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day 1 +day 2 ATLS Flash Card
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What ICP is abnormal?==>>20mmHg
>40 is severe
sustained increased ICP leads to decreased brain function and poor outcome
CBF is maintained at a mean BP of what?==>50–150
what is the Monro–Kellie Doctrine of head injury?==>total volume of the intracranial compartment must stay constant
Lucid interval, bi convex (lenticular) skull fracture that may be rapidly fatal... what is the classic artery affected?==>middle meningeal, this is an Epidural
what vessel is responsible for a brain bleed that crosses suture lines and is concave...==>Bridging veins (brain laceration), subdural hematoma
When is rapid surgical evacuation of a subdural recommended?==>>5mm shift of midline
loss of gray/white matter differentiation indicates what==>diffuse axonal damage, this has poor outcomes
give a Mild, Moderate, or severe GCS (the ranges)==>Mild 15–13, Moderate 12–9, Severe < 8
if patient has a GCS of 12 or below, when should you get a repeat CT?==>6 hours, or if they have notable deterioration
Indications for CT a pt with head injury?==>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
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?==>no further evaluation or xray needed, can clear the c–spine and remove collar
if a pt has altered LOC or has sx, what should be obtained?==>CT, radiographic visualization of entire spine
what 3 views do you need for c–spine xray==>Cross table lateral, AP , Odontoid (open mouth)
if you find an isolated c–spine fracture, what should you look for?==>ANOTHER noncontiguous vertebral column fracture, it happens 10% of the time
what % of pts with spinal cord injuries will worsen at the hospital==>5%
Dorsal column carries what info? same side or opposite side?
***==>position, vibration, fine touch, ipsilateral side
two fracture sites that are commonly missed sites that can cause shock? How much blood can go there?(*?*)==>5L in pelvis, 1.5L in femur
how soon after arrival should a patient with major open MSCK wounds be given abx?==>within the first hour
when getting xrays, what must you get a picture of in in addition to the site of injury==>joint above and below
2 most common places for compartment syndrome==>tibia and forearm, can be caused by severe crush injury, burn, casts, tissue pressures >35–40 mm Hg
Myoglobinuria can result from what kind of injury? What should you do?==>Crush injury, Hydrate
know that the cervical spine in old people has lots of OA....==>so it makes them tough to intubate
most common cause of death/disability in kids?==>injury
3 ways kids are harder to intubate==>smaller jaw, larger tongue, anterior larynx
if a child is laying on a backboard, what must you consider==>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
kids less than 10, seen at C2/3, seen worse in felxion...
what is the 442 rule?==>for Maintenance fluid
4mL/kg for first 10 kg, 2mL/kg for second 10kg
1mL/kg for every kg beyond 20 kg
ETT depth is how long in kids?==>3x the ETT size
Bolus for kids fluid: 20 mL/kg,
blood dosage?==> blood: 10 mL/kg
What is the Parkland formula==>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
are the following increased or decreased in pregnancy?
minute ventilation
HR/CO
Blood Volume
GFR
gastric emptying time==>all increased
are the following increased or decreased in pregnancy?
pCO2
Hematocrit==>Decreased
What is the primary survey?
**-->ABCDEs
In a trauma situation, what should be treated first-->Greatest threat to life
anytime you come into a trauma pt what should you do? (2 things)-->Airway with c–spine protection
Universal precautions:hat mask w shieldgowngloves (double glove, single gloving viral transmission is 67%)
What are the 2 areas that are part of xray in resuscitation adjunct?-->Chest and pelvis
house the most blood
note: use FAST for abdomen
what size needle is used for needle decompression-->14/16 gauge
2nd intercostal space mid clavicular line
aim down the pt
What should you ask for from your ancillary staff upon start of a trauma?-->EKG,Pulse Ox,IV,BP,Draw Labs
what is considered large bore IV? ?-->14/16 gauge
how much fluid should initially be given in the trauma pt?--> (2L as fast as possible over 10 min
if you are able to obtain a pulse at the following areas, what is the SBP?
Carotid: Femoral: Dorsalis pedis:-->
Carotid: 60 Femoral: 70 Dorsalis pedis: 80
if you are the only physician available in a trauma scenario, what are you going to likely do?-->transfer him out
Describe the GCS and scoring
***-->Eye Response:
Eyes open spontaneously. +4
Eye opening to verbal command. +3
Eye opening to pain. +2
No eye opening. +1
Verbal Response:
Oriented. +5
Confused. +4
Inappropriate words. +3
Incomprehensible sounds. +2
No verbal response. +1
Motor Response:
Obeys commands. +6
Localizes pain. +5
Withdrawal from pain. +4
Flexion to pain (Decorticate). +3
Extension to pain (Decerebrate). +2
No motor response. +1
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