ATLS Flashcards by Ivan De Figueiredo Fernandes

What is the first step when assessing a trauma patient

Ensuring the safety of the scene

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What does A stand fo in the primary trauma survey

Airway maintenance and cervical spine protection

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Name three indications for spinal motion restriction

Dangerous mechanism of injury
Altered mental status (including intoxication)
Midline neck pain
Focal neurologic deficit (numbness or weakness)
Anatomic deformity of the spine
Distracting injury (e.g. broken leg)

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List ALL components of the Glasgow Coma Scale (GCS), including the individual scoring criteria for each response.

Eye Opening (E)
4 = Spontaneous
3 = To speech
2 = To pain
1 = None

Verbal Response (V)
5 = Oriented
4 = Confused conversation
3 = Inappropriate words
2 = Incomprehensible sounds
1 = None

Motor Response (M)
6 = Obeys commands
5 = Localizes pain
4 = Withdraws from pain
3 = Abnormal flexion (decorticate)
2 = Abnormal extension (decerebrate)
1 = None

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A 32-year-old man is brought to the ED after an MVC. He opens his eyes to pain, makes incomprehensible sounds, and withdraws from pain. What is his GCS score?

Eyes to pain = 2

Verbal incomprehensible sounds = 2

Motor withdraws from pain = 4

Total GCS = 8

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A 74-year-old woman is found unresponsive. She does not open her eyes, makes no verbal sounds, and shows abnormal flexion to painful stimulus. What is her GCS score?

Eyes none = 1

Verbal none = 1

Motor abnormal flexion (decorticate) = 3
Total GCS = 5

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What GCS level warrants intubation?

GCS ≤ 8

(“Less than 8, intubate.”)

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Name two basic maneuvers to support airway

Chin-lift
Jaw-thrust

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When are chin-lifts contraindicated?

Blunt trauma
(protect the C-spine)

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T or F:
Supplemental O2 should be administered to all trauma patients

True

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Name three temporizing airway measures

LMA
NPAs
OPAs

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When should you consider a NPA?

Patients with intact cough/gag reflezes

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What is the main contriandication to an OPA?

Patient with gag or cough reflexes

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What is the goal of a Rapid Sequence intubation?

A method that allows for quick sedation and temporary paralysis for patients at high risk of aspiration

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What is the preferred first-line surgical airway

Cricothyroidotomy

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What is the acronym that likely predicts a difficult airway

LEMON

Look: Obesity, beards, dental or facial abnormalities

Evaluate (3-3-2 rule):
-Interincisor distances ≤ 3 fingers
-Cricoid-hyoid distance ≤ 2 fingers
-Hyoid-thyroid distance ≤ 2 fingers

Mallampati score

Obstruction
-Stridor
-Excess blood
-Foreign body
-Masses

Neck mobility

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Name the 4 Mallampati score categories

Class I
Soft palate, uvula, fauces, and pillars visible

Class II
Soft palate, uvula, and fauces visible

Class III
Soft palate and base of uvula visible

Class IV
Only hard palate visible

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What Mallampati classes are associated with difficult intubation?

Classes III-IV

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Name 6 components to be assessed in the Breathing component of the primary trauma survey

RR
SPO2
Visible signs of increased work of breathing
Chest inspection
Feeling for tracheal tug and chest crepitus/flail segments
Bilateral air entry

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What is the minimum and maximum amount of oxygen that can be delivered in a non-rebreather mask?

Minimum: 6L/min
Maximum: 15 L/min

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Describe the technique for needle decompression in a trauma patient with suspected tension pneumothorax. Name FOUR key steps.

1 - Identify site:

4th–5th ICS, anterior axillary line (increasingly preferred in adults).

2 - Insert a large-bore catheter (14–16G, ≥5–8 cm in adults).

3 - Insert just ABOVE the superior border of the rib (avoid neurovascular bundle).

4 - Advance until a rush of air is heard, then leave catheter in place and proceed to chest tube insertion (definitive).

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Name the 4 categories of shock

Hypovolemic
Obstructive
Cardiogenic
Distributive

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What are two vital signs abnormalities of early shock?

Tachypneic
Tachycardic

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Name three causes of obstructive shock

Cardiac tamponade
Tension pneumothorax
PE

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Describe the key features of Class I hemorrhagic shock (blood loss %, vitals, mental status, urine output)

Blood loss: <15% (<750 mL) HR: <100 BP: Normal Mental status: Mild anxiety Urine output: >30 mL/hr

Describe the key features of Class II hemorrhagic shock.

Blood loss: 15–30% (750–1500 mL) HR: >100 BP: Usually normal, narrow pulse pressure Mental status: Anxious Urine output: 20–30 mL/hr

Describe the key features of Class III hemorrhagic shock.

Blood loss: 30–40% (1500–2000 mL) HR: >120 BP: Decreased Mental status: Confused Urine output: 5–15 mL/hr

Describe the key features of Class IV hemorrhagic shock.

Blood loss: >40% (>2000 mL) HR: >140 BP: Markedly decreased Mental status: Lethargic/obtunded Urine output: Negligible

What is the earliest sign of Class II hemorrhagic sign

Tachycardia

As of which hemorrhagic shock class does hypotension start?

Class III

Which classes of hemorrhagic shock require blood transfusion?

Class III-IV

Name 10 components to assess in the Circulation component of the trauma primary survey

HR BP LOC Skin colour Temperature Cap refill Pulse in all 4 limbs Palpation of the abdomen Palpation of the hips Palpation of the long bones

What should be emergent management for a patient with a unstable pelvis?

Pelvic binder

In case of a penetrating injury that cannot be stopped by direct compression, what would be the next best step?

Tourniquet

What are the three main imaging adjuncts to the trauma survey

CXR Pelvis Xray e-FAST

What should be started concomitantly with the initial assessment of circulation?

**2 large bore IVs** (or I/O) **WARM**Crystalloid fluid resuscitation (start with **1L**)

What are the two preferred I/O sites in adults?

Proximal tibia Humeral head

What are the three preferred I/O sites in infants and neonates?

Distal femur Proximal tibia Distal tibia

What is the main complication of excessive crystaloid infusion?

Dillutional coagulopathies

Which trauma patients require type O pRBCs?

Those with **exsanguinating hemmorhage** (without a type and screen)

Which patients benefit more from Rh negative pRBCs? (1)

Females of childbearing age

What is one medication to consider in hemorrhagic shock?

Tranexamic acid

What is the definition of a massive hemorrhage protocol? (2)

Transfusion of more than 10 unites of pRBCs in a 24h period OR More than 4 units/hour

What are the five spaces assessed in the e-FAST?

-Pericardial space -Right upper quadrant (Morison’s pouch / hepatorenal recess) -Left upper quadrant (splenorenal recess) -Pelvis (rectovesical pouch in males / pouch of Douglas in females) -Paracolic gutters

Name 5 components of the disability assessment in the trauma survey

Level of consciousness Pupils size and responsiveness GCS Motor (moving all four limbs spontaneously) **POC Blood glucose**

What are the 4 components of the exposure assessment in the trauma survey?

Completely expose patient from head to toe **Log roll** DRE (for anal bleeds and anal tone) Covering the patient to avoid hypothermia

What is the definition of hypothermia?

Core body temperature < 35 C

What is the definition and 3 S+S of **mild** hypothermia?

T: 32 - 34.9 S+S Tachypnea Tachycardia Shivering Ataxia/disarthria

What is the definition and 3 S+S of **moderate** hypothermia

T: 28 - 31.9 C S+S - ↓ LOC - Combativeness - Muscle rigidity - No shivering - Dilated pupils

What is the definition and 3 S+S of *severe* hypothermia

T: < 28 C S+S - Hypotension - Acidemia - Vfib - Asystole - Apnea - Coma

What is the triad of death in trauma?

Hypothermia Acidosis Coagulopathy

What are 5 S+S of tension pneumothorax

Tachycardia Tachypnea Unilaterally decreased breath sounds Tracheal deviation Increased JVP (*hypotension and hypoxia* are **late** findings)

What is the temporary management option for an **open** penumothorax?

Three-sided occlusive dressing in the open wound

What is the **definitive** management option for an **open** penumothorax?

Chest tube insertion

What are 2 S+S of a hemothorax

Unilaterally decreased breath sounds **Dullness** to percussion

What is the treament for a hemothorax?

Chest tube insertion at the 4-5th intercostal space at the mid-axillary line (*same as a pneumothorax)*

What are the three classic S+S of a cardiac tamponade?

**Beck's triad** Hypotension JVD Muffled heart sounds

What is the treatment for a cardiac tamponade?

Emergent pericardiocentesis (or thoracotomy)

What is the definition of a flail chest?

≥3 consecutive broken ribs in **2 or more places**

Three S+S of a flail chest

↓ breath sounds Hypoxia Paradoxical chest wall motion

How to treat a flail chest?

Supplemental O2 Pain control (Intubation for severe cases)

What is the first step of the secondary survey

History taking **AMPLE** **A**llergies **M**edications **P**MHx **L**ast Meal **E**vents leading to the injury

Name 5 lab investigations to be ordered in a secondary trauma survey

**Labs** -Hb - Platelets - Blood type and screen - Lytes - Creatinine -Lactate *Additional* -CK -Liver enzymes -VBG

Name 4 imaging investigations to consider ordering in a secondary trauma survey

CXR Xray of affected body parts CT POCUS

Immediately after finishing the secondary survey, what should be addressed in a stable patient?

Transfering patients to an appropriate institution

Name 4 medical problems that could contribute to trauma

Seizures Drug intoxication Hypoglycemia Attempted suicide

What should be initially done with potentially life-threatening fractures?

Reduce and immobilize

Name 4 preventative counseling strategies for trauma

1 - Avoid driving while intoxicated 2- Using seatbelts 3 - Using helmets 4 - Have a first-aid kit in the car

Name 7 features of non-accidental injury in children

**Head/CNS**: - Torn frenulum - Dental injuries - Bilateral periorbital ecchymosis - **Retinal hemmorhage** **Skin** - Bruises in different stages of healing - Bite marks - **Glove/stocking** burn distributions - Bruises in easily concealed areas **Bone injuries** - **Spiral fractures** injuries in a non-ambulatory baby - Infants with metaphyseal fractures - Multiple fractures of various ages - Rib fractures

Name 3 S+S of Shaken baby syndrome

Subdural hematoma Retinal hemorrhages Altered level of consciousness (e.g., lethargy, seizures)

Name FOUR signs and symptoms of neurogenic shock.

Hypotension Bradycardia Warm, flushed skin (loss of sympathetic tone) Hypothermia

ATLS Flashcards

(71 cards)