Surgery 99: Atls

Front 1

3 stages of ATLS

Back 1

primary survey
resuscitation
secondary survey

Front 2

primary survey means

Back 2

airway
breathing
circulation
disability
exposure

Front 3

3 causes of 1st wave (fastest) death

Back 3

spinal cord transsection
bleeding from great vessels
severe brain injury

Front 4

2nd wave death occurs at ___ (time) and is due to ___ problems such as ___ (3)

Back 4

1st 2 hours
B, C
internal bleeding
cardiac tamponade
severe pulmonary hemorrhage

Front 5

3rd wave of mortality occurs at ___ (time) and is due to ___

Back 5

1 week
sepsis

Front 6

A problems may be excluded if ___ (2)

Back 6

patient is conscious
patient talks in normal voice

Front 7

if A problems are present, determine ___

Back 7

whether urgent intubation is required

Front 8

6 indications for urgent intubation

Back 8

cyanosis
apnea
hole in trachea
expanding hematoma present
active bleeding in mouth
black deposits in mouth (burn)

Front 9

black deposits in mouth indicate risk for ___

Back 9

fulminant edema of oropharynx

Front 10

if A problems are present but urgent intubation not indicated, do ___ (3). if this improves A, do ___ (3). otherwise, do ___.

Back 10

chin lift
jaw thrust
evacuate debris from mouth
stabilize C-spine
give 100% O2 via mask
proceed to B
intubate

Front 11

after 2 failed attempts at intubation, do ___

Back 11

surgical airway (cricothyroidotomy)

Front 12

always do ___ (2) as part of A

Back 12

stabilize C-spine
give 100% O2 via mask

Front 13

5 life-threatening B problems

Back 13

hemothorax
tension PTX
open PTX
flail chest
cardiac tamponade

Front 14

2 signs of hemothorax

Back 14

hemodynamic instability
diminished breathing sounds

Front 15

tx of hemothorax (2)
a hemothorax is massive if ___ or ___, since ___

Back 15

chest tube
fluid resuscitation
>1500cc of blood via chest tube
>200cc/hour of blood via chest tube
bleeding that fast doesn't stop spontaneously

Front 16

4 signs of tension PTX

Back 16

tracheal deviation
JV distention
hemodynamic instability
unilaterally decreased breath sounds

Front 17

JV distention in tension PTX is due to ___

Back 17

kinking of SVC due to shift of mediastinum

Front 18

hemodynamic instability in tension PTX is due to ___

Back 18

kinking of SVC due to shift of mediastinum

Front 19

tension PTX can be caused by ___ trauma

Back 19

blunt or penetrating

Front 20

first aid for tension PTX
after first aid, ___.
first aid should be attempted ___ times

Back 20

needle application at 2nd intercostal space, midclavicularly
reassess signs of tension PTX
2

Front 21

if first aid for tension PTX fails twice, do ___ at ___

Back 21

chest tube
4th interspace, 1 cm lateral to ant axillary line

Front 22

if chest tube for tension PTX fails, do ___ at ___.

Back 22

second chest tube
2nd interspace, midclavicularly

Front 23

open PTX is aka ___
sign of open PTX

Back 23

sucking chest wound
hole in chest

Front 24

tx for open PTX (3)

Back 24

closure of chest wound
chest tube
if converts to tension PTX, treat as such

Front 25

flail chest is fracture of ___ ribs in ___ places

Back 25

2 or more
2 or more

Front 26

sign of flail chest

Back 26

paradoxical inspiration

Front 27

flail chest is bad because ___

Back 27

pulmonary contusion is likely

Front 28

tx for flail chest (2)

Back 28

intubate
ventilate with PEEP

Front 29

3 signs of cardiac tamponade

Back 29

JV distension
distant heart sounds
hypotension

Front 30

severity of tamponade is given by ___

Back 30

BP

Front 31

impending death from tamponade is indicated by ___. tx is with ___ (2)

Back 31

sys BP=50
anterolateral thoracotomy
pericardotomy

Front 32

intermediate severity of tamponade is indicated by ___. tx is with ___.

Back 32

sys BP = 80--90
chest CT angio

Front 33

lowest severity of tamponade is indicated by ___. tx is with ___ (2).

Back 33

hemodynamic stability
further stabilization
CT angio

Front 34

grade 1 shock corresponds to ___% IVV loss, which is ___cc in a 70kg person, and observable as ___.

Back 34

15
750
tachycardia

Front 35

grade 2 shock corresponds to ___% IVV loss, which is ___cc in a 70kg person, and observable as ___.

Back 35

30
750-1500
tachycardia

Front 36

grade 3 shock corresponds to ___% IVV loss, which is ___cc in a 70kg person, and observable as ___ (3).

Back 36

40
1500--2000
hypotension
tachycardia
oliguria

Front 37

grade 4 shock corresponds to ___% IVV loss, which is ___cc in a 70kg person, and observable as ___ (4).

Back 37

50
>2000
hypotension
tachycardia
oliguria
loss of consciousness

Front 38

tx for shock grades 1--3 (2)

Back 38

stop external bleeding
IVF

Front 39

tx for grade 4 shock

Back 39

surgery

Front 40

external bleeding should be stopped with ___. if this is not possible, use ___ (2)

Back 40

direct pressure
packing
inflating foley cath

Front 41

IVF for hypovolemic shock

Back 41

2L of lactated ringer's

Front 42

response to fluids is measured by ___ (3)

Back 42

BP
HR
urine

Front 43

minimal urine output for adults is ___/hr
minimal urine output for kids is ___/hr
minimal urine output for infants is ___/hr

Back 43

.5 cc/kg
1 cc/kg
2 cc/kg

Front 44

if BP is completely normalized after IVF, do ___.

Back 44

stop fluids

Front 45

if full responder deteriorates after stopping fluids, do ___. otherwise do ___

Back 45

tx as partial responder
CT

Front 46

tx for partial responder (2)

Back 46

1L bolus
search for source of bleeding

Front 47

tx for non-responder (2)

Back 47

blood
search for source of bleeding

Front 48

blood type for adults
blood type for kids, child-bearing age women

Back 48

O+
O-

Front 49

T/F: head is never source of hemorrhagic bleeding in adults

Back 49

true

Front 50

imaging studies for bleeding localization

Back 50

CXR
FAST

Front 51

in neck hemorrhage is ___

Back 51

visible

Front 52

when searching for bleeding in chest, do ___.

Back 52

bilateral chest tubes

Front 53

if <___ of blood is obtained from chest tubes, ___.

Back 53

1.5L
chest is not the only source of bleeding

Front 54

if FAST is positive, do ___. otherwise, ___.

Back 54

go to OR for laparotomy
check pelvis

Front 55

checks performed for D

Back 55

pupils (symmetry, reflexes)
GCS
basic motor exam

Front 56

E phase

Back 56

exposure (strip patient)

Front 57

7 procedures performed in resuscitation phase

Back 57

ECG
insert NGT
PR
insert foley cath
CXR
portable pelvic XR
FAST

Front 58

FAST is for finding ___ (2)

Back 58

free abdominal fluid
rule out cardiac tamponade

Front 59

5 methods of reducing ICP

Back 59

ventriculostomy
diuresis (mannitol)
hyperventilation
barbiturate coma
craniotomy (last resort)

Front 60

hyperventilation is only performed on scene if ___ or ___

Back 60

anisocoria present
fulminant deterioration wihhout hypovolemic shock or hypoxia