ATLS 10 POST-TEST AND PRE-TEST -

ATLS 10 POST-TEST AND PRE-TEST -

CORRECT DETAILED ANSWERS|ALREADY

GRADED A+

Laryngeal fracture is confirmed with what test?Computed tomography (CT) Airway obstruction objective signs Agitation (hypoxia) Obtundation (hypercarbia) Cyanosis (nail beds, circumoral skin) Increased work of breathing (retractions, accessory muscles) Pulse oximetry Abnormal breath sounds (snoring, gurgling, stridor, hoarseness) Risk factors for ventilation compromise Direct trauma to the chest Rib fractures Intracranial injuries Cervical spine injury High cervical spine injuries above ___ will ___ Low cervical spine injuries below ___ will ___, but ___ C3, paralyze the diaphragm.C3, maintain the diaphragm, but paralyze the intercostal and abdominal muscles (diaphragmatic or see-saw breathing) Signs of inadequate ventilation 1 / 4

Asymmetric tidal breathing Inadequate chest wall excursion Laboured breathing Decreased or absent breath sounds Tachypnea Pulse oximetry Capnography Altered mental status Symptoms of inadequate ventilation Dyspnea Orthopnea Urge to sit up to breathe Confusion Potential situations causing difficulties in airway maneuvers C-spine injury Severe arthritis of the C-spine Significant maxillofacial or mandibular trauma Limited mouth opening Retrognathia Short, muscular necks Bariatrics Pediatrics LEMON Assessment for Difficult Airway Look externally (e.g. small mouth, large overbite, facial trauma) Evaluate 3-3-2 rule (incisor teeth distance of 3 finger breadths; hyoid bone Mallampati score to evaluate hypopharynx (soft palate) evaluation Obstructions that can make laryngoscopy and ventilation difficult.Neck mobility (C-spine flexion, extension) - obviously cannot be 2 / 4

performed in blunt trauma with suspected C-spine injury, also in those with C-spine surgery, Down syndrome, and rheumatoid arthritis.The ATLS airway decision scheme only applies in which scenarios?Acute respiratory distress Apneic patient Immediate airway needed Potentially have C-spine injury Equipment checklist for airway maneuvers Suction Oxygen OPA and NPA Bag-mask Laryngoscope Gum elastic bougie (GEB) Extraglottic devices (LMA, LTA) Surgical or needle cricothyroidotomy kit Endotracheal tubes Pulse oximeter CO2 detection device Drugs Methods to pre-oxygenate Supplemental oxygen Bag-mask Oropharyngeal airway Nasopharyngeal airway

Scenario: Can't oxygenate or can't intubate

Definitive airway or surgical airway

Scenario: Easy airway (LEMON) 3 / 4

Attempt intubation with cricoid pressure, ± drug-assistance.

Scenario: Difficult airway (LEMON)

Call for help and consider awake intubation.

Adjuncts for difficult airway or failed airway:

Gum elastic bougie Intubating supraglottic device (e.g. ILMA, ILTA) Mallampati Score I - soft palate, fauces, uvula, tonsillar pillars II - soft palate, fauces and uvula III - soft palate and base of uvula IV - soft palate not visible 3-3-2 Rule

• finger-breadths wide between maxillary and mandibular incisors.
• finger-breadths from the base of the mandible to the tip of the chin.
• finger breaths from the hyoid bone to the thyroid notch.

Describe Chin-Lift technique:

Place fingers of one hand under the mandible and lift it upwards to bring chin anterior. Open the mouth with the thumb of the same hand.

Describe Jaw-Thrust technique:

Grasp the angles of the jaw and then displace the mandible forward (e.g.into the facemask to get a better seal).

Nasopharyngeal Airway insertion technique:

• Ensure no contraindications (nasal trauma, suspicion of cribriform

plate injury).

• Lubricate the device.
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