ADVANCED PROVIDER ITLS STUDY GUIDE To help students master the concepts of excellent trauma care, the following

study guide has been developed. Please use your ITLS for Prehospital Care Providers, 7th ed. to answer the questions. Then, memorize the material!!!!! Dont just reckon you know the answer! Chapter One 1. What is a windshield survey and when should it be done? 2. What are the three collisions that happen in any MVC? 3. When assessing a MVC, ____________ is more important than mass in a collision. 4. The following injuries may be suspected in a head on collision _______________________________________________________________________ _______________________________________________________________________ __Rear end collision _______________________________________________________________________ _______________________________________________________________________ __ 5. What are the three important things to ask about in a fall?

6. State the five phases of a blast injury.

Chapter Two 7. What survey has the lowest priority in assessing the multitrauma patient? 8. What types of injuries would allow the medic to perform the primary, secondary and on-scene treatments? 9. What finding in the primary survey may justify it being interrupted? 1. 2. 3.

10. List the interventions(Fix it!) that may be performed on the load and go patient on the scene. (all nine!)

11. Identify the physical assessment findings that make the patient Load and Go. 12. At what point in the primary survey may a medic begin transport on a critical load and go patient? 13. What should a medic do if his patient deteriorates? 14. Which actions or interventions can you delegate to a team member while performing the primary survey? 15. Patients with an altered mental status should have a brief neurological exam performed at the end of the primary survey. What three assessments are part of the brief neurological exam? 1. Check for S/S of cerebral herniation 2. 3.

16.. Non traumatic causes of altered mental status includes ________________ and __________________ or ______________ _____________. 17. All altered mental status patients should have a ______________ checked. 18. Define the CABC approach. 19. In trauma the pulse oximetry should be kept above _________ with the critical level being _______. 20. When is it appropriate to use the scoop stretcher? Know what assessments make up the primary survey! Know your assessment!! Primary Assessment Scene Size-up General impression/Stop any major bleeding Initial assessment Check LOC/Assign SMR Check and fix airway Check rate and quality of breathing

Too slow-< 10BVM Inadequate despite rateBVM OK give 100% O2 Check pulsecarotid and radial Check skin color, condition Reassess major bleeding and fix it Cool burns now if need to State Load and go. If Load and Go Rapid trauma survey always before package. Look only for life threats!! Headfluids from ears or nose? Intact skull? Check pupils Do I need to hyperventilate? Neckstep offs?, distended neck veins?, trachea midline? Do I have a tension pneumo/cardiac tamponade/hemorrhagic shock? Secure impaled objects Put on collar ChestLook DCAPBTLS equal rise and fall? Listen to breath sounds Feel for Flail? Tension Pneumo? Sucking chest wound? Abdomen Look Feel Pelvis Feel Use scoop if unstable and secure with sheet Lower legs-Look, Feel PMS Use scoop if bilateral femur fractures Upper arms same as legs LBB_or scoop check back Get history on scene if patient unconscious. Secondary Assessment On going exam Reevaluate Airway, Breathing and pulse fix if anything has changed Check on ALS intercepts In ambulanceGet vital signs, include pulse ox and glucose and capnography Treat for shock now!!! SAMPLE if not done Detailed exam Head to toe

Fix wounds, splint if needed On Going Reassessment Recheck vital signs and interventions Do call in M I V I T Mechanism of injury Injuries Vitals Interventions Time to arrival Chapter Four 21. What abnormal airway sound would indicate that the patient needs immediate endotracheal intubation? 22. In order to reduce hyperventilation in the multitrauma patients who needs ventilation assistance, the medic must ventilate a rate of _________ breaths/minute or a breath every _____ seconds with volumes that cause adequate chest rise. 23. What may cause a 20 mmHg decrease in ETCO2 in a trauma patient who is being adequately ventilated? 24. What is the normal end tidal CO2 reading? 25 . Name the BIADS. 26. When end tidal CO2 is > 45 you suspect ___________________ and when it is < 35 you might suspect ____________________. 27. What is MMAP?

Chapter Five 28. The most reliable way to ensure that an ETT is being placed in the trachea and not in the esophagus is 29. The medic must constantly monitor correct placement of an endotracheal tube. What is the BEST way to ensure continuous ETT placement?

30. When nasally intubating a breathing patient, after the tube enters the glottic opening, the patient will often _____________ or _________________ indicating that tube has been correctly placed. 31. Using external laryngeal manipulation during intubation improves the visibility of the ____________ ____________. 32 . What makes it difficult to read a pulse ox?

33. In trauma you want the pulse ox above _________ with a critical value being below _________. Chapter Six 34. When a MVC patient shows the following signs and symptoms: cyanosis, JVD, rapid, weak pulses and equal breath sounds, the medic must administer high concentration oxygen, apply ____________ and ____________ the patient. 35. When bagging an intubated patient who suffered blunt chest trauma, the ambu bag becomes progressively more difficult to squeeze. The patient is most likely experiencing a ____________________. 36. If a patient has an isolated sternal fracture, the appropriate field management of this injury is application of the ____________. (Hint: Think cardiac contusion!) 37. Describe the signs and symptoms of a cardiac tamponade.

38. What is/are the major differences between a tension pneumo and a hemothorax?

39. List the chest injuries that are immediately life-threatening.

40. List the chest injuries which are NOT immediately life threatening.

41. When a patient develops severe DIB, cyanosis, weak/absent radial pulse, JVD and decreased breath sounds on the LEFT, the paramedic must perform immediate ____________________________________. 42. The BEST way to treat a large flail chest in the unresponsive multitrauma patient is ________________________________________. 43. Signs of a tension pneumothorax include : ________________, _____________, ___________________, _____________, ______________, _______________, while signs of a simple pneumothorax include ______________, __________, and ________________. 44. Subcutaneous emphysema may be seen in _________________________. 45. What is Becks triad?

Chapter 7 46. Sites for needle chest decompression include the anterior approach with the following landmarks: and needle chest decompression in the lateral approach with the following landmarks: 47. What is the proper needle length for a needle chest decompression? Chapter 8 48. When a patient with CONTROLLED BLEEDING presents with signs and symptoms of shock, the correct IV fluid resuscitation includes: 49. What is the appropriate way to control bleeding in a part of the body that cannot be tourniqueted and cannot be controlled with direct pressure? 50. List the possible injuries responsible for mechanical shock.

51. What is the initial chemical released by the body in hypoxia and shock that is attributed to many of the signs of shock?

52. Describe what this chemical does to the 1) HR ____________ 2) Pumping action of the heart _____________ and 3) blood vessels. _________________. 53. Shock is defined as ______________tissue perfusion. 54. This results in the tissues not getting ___________ and_____________ that they need to live. 55. In compensated shock the B/P ____________ and in decompensated shock the B/P ____________. 56. Define the approximate B/P for the following present pulses Carotid ________ Radial _________ Femoral ____________ 57. A pulse rate > than _________ in the primary survey in the adult makes one suspect _________________. Know Shock Hemorrhagic hypovolemic shock Hypovolemic shock Neurogenic shock Cardiogenic shock Obstructive Shock Cause (Type of injury) Skin Vitals HR RR B/P Neck veins HR RR B/P HR RR B/P HR RR B/P HR RR B/P Neck veins Mechanism of shock Drop in fluid to pump

Drop in fluid to pump Vessels dilated, blood pools Pump failing, cannot get blood around Flow Obstructed

58. Fluid management for uncontrolled internal bleeding with hypotensive shock: 59. Fluid management for uncontrolled external bleeding with hypotensive shock:

60. Fluid management for hypovolemic shock with no bleeding:

Chapter 10 61. The ITLS recommendations for care of the multitrauma patient with a severe head injury include maintaining a systolic BP of ______ to ________ mmHg. 62. Patients with an isolated severe head injury are best managed with _________ and ventilation to maintain an ETCO2 of _____ to______mmHg. 63. In the absence of ETCO2 monitoring capability, an unresponsive patient with an isolated severe head injury with evidence of brain herniation should be ventilated at a rate of ____________ times/minute. 64. An ETCO2 level of ___________ mmHg and an O2 saturation level of ________________% is recommended when caring for patient with signs of brain herniation syndrome. 65. CPP= ______________. 66. Describe the Cushings reflex.

67. According to ITLS, when is one allowed to hyperventilate in the field _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ ___ Chapter 11 68. Describe a mechanism of injury when spinal motion restriction would not be indicated and may reduce the patients chance of survival.

69. Describe an unreliable patient when considering SMR. 70. Describe the movement of the spine in the different mechanisms of spinal trauma. Hyperextension Hyperflexion Compression Distraction 71. Describe the conditions under which an athletic helmet may be removed in the field.

Chapter 12 72. The technique of emergency rescue is indicated when scene size up reveals ____________________________. 73. To avoid aspiration in the packaged patient, the medic must ___________-_______________ when the patient is vomiting. 74. Describe the difference between emergency rescue and rapid extrication.

Chapter 13 75. Shock management of the patient with an adequate BP but probable UNCONTROLLED internal hemorrhage includes IV fluid at a _________________ rate. 76. IV fluid resuscitation for the patient with uncontrolled hemorrhage who is in decompensated shock includes ___________________________ to maintain peripheral pulses. 77. What major organ is in the RUQ? __________ LUQ ___________ Retroperitoneal space? _______________________. 78. Name two solid organs. _______________ _________________ in the abdomen. Name two hollow organs. ___________________ ___________________ in the abdomen

79. Blunt or penetrating trauma below the ____________________ should make you suspicious for both chest and abdominal trauma. 80. During the primary survey, _________________, ____________________, or ______________________ of the abdomen should make one suspicious for intraabdominal bleeding. Chapter 14 81. Care of the patient who has sustained a massive crush injury includes administration of ______________ as well as ____________________. 82. What orthopedic injury is most likely to have associated neurovascular injury? 83. Describe the five Ps of compartment syndrome.

84. Ideally a tourniquet should be left in place ______________ or less. 85. When using hemostatic agents, ____________________ must still be maintained for optimal efficacy. Chapter 16 86. Immediate care of burn victim whose skin is warm to touch includes _______ ___________ for one to two minutes but avoiding __________________. 87. Patients who have been involved in house fires who complain of nausea, SOB, a headache are assumed to be suffering from ____________________________ and are treated with ____________________________. 88. A superficial burn is considered to involve just the _____________ dermis and the skin color is __________. Partial thickness burns cause ___________________ on the skin surface. Full thickness burns have __________________________skin color and require skin grafting. 89. The current recommended treatment agent for cyanide poisoning is ________________________________. 90. List 6 danger signs of upper airway burns.

91 The most serious and immediate injury that results from an electrical contact is ____________________________ 92. In burns, the breakdown of muscle with the release of myoglobin causes __________________________ and in this case fluid resuscitation should be enough to maintain urine output of _________________________. 93. Your patient has received 40% partial thickness burns to his body. He weighs 186 pounds. Using the Parkland formula: How much overall fluid replacement does the patient need? ___________ How much will he receive in the first 8 hours? ______________ Chapter 17 94. Pediatric multitrauma patients with head injuries who are exhibiting signs of shock must be treated with a IV fluid bolus of ________________ to help maintain cerebral perfusion pressure.

95. One of the most reliable early signs of shock in the pediatric patient is __________________ ____________________. 96. A ___________________________________ should be utilized to determine equipment and drug needs for the pediatric patient. 97. Rescue breathing for the infant is _____bpm, child up to adolescence is ____bpm. 98. Grunting respirations in a toddler indicate that the medic must provide _____________________ support. Chapter 18 99. Even when the initial assessment exam of a geriatric patient reveals nothing of note, the medic must perform a ________________________________. 100. Problems in the elderly: Dentures, fillings, etc present a potential _____________________ problem Pulmonary circulation decreases causing a decrease in ________________at the alveolar level. Blood pressure normally will ___________in the elderly causing one to consider shock early in the elderly. Elderly may have an increased risk of ____________________ in trauma because of brain shrinkage. Temperature regulation may not ___________________ causing the elderly to be prone to both ____________________ and ____________________.

Due to _________________ their bones are more fragile. 101. The elderly may take the medicines _________________ that may increase their bleeding, ________________________that may keep their heart rate low, and ___________________that may not allow their blood vessels to constrict. Chapter 19 102. Shock in pregnant patient in the last trimester INITIALLY requires positioning the patient in the ___________ ___________ _____________. 103. During pregnancy the HR will _______________, RR will ____________and B/P will _________ normally. 104. Gastric motility will decrease, placing the pregnant patient at risk for ______________________. 105. Hypovolemia in the pregnant patient causes early constriction to the _____________thus compromising the blood flow to the fetus. 106. At 20 weeks gestation the top of the uterus is at the ___________________. 107. After 20 weeks gestation, placing the mother in the supine position can cause a ____________ in her blood pressure , and this is called ___________________ ______________________ __________________.

Chapter 21 108. Trauma patients with absent pupil response, blunt trauma, no respirations or Pulses should have _________________- withheld.