Mixed Deck — All ITLS Topics Flashcards

A factory worker has been splashed in the face and on the chest with a large amount of an unknown liquid chemical. He is complaining of intense burning pain. What is the most appropriate and immediate action after ensuring scene safety?

Answer: Immediately begin copious irrigation with large amounts of water.

The immediate priority for most liquid chemical burns is to stop the burning process by removing contaminated clothing and flushing the area with copious amounts of water for an extended period (at least 20 minutes). Attempting to neutralize a chemical without knowing its identity can worsen the injury by creating an exothermic reaction. Identification can occur concurrently with irrigation but should not delay it.

What is the minimum gestational age at which fetal viability is generally considered possible in the US?

Answer: 22–24 weeks

Fetal viability is generally considered possible at 22–24 weeks of gestation with advanced neonatal support.

Which patient presentation most strongly indicates the need for assisted ventilation rather than supplemental oxygen alone?

Answer: Respiratory rate of 8 with shallow chest rise and cyanosis

A respiratory rate of 8 (bradypnea) with shallow chest rise and cyanosis indicates inadequate ventilation requiring assisted ventilations with a BVM, not just supplemental oxygen.

In the START algorithm, if an apneic adult patient does not begin breathing after airway repositioning, the rescuer should:

Answer: Tag the patient expectant and move to assess the next patient

In START triage (for adults), an apneic patient who does not breathe after a single airway opening maneuver is tagged expectant, as CPR is not initiated during active MCI triage.

A 7-year-old falls off his bicycle, striking the handlebar directly into his upper abdomen. He is now tachycardic, pale, and has significant epigastric tenderness. In pediatric blunt abdominal trauma, which solid organ is most frequently injured?

Answer: Spleen

In pediatric blunt abdominal trauma, the solid organs are most at risk. The spleen and liver are the most commonly injured organs due to their size and location. The spleen is particularly vulnerable because of its rich blood supply and relatively unprotected position in the left upper quadrant.

Which of the following is the primary goal of permissive hypotension in the prehospital management of a patient with suspected non-compressible torso hemorrhage?

Answer: To prevent clot disruption and re-bleeding before surgical control.

Permissive hypotension is a strategy of restricting fluid resuscitation to maintain a lower-than-normal blood pressure (e.g., SBP of 80-90 mmHg) in patients with suspected non-compressible hemorrhage. The goal is to avoid dislodging newly formed clots by excessive intravascular pressure, which could worsen bleeding before the patient reaches definitive surgical care.

What mnemonic does ITLS use for the detailed secondary survey assessment of each body region, and what does each letter stand for?

Answer: DCAP-BTLS - Deformities, Contusions, Abrasions, Punctures/Penetrations, Burns, Tenderness, Lacerations, Swelling

DCAP-BTLS is the ITLS mnemonic used during the secondary survey to systematically assess each body region for: Deformities, Contusions, Abrasions, Punctures/Penetrations, Burns, Tenderness, Lacerations, and Swelling.

What is neurogenic shock, and how does it differ from hypovolemic shock in its presentation?

Answer: Neurogenic shock presents with hypotension and bradycardia due to loss of sympathetic tone, while hypovolemic shock presents with hypotension and tachycardia

Neurogenic shock results from spinal cord injury disrupting sympathetic outflow, causing vasodilation (hypotension) and unopposed vagal tone (bradycardia)—the opposite of the tachycardia seen in hypovolemic shock.

A trauma patient with facial fractures and significant oral bleeding is unable to maintain their airway. Oral intubation attempts have failed twice. What is the next appropriate airway intervention?

Answer: Perform a surgical cricothyrotomy

After two failed oral intubation attempts in a patient who cannot maintain their airway, a surgical cricothyrotomy provides a definitive surgical airway and is the appropriate rescue technique.

An electrician is found unconscious after contact with a high-voltage wire. He has small entry and exit burns on his hands and feet. What is the most critical and immediate concern for this patient beyond the surface burns?

Answer: Severe internal tissue damage and potential cardiac dysrhythmias.

High-voltage electricity travels through the body, causing extensive internal damage to muscles and organs (rhabdomyolysis) that is not visible externally. The current can also disrupt the heart's electrical conduction system, leading to life-threatening dysrhythmias like ventricular fibrillation. Therefore, cardiac monitoring and aggressive fluid resuscitation are paramount, as the visible burns are a poor indicator of the true injury severity.

What is the appropriate tidal volume when ventilating an adult trauma patient with a bag-valve-mask?

Answer: 500-600 mL per breath

The recommended tidal volume for BVM ventilation in adults is approximately 500-600 mL (6-7 mL/kg), providing adequate gas exchange while minimizing gastric insufflation and barotrauma risk.

What is the single most important prehospital intervention for a hemodynamically unstable patient with suspected significant intra-abdominal hemorrhage following blunt trauma?

Answer: Minimizing on-scene time and ensuring rapid transport to a trauma center.

Definitive care for significant intra-abdominal hemorrhage is surgical intervention to stop the bleeding. While initiating IV access and treating shock are important, they are supportive measures. The most critical action in the prehospital setting is to recognize the life threat and transport the patient without delay to a facility capable of performing surgery. Prolonged on-scene time for procedures that do not stop the bleeding increases mortality.

What anatomical difference makes children more susceptible to cervical spine injuries at the C1-C3 level compared to the adult pattern of lower cervical injuries?

Answer: Children have proportionally larger and heavier heads, higher fulcrum of cervical motion (C1-C3 vs. C5-C6 in adults), and more horizontal facet joints that allow greater mobility

Children's disproportionately large, heavy heads create a higher fulcrum of cervical motion (C1-C3 versus C5-C6 in adults), and their more horizontal facet joints and ligamentous laxity allow greater mobility, concentrating forces at the upper cervical spine.

In ITLS Advanced, what is the Glasgow Coma Scale score for a patient who opens eyes to pain, makes incomprehensible sounds, and exhibits flexion withdrawal?

Answer: GCS 8

Eye opening to pain = 2, incomprehensible sounds = 2, flexion withdrawal = 4. Total GCS = 2 + 2 + 4 = 8.

Why is the pregnant trauma patient at increased risk for aspiration during emergency airway management?

Answer: Progesterone-mediated relaxation of the lower esophageal sphincter, decreased gastric motility, increased intra-abdominal pressure, and mechanical upward displacement of the stomach all increase regurgitation risk

Pregnancy creates multiple aspiration risk factors: hormonal relaxation of the gastroesophageal sphincter, delayed gastric emptying, increased intra-abdominal pressure from the uterus, and upward stomach displacement, making regurgitation and aspiration more likely during airway management.

What is the significance of Rh factor in pregnant trauma patients, and what intervention may be needed?

Answer: Rh-negative mothers may develop antibodies against Rh-positive fetal blood cells if fetomaternal hemorrhage occurs from trauma; Rh immune globulin (RhoGAM) should be administered within 72 hours

Trauma can cause fetomaternal hemorrhage, exposing the Rh-negative mother to Rh-positive fetal red blood cells. Without RhoGAM administration within 72 hours, the mother may develop anti-D antibodies that threaten current and future pregnancies.

What is the recommended oxygen saturation target when providing supplemental oxygen to a critically injured pregnant patient?

Answer: Above 95%

Maintaining SpO2 above 95% helps ensure adequate fetal oxygenation, as fetal hemoglobin has a different oxygen dissociation curve.

Why is the cervical spine of elderly patients more vulnerable to injury, even from low-energy mechanisms?

Answer: Degenerative changes (osteoarthritis, spinal stenosis, disc disease) create a rigid, brittle spine with a narrowed spinal canal

Age-related degenerative changes make the cervical spine rigid and brittle, while spinal stenosis narrows the canal, meaning even minor forces can cause fractures and spinal cord compression.

During CPR on a 38-week pregnant patient, how should chest compressions be modified?

Answer: Perform standard chest compressions but with continuous manual left uterine displacement to improve venous return, and place hands slightly higher on the sternum to account for the elevated diaphragm

CPR in late pregnancy requires manual left uterine displacement to relieve IVC compression during compressions, and hand placement may be slightly higher on the sternum to account for the diaphragm and heart being displaced superiorly by the gravid uterus.

A motorcyclist has an open femur fracture with arterial bleeding. After applying a tourniquet, what is the next priority in ITLS Advanced assessment?

Answer: Continue the primary survey

After controlling life-threatening hemorrhage, the ITLS approach mandates continuing the primary survey (ABCDE) before addressing secondary concerns like splinting, IV access, or wound care.