Atls Ch. 2

Front 1

What is the earliest intervention for "A" in trauma patients?

Back 1

All trauma patients must receive supplemental O2

Front 2

What are 2 key reasons to assure a trauma patient has a patent airway?

Back 2

1. Prevent hypercarbia
2. Maintain oxygenation

Front 3

What are the objective signs of airway obstruction? (4)

Back 3

1. Observe patient: agitation (hypoxemia) vs obtunded (hypercarbia); cyanosis? (hypoxemia); retractions/acc. muscle use? (airway compromise)

2. Abnormal breath sounds: snoring, gurgling, stridor are all abnormal

3. Position of trachea: midline?

4. Patient's behavior: abusive/belligerent may be HYPOXIC and not intoxicated

Front 4

3 signs of laryngeal trauma?

Back 4

1. Hoarseness
2. SubQ emphysema
3. palpable fracture

Front 5

High concentrations of O2 can mask breathing problems, what are 2 ways to more accurately measure ventilatory efforts?

Back 5

1. Arterial CO2
2. End tidal CO2

Front 6

Name 3 objective signs of inadequate ventilation.

Back 6

1. Asymmetric chest rise/chest wall excursion - splinting of rib cage or flail chest

2. Asymmetric breath sounds - presence of thoracic injury

3. Pulse oximeter - O2 saturation (NOT adequacy of vent)

Front 7

During "B" in the ABCDEs, what precaution is of utmost importance?

Back 7

Maintaining C-spine protection

Front 8

What is a contraindication to a nasopharyngeal airway?

Back 8

Suspected cribiform plate fracture

Front 9

A patient arrives with a LMA in place, what must be done?

Back 9

Plan for a definitive airway -- LMAs are NOT definitive airway options

Front 10

What are the 3 types of definitive airways?

Back 10

1. Orotracheal
2. Nasotracheal
3. Surgical airways (cricothyroidotomy/tracheostomy)

Front 11

When is an orotracheal intubation indicated over a nasotracheal route?

Back 11

If the patient has apnea

Front 12

What are 3 contraindications to use of succinylcholine?

Back 12

Can precipitate severe hyperkalemia in:
1. Burn victims
2. Crush injuries
3. electrical injuries

Front 13

What is the normal RSI dose of etomidate?

Back 13

0.3mg/kg for induction, typically 30mg

Front 14

What is the normal RSI dose of succinylcholine?

Back 14

1-2mg/kg for paralysis, typically 100mg

Front 15

What is the DOC to reverse benzo action in trauma patients?

Back 15

Flumazenil

Front 16

Why are some induction agents (e.g. thiopental) and sedatives particularly dangerous in trauma patients?

Back 16

If hypovolemia is present, can exacerbate

Front 17

What is preferred in the ED for a surgical airway?

Back 17

cricothyroidotomy (over a tracheostomy)

Front 18

What does the pulse oximetry NOT measure?

Back 18

PaO2 levels -- which can vary greatly based upon the position of the oxyhemoglobin curve

Front 19

What O2 sat typically signifies adequate periph arterial oxygenation?

Back 19

O2 Sat > 95% (usually indicates PaO2 > 70mmHg)

Front 20

What scenario limits the usefulness of pulse oximetry?

Back 20

CO poisoning -- the pulse oximeter cannot distinguish between oxyhemoglobin and carboxy-/met-hemoglobin

Front 21

Bag-mask ventilation can result in gastric distention, what are 2 complications associated with this?

Back 21

1. Vomiting and aspiration
2. Stomach distention placing pressure on the IVC resulting in hypotension and bradycardia