Intern Year: Atls : Class Day Two

Front 1

What ICP is abnormal?

Back 1

>20mmHg

>40 is severe

sustained increased ICP leads to decreased brain function and poor outcome

Front 2

CBF is maintained at a mean BP of what?

Back 2

50-150

Front 3

what is the Monro-Kellie Doctrine of head injury?

Back 3

total volume of the intracranial compartment must stay constant

Front 4

Lucid interval, bi convex (lenticular) skull fracture that may be rapidly fatal... what is the classic artery affected?

Back 4

middle meningeal

this is an Epidural

Front 5

what vessel is responsible for a brain bleed that crosses suture lines and is concave...

Back 5

Bridging veins (brain laceration)

subdural hematoma

Front 6

When is rapid surgical evacuation of a subdural recommended?

Back 6

>5mm shift of midline

Front 7

loss of gray/white matter differentiation indicates what

Back 7

diffuse axonal damage

this has poor outcomes

Front 8

give a Mild, Moderate, or severe GCS (the ranges)

Back 8

Mild 15-13

Moderate 12-9

Severe < 8

Front 9

if patient has a GCS of 12 or below, when should you get a repeat CT?

Back 9

6 hours

or if they have notable deterioration

Front 10

Indications for CT a pt with head injury?

Back 10

GCS still <15 two hours after injury

Neuro deficit

open skull fracture

sign of basal skull fracture

vomiting >2 episodes

extremes of age

retrograde amnesia

Front 11

pt is conscious, cooperative, able to concentrate on C-spine

no neck/spine tenderness

if still no pain or tenderness with voluntary movement what should you do?

Back 11

no further evaluation or xray needed

can clear the c-spine and remove collar

Front 12

if a pt has altered LOC or has sx, what should be obtained?

Back 12

CT

radiographic visualization of entire spine

Front 13

what 3 views do you need for c-spine xray

Back 13

Cross table lateral

AP

Odontoid (open mouth)

Front 14

if you find an isolated c-spine fracture, what should you look for?

Back 14

ANOTHER noncontiguous vertebral column fracture

it happens 10% of the time

Front 15

what % of pts with spinal cord injuries will worsen at the hospital

Back 15

5%

Front 16

Dorsal column carries what info? same side or opposite side?

***

Back 16

position, vibration, fine touch

ipsilateral side

Front 17

two fracture sites that are commonly missed sites that can cause shock? How much blood can go there?

(*?*)

Back 17

5L in pelvis

1.5L in femur

Front 18

how soon after arrival should a patient with major open MSCK wounds be given abx?

Back 18

within the first hour

Front 19

when getting xrays, what must you get a picture of in in addition to the site of injury

Back 19

joint above and below

Front 20

2 most common places for compartment syndrome

Back 20

tibia and forearm

can be caused by severe crush injury, burn, casts

tissue pressures >35-40 mm Hg

Front 21

Myoglobinuria can result from what kind of injury? What should you do?

Back 21

Crush injury

hydrate

Front 22

know that the cervical spine in old people has lots of OA....

Back 22

so it makes them tough to intubate

Front 23

most common cause of death/disability in kids?

Back 23

injury

Front 24

3 ways kids are harder to intubate

Back 24

smaller jaw

larger tongue

anterior larynx

Front 25

if a child is laying on a backboard, what must you consider

Back 25

put a pad under the back...

the large head of the child will cause them to be in flexion if on a back board. Having the pad will neutralize the c-spine

Front 26

kids less than 10, seen at C2/3, seen worse in felxion...

what xray finding does this describe?

Back 26

pseduosubluxation

Front 27

what is the 442 rule?

Back 27

for Maintenance fluid

4mL/kg for first 10 kg

2mL/kg for second 10kg

1mL/kg for every kg beyond 20 kg

Front 28

ETT depth is how long in kids?

Back 28

3x the ETT size

Front 29

bolus for kids?

blood dosage?

Back 29

fluid: 20 mL/kg

blood: 10 mL/kg

Front 30

What is the Parkland formula

Back 30

2-4/mL x weight in kg x % body surface area

first half over the first 8 hours
second half over the next 16

used in burns

Front 31

are the following increased or decreased in pregnancy?

minute ventilation

HR/CO

Blood Volume

GFR

gastric emptying time

Back 31

all increased

Front 32

are the following increased or decreased in pregnancy?

pCO2

Hematocrit

Back 32

Decreased