ATLS 10 EXAMS TEST BANK WITH ACTUAL
CORRECT QUESTIONS AND VERIFIED DETAILED
RATIONALES ANSWERS| LATEST UPDATE 2024
ALREADY GRADED A+| GUARANTEED PASS 100%
Describe the mechanism of injury of severe diffuse hypoxic, ischemic brain injuries:
Prolonged shock or apnea occurring immediately after trauma will starve the brain, leading to ischemic
injury.
Initially, the brain may appear radiographically normal.
Over time, cerebral edema will develop leading to loss of gray-white matter distinction.
Describe the injury patterns in high-velocity impact or deceleration injuries on the brain:
Shearing injuries occur at the border between gray and white matter, which present as multiple
punctate hemorrhages throughout the cerebral hemispheres.
This pattern is often characterized as diffuse axonal injury, which has variable often poor outcomes.
Epidural hematomas occur in about ___ % of patients with brain injuries and __ % of patients with TBI
who are comatose.
0.5%, 9%
Describe the appearance of epidural hematomas and how they most often occur:
Biconvex (lenticular, lens-shaped) as they push the adherent dura away from the inner table of the skull.
Most often in the temporal or temporoparietal regions.
Most often result from tears of the middle meningeal artery due to fracture.
Most often arterial in origin, but can result from major venous sinus hemorrhage, or bleeding from a
skull fracture.
Describe the classic presentation of epidural hematoma:
A lucid interval between the time of injury and neurological deterioration.
Subdural hematomas occur in approximately __% of patients with severe brain injuries:
30%
Describe the appearance of subdural hematomas and how they most often occur.
Crescent-shaped (conforming to the contours of the brain).
Develop from shearing of the small surface or bridging blood vessels of the cerebral cortex.
,Often accompanies severe parenchymal injury.
Cerebral contusions occur in approximately __% of patients with severe brain injuries.
20-30%
Describe the appearance of cerebral contusions and how they most often occur.
Most occur in the frontal and temporal lobes, but can be anywhere in the brain.
Over hours–days, contusions evolve to form an intracerebral hematoma or a coalescent contusion.
Mass effect can develop, indicating immediate surgical evacuation in about 20% of cases.
Common presenting features in mild TBI:
Transient loss of consciousness
Disorientation
Amnesia
Often confounded by alcohol or other intoxicants
Initial management of mild traumatic brain injury
Mechanism
Time of injury
Initial GCS
Confusion
Amnestic interval
Seizure
Headache severity
AMPLE history
Neurological examination
Anticoagulation assessment
Secondary management of mild traumatic brain injury
Serial examination until GCS 15 and no persistent memory deficit or perseveration.
Follow-up CT scan if first is abnormal or GCS remains <15.
Consider transfer if neurological status deteriorates.
Prognosis of mild traumatic brain injury:
Most have uneventful recovery.
Approximately 3% unexpectedly deteriorate, potentially resulting in severe neurological dysfunction
unless the decline in mental status is detected early.
Diagnostic workup for mild traumatic brain injury
CT scan (if CT Head rules apply)
EtOH and drug screen
Admission criteria for mild traumatic brain injury
,No CT available
CT abnormal
Skull fracture
Penetrating head injury
No reliable companion at home
Moderate-severe headache
Evidence of CSF leak
Focal neurological deficit
GCS does not return to 15 after 2 hours
Significantly intoxicated (for observation)
Disposition of minor traumatic brain injury
Home if no admission criteria, discharge with Head Injury Warning sheet and out-patient follow-up.
Medical and/or neuropsychological follow-up if at risk but no admission criteria.
Admission and/or transfer to neurosurgery if abnormal CT, abnormal examination, or if patient status
deteriorating.
Canadian CT Head Rules
Inclusion Criteria
Glasgow Coma Scale (GCS) 13-15 and at least one of the following:
Loss of consciousness.
Amnesia to the head injury event.
Witnessed disorientation.
Exclusion Criteria
Age <16 years
Blood thinners
Seizure after injury
High risk factor (≥1) for neurosurgical intervention
GCS <15 at 2 hours post-injury
Suspected open or depressed skull fracture
Any sign of basilar skull fracture
Vomiting >2 episodes Age >65 years
Anticoagulation use Moderate risk for brain injury
Loss of consciousness >5 minutes
Retrograde amnesia >30 minutes
, Dangerous mechanism (e.g. pedestrian vs. car, ejected from vehicle, fall >3 feet or 5 stairs)
Other compelling indications for CT scan (not in formal rules)
Severe headaches
Seizures
Short-term memory deficit
Alcohol or drug intoxication
Focal neurological deficit attributable to brain
Common presenting features in moderate TBI:
Can follow simple commands
Confused or somnolent
May have focal neurological deficits such as hemiparesis
Diagnostic workup for moderate traumatic brain injury
CT scan in all cases
Type and crossmatch and coagulation studies
EtOH and drug screen
Evaluate for other injuries and investigations as appropriate
Admission criteria for moderate traumatic brain injury
All moderate TBI requires admission and observation in unit capable of close nursing observation and
frequent neurological reassessment for at least the first 12 to 24 hours.
A follow-up CT scan within 24 hours is recommended if the initial CT scan is abnormal or the patient's
neurological status deteriorates.
Initial management of moderate traumatic brain injury
Early neurosurgical consultation and transfer if needed
Primary survey and resuscitation
Focused neurological examination
AMPLE history
Secondary survey
Secondary management of moderate traumatic brain injury
Serial examination
Follow-up CT scan in 12-18 hours
Urgent transfer if neurological status deteriorates.
Disposition of moderate traumatic brain injury
Admission and/or transfer to neurosurgery and/or trauma center for serial observation, CT scan, and
intervention if needed
CORRECT QUESTIONS AND VERIFIED DETAILED
RATIONALES ANSWERS| LATEST UPDATE 2024
ALREADY GRADED A+| GUARANTEED PASS 100%
Describe the mechanism of injury of severe diffuse hypoxic, ischemic brain injuries:
Prolonged shock or apnea occurring immediately after trauma will starve the brain, leading to ischemic
injury.
Initially, the brain may appear radiographically normal.
Over time, cerebral edema will develop leading to loss of gray-white matter distinction.
Describe the injury patterns in high-velocity impact or deceleration injuries on the brain:
Shearing injuries occur at the border between gray and white matter, which present as multiple
punctate hemorrhages throughout the cerebral hemispheres.
This pattern is often characterized as diffuse axonal injury, which has variable often poor outcomes.
Epidural hematomas occur in about ___ % of patients with brain injuries and __ % of patients with TBI
who are comatose.
0.5%, 9%
Describe the appearance of epidural hematomas and how they most often occur:
Biconvex (lenticular, lens-shaped) as they push the adherent dura away from the inner table of the skull.
Most often in the temporal or temporoparietal regions.
Most often result from tears of the middle meningeal artery due to fracture.
Most often arterial in origin, but can result from major venous sinus hemorrhage, or bleeding from a
skull fracture.
Describe the classic presentation of epidural hematoma:
A lucid interval between the time of injury and neurological deterioration.
Subdural hematomas occur in approximately __% of patients with severe brain injuries:
30%
Describe the appearance of subdural hematomas and how they most often occur.
Crescent-shaped (conforming to the contours of the brain).
Develop from shearing of the small surface or bridging blood vessels of the cerebral cortex.
,Often accompanies severe parenchymal injury.
Cerebral contusions occur in approximately __% of patients with severe brain injuries.
20-30%
Describe the appearance of cerebral contusions and how they most often occur.
Most occur in the frontal and temporal lobes, but can be anywhere in the brain.
Over hours–days, contusions evolve to form an intracerebral hematoma or a coalescent contusion.
Mass effect can develop, indicating immediate surgical evacuation in about 20% of cases.
Common presenting features in mild TBI:
Transient loss of consciousness
Disorientation
Amnesia
Often confounded by alcohol or other intoxicants
Initial management of mild traumatic brain injury
Mechanism
Time of injury
Initial GCS
Confusion
Amnestic interval
Seizure
Headache severity
AMPLE history
Neurological examination
Anticoagulation assessment
Secondary management of mild traumatic brain injury
Serial examination until GCS 15 and no persistent memory deficit or perseveration.
Follow-up CT scan if first is abnormal or GCS remains <15.
Consider transfer if neurological status deteriorates.
Prognosis of mild traumatic brain injury:
Most have uneventful recovery.
Approximately 3% unexpectedly deteriorate, potentially resulting in severe neurological dysfunction
unless the decline in mental status is detected early.
Diagnostic workup for mild traumatic brain injury
CT scan (if CT Head rules apply)
EtOH and drug screen
Admission criteria for mild traumatic brain injury
,No CT available
CT abnormal
Skull fracture
Penetrating head injury
No reliable companion at home
Moderate-severe headache
Evidence of CSF leak
Focal neurological deficit
GCS does not return to 15 after 2 hours
Significantly intoxicated (for observation)
Disposition of minor traumatic brain injury
Home if no admission criteria, discharge with Head Injury Warning sheet and out-patient follow-up.
Medical and/or neuropsychological follow-up if at risk but no admission criteria.
Admission and/or transfer to neurosurgery if abnormal CT, abnormal examination, or if patient status
deteriorating.
Canadian CT Head Rules
Inclusion Criteria
Glasgow Coma Scale (GCS) 13-15 and at least one of the following:
Loss of consciousness.
Amnesia to the head injury event.
Witnessed disorientation.
Exclusion Criteria
Age <16 years
Blood thinners
Seizure after injury
High risk factor (≥1) for neurosurgical intervention
GCS <15 at 2 hours post-injury
Suspected open or depressed skull fracture
Any sign of basilar skull fracture
Vomiting >2 episodes Age >65 years
Anticoagulation use Moderate risk for brain injury
Loss of consciousness >5 minutes
Retrograde amnesia >30 minutes
, Dangerous mechanism (e.g. pedestrian vs. car, ejected from vehicle, fall >3 feet or 5 stairs)
Other compelling indications for CT scan (not in formal rules)
Severe headaches
Seizures
Short-term memory deficit
Alcohol or drug intoxication
Focal neurological deficit attributable to brain
Common presenting features in moderate TBI:
Can follow simple commands
Confused or somnolent
May have focal neurological deficits such as hemiparesis
Diagnostic workup for moderate traumatic brain injury
CT scan in all cases
Type and crossmatch and coagulation studies
EtOH and drug screen
Evaluate for other injuries and investigations as appropriate
Admission criteria for moderate traumatic brain injury
All moderate TBI requires admission and observation in unit capable of close nursing observation and
frequent neurological reassessment for at least the first 12 to 24 hours.
A follow-up CT scan within 24 hours is recommended if the initial CT scan is abnormal or the patient's
neurological status deteriorates.
Initial management of moderate traumatic brain injury
Early neurosurgical consultation and transfer if needed
Primary survey and resuscitation
Focused neurological examination
AMPLE history
Secondary survey
Secondary management of moderate traumatic brain injury
Serial examination
Follow-up CT scan in 12-18 hours
Urgent transfer if neurological status deteriorates.
Disposition of moderate traumatic brain injury
Admission and/or transfer to neurosurgery and/or trauma center for serial observation, CT scan, and
intervention if needed
