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ATLS EXAM QUESTIONS AND ANSWERS LATEST 2023.GRADED A+
True or false? Although the mechanism of injury may be similar to those for the younger population, data shows increased mortality with similar severity of... [Show More] injury in older adults. True In the elderly population, what is decreased physiological reserve? aging is characterized by impaired adaptive and homeostatic mechanisms that caused an increased susceptibility to the stress of injury. Insults tolerated by the younger population can lead to devastating results in elderly patients. Pre-existing conditions that affect morbidity and mortality include: cirrhosis, coagulopathy, COPD, ischemic heart disease, DM What is the most common mechanism of injury in the elderly? Fall. Nonfatal falls are common in women and fractures are common in women who fall. Falls are the most common cause of TBI. In the elderly population, what are risk factors for falls? advanced age, physical impairment, history of previous fall, medication use, dementia, unsteady gait, and visual, cognitive impairment Most of elderly traffic fatalities occur in the daytime and on weekends and typically involve other vehicles. Why? Older people drive on more familiar roads and at lower speeds and tend to drive during the day. Older people have slower reaction time, a larger blind spot, limited cervical mobility, decreased hearing, and cognitive impairment. True or False? Mortality associated with small to moderate sized burns in older adults remains high True Spilled hot liquids on the leg, which in younger patients may re-epithelialize due to an adequate number of hair follicles, will result in a full thickness burn in older patients. this is true Airway-patients may have dentures that may loosen or obstruct the airway. If dentures are not obstructing the airway, leave them in place for what? bag mask ventilation, as it improves mask fitting. When preforming rapid sequence intubation, the dose of benzos, barbiturates, and other sedatives should be reduced to what percentage to minimize the risk of cardiovascular depression? 20-40% Functional changes in cardiac system include declining function, decreased sensitivity to catecholamines, atherosclerosis of coronary vessels, increased afterload, fixed heart rate (beta blockers) this results in lack of classic response to hypovolemia, risk for cardiac ischemia, elevated BP at baseline, and increased risk of dysrythmias. Functional changes in pulmonary system include decreased elastic recoil, reduced residual capacity, decreased gas exchange and decreased cough reflex thus they are at increased risk for respiratory failure, increased risk for pneumonia, and poor tolerance to rib fractures Functional changes in renal system include loss of renal mass, decreased GFR, and decreased sensitivity to ADH and aldosterone resulting in drug dosing for renal insufficiency, decreased ability to concentrate urine, increased risk for AKI and urine flow may be normal with hypovolemia Functional changes to MSK include loss of lean body mass, osteoporosis, changes in joints and cartilage, c spine degenerative changes and loss of skin elastin and subcutaneous fat resulting in increased risk for fractures, decreased mobility, difficulty for oral intubation, risk of skin injury, increased risk for hypothermia, challenges in rehabiliation Functional changes in Endocrine system include decreased production and response to thyroxin and decreased dehydroepiandrosterone (DHEA) resulting in occult hypothyroidism, relative hypercortisone states and increased risk of infection True or false: Arthritis can complicate the airway and cervical spine. Patients can have multilevel degenerative changes affecting disk spaces and posterior elements associated with severe central canal stenosis, cord compression, and myelomalacia true In elderly population, due to their changes in pulmonary system, placing a gauze between gums and cheek to achieve seal when using bag valve mask ventilation is okay. In addition, because aging causes a suppressed heart rate response to hypoxia...... respiratory failure may present insidiously in older adults. Age related changes in the cardiovascular system place the elderly trauma patient at significant risk for being inaccurately categorized as hemodynamically stable. Elderly patients have a fixed heart rate and fixed cardiac output, thus, their response to hypovolemia will involve increasing their systemic vascular resistance. Furthermore, since older patients have HTN, an acceptable BP may truly reflect a hypotensive state. A systolic BP of 110 is to be utilized as the threshold for identifying hypotension in patients 65 and older. Do no equate blood pressure with shock in older patients BP in older patients may look normal due to the medications they are on. Use lactate and base deficit to evaluate for evidence of shock what 2 factors place elderly patients at risk for intracranial hemorrhage? aging causes dura to become more adherent to the skull increasing risk of injury and older patients are on anticoagulant and antiplatelet medications. Loss of subcutaneous fat, nutritional deficiencies, chronic medical conditions place elderly patients as risk for hypothermia and complications for immobility. Rapid evaluation and when possible early liberation from spine boards and cervical collars will minimize complications. True or False: Fall prevention is the mainstay of reducing the mortality associated with pelvic fractures. true poor hygiene, dehydration, oral injury, contusions affecting the inner arms, inner thighs, palms, soles, scalp, ear, nasal bridge and temple injury from being struck while wearing glasses, contact burns and scalds. These are all signs of.......? Elder maltreatment. The presence of physical findings of maltreatment should prompt a detailed history. if history conflicts with findings, immediately report findings to authorities. True of false: early activation of the trauma team may be required for elderly patients who do not meet traditional criteria for activation True. A simple injury such as an open tibia fracture in a frail elderly patient may become life threatening. Common mechanisms of injury include falls, MVC, burns, and penetrating injuries common injuries in the elderly include rib fractures, TBI, pelvic fractures The best initial treatment for the fetus is to provide optimal resuscitation of the mother. True or False? True. Also if xray examination is indicated during the pregnant patient's treatment, it should not be withheld because of the pregnancy. What happens as the uterus enlarged and the bowel is pushed cephalad. When the uterus enlarges it pushes the bowel cephalad and the uterus lies in the upper abdomen. As a result, the bowel is somewhat protected from blunt abdominal trauma, whereas the uterus and its contents (fetus and placenta) become more vulnerable. Uterus remains intrapelvic until 12 weeks and then at 20 weeks it is at the umbilicus, and at 34-36 weeks it reaches the costal margin. Amniotic fluid can cause amniotic fluid embolism and disseminated intravascular coagulation following trauma if fluid enters maternal intravascular space. True or False True By the third trimester, what is the complication of trauma to the pelvis of the mother? by the third trimester, the uterus is large and thin walled. In vertex presentation, fetal head is usually in the pelvis and the remainder of the fetus is exposed above the pelvic brim. Pelvic fractures in late gestation can result in skull fracture or intracranial injury to the fetus. Also we can have a placental abruption due to its little elasticity and vulnerability to sheer forces. An abrupt decrease in maternal intravascular volume can result in a profound increase in uterine vascular resistance reducing fetal oxygenation despite reasonably normal maternal vital signs. this is true Physiological anemia of pregnancy A smaller increase in red blood cell volume can occur resulting in a decreased hematocrit level. Thus, in late pregnancy a hematocrit of 31-33% is normal. Healthy pregnancy patients can lose 1200-1500 mL of blood before exhibiting signs and symptoms of hypovolemia. How can this manifest? this amount of hemorrhage may be reflected by fetal distress as evidenced by an abnormal fetal heart rate. [Show Less]
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ATLS Pretest questions and answers with graded solutions.Graded A+
A 22-year-old man is hypotensive and tachycardic after a shotgun wound to the left shoulder. His blood pressure is initially 80/40 mm Hg. After initial flu... [Show More] id resuscitation his blood pressure increases to 122/84 mm Hg. His heart rate is now 100 beats per minute and his respiratory rate is 28 breaths per minute. A tube thoracostomy is performed for decreased left chest breath sounds with the return of a small amount of blood and no air leak. After chest tube insertion, the most appropriate next step is: re-examine the chest A construction worker falls two stories from a building and sustains bilateral calcaneal fractures. In the emergency department, he is alert, vital signs are normal, and he is complaining of severe pain in both heels and his lower back. Lower extremity pulses are strong and there is no other deformity. The suspected diagnosis is most likely to be confirmed by: complete spine x-ray series Which of the following is true regarding the initial resuscitation of a trauma patient? Evidence of improved perfusion after fluid resuscitation could include improvement in Glasgow Coma Scale score on reevaluation. In managing a patient with a severe traumatic brain injury, the most important initial step is to: secure the airway A previously healthy, 70-kg (154-pound) man suffers an estimated acute blood loss of 2 liters. Which one of the following statements applies to this patient? An ABG would demonstrate a base deficit between -6 and -10 mEq/L. The physiological hypervolemia of pregnancy has clinical significance in the management of the severely injured, gravid woman by: increasing the volume of blood loss to produce maternal hypotension The best assessment of fluid resuscitation of the adult burn patient is: urinary output of 0.5 mL/kg/hr The diagnosis of shock must include: evidence of inadequate organ perfusion A 7-year-old boy is brought to the emergency department by his parents several minutes after he fell through a window. He is bleeding profusely from a 6-cm wound of his medial right thigh. Immediate management of the wound should consist of: direct pressure on the wound For the patient with severe traumatic brain injury, profound hypocarbia should be avoided to prevent: cerebral vasoconstriction with diminished perfusion After being involved in a motor vehicle crash, a 25-year-old man is brought to a hospital that has surgery capabilities available.. Computed tomography of the chest and abdomen shows an aortic injury and splenic laceration with free abdominal fluid. His blood pressure falls to 70 mm Hg after CT. The next step is: perform an exploratory laparotomy Which one of the following statements regarding abdominal trauma in the pregnant patient is TRUE? Leakage of amniotic fluid is an indication for hospital admission. The first maneuver to improve oxygenation after chest injury is: administer supplemental oxygen A 25-year-old man, injured in a motor vehicular crash, is admitted to the emergency department. His pupils react sluggishly and his eyes open to pressure. He does not follow commands, but he does moan periodically. His right arm is deformed and does not respond to pressure; however, his left hand reaches purposefully toward the stimulus. Both legs are stiffly extended. His GCS score is: 9 A 20-year-old woman who is at 32 weeks gestation, is stabbed in the upper right chest. In the emergency department, her blood pressure is 80/60 mm Hg. She is gasping for breath, extremely anxious, and yelling for help. Breath sounds are diminished in the right chest. The most appropriate first step is to: perform needle or finger decompression of the right chest Which one of the following findings in an adult is most likely to require immediate management during the primary survey? respiratory rate of 40 breaths per minute The most important, immediate step in the management of an open pneumothorax is: placement of an occlusive dressing over the wound The following are contraindications for tetanus toxoid administration: history of neurological reaction or severe hypersensitivity to the product A 56-year-old man is thrown violently against the steering wheel of his truck during a motor vehicle crash. On arrival in the emergency department he is diaphoretic and complaining of chest pain. His blood pressure is 60/40 mm Hg and his respiratory rate is 40 breaths per minute. Which of the following best differentiates cardiac tamponade from tension pneumothorax as the cause of his hypotension? breath sounds Bronchial intubation of the right or left mainstem bronchus can easily occur during infant endotracheal intubation because: The trachea is relatively short. A 23-year-old man sustains 4 stab wounds to the upper right chest during an altercation and is brought by ambulance to a hospital that has full surgical capabilities. His wounds are all above the nipple. He is endotracheally intubated, closed tube thoracostomy is performed, fluid resuscitation is initiated through 2 large-caliber IVs. FAST exam does not reveal intraabdominal injuries. His blood pressure now is 60/0 mm Hg, heart rate is 160 beats per minute, and respiratory rate is 14 breaths per minute (ventilated with 100% O2). 1500 mL of blood has drained from the right chest. The most appropriate next step in managing this patient is to: urgently transfer the patient to the operating room A 39-year-old man is admitted to the emergency department after an automobile collision. He is cyanotic, has insufficient respiratory effort, and has a GCS score of 6. His full beard makes it difficult to fit the oxygen facemask to his face. The most appropriate next step is to: restrict cervical motion and attempt orotracheal intubation using 2 people A patient is brought to the emergency department after a motor vehicle crash. He is conscious and there is no obvious external trauma. He arrives at the hospital completely immobilized on a long spine board. His blood pressure is 60/40 mm Hg and his heart rate is 70 beats per minute. His skin is warm. Which one of the following statements is TRUE? Flaccidity of the lower extremities and loss of deep tendon reflexes are expected. Which one of the following is the most effective method for initially treating frostbite? moist heat A 32-year-old man's right leg is trapped beneath his overturned car for nearly 2 hours before he is extricated. On arrival in the emergency department, his right lower extremity is cool, mottled, insensate, and motionless. Despite normal vital signs, pulses cannot be palpated below the right femoral artery and the muscles of the lower extremity are firm and hard. During the management of this patient, which of the following is most likely to improve the chances for limb salvage? surgical consultation for right lower extremity fasciotomy A patient arrives in the emergency department after being beaten about the head and face with a wooden club. He is comatose and has a palpable depressed skull fracture. His face is swollen and ecchymotic. He has gurgling respirations and vomitus on his face and clothing. The most appropriate step after providing supplemental oxygen and elevating his jaw is to: suction the oropharynx A 22-year-old man sustains a gunshot wound to the left chest and is transported to a small community hospital no surgical capabilities are available. In the emergency department, a chest tube is inserted and 700 mL of blood is evacuated. The trauma center accepts the patient in transfer. Just before the patient is placed in the ambulance for transfer, his blood pressure decreases to 80/68 mm Hg and his heart rate increases to 136 beats per minute. The next step should be to: repeat the primary survey and proceed with transfer A 64-year-old man involved in a high-speed car crash, is resuscitated initially in a small hospital without surgical capabilities. He has a closed head injury with a GCS score of 13. He has a widened mediastinum on chest x-ray with fractures of left ribs 2 through 4, but no pneumothorax. After initiating fluid resuscitation, his blood pressure is 110/74 mm Hg, heart rate is 100 beats per minute, and respiratory rate is 18 breaths per minute. He has gross hematuria and a pelvic fracture. You decide to transfer this patient to a facility capable of providing a higher level of care. The facility is 128 km (80 miles) away. Before transfer, you should first: call the receiving hospital and speak to the surgeon on call [Show Less]
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ATLS Test 1 questions and answers with complete top solutions.Latest 2023
A 22-year-old man is hypotensive and tachycardic after a shotgun wound to the left shoulder. His blood pressure is initially 80/40 mm Hg. After initial flu... [Show More] id resuscitation his blood pressure increases to 122/84 mm Hg. His heart rate is now 100 beats per minute and his respiratory rate is 28 breaths per minute. A tube thoracostomy is performed for decreased left chest breath sounds with the return of a small amount of blood and no air leak. After chest tube insertion, the most appropriate next step is: Select one: a. reexamine the chest b. perform an aortogram c. obtain a CT scan of the chest d. obtain arterial blood gas analyses e. perform transesophageal echocardiography A) Reexamine the chest A construction worker falls two stories from a building and sustains bilateral calcaneal fractures. In the emergency department, he is alert, vital signs are normal, and he is complaining of severe pain in both heels and his lower back. Lower extremity pulses are strong and there is no other deformity. The suspected diagnosis is most likely to be confirmed by: Select one: a. angiography b. compartment pressures c. retrograde urethrogram d. Doppler ultrasound studies e. complete spine x-ray series e) Complete spine x-ray series Which of the following is true regarding the initial resuscitation of a trauma patient? Select one: a. A patient that presents with a torso gunshot wound and is hypotensive should receive crystalloid fluid resuscitation until the blood pressure is normal b. Evidence of improved perfusion after fluid resuscitation could include improvement in Glasgow coma scale score on reevaluation c. Massive transfusion is defined as transfusion of more than >10 of packed red blood cells and plasma in 24 hours d. When tranexamic acid is administered by pre-hospital providers a second dose is required within 24 hours e. Fluid resuscitation is far more important than bleeding control in trauma patients b. Evidence of improved perfusion after fluid resuscitation could include improvement in Glasgow coma scale score on reevaluation In managing a patient with a severe traumatic brain injury, the most important initial step is to: Select one: a. Secure the airway b. obtain a c-spine film c. support the circulation d. control scalp hemorrhage e. determine the GCS score Feedback Your answer is corr a. Secure the airway A previously healthy, 70-kg (154-pound) man suffers an estimated acute blood loss of 2 liters. Which one of the following statements applies to this patient? Select one: a. His pulse pressure will be widened. b. His urinary output will be at the lower limits of normal. c. He will have tachycardia, but no change in his systolic blood pressure. d. An ABG would demonstrate a base deficit between -6 and -10 mEq/L e. His systolic blood pressure will be maintained with an elevated diastolic pressure. d. An ABG would demonstrate a base deficit between -6 and -10 mEq/L The physiologic hypervolemia of pregnancy has clinical significance in the management of the severely injured, gravid woman by: Select one: a. reducing the need for blood transfusion b. resulting in an elevated hematocrit c. complicating the management of closed head injury d. reducing the volume of crystalloid required for resuscitation e. increasing the volume of blood loss to produce maternal hypotension e. increasing the volume of blood loss to produce maternal hypotension The best assessment of fluid resuscitation of the adult burn patient is: Select one: a. Urine output of 0.5 mL/kg/hr b. normalization of blood pressure c. normalization of the heart rate d. measuring a normal central venous pressure e. providing 4 mL/kg/percent body burn/24 hours of crystalloid fluid a. Urine output of 0.5 mL/kg/hr The diagnosis of shock must include: Select one: a. hypoxemia b. acidosis c. hypotension d. increased vascular resistance e. evidence of inadequate organ perfusion e. evidence of inadequate organ perfusion A 7-year-old boy is brought to the emergency department by his parents several minutes after he fell through a window. He is bleeding profusely from a 6-cm wound of his medial right thigh. Immediate management of the wound should consist of: Select one: a. application of a tourniquet b. direct pressure on the wound c. packing the wound with gauze d. direct pressure on the femoral artery at the groin e. debridement of devitalized tissue b. direct pressure on the wound For the patient with severe traumatic brain injury, profound hypocarbia should be avoided to prevent: Select one: a. respiratory acidosis b. metabolic acidosis c. cerebral vasoconstriction with diminished perfusion d. neurogenic pulmonary edema e. shift of the oxyhemoglobin dissociation curve c. cerebral vasoconstriction with diminished perfusion After being involved in a motor vehicle crash, a 25-year-old man is brought to a hospital that has surgery capabilities available.. Computed tomography of the chest and abdomen shows an aortic injury and splenic laceration with free abdominal fluid. His blood pressure falls to 70 mm Hg after CT. The next step is: Select one: a. obtain contrast angiography b. transfer to a higher level trauma center c. perform an exploratory laparotomy d. infuse additional crystalloid fluids e. Obtain transesophageal echocardiography c. perform an exploratory laparotomy Which one of the following statements regarding abdominal trauma in the pregnant patient is TRUE? Select one: a. The fetus is in jeopardy only with major maternal abdominal trauma. b. Leakage of amniotic fluid is an indication for hospital admission. c. Indications for peritoneal lavage are different from those in the nonpregnant patient. d. With penetrating trauma, injury to the mother's abdominal hollow viscus is more common in late than in early pregnancy. e. The secondary survey follows a different pattern from that of the nonpregnant patient. b. Leakage of amniotic fluid is an indication for hospital admission. 00:11 01:29 The first maneuver to improve oxygenation after chest injury is to: Select one: a. intubate the patient b. assess arterial blood gases c. administer supplemental oxygen d. ascertain the need for a chest tube e. obtain a chest x-ray c. administer supplemental oxygen A 25-year-old man, injured in a motor vehicular crash, is admitted to the emergency department. His pupils react sluggishly and his eyes open to pressure. He does not follow commands, but he does moan periodically. His right arm is deformed and does not respond to pressure; however, his left hand reaches purposefully toward the stimulus. Both legs are stiffly extended. His GCS score is: Select one: a: 2 b: 4 c: 6 d: 9 e: 12 d: 9 Which one of the following findings in an adult is most likely to require immediate management during the primary survey? Select one: a. distended abdomen b. Glasgow Coma Scale score of 11 c. temperature of 36.5°C (97.8°F) d. deformity of the right thigh e. respiratory rate of 40 breaths per minute e. respiratory rate of 40 breaths per minute [Show Less]
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ATLS practice questions and answers rated A solutions
Assessed first in trauma patient Airway (*)Degree of burn that is characterized by bone involvement Fourth Complications of head trauma In... [Show More] tracerebral hematoma Extradural hematoma Brain abscess Most common cause of laryngotracheal stenosis Trauma Intervention that can help prevent development of acute renal failure Infusion of normal saline A 26-year-old male is resuscitated with blood transfusion after a motor vehicle collision that was complicated by a fractured pelvis. A few hours later, the patient becomes febrile, hypotensive with a normal CVP, and oliguric. Upon examination, the patient is found to be bleeding from the NG tube and IV sites. Which of the following is the most likely diagnosis? A. Hemorrhagic shock B. Acute adrenal insufficiency C. Fat embolism syndrome D. Transfusion reaction D. Transfusion reaction Skin antiseptic -Ethanol 70% is an effective skin antiseptic -Acetic acid can be used to treat Gram- skin infections -Salicylic acid is used to treat certain skin yeast infections Class IV hemorrhage indicates what % blood loss 55% How does shivering affect body temperature Increases body temperature Class III hemorrhage indicates what % of blood loss 35% Management of a stable patient with kidney contusion Observation Associated with hypovolemic shock -Inadequate tissue perfusion with resultant tissue hypoxia -Blood shunting to vital organs -Decreased circulating blood volume and decreased venous return -Low cardiac output -Loss of less than 20% of the blood volume is usually without symptom except for mild tachycardia -Patients become orthostatic with losses between 20 and 40% -Shock is evidenced by tachycardia, hypotension, oliguria, flat neck veins The most effective method of monitoring the success of resuscitation during CPR? Reactivity of pupils to light Used to ensure correct placement of endotracheal tube -Ultrasound -Bilateral breath sounds -Sustained end-tidal CO2 Total body surface area involved in a burn in an adult to the anterior chest and abdomen 18% What is often caused by carotid massage? Bradycardia Step in a patient diagnosed with tension pneumothorax 1. Needle decompression/ thoracotomy 2. Chest tube True statements regarding diaphragmatic injuries -Blunt diaphragmatic injuries are usually associated with skeletal trauma -Penetrating diaphragmatic injuries may be missed -Repair of traumatic diaphragmatic injuries usually does not require prosthetic material First priority in the treatment of an unconscious patient Checking the pulse A patient involved in a road accident is brought to the emergency department in an unconscious state. On arrival, her vitals show a temperature of 96.4 degrees Fahrenheit, a respiration rate of 24 breaths per minute, a heart rate of 140 beats per minute, and a blood pressure of 80/40 mm Hg. She is cold, shivering, and perspiring profusely. She has bilateral reactive pupils but she does not respond to pain. On physical examination, she has no obvious sign of external bleeding. Which of the following cannot be the cause of hypotension in this patient? A. Pelvic fracture B. Fracture of femur C. Intracranial hemorrhage D. Hemothorax C. Intracranial hemorrhage A patient suffered a slash to his right neck. The wound is over the mid-portion of the sternocleidomastoid. There is a large hematoma and brisk bleeding when uncovered. He is stable. What is the next step in management? A. Get an angiogram B. Close the wound in the ER C. Take him to the operating room D. CT scan to evaluate neck structure C. Take him to the OR After abdominal injury, which of the following urinalysis findings would be an indication for further testing? A. 0-5 casts/HPF B. 5-10 WBC/HPF C. 10-20 RBC/HPF D. Gross hematuria D. Gross hematuria A laceration of the neck superficial to the deep cervical fascia along the sternocleidomastoid muscle at its midpoint would cause bleeding from which structure? External jugular vein Clinical features associated with tension pneumothorax Unilateral decrease in breath sounds Hyperresonance Respiratory distress Tachycardia Tracheal shift Desatruation Decreased breath sounds Decreased compliance Asymmetric chest movement NOT hypertension, audible bronchial sounds Not recommended as a mode of ventilation for a patient with a diaphragmatic hernia A. Bag and mask B. LMA C. Endotracheal intubation D. Jet ventilation A. Bag and mask What is the next step in the assessment of a traumatic patient after airway is established? Breathing Blood group that is considered a universal donor O A provider is examining a patient who sustained a severe traumatic head injury. He documents no Doll's eyes. What does this signify? Brainstem injury Which of the following is the least preferred method of administering IV fluids? A. Cubital veins B. Cephalic veins C. Subclavian veins D. Saphenous vein Subclavian veins Dermatome level for nipple sensation Dermatome level for umbilicus T4 T10 At which temperature would a hypothermic patient stop shivering? 88 degrees F What is the energy recommendation for the first defibrillation in an adult (*) 300 J Pharmacologic effects of Morphine Behavioral changes Analgesia Respiratory depression NOT diarrhea A patient with which condition should be triaged to receive medical attention first? A. Choking B. Dizziness C. Leg cramp D. Vomiting A. Choking For pediatric patients, what volume of fluid resuscitation should be given initially in the setting of shock? A. 750 mL of saline uniformly B. 1 liter of saline C. 20 mL/kg of 0.45% NaCl with 5% glucose D. 10 to 20 mL/kg of Ringers lactate D. 10 to 20 mL/kg of Ringers lactate A patient is found unconscious after a fire in his bedroom. He is found to have severe burns around his face. What is the first aspect of treatment? A. Tetanus toxoid B. Cover the wound C. Airway D. Obtain blood work C. Airway Basilar skull fracture PE: raccoon eyes, battle sign, CSF ottorrhea (rhinorrhea), loculated pneumoencephalocele Bone MC involved = Temporal A patient with von Willebrand disease is bleeding after sustaining a knife wound. Which of the following is most appropriate for the treatment of this patient? A. Vitamin K B. Cryoprecipitate C. Protamine D. DDAVP D. DDAVP What is the total body surface area involved in a burn to both lower extremities? 36% Which injury is most common in rear end motor vehicle accidents? A. Cervical fractures B. Hypextension-hyperflexion neck injuries C. Forearm fractures D. Rotational neck injuries B. Hypextension-hyperflexion neck injuries What is true about an unrestrained pregnant driver? A. She is at increased risk of placenta previa B. She is at increased risk of placental abruption C. At 33 weeks, her fetus is well protected by an amniotic fluid cushion and thus the pregnancy is not at risk D. If the mother's vital signs are stable, complications are unlikely B. She is at increased risk of placental abruption In adults, an aspirated foreign body is most likely to get stuck in the: A. Left main bronchus B. Carina C. Right main bronchus D. Esophagus C. Right main bronchus Skin finding characteristic of second-degree burns Blisters [Show Less]
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ATLS Written Review Questions and answers with verified content.A+ test
What is the primary goal of treating TBI? How is this done? preventing secondary brain injury. This is done by maintaining blood pressure and providing ad... [Show More] equate profusion. After managing ABCDEs of TBI what MUST be identified if present? How is this done? 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: 1. anterior fossa: 2. middle fossa: 3. posterior fossa: 1. anterior fossa: frontal lobes 2. middle fossa: temporal lobes 3. posterior fossa: lower brainstem and cerebellum What are the 3 layers of the meninges? dura mater, arachnoid mater, pia mater What does the dura mater adhere firmly to? the skull. it is tough and fibrous What layer of the meninges splits into two leaves as specific sites to enclose large venous sinuses? What do these sinuses do? 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? 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)? meningeal arteries. What is the most commonly injured meningeal artery and where is it located? middle meningeal artery. Located over the temporal fossa T/F: the arachnoid mater is fused to the dura mater? FALSE: not attached. This produces a potential space for a subdural hematoma In a subdural hematoma, what is the cause? injury to bridging veins that extend from brain surface to the sinuses within the dura. _______ fills the space between the arachnoid and pia mater? 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? subarachnoid. The ____ and _____ contain the reticular activating system which is responsible for ____. midbrain and upper pons state of alertness What important function resides in the medulla? cardiorespiratory centers. What important functions are in the following brain segments: 1. left hemisphere: 2. frontal lobe: 3. parietal lobe: 4. temporal: 1. left hemisphere: language center 2. frontal lobe: executive function, emotions, motor 3. parietal lobe: sensory function/spatial orientation 4. temporal: memory functions What divides the brain into supratentorial and infratentorial compartments? tentorium cerebelli. (tent over cerebellum) What is the physiology behind a blown pupil? blown pupil: dilation of pupil -CN III runs along the tentorium cerebelli. parasympathetic fibers that constrict the pupil run along CN III (oculomotor). When temporal lobe is herniated, it can compress these fibers. Unapposed sympathetic activity causes pupillary dilation. What is the tentorial notch/hiatus this is where the midbrain passes through into the infratentorial compartment. what part of the brain most commonly herniates through the tentorial notch? Uncus (medial part of temporal lobe) does weakness occur on the same or opposite side of the uncal herniation? 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. ipsi contra average ICP is _____ mmHg. 10 The monro-kellie doctrine states that the total volume of intracranial contents must remain constant, because the cranium is ___ a rigid, non expandable container. The monro-kellie doctrine states that _____ and _____ may be compressed out of the skull providing a degree of buffering. 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)? CPP=MAP-ICP in TBI, Every effort should be made to reduce ______, while normalizing ____, ___, and _____. ICP MAP, oxygenation, intravascular volume What GCS ranges for the following classes: 1. Minor 2. Moderate 3. Severe 1. 13-15 2. 9-12 3. 3-8 What nerve palsy may occur with basilar skull fracture? seventh nerve. A GCS of ___ is accepted definition of coma? 8 or less How do you assess a GCS of someone with asymmetric responses? Use the best possible because this will be the best predictor of outcome Basilar fractures of the skull usually require what type of imaging? this requires CT with bone-window setting. What are the typical clinical signs of basilar skull fractures? 1.periorbital ecchymosis (raccoon eyes) 2. retroauriculor ecchymosis (battle sign) 3. CSF leak from nose or ears 4. 7th or 8th CN dysfunction (facial paralysis and hearing loss) What should be a primary consideration for any patient with a skull fracture, especially a linear skull fracture? hematoma. linear skull fracture increases likelihood of intracranial hematoma by about 400x What mechanism is common with diffuse axonal injury and what is the likely outcome? these injury often occur with high velocity or deceleration injures. They appear as diffuse cerebral hemorrhage often between grey and white matter. These are associated with variable but often poor outcomes. Epidural hematomas often occur in the _____ area of the skull and result from a tear of the _______ arteries. temporal middle meningeal artery What is the classic presentation of a epidural hematoma? a lucid interval between time of injury and neurologic a deterioration. What are more common brain injury: epidural or subdural? subdural 30% epidural 0.5% Subdural hematoma occur from tear of _________. bridging vessels of the cerebral cortex Contusion occur in ___% of TBI. They often occur in _____ or ______ lobes of brain. They may coalesce to form ______ in as many as 20$%. 20-30% frontal or temporal intracerebral hematoma. What is the imaging protocol for a patient with cerebral contusion? 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? 1. suspected open skull frac 2. basilar frac 3. >2 episode vomitting 4. pt older than 65 5. LOC >5 min 6. amnesia before impact of >30 min How long after discharge should patient with mild brain injury be observed by friend? 24 hours What type of brain injury requires serial GCS? ALL. minor. moderate. major What imaging is done in all patient with moderate brain injury? CT What factor of ABCDE must be monitored closely in moderate brain injury? 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? CT. REMEMBER: CT should never delay patient transfer When assessing ABCDE of severe brain injury, when does DPL or FAST come before neuro exam? 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? hypotension. This may also occur in terminal brain injury with medullary failure What needs to be cleared before Doll's eye testing is conducted? cervical spine must cleared. What tests should be performed before sedation? 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 5mm What type of fluids should be used? hypertonic (ringers lactate or normal saline). NO GLUCOSE. [Show Less]
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ATLS questions and answers rated A solutiuons.Latest 2023
A 23-year-old man is brought immediately to the ED from the hospitals parking lot where he was shot in the lower abdomen. Examination reveals a single bull... [Show More] et wound. He is breathing and has a thready pulse. However, he is unconsious and has no detectable blood pressure. Optimale immediate management is to: A. Perform a FAST B. Initiate infusion of packed red blood cells C. Insert a nasogastric tube and urinary catheter D. Transfer the patient to the operating room, while initiating fluid therapy E. Initiate fluid therapy to return his blood pressure to normotensive D. Transfer the patient to the operating room, while initiating fluid therapy A 22 year old male present following a motorcycle crash. He complains of the inability to move his legs. His BP is 80/50, HR 70, RR 18 and GCS 15. Oxygen saturation is 99% on 21 nasal prongs. Chest x-ray, pelvic x-ray and FAST are normal. Extremities are normal. His management should be: A: 1L of iv . crystalloid and two units of pRBCs B. 1L of iv. crystalloid, mannitol and iv steroids C. 1 unit of albumin and compression stockings D. Vasopressors and laparotomy E. 1 L of cystalloid and vasopressors if blood pressure does not respond E. 1 L of cystalloid and vasopressors if blood pressure does not respond Which of the following is MOST RELIABLE to confirm endotracheal intubation? a. presence of breath sounds bilaterally b. absence of borborygmi in the epigatrium on ascultation c. presence of CO2 in exhaled air via capnography d. appearance of fog in the endotracheal tube e. chest xray with endotracheal tube tip appearing above the carina e. chest xray with endotracheal tube tip appearing above the carina A 6 month old infant, being held in her mothers arms, is ejected on impact from a vehicle that is struck head on by an oncoming car traveling at 64kph. The infant arrives in the ED with multiple facial injuries, is lethargic, and is in severe respiratoy distress. Respiratory support is not effective using a bag mask device, and her oxygen saturation is falling. Repeated attempts at orotracheal intubation are unsuccessful. the most appropriate procedure to perform next is: A.Administer heliox and racemic epinephrine B. Perform nasotracheal intubation C.Perform surgical cricothyroidotomy D.Repeat orotracheal intubation E. Perform needle cricothyroidotomy with jet insufflation E. Perform needle cricothyroidotomy with jet insufflation A 28 year olf male is brought to the ED. He was involved in a fight, during which he was beaten with a wooden stick. His chest shows multiple severe bruises. His arway is clear, resp rate is 22, hear rate 126, and systolic blood pressure is 90 mmHG. Which of the following should be performed during the primary survey a. glasgow coma b. tetanus status c. cervical spine xray d. blood alcohol level e. rectal exam a. glasgow coma an 18yo male is brought to the emergency department after being dumped by a large wave while surfing. He landed head first on the firm beach sand. His vital signs are blood pressure 85/60 mmHg, heart rate 60, and respiratory rate 18; he is unable to move his lower extremities. He appears calm and asks if he will ever walk again. The most appropriate next step is to: a. reassure patient that he will walk again b. proceed to a more detailed neuro exam c. obtain c spin xrays d. begin infusion of vasopressors e. begin bolus of warm IV crystalloid e. begin bolus of warm IV crystalloid Whic one of the following statements is true regarding access in pediatric resuscitation? a. intraosseous access should be considered only after 5 percutaneous attempts b. cutdown at teh ankle is the preferred initial access technique c. internal jugular cannulation is the next preferred option when percutaneous venous access fails d. intraosseous cannulation should be the first choice e. blood transfusion can be delivered through intraosseous access e. blood transfusion can be delivered through intraosseous access a 35 year old female ustains multiple linjuries in a MVA and is transported to a small hospital. She has a GCS of V2E2M2. Spinal motion restrictions are in place. ET is performed, IV and wamred fluids are administered. She remains hemodynamically normal, and preparations are made to transfer to another facility for definitive neuro care. Which of the following tests or treatment should occur before transport? a. ct abdomen and chest b. chest xray c. lateral cervical spine xray d. admin of methlyprednisolone e. transfusion of 2 units packed RBCs b. chest xray A 22 year old male sustains a shotgun wound to the left shoulder and chest at close range. His BP is 80/40mmHg and his HR is 130bpm. Fluid resusciation is initiated, his BP increases to 122/84, and HR decreases to 100bpm. He is tachypneic with RR of 28. On physical examination, his breath sounds are decreased at the left upper chest with dullness on percussion. A tube thoracostomy is inserted in the fifth intercostal space with the return of 200ml of blood and no air leak. The most appropriate next step is to: a. measure blood pressure again b. begin transfuse O negative blood c. wait until the chest xray is completed d. obtain a CT scan of the chest and abdomen e. repeat the physical exam of the chest e. repeat the physical exam of the chest A 22 yo male is brought to the ED after being assaulted in a bar. On intial exam, his vital signs are normal and his Glasgow Coma scale is V5E4M6. A definite indication for a head CT is a. prescence of hemotympanum b. complains of headache c. prescense of 10cm scapl laceration d. prescence of mandibular fracture e. history of assault a. prescence of hemotympanum a 23 yo construction worker is brought to the ED after falling more than 9 meters from scaffolding. He is reported to have landed on his feet and then been unable to bear weight. His vital signs are heart 140, blood pressure 96/60 mmHg, resp rate 36. He is complaining of lower abdbominal and lower limb pain, and has obvious deformity of both lower legs with bilateral open tibial fractures. WHich one of the following statements concerning this patient is true? a. pelvic injury can be ruled out, based on the MOI b. blood loss from the lower limbs is the most likely cause of his tachycardia c. xrays of the patient chest and pevlic are important adjuncts in the inital assessment d. spinal cord injury is the most likely cause of hypotension e. aortic injury is likely c. xrays of the patient chest and pevlic are important adjuncts in the inital assessment 25 yo female in the third trimester of preganacy is brought to the ED following a high speed MVA. She is conscious, and her vital signs are RR 16, HR 120, BP 70/50. The laboratory results show a PaCO2 of 50mmHg/5.3kPa (normal range 35-45). Which one of the following statments concerning this patient is true? a. fetal assessment should take priority b. logrolling the patient to the right will decompress the vena cava c. Rh immuno therapy sshould be immediately adminstered d. normal PaCO2 is concerning for impending RR e. vasopressors should be given to the patient d. normal PaCO2 is concerning for impending RR 00:10 01:29 a 30 year old male is stabbed in the right chest. on arrival in the ED he is very short of breath. His heart rate is 120, and blood pressure is 80/50 mmHg. His neck veins are flat. On auscultation of the chest, there is diminished air entry on the right side and on percussion there is dullness posteriorly. These findings are most consistent with a. tension pneumothorax b. pericardial tamponade c. hypovolemia from liver injury d. massive hemothorax e. spinal cord injury d. massive hemothorax which one of the following is true regarding burns? a. alkali chemica burns should be neutralized with a dilute acid rather than irrigated with warm water b. patients who sustain thermal burns are at a lower risk for hypothermia c. initial treatment of partial thickness thermal burns should include antibiotic cream and cold compress d. an electrical burn with only a small external injury associated with a clenched hand indicates deep ST injury e. The parkland formula should be used to determine adequacy of resuscitation d. an electrical burn with only a small external injury associated with a clenched hand indicates deep ST injury A 15 year old is brought to the ED after being involved in a MVA. He was intubated by emergency medical personnal with subsequent bilateral breath sounds per their report. Upon arrival to the ED the patients O2 saat is 92%, heart 96, and blood pressure 150/85. Breath sounds are decreased in the left side of the thorax. The next step is a. immediate needle cricothyroidotomy b. immediate needle thoracentesis c. chest tube insertion d. reassess the position of the endotracheal tube e. obtain a chest CT d. reassess the position of the endotracheal tube Which one of the following statements is true regrading patients with severe traumatic brain injuries a. Dextrose is the IV fluid of choice b. prescence of hypoxia and hypotension significantly increase the risk of mortality c. Benzodiazepines are the medications of choice for sedation d. In a unresponsive patient, mannitol should be the first line therapy to treat increased ICP b. prescence of hypoxia and hypotension significantly increase the risk of mortality The first priority in the management of a long bone fracture is a. reduction of pain b. prevention of infection in cause of open fracture c. prevention of further ST injury d. reduction of blood loss e. improvement of long term function d. reduction of blood loss a 40 yo obese patient with a GCD of V2E2M4 requires a CT scan. Before transfer to the scanner, you should a. give more sedative drugs b. insert a multi lumen esophageal airway c. obtain a definitive airway d. request cervical spine film e. insert a NG tube c. obtain a definitive airway Which of the following patient require imaging.....? a. 28 yo who fell from a 3 meter balcony and sustained a fracture. The patient does not have spine pain, motor or sensory deficits and has an otherwise normal PE. b. 40 yo patient who sustained a severe closed head injury and has a GCS of 8 V2M3E3 c. 6month old who fell from the couch to the carpted floor and has a GCS of 15 d. 10 yo who was hit in the head with a bat and has a right frontal hematoma without history of LOC and does not have neck pain or tenderness e. 30 yp man who after a MVA, briefly LOC but was ambulating at teh scene and does not have neck or back pain b. 40 yo patient who sustained a severe closed head injury and has a GCS of 8 V2M3E3 A 30 year old male is brought toe the hospital after falling 6 meters. Inspection reveals an obvious flail chest on the right. Breath sounds on the right are slightly increased. Twelve hours later, the patient is in severe respiratory distress. Arterial blood gas obtained while the patient recieves oxygen by face mask are: pH of 7,47, PaO2 of 45mmHg (6Kpa), PaCO2 of 28mmHg (3,7 Kpa). The component of injury that most likely responsible for abnormalities in this patients blood gas is: a. pain b. hypovolemia c. PTX d. pulmonary contusion e. chest wall instability c. pulmonary contusion [Show Less]
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EMST / ATLS Ch 7 Spine and Spinal cord 100% accurate answers rated A+
What percentage of pt with spinal injury have at least a mild brain injury at least 25% what percentage of injuries occur in each part of the spine... [Show More] cervical 55%, thoracic 15%, thoracolumbar junction 15%, lumbosacral 15% what do approx 10% of pt with c spine fracture have second non contiguous vertebral column fracture why do at least 5% of pts experience onset of neuro sx after reaching ED ishcaemia, or progression of spinal for oedema, or failure to adequately immobilise. how to exclude spinal injury if pt awake and alert neurologically intact, no pain or tenderness along spine risk of prolonged immobilisation pressure sores (decubitus ulcers) - so come off the spinal board and log roll every two hours components of spinal stability facet joints, interspinous ligaments, paraspinal muscles why do some c spine injury pts die at the scene apnea from loss of phrenic nerve what type are most thoracic fractures wedge compression - not associated with spinal cord injury usually, but fracture dislocation has high chance of complete spinal cord injury three spinal cord tracts that can be clinically assessed corticospinal (posterolateral) - ipsilateral motor power, spinothalamic (anterolateral) - contralateral pain and temperature, posterior columns - proprioception, vibration how to demonstrate sacral sparing sensory perception in perianal area, or voluntary contraction of anal sphincter Key sensory points - C5, C6, C7 C5- area over deltoid. C6 Thumb. C7 Middle finger 00:32 01:29 Key sensory points C8 T4 T8 T10 C8 little finger. T4 Nipple. T8 xiphisterum. T10 umbilicus Key sensory points T12 L4 L5 T12 symphysis pubis. L4 medial aspect of calf. L5 1st-2nd toe webspace Key sensory points S1, S3, S4/5 S1 Lateral border of foot, S3 ischial tuberosity, S4/5 Perianal Key muscles C5 C6 C7 C5 deltoid. C6 Wrist extensors. C7 Elbow extensors Key muscles C8 T1 L2 C8 middle finger flexor, T1 small finger abductors, L2 hip flexors Key muscles L3/4, L4/5/S1, L5, S1 L3/4 - knee extensors. L4/5/S1 - knee flexors. L5 ankle and big toe dorsiflexors. S1 ankle plantar flexors how is muscle strength graded 0 total paralysis. 1 palpable contraction. 2 full ROM but not against gravity. 3 full ROM against gravity. 4 weaker than normal. 5 normal. how to identify neurogenic shock loss of sympathetic pathways - vasomotor done drops, vasodilation, bradycardia. consider vasopressors and atropine once certain what is spinal shock flaccidity and loss of reflexes, seen after spinal cord injury - makes spinal injuries seem worse than they reallya re pitfall of cervical and thoracic spinal injuries may hypoventilate. may not percieve pain from an acute abdomen four characteristics to classify spinal injury level, severity, spinal cord syndrome, morphology further classification of level sensory level (lowest level with normal function) motor level (al least 3/5) - there may be a zone of partial preservation. Bony level and neurologic level also. which injuries result in quadriplegia or paraplegia above T1 - quad. below T1 - para what is central cord syndrome arms weaker than legs with varying sensory loss. often after hyperextension with preexisting cervival canal stenosis. mechanism for central cord syndrome thought to be due to vascular compromise - anterior spinal artery what is anterior cord syndrome paraplegia and dissociated sensory loss with a loss of pain and temperature. posterior column (position and vibration) is preserved what is Brown-Sequard syndrome hemisection of the spinal cord - often after penetrating trauma. ipsilateral motor and porterior column losses, contralateral pain and temperature most common C1 fracture burst fracture (jefferson) - best seen on peg view how many C1 fractures have associated C2 fracture 40% types of C2 fracture 60% involve the peg, Hangman's fracture involves pars interarticularis - 20% most common level of cervical spinal injury in adults C5 fractures, and C5 on C6 subluxation what feature makes neurological injury more likely facet dislocation - unilateral 80% will have neuro injury types of thoracic fracture anterior wedge compression, burst injuries, chance fractures, fracture-dislocation what is a chance fracture transverse fractures through the vertebral body, caused by flexion about an axis anterior to the vertebral column define thoracolumbar junction. who sustains fractures at this level T11-L1. fall from height, restrained drivers with severe flexion energy transfer steps in xray evaluation of c spine lateral AP and peg view. examine films. if normal, remove collar. then obtain flexion and extension views ABCDE of c spine adequacy, alignment, bones, cartilace, dens, extraaxial soft tissues assessment of atlanto occipital joint power's ration >1 - (distance from basion to posterior arch C1)/ (distance from anterior arch of C1 to opisthion) wackenheims line - alignment of posterior clivus to posterior tip of dens things to feel for when palpating spine deformity and/or swelling, grating crepitus, increased pain with palpation, contusion and lacerations and penetrating wounds [Show Less]
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ATLS Module 6: Head Trauma 100% accurate answers.Latest 2023
Distribution of brain injuries in the ED 75% mild 15 moderate 10% severe Primary goal of treatment is what To prevent secondary brain injury (AB... [Show More] CDEs) Neurosurgical consolation table for patients with TBI Box 6-1 Monroe-Kellie Doctrine when one content in the skull increases, another must decrease to compensate and maintain normal ICP Dura mater thick, outermost layer of the meninges surrounding and protecting the brain and spinal cord -Skull fractures lacerate the meningeal arteries, causing hemorrhage in the epidural space. MC= middle meningeal artery. arachnoid mater middle layer of the meninges named for the spider-web-like trabeculae that extend between it and the pia mater Subdural hematoma: veins beneath the surface of brain and venous sinus within dura tear, causing hemorrhage in subdural space. Pia Mater Attached to surface of brain Subarachnoid space: Between arachnoid and pia layers, filled with cerebrospinalfluid. Subarachnoid hemorrhage: Brain contusion and/or injuries to major blood vessels at base of brain cause bleeding into subarachnoid space. Cerebrum parts Right and left hemispheres, including frontal, parietal, temporal, and occipital lobes. Brainstem parts midbrain, pons, medulla, including cardiorespiratory centers Cerebellum connects to spinal cord, brainstem, and cerebral hemispheres. Intracranial cavity is divided into supratentorial and infratentorial compartments. Blown pupil Cranial nerve 3 compression during temporal lobe herniation temporal lobe herniation Uncus Medial part of temporal lobe that herniates through the tentorial notch, causing compression of midbrain and contralateral hemiparesis. ipsilateral pupillary dilation with contralateral hemiparesis classic sign of uncal herniation uncal herniation Medially displaced medial temporal lobe over free margin of tentorium. Focal effacement of ambient cistern and lateral suprasellar cistern. Rarely compresses contralateral cerebral peduncle (Kernohan's notch) against tentorial margin. Normal ICP 10 mmHg Pressures greater than 20 mmHg poor outcomes Cerebral perfusion pressure CPP = MAP - ICP For patients with right/left or upper/lower deficit how to do you calculate GCS use response on better side GCS Eye movement+ Motor involvement+ speech E=M=S epidural hematoma Uncommon a collection of blood in the space between the skull and dura mater Classically arterial Often result from middle meningeal tear from fracture Classic presentation: lucid interval between injury and neurological deficit. Appears lenticular or biconvex on CT Subdural hematoma pertaining to below the dura mater, tumor of blood MC than epidural hematoma Typically from tears of bridging veins Damage is severe due to underlying brain injury Appear to cover cerebral surface on CT cerebral contusions Fairly common- 20-30% of severe brain injuries. In the frontal and temporal lobes Can evolve to form over hours or days intracerebral hematomas or coalescent contusions that may require surgical evaluation. Repeat CT scanning is warranted due to progressive changes. What types of intracranial hemorrhage can be seen on CT scan? epidural, subdural, intra-ventricular hemorrhage, subarachnoid hemorrhage, intra-parenchymal. basal cisterns prepontine interpeduncular (btwn grooves) ambient (lat) quadrigeminal (post) (suprasellar is supra-sella) Indications for head CT in patients with mild TBI required for patients with suspected mild TBI (witnessed loss of conciousness, definite amnesia, or witnessed disorientation in a patient with GCS of 13-15 +: High risk features: -GCS score < 15 at 2 hours after injury -suspected skill fracture ->2 episodes of vomiting -Age > 65 -anticoagulant use Moderate risk features: Loss of conciousness (<5 mins) Amnesia before impact (>30 mins) Dangerous mechanism (impacted by vehicle, ejected from vehcile, fall from more than 3 feet or 5 stairs) Mgmt of mild brain injury Most patients make uneventful recoveries Secondary surgery is critical (mechanism of injury, loss of consciousness, seizure activity, etc...) Serial exam and GCS scoring are important Its with abnormal CT or persistent symptoms: Admit and neurosurgical consult or transfer Patients who are asymptomatic, awake/alert: Observe for several hours, re-examine, and safely discharge. Look up head injury warning discharge instructions. ... Second impact syndrome exponential increase in symptoms from a concussion following the immature return of an athlete back into competition prior to symptoms being resolved Look up return to play criteria after concussion ... Mgmt of moderate brain injury (GCS 9-12) ~15% of pts with brain injury have moderate brain injury Its may follow simple commands, but are typically confused or somnolent May have focal neurological deficits Approx 10-20% deteriorate and lapse into coma Serial Neuro exams are critical -Obtain brief H&P -perform neuro assessment -Order head CT, f/u scan within 24 hours -contact neurosurgeon or trauma center if transfer necessary -Admit for observation in ICU Mgmt of severe brain injury (GCS 3-8) 10% of pts with brain injury have severe injury -unable to follow simple commands -high risk of morbidity and mortality -Prompt diagnosis and treatment are critical. Can intracranial hemorrhage cause hemorrhagic shock no ABCs of head injury Intubate early, 100% O2, followed by FiO2 Pulse Ox >98% pCO2 goal 35 mmHg Maintain SBP >100 for pts 50-69 or at >110 for pts 15-49 or >70 Disability of neuro exam GCS score, pupillary response, focal neruological deficits. Obtain GCS score and pupil response before paralyzing or sedating the patient. Use the shortest acting paralytic and sedating agents possible. [Show Less]
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ATLS: Thermal Injuries questions and answers with complete top solutions
airway compromise The major principles of thermal injury management include maintaining a high index of suspicion for the presence of __________ following... [Show More] smoke inhalation and secondary to burn edema; identifying and managing associated mechanical injuries; maintaining hemodynamic normality with volume resuscitation; controlling temperature; and removing the patient from the in- jurious environment. rhabdomyolysis and cardiac dysrhythmias Clinicians also must take measures to prevent and treat the potential com- plications of specific burn injuries. Examples include ________, which can be associated with electrical burns; extremity or truncal compartment syndrome, which can occur with large burn resuscitations; and ocular injuries due to flames or explosions. extent of the inflammatory response to the injury The most significant difference between burns and other injuries is that the consequences of burn injury are directly linked to the _________ edema Airway injury in burns may develop over time and not be immediately present compared to other trauma, this is due to the process of ______ capillary Burn injury hypovolemia is due to the inflammatory changes and _____ leak leak The goal of burn resuscitation is to maintain intravascular fluid in the face of an ongoing ________. Whereas the other trauma stops the leak and fills vascular space. Clean (the heat killed the bacteria) Are burn injuries dirty or clean? immediate intubation Stridor occurs late and indicates the need for _____ intubate the patient Transfer patient to burn center with inhalation injury but first neck Early intubation is indicated for full thickness circumferential ____ burns carbon monoxide poisoning Direct thermal injury to the lower airway is very rare and essentially occurs only after exposure to superheated steam or ignition of inhaled flammable gases. Breathing concerns arise from three general causes: hypoxia, __________, and smoke inhalation injury. carboxyhemoglobin (HbCO) The diagnosis of CO poisoning is made primarily from a history of exposure and direct measurement of __________ high-flow (100%) oxygen via a non-rebreathing mask. Because the half-life of HbCO can be reduced to 40 minutes by breathing 100% oxygen, any patient in whom CO exposure could have occurred should receive __________ 2ml lactated ringer x patients body weight in kg x % TBSA One half in first hour One half over next 16 hours then adjust based on UO Initial Fluid rate for adults with 2nd and 3rd degree burns is: 3ml lactated ringer x patients body weight in kg x % TBSA One half in first hour One half over next 16 hours Under 30 kg give 5% dextrose in water then adjust based on UO Initial Fluid rate for adults with 2nd and 3rd degree burns is: infection There is no indication for prophylactic antibiotics in the early postburn period. Reserve use of antibiotics for the treatment of _______. 20. Insert a gastric tube and attach it to a suction setup if the patient experiences nausea, vomiting, or abdomin- al distention, or when a patient's burns involve more than ___% total BSA. reaction with the neutralizing agent can itself produce heat and cause further tissue damage Neutralizing agents offer no advantage over water lavage, because ___________ 8 Alkali burns to the eye require continuous irrigation during the first ___ hours after the burn First ________-degree frostbite: Hyperemia and edema are present without skin necrosis. Second ______-degree frostbite: Large, clear vesicle formation accompanies the hyperemia and edema with partial-thickness skin necrosis. Third ______-degree frostbite: Full-thickness and subcutaneous tissue necrosis occurs, commonly with hemorrhagic vesicle formation. Fourth _______-degree frostbite: Full-thickness skin necrosis occurs, including muscle and bone with later necrosis. 40°C (104°F) Replace constricting, damp clothing with warm blankets, and give the patient hot fluids by mouth, if he or she is able to drink. Place the injured part in circulating water at a constant ____F until pink color and perfusion return (usually within 20 to 30 minutes). maintaining the urine output of 100 mL/hr The immediate treatment of electrical injury consists of: [Show Less]
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