ATLS Chapters 1-3

Question Answer
Patients with a GSC of less than ___ usually
8
require intubation.
Airway maintenance with CERVICAL
The "A" in ABCD stands for _______.
SPINE PROTECTION
You should assume that any patient in a
multisystem trauma with an altered level of
Cervical spine injury
consciousness or blunt injury above the clavicle
has what type of injury?
Flail chest is invariably accompanied by ______ pulmonary contusion - do NOT over fluid
which can interfere with blood oxygenation. resuscitate these patients!
Hypotension is caused by _____ until proven
hypovolemia
otherwise.
When you don't have/can't get a blood pressure, 1. Level of consciousness (brain perfusion),
what are three things to look for when evaluating 2. Skin color (ashen face/grey extremities) 3.
perfusion. Pulse (bilateral femoral - thready/tachy)
Elderly patients have a limited ability to ______ to
increase heart rate
compensate for blood loss.
Resuscitation fluids should be warmed 39 degrees
YES - for CRYSTALLOID ONLY (but
Celsius (102.2 F). Can you use a microwave to do
NOT for blood products).
this?
Urinary catheters are good for assessing renal
Blood at urethral meatus, perineal
perfusion and volume status. List 5 signs of
ecchymosis, blood in scrotum, high-
urethral injury that might prevent you from
riding/non-palpable prostate, pelvic fracture
inserting one.
Which arm should you NOT put a pulse-ox on? The arm with a blood pressure cuff on it
Name two anatomical things that can interfere
Obesity & intraluminal bowel gas
with doing a FAST scan.
When should radiographs be obtained? During the SECONDARY survey.
A=Allergies, M=Medications,
How do you get an ample patient history? P=PMH/Pregnancy, L=Last meal,
E=Events/Environment of injury
Why might you want a Bair Hugger for a patient
Vasodilation can lead to hypothermia
who smells of alcohol?
What things are you looking for when you do a Blood, high-riding prostate (in males), and
DRE in a trauma? sphincter tone
What should you do for every female patient? Pregnancy test (females of childbearing age)
Adult patients should maintain UOP of at least
___ mL/kg/hr. Kids should have at least ___ Adults 0.5 mL/kg/hr, Kids 1.0 ml/kg/hr
mL/kg/hr.
Preventing hypercarbia is critical in patients who
head
have sustained a _____ injury.
What two places would you LOOK at a patient if
Lips and fingernail beds
you suspect hypoxemia?
Patients may be abusive and belligerent because of
_____, so don't just assume it's due to drugs,
hypoxia
alcohol, or the fact that they are just inherently a
jerk.
Yes, if the phrenic nerves (C3-C5) are
Can a patient breathe on their own after complete spared. This will result in "abdominal"
cervical cord transection? breathing. The intercostal muscles will be
paralyzed though.
Can you use an OPA (Guedel) in a conscious No, it could make them vomit. An NPA
patient? (trumpet) would be okay.
You can feel the "clicks" as the distal tip
Bougies are typically inserted blindly, how do you
rubs against the cartilaginous tracheal rings,
know you are in the trachea and not the
or it will deviate right or left when entering
esophagus?
either bronchus (usually at 50 cm).
What do you NOT want to hear if you ascultate a Borborygmi - rumbling or gurgling noises
patient after placement of an ET tube? suggesting esophageal insertion.
What is the RSI dose for etomidate? 0.3 mg/kg (usually 20 mg)
What is the RSI dose for sux? 1-2 mg/kg (usually 100 mg)
It doesn't - at least it SHOULDN'T have any
significant effect on BP. Ketamine will
How does etomidate affect blood pressure?
increase BP, and propofol and thiopental will
both drop BP.
A RSI dose of sux usually lasts about ___ minutes. 5
SUX - patients with severe burns, crush
What hypnotic/sedative/induction agent do you injuries, hyperkalemia, or chronic
NOT want to use for a severely burned patient? paralytic/neuromuscular diseases should
NOT get sux because of hyperkalemia risk.
Oxygen should flow at 15L for needle
cricothyroidotomy, and have a Y-connector for
Adults 12-14 gauge, kids 16-18 gauge
insufflation if possible. What size needle do you
use for adults? Kids?
Cricoid cartilage is the only circumferential 12
support for the upper trachea in kids, therefore
surgical cricothyroidotomy is not recommended in
kids under the age of ___.
In a "normal" patient without significant chest
wall injury or lung disease, needle
30-45
cricothyroidotomy can provide adequate
oxygenation for approximately ____ minutes.
Chin-lift, jaw-thrust (NOT head-tilt while
For a patient with difficulty breathing, what things
maintaining c-spine precautions), OPA
might you try before you provide a surgical
(guedel), NPA (trumpet), LMA, Combitube,
airway?
ET tube +/- bougie
A correctly sized OPA will extend from the
How do you know if an OPA/Guedel is the correct
corner of the patient's mouth to the external
size for the patient?
auditory canal.
What should do with the balloon on an ET Inflate it to make sure it doesn't leak - then
tube/LMA/foley before you insert it? deflate and insert.
Kid: 3, Woman/small man: 4, Large
What size LMA do you use for kid, woman/small
woman/man: 5 (C3,4,5 keep the diaphragm
man, large woman/man?
alive)
The same size as the infant's nostril or little
The proper size ET tube for an infant is ______. finger. (Usually size 3 for neonates, 3.5 for
infants)
What size cuffed endotracheal tube do you use for
5 or 6
an emergency cricothyroidotomy?
Use size 3 ET tubes for neonates, 3.5 for infants 0-
6 months, and size 4 for infants 6-12 months. How
Age/4 + 4 mm = internal diameter
do you calculate what size ET tube to use for
toddlers and kids?
Shock is defined as an abnormality of the
circulatory system that results in inadequate organ Neurogenic, cardiogenic, hypovolemic,
perfusion and tissue oxygenation. What are the 4 septic
different types?
The most common cause of shock in the injured
hemorrhage
trauma patient is _____.
Approximately ___% of the body's total blood
70
volume is located in the venous circuit.
Anaerobic metabolism --> can't make more
ATP --> Endoplasmic then mitochondrial
Why does shock actually reduce the total volume
damage --> lysosomes rupture --> sodium
of circulating blood?
and WATER enter the cell, which SWELLS
and dies.
 NEVER use pressors for hypovolemic shock
Which vasopressors should you use to treat - use VOLUME replacement. Pressors will
hemorrhagic shock? What are the drug doses? worsen tissue perfusion in hemorrhagic
shock.
Compensatory mechanisms may preclude a
measurable fall in systolic blood pressure until up 30
to __% of the patient's blood volume is lost.
Any patient who is cool and is tachycardic is
in shock
considered to be ______ until proven otherwise.
The definition of tachycardia depends on the
patient's age. What heart rate is considered Infants >160, toddlers/preschoolers >140,
tachycardic for infants, toddlers/preschoolers, school age/prebuscent >120, adults >100
school age/prebuscent, and adults?
Elderly patients may not exhibit tachycardia in
response to hypovolemia because of limited They might be on a beta-blocker or have a
cardiac response to catecholamines. Why else pacemaker.
might not they get tachy?
A FAST scan is an excellent way to diagnose Becks's Triad: JVD, muffled heart sounds,
cardiac tamponade. What signs suggest and hypotension (will be resistant to fluid
tamponade? therapy). Will also likely be tachycardic.
Patients with a tension pneumo and patients with
cardiac tamponade may present with many of the
Absent breath sounds and hyperresonance to
same signs. What findings will you see with a
percussion over the affected hemithorax.
tension pneumo that you will NOT see with
tamponade?
Immediate thoracic decompression is warranted
for anyone with absent breath sounds, Acute respiratory distress & subcutaneous
hyperresonance to percussion, tracheal deviation, emphysema
____, and ____.
Can isolated intracranial injuries cause neurogenic
NO
shock?
70 mL per kg body weight. A 70 kg person
How do you calculate total blood volume in an
has about 5 liters of circulating blood.
adult?
(70*70=4900)
How do you calculate total blood volume in an
Body weight in kg x 80-90 mL
child?
The blood volume of an obese person is calculated
ideal
based upon their ______ weight.
Fluid replacement should be guided by ________,
The patient's response to initial replacment
not simply by the initial classification (Class I-IV).
How much blood volume is lost with Class I Up to 15% Donating 1 pint, or ~500 mL of
Hemorrhage? blood is about a 10% volume loss and would
qualify as Class I Hemorrhage!
You don't (usually). Transcapillary refill and
How do you treat a Class I Hemorrhage? other compensatory mechanisms usually
restore blood volume within 24 hours.
How much blood volume is lost with Class II
15-30% (750-1500 mL in a 70 kg adult)
Hemorrhage?
How do you treat a Class II Hemorrhage? Usually just crystalloid resuscitation
Subtle CNS changes such as anxiety, fright, and
hostility would be expected in a patient with a II
Class __ Hemorrhage.
How much blood volume is lost with Class III
30-40% (2000 mL in a 70 kg adult)
Hemorrhage?
A patient with inadequate perfusion, marked III or IV - These patients almost always
tachycardia and tachypnea, significant mental require a blood transfusion, which depends
status change, and a measurable fall in systolic on their response to initial fluid resuscitation.
blood pressure likely has a Class ___ Hemorrhage. The first priority is stopping the hemorrhage.
Loss of more than ___% of blood volume results
50
in loss of consciousness.
More than 40%. Unless very aggressive
How much blood volume is lost with Class IV
measures are taken the patient will die within
Hemorrhage?
minutes.
A Class ___ Hemorrhage represents the smallest
volume of blood loss that is consistently III
associated wiht a drop in systolic blood pressure.
Up to ______ mL of blood loss is commonly
1500
associated with femur fractures.
Unexplained hypotension or cardiac dysrhythmias
(usually bradycardia from excessive vagal
gastric distention
stimulation) are often caused by ______,
especially in children.
Adults: 2 liters, Kids: 20 mL/kg (may repeat
How much crystalloid should you give an adult for and give as much as 60 mL/kg but with high
an initial fluid resuscitation bolus? For kids? reserve in kids, if they're in shock they
should get blood sooner rather than later.
Each mL of blood loss whould be replaced with
___ mL of crystalloid, thus allowing for
3
replacement of plasma volume lost into interstitial
and intracellular spaces.
Blood on the floor x four more is a mnemonic for Chest, pelvis, retroperitoneum, and thigh
occult blood loss where?
For children UNDER 1 year of age, UOP should
2
be ___ mL/kg/hr.
Alkalotic - respiratory alkalosis from
Would patients in EARLY hypovolemic shock be
tachypnea....followed later by mild metabolic
acidodic or alkalotic?
acidosis in the early phase of shock.
"Rapid responders" whose vital signs return to
normal (and stay there) after fluid resuscitation I or II
likely have/had a Class ___ Hemorrhage.
"Transient responders" are associated with Class
II or III
___ Hemorrhage.
NON-HEMORRHAGIC causes, e.g. tension
What differential diagnoses should you always
pneumothorax, tamponade, blunt cardiac
consider for "non-responders" following fluid
injury, MI, acute gastric distention,
resuscitation?
neurogenic shock...
Most patients receiving blood transfusions ____
don't
need calcium replacement.
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