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!!!!! Don’t 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-< 10—BVM
Inadequate despite rate—BVM
OK give 100% O2
Check pulse—carotid 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!!
Head—fluids from ears or nose?
Intact skull?
Check pupils
Do I need to hyperventilate?
Neck—step offs?, distended neck veins?, trachea midline?
Do I have a tension pneumo/cardiac tamponade/hemorrhagic shock?
Secure impaled objects
Put on collar
Chest—Look 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 ambulance—Get 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 Beck’s 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
Vitals
Mechanism of shock
Hemorrhagic
hypovolemic
shock
HR
RR
B/P
Neck veins
Drop in fluid to pump
Hypovolemic
shock
HR
RR
B/P
HR
RR
B/P
HR
RR
B/P
HR
RR
B/P
Neck veins
Drop in fluid to pump
Neurogenic
shock
Cardiogenic
shock
Obstructive
Shock
Cause
(Type of
injury)
Skin
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 Cushing’s 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 patient’s 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 P’s 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.