Intern Year: Atls : Chapter 1. Initial Assessment And Management

Front 1

Field Triage Decision Scheme-

What should be the next step given the following information:

Patient with Glasgow coma scale of 9

Back 1

Take to trauma center

GCS of <13 goes immediately to trauma, if above assess anatomy of injury

Front 2

Field Triage Decision Scheme-

What should be the next step given the following information:

SBP 101

Back 2

Assess anatomy of injury

had the patient had a SBP of <90 then take to trauma center

Front 3

Field Triage Decision Scheme-

What should be the next step given the following information:

Respiratory rate <10 or >29

Back 3

Take to trauma center

Front 4

Field Triage Decision Scheme-

You have determined the vitals are stable and do not warrant immediate transfer.

What type of penetrating injuries go immediately to the trauma center?

Back 4

All penetrating injuries to the following:
Head
Neck
Torso
extremities proximal to elbow/knee

Front 5

Field Triage Decision Scheme-

You have determined the vitals are stable and do not warrant immediate transfer.

The patient has an obvious fracture to both the right femur and right humerus.

What is the next step?

Back 5

transfer to trauma

patient has 2 or more proximal long-bone fractures

Front 6

Field Triage Decision Scheme-

You have determined the vitals are stable and do not warrant immediate transfer.

The patient has no crushed pulseless extremities, proximal amputations, pelvic fractures, paralysis, or open/depressed skull fractures.

What is the next step

Back 6

Assess mechanism of injury and evidence of high energy impact

Front 7

Field Triage Decision Scheme-

You have determined the vitals are stable and do not warrant immediate transfer. There are no penetrating wounds, multiple proximal fractures, or other serious injuries.

You are now assessing the mechanism of the injury for evidence of high energy impact.

at what height fall do you transfer a patient to the trauma center immediately

Back 7

Adults: >20 ft

Kids: >10 feet or 2/3x the height of the child

note: 1 story = 10 feet

Front 8

Field Triage Decision Scheme-

You have determined the vitals are stable and do not warrant immediate transfer. There are no penetrating wounds, multiple proximal fractures, or other serious injuries.

You are now assessing the mechanism of the injury for evidence of high energy impact.

the patient being assessed appears to not be injured, but another person died in the car from the accident

what should be the next step

Back 8

Transport to closes trauma center

Front 9

Field Triage Decision Scheme-

You have determined the vitals are stable and do not warrant immediate transfer. There are no penetrating wounds, multiple proximal fractures, or other serious injuries.

You are now assessing the mechanism of the injury for evidence of high energy impact.

motor cycle crashes > ____ mph should go right to trauma

Back 9

20 mph

note: this is the same speed as an Auto vs Ped/biclist thrown, run over, or with significant impact

Front 10

Field Triage Decision Scheme-

You have determined the vitals are stable and do not warrant immediate transfer. There are no penetrating wounds, multiple proximal fractures, or other serious injuries.

There is no evidence of high energy impact.

You are now assessing special patient/system considerations.

Over what age does the risk of injury/death increase?

What SBP might represent shock after age 65?

Back 10

Over 55 the risk of death increases

SBP< 110 if over 65 may represent shock

Front 11

Field Triage Decision Scheme-

You have determined the vitals are stable and do not warrant immediate transfer. There are no penetrating wounds, multiple proximal fractures, or other serious injuries.

There is no evidence of high energy impact.

You are now assessing special patient/system considerations.

Patient is 72 years old. SBP is 105. What must be considered?

Back 11

Shock.

this patient is over 65

Front 12

Give the ABCDEs of primary survey

Back 12

A: Airway maintenance with cervical spine protection
B: Breathing and ventilation
C: Circulation with hemorrhage control
D: Disability/neurologic status
E: Exposure/environmental control- completely undress the patient but prevent hypothermia

Front 13

What is a quick simple way to assess a patient in 10 seconds?

Back 13

ask the pt for his or her name and what happened.

Appropriate response suggest that there is no major airway compromise (ability to speak clearly)

Breathing is not severely compromised (ability to generate air movement to permit speech)

and no major decrease in level of consciousness (alert enough to describe what happened)

failure to respond to these questions suggests abnormalities in A,B, or C

Front 14

At what GCS is a definitive airway recommended

Back 14

8 or less

Front 15

The finding of nonpurposeful motor responses strongly suggest the need for....?

Back 15

definitive airway management

Front 16

Assume a _____ ______ injury in patients with blunt multisystem trauma, especially those with altered LOC or blunt injury above the clavicle.

Back 16

cervical spine injury

note: lateral film identifies only 85% of all injuries. Do not rely on it

Front 17

PITFALL:

patients who have profound dyspnea and tachypnea appear as though their primary problem is related to an inadequate airway. However if the ventilation problem is caused by _________, intubation with vigorous bag-mask ventilation can rapidly lead to further deterioration of the patient

Back 17

Pneumothorax or tension PTX

Front 18

what is one of the earliest signs of volume depletion?

what patient population may not show this?

Back 18

Tachycardia

Elderly- they have a limited ability to increase HR in response to blood loss

this was in PITFALLS

Front 19

a bolus of ____ of an isotonic solution may be required to achieve an appropriate response in the adult pt

Back 19

1-2L

upper-extremity peripheral IV access is preferred

maximum rate of fluid administration is determined by the internal diameter of the catheter and inversely by its length-- not by the size of the vein in which the catheter is placed

Front 20

PEA can indicate what 3 things

Back 20

Cardiac tamponade
Tension PTX
Profound hypovolemia

Front 21

Urethral injury should be suspected in the presence of 3 things....

Back 21

Blood at urethral meatus

Perineal ecchymosis

High-riding or nonpalpable prostate

Front 22

What should be done to confirm urethral injury

Back 22

retrograde urethrogram

Front 23

PITFALL:

placement of a gastric catheter can induce vomiting or gagging and produce the specific problem that its placement is intended to prevent--namely _______

Back 23

Aspiration

therefore you should have suctioning equipment available

Front 24

When does the secondary survey start?

Back 24

until the primary survey (ABCDEs) is completed, resuscitative efforts are underway, and the normalization of vital functions has been demonstrated

the secondary survey is a head to toe evaluation including: complete history and PE including reassessment of all vital signs

Front 25

What is an AMPLE history?

Back 25

A: Allergies
M: Medications
P: Past illnesses/Pregnancy
L: Last meal
E: Events/Environment related to the injury

Front 26

when should a vaginal exam be done in a trauma setting?

Back 26

secondary survey in the presence of pelvic fracture

Front 27

an increase in ICP can reduce cerebral perfusion pressure and lead to secondary brain injury. Most of the diagnostic and therapeutic maneuvers necessary for the evaluation and care of patients with brain injury will increase ICP. A classic example of this is....

Back 27

intubation

Front 28

desired urinary output for adults?

Back 28

0.5 mL/kg/hr

note: in peds over 1 year, 1mL/kg/hr

Front 29

When receiving a patient from EMS, the MIST acronym can be used...what is it

Back 29

M: Mechanism (and time) of injury
I: Injuries found and suspected
S: Symptoms and signs
T: Treatment initiated