Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ INTRODUCTION ++ Test Taking Tips Historically, there is always a question that tests your priorities in caring for the trauma patient. Do not get sidetracked! It is always primary survey with airway, breathing, and circulation. Know how to calculate the Glasgow Coma Scale (GCS) score. Be familiar with new ATLS updates, such as amount of crystalloid in initial resuscitation. +++ INITIAL MANAGEMENT +++ When does the first mortality peak for trauma occur? ++ Within seconds to minutes after injury +++ The trauma system and acute patient care have the greatest impact on patients in which mortality peak for trauma? ++ Second mortality peak (golden hour) +++ What do most of the deaths during the second mortality peak for trauma occur from? ++ Hemorrhage, central nervous system injuries +++ When does the third mortality peak for trauma occur? ++ 24 hours after injury, from multisystem organ failure and sepsis +++ How long should the primary survey in the initial evaluation of a trauma patient take? ++ No more than 5 minutes unless an intervention is needed. +++ What mnemonic is used to conduct the primary survey? ++ ABCDE: Airway, Breathing, Circulation, Disability, Exposure +++ What are the goals during airway assessment? ++ Secure the airway, protect the spinal cord +++ What is required for spinal immobilization? ++ A rigid cervical collar, use of a full backboard +++ Contraindications to nasotracheal intubation: ++ Apnea, maxillofacial fracture +++ What is the quickest way to test for an adequate airway in an awake, alert patient? ++ Ask a question; if the patient is able to speak, the airway is intact +++ Indications for a surgical airway: ++ Anatomic distortion as a result of neck injury, massive maxillofacial trauma, inability to visualize the vocal cords (blood, secretions, airway edema) +++ What are the goals during the breathing assessment? ++ Secure oxygenation and ventilation; treat life-threatening thoracic injuries +++ What should be done on physical examination to adequately assess breathing? ++ Inspection (air movement, cyanosis, tracheal shift, JVD, respiratory rate, asymmetric chest expansion, open chest wounds, use of accessory muscles of respiration) Auscultation/percussion (hyperresonance or dullness over lung fields) Palpation (flail segments, subcutaneous emphysema) +++ What life-threatening conditions must be treated during the breathing assessment if encountered? ++ Open pneumothorax, tension pneumothorax, massive hemothorax +++ What is the most common cause of upper airway obstruction? ++ The tongue +++ What is the ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Download the Access App: iOS | Android Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.