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ACS American College of
Surgeons
ATLS Advanced Trauma Life Support
ATLS Written Examination & Practical Skills
Assessment
ATLS Final Exams
Course Title and Number: ATLS Written Examination &
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ATLS Chapter 3 Shock ATLS Advanced Trauma Life Support Exam Review Questions and Answers | 100% Pass Guaranteed | Graded A+ | 2025- ATLS Modules / Chapter Review
ATLS Written Examination & Practical Skills
Assessment
ATLS Advanced Trauma Life Support Exam Read All Instructions Carefully and Answer All the Questions Correctly Good Luck: -
What are two broad categories of shock in trauma? - =Answer>> Hemorrhagic
and non-hemorrhagic
What are types of non-hemorrhagic shock? - =Answer>> Obstructive,
neurogenic, septic, cardiogenic
What is the most common cause of shock in the trauma patient? - =Answer>>
Hemorrhagic shock secondary to blood loss What are common causes of non-hemorrhagic shock in the trauma patient? How can
you diagnose them? - =Answer>> Cardiac tamponade (distended neck veins,
muffled heart sounds, positive FAST for pericardial fluid) Tension pneumothorax (distended neck veins, tracheal deviation, hyperresonant percussion over hemithorax) Neurogenic shock secondary to the cervical or thoracic spine injury (hypotension without tachycardia or cutaneous vasoconstriction) Need Writing 📱Help? We've Got You Covered! ✍ 100% NO A I or Plagiarism Guaranteed📱
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What is the most common cause of shock in trauma patients? Hemorrhage 27y/o M helmeted involved in high-speed MCC (motorcycle collision). Patient is confused. What are the possible reasons for the pt's confusion? Shock from any source, but most likely hemorrhage, could cause confusion in the patient. Other possible causes include brain injury, stroke, and alcohol and/or drug ingestion. Don't forget: Patients may have more than one form of shock Even without blood loss, most non-hemorrhagic shock states transiently improve with
Volume resuscitation Basic Cardiac Physiology CO=___ x ___ CO= SV x HR Preload Preload -volume of venous blood return to the left and right sides of the heart Hemorrhage reduces preload Afterload Need Writing 📱Help? We've Got You Covered! ✍ 100% NO A I or Plagiarism Guaranteed📱
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Afterload -Resistance to the forward flow of blood Early physiologic responses to blood loss Early physiologic responses to blood loss: Progressive vasoconstriction to preserve blood flow to kidneys, heart, and brain Increase in HR to preserve cardiac output Release of catecholamines, which increases peripheral vascular resistance and diastolic blood pressure Shift from aerobic to anaerobic metabolism in cells Early clinical manifestations of shock Tachycardia Cutaneous vasoconstriction -do not just rely on BP Evaluate: -RR -HR and character -Skin perfusion -Pulse pressure Massive blood loss effect on hematocrit What lab values can help determine presence and severity of shock? Lactate -serial measurements to monitor a petient's response to therapy are useful Very low hematocrit value shortly after injury suggests what? massive blood loss or preexisting anemia Need Writing 📱Help? We've Got You Covered! ✍ 100% NO A I or Plagiarism Guaranteed📱
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-an acute loss of circulating blood volume What are the 4 classes of hemorrhagic shock? Mild Hemorrhage (Class I) :
15% of total blood volume (~750 mL for a 70 kg adult). -minimal tachy -normal BP, pulse pressure and RR -Base deficit: 0- -2 mEq/L Moderate Hemorrhage (Class II) : 15–30% of total blood volume (~750–1,500 mL). Symptoms include tachycardia, narrowed pulse pressure, and mild anxiety. -Decreased pulse pressure -Subtle CNS signs (e.g. anxiety, fear, hostility) -Urinary output 20-30 mL/hr in adults -Base deficit: -2 to -6 mEq/L Severe Hemorrhage (Class III) : 31–40% of total blood volume (~1,500–2,000 mL). -Inadequate perfusion -Marked tachycardia, -Tachypnea, -AMS -Profound hypotension, Need Writing 📱Help? We've Got You Covered! ✍ 100% NO A I or Plagiarism Guaranteed📱
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-Base deficit -6 to -10 mEq/L Life-Threatening Hemorrhage (Class IV) : More than 40% of total blood volume (>2,000 mL). -Marked tachy -profound hypotension -very narrow pulse pressure or unmeasurable diastolic BP -Negligible urinary output -Marked depressed mental state -Cold, pale skin -Base deficit: -10 mEq/L or more What is the relevancy of base deficit in hemorrhage? Hypoperfusion : Decreased oxygen delivery to tissues results in anaerobic metabolism. Anaerobic metabolism produces lactic acid , leading to lactic acidosis. The buffering system consumes bicarbonate to neutralize excess acid, resulting in a negative base deficit. Indicator of Shock Severity : A higher (more negative) base deficit suggests more severe shock and hypoperfusion. It correlates with blood loss, tissue hypoxia, and worse outcomes. In summary, the base deficit in hemorrhagic shock reflects the loss of HCO ₃⁻ secondary to buffering the acidosis caused by tissue hypoxia and lactic acid accumulation. It is a critical marker for assessing the metabolic impact of blood loss.
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-tissue edema is the result of shifts in fluid from plasma into ECF, these shifts cause additional depletion in intravascular volume What pt population are particularly at risk for extensive blood loss into tissues? Obese and elderly patients are particularly at risk for extensive blood loss into tissues Blood loss can be underestimated from soft-tissue injury in obese and elderly individuals. What is a possible solution? Evaluate and dress wounds early to control bleeding with direct pressure and temporary closure Reassess wounds and wash and close them definitively once the patient has stabilized Initial mgmt of hemorrhagic shock Methods to stop hemorrhage Gastric Dilation and Urinary Catheterization in Trauma In unconscious patients, gastric dilation increases the risk of aspiration of gastric contents (a potentially fatal complicaiton) Bladder cath allows clinicans to assess the urine for hematuria which can identify the retroperitoneum as a significant source of blood loss Initial Fluid Therapy Need Writing 📱Help? We've Got You Covered! ✍ 100% NO A I or Plagiarism Guaranteed📱
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What is meant by Balanced/Controlled Resuscitation Possible solutions for scenario: Shock does not respond to initial crystalloid fluid bolus FAST only shows you intraperitoneal FAST won't show retroperitoneal The pelvic xray will show you a shattered pelvis and will suggest retroperitoneal hemorrhage Urinary output is one of the prime monitors of resus and patient response-->adequate organ perfusion What is normal urinary output for adults, peds, and infants Three groups of patterns of response to initial fluid therapy
- Rapid response
- Transient Response
- Minimal or No Response Rapid Responders of IVF therapy Need Writing 📱Help? We've Got You Covered! ✍ 100% NO A I or Plagiarism Guaranteed📱
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Pitfall: Uncontrolled blood loss can occur in patients taking anti-platelet or anticoagulant meds Possible solution? Pitfall: Thromboembolic complications can occur from agents given to reverse anticoagulant and antiplatelet medications. Possible solution? What adjuncts should be considered to determine the cause of shock? Resus should include consideration of additional fluid bolus and preparation to transfuse blood -Ultimately, therapy will be guided by the results of imaging and ongoing physical exam/reassessent Which factor can make identifying of hemorrhagic sock--] Need Writing 📱Help? We've Got You Covered! ✍ 100% NO A I or Plagiarism Guaranteed📱
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The use of meds suchs as BBs can block the tachy response to hemorrhagic shock -Older adults have reduced cardiac compliance, reduced cardiac contractility, and may use diuretics, which renders them relatively hypovolomic What is the most common cause of transient response to fluid therapy? An undiagnosed source of bleeding -These patients require persistent investigation to identify the source of blood loss -Immediate surgical intervention may be necessary Does increased Blood Pressure = CO? Blood Pressure (BP) = Cardiac Output (CO) × Systemic Vascular Resistance (SVR) Cardiac Output (CO) = Stroke Volume (SV) × Heart Rate (HR) An increase in BP can occur due to changes in CO , SVR , or both. Here’s why BP and CO can diverge: Compensatory Vasoconstriction (Increased SVR) : In shock (e.g., hypovolemic or obstructive shock), the body compensates by increasing SVR through vasoconstriction to maintain BP and perfusion to vital organs. This increased SVR can raise BP even when CO is critically low. Thus, the BP might look normal or high, masking low cardiac output.
An increase in BP may reflect compensatory mechanisms (increased SVR), medication effects, or fluid resuscitation, but these do not necessarily translate to improved CO or tissue perfusion. Shock management focuses on restoring effective perfusion , not just increasing BP. CO and other markers of perfusion are key indicators of recovery. Recovery from shock is better assessed by what? Recovery from shock is better assessed by improvements in mental status, urine output, capillary refill, and lactate clearance, rather than BP alone. What are the special considerations of advanced age in trauma/hemorrhage/shock? Prompt, aggressive resuscitation and early advanced monitoring are important to determine appropriate volume resus. Need Writing 📱Help? We've Got You Covered! ✍ 100% NO A I or Plagiarism Guaranteed📱
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What are the special considerations of Pacemakers and Impantable Cardioverter- Defibrillators (ICDs) in trauma/hemorrhage/shock? After ensuring a patent airway and adequate ventilation, trauma team members must carefully evaluate the patient's circulatory status for early manifestations of shock, such as: Tachycardia and cutaneous vasoconstriction
What is the first step in managing shock and a trauma patient - =Answer>> To
recognize its presence
What is the second step in managing shock - =Answer>> Identified the
probable cause of shock and adjust treatment accordingly
Define shock - =Answer>> An abnormality of the circulatory system that
results in adequate organ perfusion and tissue oxygenation
List the 5 types of shock - =Answer>> Hypervolemic/hemorrhagic, cardiogenic,
obstructive, neurogenic, septic
What is the most common causes of shock in trauma patients - =Answer>>
Hemorrhage/hemorrhagic shock
Give formula for cardiac output - =Answer>> HR (beats/min) x Stroke volume
(mL/beat)= Q Need Writing 📱Help? We've Got You Covered! ✍ 100% NO A I or Plagiarism Guaranteed📱
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Define preload - =Answer>> Volume of venous blood returning to both sides of
the heart
How does hemorrhage affect preload - =Answer>> It reduces it
Stallings principal pertains to what aspect of cardiac output - =Answer>>
Myocardial contractility
Would influence his myocardial contractility/length - =Answer>> Volume of
venous blood returned after ventricular filling at the end of diastole
Define afterload - =Answer>> Resistance to the forward flow of blood
What are the 3 components of stroke-volume - =Answer>> preload, afterload,
contractility What is the earliest physiologic response to blood loss and may be the only sign upon
presentation - =Answer>> Tachycardia
With 3 organs his blood shunted to hemorrhage - =Answer>> Heart, brain,
kidneys T/F even if the patient does not appear to be in shock, organ perfusion and tissue
oxygenation may be compromised - =Answer>> True
During hemorrhage due to release ______ which affect blood pressure in 2 ways(explain
them), which clinical signs would you see to suggest this - =Answer>>
Release of catecholamines, increase in peripheral vascular resistance and diastolic blood pressure, this will result in an increase of blood pressure and the narrowing of the pulse pressure
What type of metabolism occurs in shock - =Answer>> Anaerobic causing
lactic acidosis In addition to tachycardia what else is an early clinical manifestation of shock -
=Answer>> Cutaneous vasoconstriction
True or false you can rely on systolic blood pressure as an indicator of shock, why -
=Answer>> False, other compensatory mechanisms can maintain systolic
blood pressure and up to loss of 30% of blood volume Need Writing 📱Help? We've Got You Covered! ✍ 100% NO A I or Plagiarism Guaranteed📱
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Explained the 4 classes of blood loss - =Answer>> Class I is equal to giving 1
unit of blood Class II is a hemorrhage that will improve with just IV fluid resuscitation Class III is a hemorrhage that requires IV fluids and blood product Class IV requires massive transfusion After initial classification and assessment what guides subsequent volume replacement -
=Answer>> Patient response to therapy
Explained the percentage of blood loss by using the classes - =Answer>>
Class I is less than 15%, class II is 15 to 30%, class III is 31 to 40%, class IV is greater than 40%
Given the base deficits based on class of hemorrhage - =Answer>> Class I is
0 to -2 mEq/L, class II is -2 to -6 mEq/L, class III is -6 to -10 mill equivalents per liter, class IV is -10 mEq or less And a class II hemorrhage what are the only 2 physical exam signs that may be
suggestive of shock - =Answer>> Tachycardia and narrow pulse pressure
List 7 suggestive signs and symptoms of class IV hemorrhage - =Answer>>
Tachycardia, hypotension, narrow pulse pressure, decreased urine output, increased respiratory rate, depressed GCS, base deficit less than - A patient has suspected hemorrhage however there heart rate is only 90 and they have
no hypertension, you (should or should not) give IV crystalloid - =Answer>>
You should, if hemorrhage is suspected you should not wait until hypotension occurs (T/F) patient can have altered mental status a class III hemorrhage -
=Answer>> True
(T/F) only single parameter is needed to diagnose shock - =Answer>> False
The test presents in elderly patient who fell and is in shock, in addition to hemorrhage
what else should you suspect and do about this? - =Answer>> Septic shock,
urinalysis When the patient has sustained trauma order the 2 ways fluid changes -
=Answer>> Blood loss, edema into the soft tissues
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What two patient populations may lose more fluid volume to edema than others which
can mask the extent of fluid volume loss - =Answer>> Elderly and obese
patient's The basic management principal of managing hemorrhagic shock is to_____ and
______ - =Answer>> Stop the bleeding and replace volume loss
Splinting fracture should be done (immediately upon recognition or during/after
secondary survey) why? - =Answer>> Immediately, splinting is a mechanism
of hemorrhage control What are the 3 problems associated with gastric distention and a trauma patient -
=Answer>> 1 hypotension, 2 dysrhythmia, increased risk for aspiration
How can you treat gastric distention and a trauma patient - =Answer>> NG or
OG tube with suction What 2 things can be monitored with urinary catheterization in a trauma patient -
=Answer>> 1 hematuria, 2 urine output
What does hematuria or oliguria suggest in a trauma patient - =Answer>>
Hematuria equals retroperitoneal hemorrhage, oliguria equals decreased renal perfusion When you obtained vascular access what labs should be drawn (5) -
=Answer>> Labs, type and crossmatch, toxicology, pregnancy, blood gases
Ratio of PRBC to Plasma and platelets should be (high/low) - =Answer>> Low
If the patient has already received a liter of crystalloid in the field and still remains in shock you should (adminsiter more fluid and reassess/strongly consider ordering blood
product) - =Answer>> Strongly consider ordering blood product
Explained the terms balanced or controlled resuscitation - =Answer>> A
concept that you will allow hypotension and not focus on resuscitation of fluids when there is strong suspicion for internal bleeding that needs to be stopped first
His balance/controlled resuscitation a definitive treatment method - =Answer>>
No it is a bridge to surgical management which is the definitive management What is a prime measurement of patient response to fluid resuscitation -
=Answer>> Urine output
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