 30 degrees.
IV fluid administration formula for burn victims -Answer- Indicated in burns involving
over 20% of the body surface area.
*(2-4 mL/kg of LR/NS) (weight in kg) (% area of burn); give 1/2 of this volume in first 8
hours. Remainder in over 16 hours.
Large caliber, at least 15 gauge intravenous line should be introduced.
Pitfalls for IV fluid requirements for burn victims. -Answer- These patients require
greater fluid requirements: ~immolation injury
~pediatric burn victims
~concomitant blunt or crush
injuries.
Basic rules regarding IV fluids administration in burn victims -Answer- IV fluid Rate
should not be based on the time of actual injury.
In very small children, less than 10 kilograms, it may be necessary to add glucose to the
IV fluids to avoid hypoglycemia.
Any adjustment in IV fluid rate should be based on urine output. In an adult, urine output
above 0.5 ml/ kilogram should result in reduction of IV fluid rate.
Initial treatment of frostbite/ cold injuries -Answer- Place injured part in circulating water
and a constant 40 degrees centigrade until pink color and perfusion return, usually
within 20 to 30 minutes.
, 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.
