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60 Cards in this Set
- Front
- Back
3 stages of ATLS
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primary survey
resuscitation secondary survey |
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primary survey means
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airway
breathing circulation disability exposure |
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3 causes of 1st wave (fastest) death
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spinal cord transsection
bleeding from great vessels severe brain injury |
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2nd wave death occurs at ___ (time) and is due to ___ problems such as ___ (3)
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1st 2 hours
B, C internal bleeding cardiac tamponade severe pulmonary hemorrhage |
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3rd wave of mortality occurs at ___ (time) and is due to ___
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1 week
sepsis |
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A problems may be excluded if ___ (2)
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patient is conscious
patient talks in normal voice |
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if A problems are present, determine ___
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whether urgent intubation is required
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6 indications for urgent intubation
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cyanosis
apnea hole in trachea expanding hematoma present active bleeding in mouth black deposits in mouth (burn) |
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black deposits in mouth indicate risk for ___
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fulminant edema of oropharynx
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if A problems are present but urgent intubation not indicated, do ___ (3). if this improves A, do ___ (3). otherwise, do ___.
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chin lift
jaw thrust evacuate debris from mouth stabilize C-spine give 100% O2 via mask proceed to B intubate |
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after 2 failed attempts at intubation, do ___
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surgical airway (cricothyroidotomy)
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always do ___ (2) as part of A
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stabilize C-spine
give 100% O2 via mask |
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5 life-threatening B problems
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hemothorax
tension PTX open PTX flail chest cardiac tamponade |
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2 signs of hemothorax
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hemodynamic instability
diminished breathing sounds |
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tx of hemothorax (2)
a hemothorax is massive if ___ or ___, since ___ |
chest tube
fluid resuscitation >1500cc of blood via chest tube >200cc/hour of blood via chest tube bleeding that fast doesn't stop spontaneously |
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4 signs of tension PTX
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tracheal deviation
JV distention hemodynamic instability unilaterally decreased breath sounds |
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JV distention in tension PTX is due to ___
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kinking of SVC due to shift of mediastinum
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hemodynamic instability in tension PTX is due to ___
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kinking of SVC due to shift of mediastinum
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tension PTX can be caused by ___ trauma
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blunt or penetrating
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first aid for tension PTX
after first aid, ___. first aid should be attempted ___ times |
needle application at 2nd intercostal space, midclavicularly
reassess signs of tension PTX 2 |
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if first aid for tension PTX fails twice, do ___ at ___
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chest tube
4th interspace, 1 cm lateral to ant axillary line |
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if chest tube for tension PTX fails, do ___ at ___.
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second chest tube
2nd interspace, midclavicularly |
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open PTX is aka ___
sign of open PTX |
sucking chest wound
hole in chest |
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tx for open PTX (3)
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closure of chest wound
chest tube if converts to tension PTX, treat as such |
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flail chest is fracture of ___ ribs in ___ places
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2 or more
2 or more |
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sign of flail chest
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paradoxical inspiration
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flail chest is bad because ___
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pulmonary contusion is likely
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tx for flail chest (2)
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intubate
ventilate with PEEP |
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3 signs of cardiac tamponade
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JV distension
distant heart sounds hypotension |
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severity of tamponade is given by ___
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BP
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impending death from tamponade is indicated by ___. tx is with ___ (2)
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sys BP=50
anterolateral thoracotomy pericardotomy |
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intermediate severity of tamponade is indicated by ___. tx is with ___.
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sys BP = 80--90
chest CT angio |
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lowest severity of tamponade is indicated by ___. tx is with ___ (2).
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hemodynamic stability
further stabilization CT angio |
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grade 1 shock corresponds to ___% IVV loss, which is ___cc in a 70kg person, and observable as ___.
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15
750 tachycardia |
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grade 2 shock corresponds to ___% IVV loss, which is ___cc in a 70kg person, and observable as ___.
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30
750-1500 tachycardia |
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grade 3 shock corresponds to ___% IVV loss, which is ___cc in a 70kg person, and observable as ___ (3).
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40
1500--2000 hypotension tachycardia oliguria |
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grade 4 shock corresponds to ___% IVV loss, which is ___cc in a 70kg person, and observable as ___ (4).
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50
>2000 hypotension tachycardia oliguria loss of consciousness |
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tx for shock grades 1--3 (2)
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stop external bleeding
IVF |
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tx for grade 4 shock
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surgery
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external bleeding should be stopped with ___. if this is not possible, use ___ (2)
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direct pressure
packing inflating foley cath |
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IVF for hypovolemic shock
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2L of lactated ringer's
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response to fluids is measured by ___ (3)
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BP
HR urine |
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minimal urine output for adults is ___/hr
minimal urine output for kids is ___/hr minimal urine output for infants is ___/hr |
.5 cc/kg
1 cc/kg 2 cc/kg |
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if BP is completely normalized after IVF, do ___.
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stop fluids
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if full responder deteriorates after stopping fluids, do ___. otherwise do ___
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tx as partial responder
CT |
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tx for partial responder (2)
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1L bolus
search for source of bleeding |
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tx for non-responder (2)
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blood
search for source of bleeding |
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blood type for adults
blood type for kids, child-bearing age women |
O+
O- |
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T/F: head is never source of hemorrhagic bleeding in adults
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true
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imaging studies for bleeding localization
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CXR
FAST |
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in neck hemorrhage is ___
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visible
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when searching for bleeding in chest, do ___.
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bilateral chest tubes
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if <___ of blood is obtained from chest tubes, ___.
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1.5L
chest is not the only source of bleeding |
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if FAST is positive, do ___. otherwise, ___.
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go to OR for laparotomy
check pelvis |
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checks performed for D
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pupils (symmetry, reflexes)
GCS basic motor exam |
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E phase
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exposure (strip patient)
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7 procedures performed in resuscitation phase
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ECG
insert NGT PR insert foley cath CXR portable pelvic XR FAST |
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FAST is for finding ___ (2)
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free abdominal fluid
rule out cardiac tamponade |
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5 methods of reducing ICP
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ventriculostomy
diuresis (mannitol) hyperventilation barbiturate coma craniotomy (last resort) |
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hyperventilation is only performed on scene if ___ or ___
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anisocoria present
fulminant deterioration wihhout hypovolemic shock or hypoxia |