ATLS 10TH EDITION TRIAGE EXAMINATION
QUESTIONS AND ANSWERS PATIENT A F
◉ A 22 year old male sustains a shotgun wound to the shoulder and
chest at close range. His BP is 80/40 and HR 130. After 2 L of
crystalloid solution are rapidly infused, his BP increases to 122/84
and HR decreases to 100. He is tachypneic with RR of 28. On PE, his
breath sounds are decreased at the left upper chest with dullness on
percussion. A large caliber tube thoracostomy is inserted into the
fifth intercostal space with the return of 200 mL of blood and no air
leak. The most appropriate next step is:
A. Insert a foley catheter
B. Begin to transfuse O negative blood
C. Perform thoracotomy
D. Obtain a CT Chest/Abd
E. Repeat the physical exam of the chest.
Answer: E. Repeat the physical exam of the chest
decreased breath sounds w/dullness -> hemothorax, need tube to
drain
vs.
decreased/absent breath sounds w/hyperresonance -> tension
pneumonia, need needle decompression followed by tube
,◉ Which one of the following statements concerning spine and
spinal cord trauma is TRUE?
A. A normal lateral C spine film excludes injury
B. A vertebral injury is unlikely in the absence of physical findings of
a cord injury
C. A patient with a suspected spine injury requires immobilization
on a short spine
D. Diaphragmatic breathing in an unconscious patient who has fallen
is a sign of spine injury
E. Determination of whether a spinal cord lesion is complete or
incomplete must be made in the primary survey.
Answer: B. A vertebral injury is unlikely in the absence of physical
findings of a cord injury
◉ A 17 year old female is brought to the ED following a 6 feet fall
onto concrete. She is unresponsive and found to have a RR of 32, BP
of 90/60, and HR of 68. The FIRST step in treatment is:
A. Administering vasopressors
B. Establishing IV access for drug-assisted intubation
C. Seeking the cause of her decreased level of consciousness
D. Applying oxygen and maintaining airway
E. Excluding hemorrhage as a cause of shock.
Answer: D. Applying oxygen and maintaining airway
,First = ABCs
◉ Signs and symptoms of airway compromise include all of the
following except:
A. Change in voice
B. Stridor
C. Tachypea
D. Dyspnea and agitation
E. Decreased pulse pressure.
Answer: E. Decreased pulse pressure
◉ A 47 year old house painter is brought to the hospital after falling
20 feet from a ladder and landing straddled on a fence. Examination
of his perineum reveals extensive ecchymosis. There is blood in the
external urethral meatus. The initial diagnostic study for the
evaluation of the urinary tract should be:
A. cystoscopy
B. cystography
C. intravenous pyelography
D. CT scan
E. retrograde urethrography.
Answer: E. retrograde urethrography
-> any ecchymosis, needs to be done before catheter!
, ◉ A 30 year old male presents after a MVC. Vitals are RR 18, HR 88,
BP 130/72, GCS 13. Laparatomy is indicated when:
A. There is a distinct seat belt sign over the abdomen
B. The CT demonstrates a grade 4 hepatic injury
C. There is evidence of extraperitoneal bladder injury
D. CT demonstrates retroperitoneal air
E. The abdomen is distended with localized rihgt upper quadrant
tenderness.
Answer: D. CT demonstrates retroperitoneal air
-> air, peritonitis (tenderness, rigidity), unstable vital signs
◉ A 20 year old male is brought to the hospital approximately 30
minutes after being stabbed in the chest. There is 3 cm wound just
medial to the left nipple. BP is 70/33 and HR is 140. Neck and arm
veins are distended. Breath sounds are normal. Heart sounds are
diminished, IV access is established and warm crystalloid is infusing.
The next most important aspect of immediate management is:
A. CT Chest
B. EKG
C. Left tube thoracostomy
D. RBC infusion
E. FAST exam.
Answer: E. FAST exam
QUESTIONS AND ANSWERS PATIENT A F
◉ A 22 year old male sustains a shotgun wound to the shoulder and
chest at close range. His BP is 80/40 and HR 130. After 2 L of
crystalloid solution are rapidly infused, his BP increases to 122/84
and HR decreases to 100. He is tachypneic with RR of 28. On PE, his
breath sounds are decreased at the left upper chest with dullness on
percussion. A large caliber tube thoracostomy is inserted into the
fifth intercostal space with the return of 200 mL of blood and no air
leak. The most appropriate next step is:
A. Insert a foley catheter
B. Begin to transfuse O negative blood
C. Perform thoracotomy
D. Obtain a CT Chest/Abd
E. Repeat the physical exam of the chest.
Answer: E. Repeat the physical exam of the chest
decreased breath sounds w/dullness -> hemothorax, need tube to
drain
vs.
decreased/absent breath sounds w/hyperresonance -> tension
pneumonia, need needle decompression followed by tube
,◉ Which one of the following statements concerning spine and
spinal cord trauma is TRUE?
A. A normal lateral C spine film excludes injury
B. A vertebral injury is unlikely in the absence of physical findings of
a cord injury
C. A patient with a suspected spine injury requires immobilization
on a short spine
D. Diaphragmatic breathing in an unconscious patient who has fallen
is a sign of spine injury
E. Determination of whether a spinal cord lesion is complete or
incomplete must be made in the primary survey.
Answer: B. A vertebral injury is unlikely in the absence of physical
findings of a cord injury
◉ A 17 year old female is brought to the ED following a 6 feet fall
onto concrete. She is unresponsive and found to have a RR of 32, BP
of 90/60, and HR of 68. The FIRST step in treatment is:
A. Administering vasopressors
B. Establishing IV access for drug-assisted intubation
C. Seeking the cause of her decreased level of consciousness
D. Applying oxygen and maintaining airway
E. Excluding hemorrhage as a cause of shock.
Answer: D. Applying oxygen and maintaining airway
,First = ABCs
◉ Signs and symptoms of airway compromise include all of the
following except:
A. Change in voice
B. Stridor
C. Tachypea
D. Dyspnea and agitation
E. Decreased pulse pressure.
Answer: E. Decreased pulse pressure
◉ A 47 year old house painter is brought to the hospital after falling
20 feet from a ladder and landing straddled on a fence. Examination
of his perineum reveals extensive ecchymosis. There is blood in the
external urethral meatus. The initial diagnostic study for the
evaluation of the urinary tract should be:
A. cystoscopy
B. cystography
C. intravenous pyelography
D. CT scan
E. retrograde urethrography.
Answer: E. retrograde urethrography
-> any ecchymosis, needs to be done before catheter!
, ◉ A 30 year old male presents after a MVC. Vitals are RR 18, HR 88,
BP 130/72, GCS 13. Laparatomy is indicated when:
A. There is a distinct seat belt sign over the abdomen
B. The CT demonstrates a grade 4 hepatic injury
C. There is evidence of extraperitoneal bladder injury
D. CT demonstrates retroperitoneal air
E. The abdomen is distended with localized rihgt upper quadrant
tenderness.
Answer: D. CT demonstrates retroperitoneal air
-> air, peritonitis (tenderness, rigidity), unstable vital signs
◉ A 20 year old male is brought to the hospital approximately 30
minutes after being stabbed in the chest. There is 3 cm wound just
medial to the left nipple. BP is 70/33 and HR is 140. Neck and arm
veins are distended. Breath sounds are normal. Heart sounds are
diminished, IV access is established and warm crystalloid is infusing.
The next most important aspect of immediate management is:
A. CT Chest
B. EKG
C. Left tube thoracostomy
D. RBC infusion
E. FAST exam.
Answer: E. FAST exam
