Initial Assessment and Management Flashcards

During the primary survey of a trauma patient, what is the immediate priority after establishing a patent airway?

Answer: Assessing for adequate breathing and ventilation.

The ATLS protocol follows the ABCDE mnemonic. After ensuring the Airway (A) is patent, the next immediate step is to assess Breathing (B) to ensure adequate ventilation and oxygenation. Life-threatening issues with breathing, such as a tension pneumothorax or open chest wound, must be addressed before moving to Circulation (C).

A 25-year-old male arrives after a motorcycle crash. He is agitated, his skin is cool and clammy, heart rate is 130 bpm, and blood pressure is 90/60 mmHg. During the primary survey, which of the following is the MOST appropriate initial step for managing his circulation?

Answer: Control any obvious external hemorrhage and establish two large-bore IV lines.

In the 'C' (Circulation) phase of the primary survey, the priority is to control hemorrhage and restore circulating volume. The patient's signs are consistent with hemorrhagic shock. The first steps are to stop any visible bleeding and secure intravenous access for fluid resuscitation. While blood transfusion may be necessary, it follows securing IV access. A CT scan is an adjunct to the secondary survey and should not delay resuscitation. Vasopressors are generally a later consideration after volume has been addressed.

Which of the following components is assessed during the 'D' (Disability) part of the ATLS primary survey?

Answer: Glasgow Coma Scale (GCS) score.

The 'D' for Disability in the primary survey is a rapid neurological evaluation. Its core components are the Glasgow Coma Scale (GCS) to assess the level of consciousness, and pupillary size and reaction. A detailed neurological exam is part of the secondary survey. AMPLE history is also taken during the secondary survey, and capillary refill is part of the 'C' (Circulation) assessment.

A trauma patient has been stabilized after the primary survey and initial resuscitation. When does the ATLS protocol indicate the secondary survey should begin?

Answer: After the primary survey is completed, resuscitation is underway, and vital signs are normalizing.

The secondary survey is a head-to-toe evaluation that should only begin after the primary survey (ABCDEs) is complete, resuscitation efforts are in progress, and the patient is demonstrating normalization of vital functions. If the patient becomes unstable at any point during the secondary survey, the provider must return to the primary survey.

During the 'E' (Exposure and Environment) phase of the primary survey, what is a critical management principle?

Answer: Applying warm blankets and external warming devices to prevent hypothermia.

In the 'E' phase, the patient must be fully undressed to allow for a thorough examination for injuries. However, this exposes them to the risk of hypothermia, a component of the 'triad of death' in trauma. Therefore, a critical step is to prevent heat loss by covering the patient with warm blankets, using external warming devices, and warming intravenous fluids.

A patient with severe facial trauma is making gurgling sounds and has difficulty breathing. According to ATLS guidelines, which of the following is the most appropriate initial maneuver to establish an airway?

Answer: Suctioning the oropharynx while applying a jaw-thrust maneuver.

In a patient with a potentially obstructed airway due to blood or secretions, the initial steps are to clear the airway with suction and use basic maneuvers like the jaw-thrust (preferred in trauma to protect the C-spine) or chin-lift to open the airway. More advanced airways like intubation or a surgical airway are considered if these initial steps fail. Nasotracheal intubation is relatively contraindicated in severe facial trauma due to the risk of intracranial placement.