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ATLS POST TEST|4 LATEST VERSIONS|ACTUAL 160
QUESTIONS AND ANSWERS|RATED A+|LATEST
UPDATE 2025- 2026
A 22 - year-old man is hypotensive and tachycardic after a shotgun wound to the left shoulder. His blood pressure is initially 80/40 mm Hg. After initial fluid resuscitation his blood pressure increases to 122/84 mm Hg. His heart rate is now 100 beats per minute and his respiratory rate is 28 breaths per minute. A tube thoracostomy is performed for decreased left chest breath sounds with the return of a small amount of blood and no air leak. After chest tube insertion, the most appropriate next step is: A) Reexamine the chest A construction worker falls two stories from a building and sustains bilateral calcaneal fractures. In the emergency department, he is alert, vital signs are normal, and he is complaining of severe pain in both heels and his lower back. Lower extremity pulses are strong and there is no other deformity. The suspected diagnosis is most likely to be confirmed by: Complete spine x-ray series Which of the following is true regarding the initial resuscitation of a trauma patient? Evidence of improved perfusion after fluid resuscitation could include improvement in Glasgow coma scale score on reevaluation In managing a patient with a severe traumatic brain injury, the most important initial step is to: Select one:
- Secure the airway A previously healthy, 70 - kg (154-pound) man suffers an estimated acute blood loss of 2 liters. Which one of the following statements applies to this patient? Select one: . - d. An ABG would demonstrate a base deficit between - 6 and - 10 mEq/L
The physiologic hypervolemia of pregnancy has clinical significance in the management of the severely injured, gravid woman by: Select one:
- e. increasing the volume of blood loss to produce maternal hypotension The best assessment of fluid resuscitation of the adult burn patient is: Select one:
- a. Urine output of 0.5 mL/kg/hr The diagnosis of shock must include: Select one:
- e. evidence of inadequate organ perfusion A 7 - year-old boy is brought to the emergency department by his parents several minutes after he fell through a window. He is bleeding profusely from a 6-cm wound of his medial right thigh. Immediate management of the wound should consist of: Select one:
- b. direct pressure on the wound For the patient with severe traumatic brain injury, profound hypocarbia should be avoided to prevent: Select one:
- c. cerebral vasoconstriction with diminished perfusion After being involved in a motor vehicle crash, a 25-year-old man is brought to a hospital that has surgery capabilities available.. Computed tomography of the chest and abdomen shows an aortic injury and splenic laceration with free abdominal fluid. His blood pressure falls to 70 mm Hg after CT. The next step is: Select one:
- c. perform an exploratory laparotomy Which one of the following statements regarding abdominal trauma in the pregnant patient is TRUE? Select one:
- b. Leakage of amniotic fluid is an indication for hospital admission.
diaphoretic and complaining of chest pain. His blood pressure is 60/40 mm Hg and his respiratory rate is 40 breaths per minute. Which of the following best differentiates cardiac tamponade from tension pneumothorax as the cause of his hypotension?
- c. breath sounds Bronchial intubation of the right or left mainstem bronchus can easily occur during infant endotracheal intubation because:
- a.The trachea is relatively short. A 23-year-old man sustains 4 stab wounds to the upper right chest during an altercation and is brought by ambulance to a hospital that has full surgical capabilities. His wounds are all above the nipple. He is endotracheally intubated, closed tube thoracostomy is performed, fluid resuscitation is initiated through 2 large-caliber IVs. FAST exam does not reveal intraabdominal injuries. His blood pressure now is 60/0 mm Hg, heart rate is 160 beats per minute, and respiratory rate is 14 breaths per minute (ventilated with 100% O2). 1500 mL of blood has drained from the right chest. The most appropriate next step in managing this patient is to
- d. urgently transfer the patient to the operating room A 39-year-old man is admitted to the emergency department after an automobile collision. He is cyanotic, has insufficient respiratory effort, and has a GCS score of
- His full beard makes it difficult to fit the oxygen facemask to his face. The most appropriate next step is to
- d.restrict cervical motion and attempt orotracheal intubation using 2 people A patient is brought to the emergency department after a motor vehicle crash. He isconscious and there is no obvious external trauma. His blood pressure is 60/ mm Hg and his heart rate is 70 beats per minute. His skin is warm. Which one of the following statements is TRUE? . - e.Flaccidity of the lower extremities and loss of deep tendon reflexes are expected Which one of the following is the most effective method for initially treating frostbite?
a. moist heat A 32 - year-old man's right leg is trapped beneath his overturned car for nearly 2 hours before he is extricated. On arrival to the emergency department, his right lower extremity is cool, mottled, insensate, and motionless. Despite normal vital signs, a pulse cannot be palpated below the right femoral artery and the muscles of the lower extremity are firm and hard. During the management of this patient, which of the following is most likely to improve the chances for limb salvage? d. surgical consultation for right lower extremity fasciotomy A patient arrives in the emergency department after being beaten about the head and face with a wooden club. He is comatose and has a palpable depressed skull fracture. His face is swollen and ecchymotic. He has gurgling respirations and vomitus on his face and clothing. The most appropriate step after providing supplemental oxygen and elevating his jaw is to:
- c. suction the oropharynx A 22 - year-old man sustains a gunshot wound to the left chest and is transported to a small community hospital; no surgical capabilities are available. In the emergency department, a chest tube is inserted and 700 mL of blood is evacuated. The trauma center accepts the patient in transfer. Just before the patient is placed in the ambulance for transfer, his blood pressure decreases to 80/68 mm Hg and his heart rate increases to 136 beats per minute. The next step should be to:
- d. repeat the primary survey and proceed with transfer A 64-year-old man involved in a high-speed car crash, is resuscitated initially in a small hospital without surgical capabilities. He has a closed head injury with a GCS score of 13. He has a widened mediastinum on chest x-ray with fractures of left ribs 2 through 4, but no pneumothorax. After initiating fluid resuscitation, his blood pressure is 110/74 mm Hg, heart rate is 100 beats per minute, and respiratory rate is 18 breaths per minute. He has gross hematuria and a pelvic fracture. You decide to transfer this patient to a facility capable of providing a higher level of care. The facility is 128 km (80 miles) away. Before transfer, you should first: d. call the receiving hospital and speak to the surgeon on call
to be paraplegic at the level of T10. Which of the following are true regarding her evaluation and management? d.log rolling using 4 people is a safe approach to limit spinal motion when moving her A trauma patient presents to your emergency department with inspiratory stridor and a suspected c- spine injury. Oxygen saturation is 88% on high-flow oxygen via a nonrebreathing mask. The most appropriate next step is to: Select one: a. apply cervical traction b. perform immediate tracheostomy c. insert bilateral thoracostomy tubes d. maintain 100% oxygen and obtain immediate c-spine x-rays e. restrict cervical motion and establish a definitive airway - e. restrict cervical motion and establish a definitive airway When applying the Rule of Nines to infants:
- c. The head is proportionally larger in infants than in adults. A healthy young male is brought to the emergency department following a motor vehicle crash. His vital signs are a blood pressure of 84/60, pulse 123, GCS 10. The patient moans when his pelvis is palpated. After initiating fluid resuscitation, the next step in management is: a. placement of a pelvic binder Which situation requires Rh immunoglobulin administration to an injured female? c. positive pregnancy test, Rh negative, and has torso trauma A 22 - year-old female athlete is stabbed in her left chest at the third interspace in the anterior axillary line. On admission to the ED and 15 minutes after the incident, she is awake and alert. Her heart rate is 100 beats per minute, blood pressure is 80/60 mm Hg, and respiratory rate is 20 breaths per minute. A chest x-ray reveals a large left hemothorax. A left chest tube is placed with an immediate return of 1600 mL of blood. The next management step for this patient is to:
d. prepare for an exploratory thoracotomy A 6-year-old boy walking across the street is struck by the front bumper of a sports utility vehicle traveling at 32 kph (20 mph). Which one of the following statements is TRUE about this patient?
. - c. A pulmonary contusion may be present in the absence of rib fractures A 23 - year-old man is brought immediately to the ED from the hospitals parking lotwhere he was shot in the lower abdomen. Examination reveals a single bullet wound. He is breathing and has a thready pulse. However, he is unconsious and has no detectable blood pressure. Optimale immediate management is to: Transfer the patient to the operating room, while initiating fluid therapy A 22 year old male present following a motorcycle crash. He complains of the inability to move his legs. His BP is 80/50, HR 70, RR 18 and GCS 15. Oxygen saturation is 99% on 21 nasal prongs. Chest x-ray, pelvic x-ray and FAST are normal. Extremities are normal. His management should be: 1 L of cystalloid and vasopressors if blood pressure does not respond Which of the following is MOST RELIABLE to confirm endotracheal intubation? a. chest xray with endotracheal tube tip appearing above the carina A 6 month old infant, being held in her mothers arms, is ejected on impact from a vehicle that is struck head on by an oncoming car traveling at 64kph. The infant arrives in the ED with multiple facial injuries, is lethargic, and is in severe respiratoy distress. Respiratory support is not effective using a bag mask device, and her oxygen saturation is falling. Repeated attempts at orotracheal intubation are unsuccessful. the most appropriate procedure to perform next is: Perform needle cricothyroidotomy with jet insufflation A 28 year olf male is brought to the ED. He was involved in a fight, during which he was beaten with a wooden stick. His chest shows multiple severe bruises. His arway is clear, resp rate is 22, hear rate 126, and systolic blood pressure is 90 mmHG. Which of the following should be performed during the primary survey a. glasgow coma
a. prescence of hemotympanum a 23 yo construction worker is brought to the ED after falling more than 9 meters from scaffolding. He is reported to have landed on his feet and then been unable to bear weight. His vital signs are heart 140, blood pressure 96/60 mmHg, resp rate
- He is complaining of lower abdbominal and lower limb pain, and has obvious deformity of both lower legs with bilateral open tibial fractures. WHich one of the following statements concerning this patient is true? a. xrays of the patient chest and pevlic are important adjuncts in the inital assessment 25 yo female in the third trimester of preganacy is brought to the ED following a high speed MVA. She is conscious, and her vital signs are RR 16, HR 120, BP 70/50. The laboratory results show a PaCO2 of 50mmHg/5.3kPa (normal range 35 - 45). Which one of the following statments concerning this patient is true? a. normal PaCO2 is concerning for impending RR a 30 year old male is stabbed in the right chest. on arrival in the ED he is very short of breath. His heart rate is 120, and blood pressure is 80/50 mmHg. His neck veins are flat. On auscultation of the chest, there is diminished air entry on the right side and on percussion there is dullness posteriorly. These findings are most consistent with d. massive hemothorax which one of the following is true regarding burns? a. an electrical burn with only a small external injury associated with a clenched hand indicates deep ST injury A 15 year old is brought to the ED after being involved in a MVA. He was intubated by emergency medical personnal with subsequent bilateral breath sounds per their report. Upon arrival to the ED the patients O2 saat is 92%, heart 96, and blood pressure 150/85. Breath sounds are decreased in the left side of the thorax. The next step is a. reassess the position of the endotracheal tube
Which one of the following statements is true regrading patients with severe traumatic brain injuries a. prescence of hypoxia and hypotension significantly increase the risk of mortality The first priority in the management of a long bone fracture is a. reduction of blood loss a 40 yo obese patient with a GCD of V2E2M4 requires a CT scan. Before transfer to the scanner, you should a. obtain a definitive airway Which of the following patient require imaging .....? a. 40 yo patient who sustained a severe closed head injury and has a GCS of 8 V2M3E A 30 year old male is brought toe the hospital after falling 6 meters. Inspection reveals an obvious flail chest on the right. Breath sounds on the right are slightly increased. Twelve hours later, the patient is in severe respiratory distress. Arterial blood gas obtained while the patient recieves oxygen by face mask are: pH of 7,47, PaO2 of 45mmHg (6Kpa), PaCO2 of 28mmHg (3,7 Kpa). The component of injury that most likely responsible for abnormalities in this patients blood gas is: a. c. pulmonary contusion A 82 year old male falls down five stairs and presents to the ED. Which of the following statements IS NOT CORRECT: c. c. Internal hemorrhage will become symptomatic more quickly A 14 year old female is brought to the ED after falling from a horse. Cervical spinal motion is restricted wit ha hard collar and cervical blocks and she is immobilized on a long spine board. Which of the following IS TRUE REGARDING Cervical spine x-ray: A. Are not needed if she is awake, alert, neurologically normal, and has no neck pain or midline tenderness
The risk of premature fetal delivery and death is reduced by the use of restraints a 28 year old man is brought in after a MVA. His airway is patent and breath sounds are equal. His GCS is E1V2M1. His BP is 146/82; HR is .......... The decision is made to secure his airway. Which of the following is a definitive airway a. LTA A 70 year old suffers blunt chest trauma after being struck by a car. On presentation, his GCS is 15, BP is 145/90, HR is 72. RR is 24 and O2-sat on 5L is 91%. Chest x-ray demonstrates multiple right sided rib fractures. CT abdomen and pelvis is normal. ECG demonstrates normal sinus rythm with no conduction abnormalities. Management should include: A. Monitoried i.v analgesia A 15 year old male present following a motorcycle crash. INitial examinations reveals normal vital signs. There is a large bruise over his epigastrium that extends to the left flank. He has no other apparent injuries. A CT-scan of the abdomen demonstrate a ruptured spleen surrounded by a large hematoma and fluid in the pelvis. The next step in the patients management is: A. Surgical consult 30 year old male present with a stab wound to the abdomen. BP is 60/34, HR 130, RR 25 and GCS 13 E3V4M6. Neck veins are flat and chest examination is clear with bilateral breath sounds. Optimal resuscitation should include: A. Preparation for laparotomy while initiating fluid resuscitation Which of the following statement are true regarding crystalloid fluid resuscitation of a patient with penetrating torso trauma? a. It can produce dilutional coagulopathy A 25 year old male is brought to the ED of a trauma center following a bar fight. He has altered consciousness, open his eyes on command, moans without forming discernible words, and localizes to painful stimuli. Which one of the following statements concerning this patient is true? A. CT scanning is an important part of the neuro assessment Which one of the following statements regarding patients with genitourinary
trauma is true? a. hypotension can be caused by renal injury Patients with a GSC of less than usually require intubation. - 8 The "A" in ABCD stands for. - Airway maintenance with CERVICAL SPINE PROTECTION You should assume that any patient in a multisystem trauma with an altered level of consciousness or blunt injury above the clavicle has what type of injury?
- Cervical spine injury Flail chest is invariably accompanied by which can interfere with blood oxygenation.
- pulmonary contusion - do NOT over fluid resuscitate these patients! Hypotension is caused by until proven otherwise.
- hypovolemia When you don't have/can't get a blood pressure, what are three things to look for when evaluating perfusion.
- Level of consciousness (brain perfusion),
- Skin color (ashen face/grey extremities)
- Pulse (bilateral femoral - thready/tachy) Elderly patients have a limited ability to to compensate for blood loss.
- increase heart rate Resuscitation fluids should be warmed 39 degrees Celsius (102.2 F). Can you use a microwave to do this?
- YES - for CRYSTALLOID ONLY (but NOT for blood products). Urinary catheters are good for assessing renal perfusion and volume status. List 5 signs of urethral injury that might prevent you from inserting one.
- Blood at urethral meatus, perineal ecchymosis, blood in scrotum, high- riding/non-palpable prostate, pelvic fracture Which arm should you NOT put a pulse-ox on?
Name two anatomical things that can interfere with doing a FAST scan.
- Obesity & intraluminal bowel gas When should radiographs be obtained?
- During the SECONDARY survey. How do you get an ample patient history?
- A=Allergies, M=Medications, P=PMH/Pregnancy, L=Last meal, E=Events/Environment of injury Why might you want a Bair Hugger for a patient who smells of alcohol?
- Vasodilation can lead to hypothermia What things are you looking for when you do a DRE in a trauma?
- Blood, high- riding prostate (in males), and sphincter tone What should you do for every female patient?
- Pregnancy test (females of childbearing age) Adult patients should maintain UOP of at least mL/kg/hr. Kids should have at least mL/kg/hr.
- Adults 0.5 mL/kg/hr, Kids 1.0 ml/kg/hr Preventing hypercarbia is critical in patients who have sustained a injury. - head What two places would you LOOK at a patient if you suspect hypoxemia?
- Lips and fingernail beds Patients may be abusive and belligerent because of , so don't just assume it's due to drugs, alcohol, or the fact that they are just inherently a jerk.
- hypoxia Can a patient breathe on their own after complete cervical cord transection?
- Yes, if the phrenic nerves (C3-C5) are spared. This will result in "abdominal" breathing. The intercostal muscles will be paralyzed though. Can you use an OPA (Guedel) in a conscious patient? - No, it could make them vomit. An NPA (trumpet) would be okay.
Bougies are typically inserted blindly, how do you know you are in the trachea and not the esophagus?
- You can feel the "clicks" as the distal tip rubs against the cartilaginous tracheal rings, or it will deviate right or left when entering either bronchus (usually at 50 cm). What do you NOT want to hear if you ascultate a patient after placement of an ET tube? - Borborygmi
- rumbling or gurgling noises suggesting esophageal insertion. What is the RSI dose for etomidate?
- 0.3 mg/kg (usually 20 mg) What is the RSI dose for sux? - 1 - 2 mg/kg (usually 100 mg) How does etomidate affect blood pressure? - It doesn't - at least it SHOULDN'T have any significant effect on BP. Ketamine will increase BP, and propofol and thiopental will both drop BP. A RSI dose of sux usually lasts about minutes. - 5 What hypnotic/sedative/induction agent do you NOT want to use for a severely burned patient? - SUX - patients with severe burns, crush injuries, hyperkalemia, or chronic paralytic/neuromuscular diseases should NOT get sux because of hyperkalemia risk. Oxygen should flow at 15L for needle cricothyroidotomy, and have a Y- connector for insufflation if possible. What size needle do you use for adults? Kids? - Adults 12 - 14 gauge, kids 16 - 18 gauge Cricoid cartilage is the only circumferential support for the upper trachea in kids, therefore surgical cricothyroidotomy is not recommended in kids under the age of . - 12 In a "normal" patient without significant chest wall injury or lung disease, needle cricothyroidotomy can provide adequate oxygenation for approximately
Why does shock actually reduce the total volume of circulating blood? - Anaerobic metabolism --> can't make more ATP --> Endoplasmic then mitochondrial damage --> lysosomes rupture --> sodium and WATER enter the cell, which SWELLS and dies. Which vasopressors should you use to treat hemorrhagic shock? What are the drug doses? - NEVER use pressors for hypovolemic shock - use VOLUME replacement. Pressors will worsen tissue perfusion in hemorrhagic shock. Compensatory mechanisms may preclude a measurable fall in systolic blood pressure until up to % of the patient's blood volume is lost. - 30 Any patient who is cool and is tachycardic is considered to be until proven otherwise. - in shock The definition of tachycardia depends on the patient's age. What heart rate is considered tachycardic for infants, toddlers/preschoolers, school age/prebuscent, and adults? - Infants >160, toddlers/preschoolers >140, school age/prebuscent
120, adults > Elderly patients may not exhibit tachycardia in response to hypovolemia because of limited cardiac response to catecholamines. Why else might not they get tachy?
- They might be on a beta-blocker or have a pacemaker. A FAST scan is an excellent way to diagnose cardiac tamponade. What signs suggest tamponade? - Becks's Triad: JVD, muffled heart sounds, and hypotension (will be resistant to fluid therapy). Will also likely be tachycardic. Patients with a tension pneumo and patients with cardiac tamponade may present with many of the same signs. What findings will you see with a tension pneumo that you will NOT see with tamponade? - Absent breath sounds and hyperresonance to percussion over the affected hemithorax. Immediate thoracic decompression is warranted for anyone with absent breath sounds, hyperresonance to percussion, tracheal deviation, , and. - Acute respiratory distress & subcutaneous emphysema
Can isolated intracranial injuries cause neurogenic shock? - NO How do you calculate total blood volume in an adult? - 70 mL per kg body weight. A 70 kg person has about 5 liters of circulating blood. (70*70=4900) How do you calculate total blood volume in an child? - Body weight in kg x 80- 90 mL The blood volume of an obese person is calculated based upon their weight. - ideal Fluid replacement should be guided by , not simply by the initial classification (Class I-IV). - The patient's response to initial replacment How much blood volume is lost with Class I Hemorrhage? - Up to 15% Donating 1 pint, or ~500 mL of blood is about a 10% volume loss and would qualify as Class I Hemorrhage! How do you treat a Class I Hemorrhage? - You don't (usually). Transcapillary refill and other compensatory mechanisms usually restore blood volume within 24 hours. How much blood volume is lost with Class II Hemorrhage? - 15 - 30% (750- 1500 mL in a 70 kg adult) How do you treat a Class II Hemorrhage? - Usually just crystalloid resuscitation Subtle CNS changes such as anxiety, fright, and hostility would be expected in a patient with a Class Hemorrhage. - II How much blood volume is lost with Class III Hemorrhage? - 30 - 40% (2000 mL in a 70 kg adult) A patient with inadequate perfusion, marked tachycardia and tachypnea, significant mental status change, and a measurable fall in systolic blood pressure likely has a
