ATLS

Question 1

C Spine restriction

• how would you do this
• when would you do this

Answer 1

Prehospital care

Assume C spine injury - Are there any neck concerns?
-Assess by asking patient if they have neeck pain, can rotate neck 45deg to either side

Restriction of C Spine

• ask someone to use 2 hands to hold head in place
• cervical collar + 2 blocks + 2 straps
• if suspecting thoracolumbar spinal injury => spinal board

Question 2

Airway assessment

• what would you ask for
• what would you assess
• what would you do

Answer 2

Patency test
Can patient speak?
Is the Hudson mask with resevoir bag fogging up?

Not patent
Basic airway maneuvres
-jaw thrust, chin lift
-O2
-bag valve to bridge intubation/CRP
-suction fluid, forceps out FB

If jaw thrust tolerated => ANAESTHETIST!
Airway adjuncts
Conscious => nasopharyngeal airway
-avoid in basal skull/facial fracture
Unconscious => oropharyngeal airway to bridge intubation
-avoid in conscious with gag reflex
If tolerated => ANAESTHETIST!
If OP not helping and still LOC => LMA (not definitive airway)
-avoid in conscious with gag reflex
Anesthetist struggling => cricothyrotomy

Ask for monitoring and assessments

• ECG, BP, RR, HR, BM, temp, SaO2
• FBC, U&E, LFT, CRP, clotting profile, ABG, Group and Match, glucose

Question 3

Indications for endotracheal intubation

Answer 3

Inability or anticipated inability to maintain airway
-obstruction
-GCS U9
Failure or anticipated failure of ventilation or oxygenation
-acute severe asthma, COPD
High risk of deterioration
-trauma, anaphylaxis, shock

Question 4

Breathing assessment

• what would you do
• what are immediately life threatening chest injuries

Answer 4

SaO2 => NRB 15L regardless of CO2 status
RR => bag mask if tiring
Chest - inspect for cyanosis, tracheal devation, accessory muscle use, asymmetry, expansion, percussion, auscultation
Calves

Tension pneumothorax
Open pneumothorax
Massive hemothorax
Cardiac tamponade

Question 5

Management of 
open and tension pneumothorax
-relationship between the 2
-suspicions
-management

Answer 5

Open can progress to tension
-open => air enters PC via chest wall

Open pneumothorax
-Hyperresonance + reduced breath sounds

Mx - 3 way occlusive dressing + chest drain

Tension pneumothorax

• SOB
• Narrow BP => falls
• High HR
• Tracheal deviation is a late sign

Mx - needle decomp 5ICS antMAL + chest drain

Question 6

Management of massive hemothorax

• suspicions
• management

Answer 6

DECREASED BREATH SOUNDS + DULL PERCUSSION

Chest drain

Question 7

Management of cardiac tamponade

• suspicions
• management

Answer 7

High HR, low BP
Muffled heart sounds
JVP

Pericardiacocentesis

Question 8

Circulation assessment
-what would you do
-what are you assessing for
-

Answer 8

BP, HR (radial and carotid) , CRT
Heart auscultation

2 large IV bore cannula => IO line (proximal tibia/humerus)

Ongoing hemorrhage

• Direct pressure
• neurovascular examination - DOCUMENT FINDINGS
• torniquet/BP cuff 30+ systolic
• if severe => 2222 major hemorrhage protocol, tranexemic acid

Hypotension
-250ml saline bolus
Bleeding => O-ve, group matched

Reversal of anticoagulation
-warfarin => VitK, prothrombin complex if acute

Question 9

Classes of shock and management

Answer 9

Total blood volume - 5L
1 - 15% lost
2 - 15-30% lost => FLUID
3 - 30-40% lost => BLOOD
4 - 40%+ lost => BLOOD

Femur - 1-2L
Pelvis - 2L+

Compartments

• floor
• chest, abdo, pelvic, femur

Question 10

Types of shock and ways to identify them

Answer 10

Hypovolemic - high HR, RR, cold, weak pulse

• hemorrhage
• D&V
• DKA
• Burns

Cardiogenic - pump failure => JVP, weak pulse, high HR, low BP, SOB

• MI
• muscle/rhythm/valve issue

Obstructive - sim to cardiogenic

• TP
• PE
• CT

Distributive

• septic, anaphylactic - fever
• neurogenic - warm peripheries, low BP, HR