ATLS EXAM QUESTIONS AND
ANSWERS
Truesorsfalse?sAlthoughsthesmechanismsofsinjurysmaysbessimilarstosthosesforsthesyoungersp
opulation,sdatasshowssincreasedsmortalityswithssimilarsseveritysofsinjurysinsoldersadults.s-
sans--True
Instheselderlyspopulation,swhatsissdecreasedsphysiologicalsreserve?s-sans--
agingsisscharacterizedsbysimpairedsadaptivesandshomeostaticsmechanismssthatscausedsan
sincreasedssusceptibilitystosthesstresssofsinjury.sInsultsstoleratedsbysthesyoungerspopulations
cansleadstosdevastatingsresultssinselderlyspatients.
Pre-existingsconditionssthatsaffectsmorbiditysandsmortalitysinclude:s-sans--
cirrhosis,scoagulopathy,sCOPD,sischemicsheartsdisease,sDM
Whatsissthesmostscommonsmechanismsofsinjurysinstheselderly?s-sans--
Fall.sNonfatalsfallssarescommonsinswomensandsfracturessarescommonsinswomenswhosfall.sF
allssaresthesmostscommonscausesofsTBI.
Instheselderlyspopulation,swhatsaresrisksfactorssforsfalls?s-sans--
advancedsage,sphysicalsimpairment,shistorysofsprevioussfall,smedicationsuse,sdementia,sun
steadysgait,sandsvisual,scognitivesimpairment
Mostsofselderlystrafficsfatalitiessoccursinsthesdaytimesandsonsweekendssandstypicallysinvolves
othersvehicles.sWhy?s-sans--
Olderspeoplesdrivesonsmoresfamiliarsroadssandsatslowersspeedssandstendstosdrivesduringsthe
sday. sOlderspeopleshavesslowersreactionstime,saslargersblindsspot,slimitedscervical smobility, s
decreasedshearing,sandscognitivesimpairment.
TruesorsFalse?sMortalitysassociatedswithssmallstosmoderatessizedsburnssinsoldersadultssrem
ainsshighs-sans--True
Spilledshotsliquidssonsthesleg,swhichsinsyoungerspatientssmaysre-
epithelializesduestosansadequatesnumbersofshairsfollicles,swillsresultsinsasfullsthicknesssburnsi
nsolderspatients.s-sans--thississtrue
Airway-
patientssmayshavesdenturessthatsmaysloosensorsobstructsthesairway.sIfsdenturessaresnotsobs
tructingsthesairway,sleavesthemsinsplacesforswhat?s-sans--
bagsmasksventilation,sassitsimprovessmasksfitting.
,Whenspreformingsrapidssequencesintubation,sthesdosesofsbenzos,sbarbiturates,sandsotherss
edativessshouldsbesreducedstoswhatspercentagestosminimizesthesrisksofscardiovascularsdep
ression?s-sans--20-40%
Functionalschangessinscardiacssystemsincludesdecliningsfunction,sdecreasedssensitivitystos
catecholamines,satherosclerosissofscoronarysvessels,sincreasedsafterload,sfixedsheartsrates
(betasblockers)s-sans--
thissresultssinslacksofsclassicsresponsestoshypovolemia,srisksforscardiacsischemia,selevateds
BPsatsbaseline,sandsincreasedsrisksofsdysrythmias.
Functionalschangessinspulmonaryssystemsincludesdecreasedselasticsrecoil,sreducedsresidu
alscapacity,sdecreasedsgassexchangesandsdecreasedscoughsreflexs-sans--
thusstheysaresatsincreasedsrisksforsrespiratorysfailure,sincreasedsrisksforspneumonia,sandspo
orstolerancestosribsfractures
Functionalschangessinsrenalssystemsincludeslosssofsrenalsmass,sdecreasedsGFR,sandsdecr
easedssensitivitystosADHsandsaldosterones-sans--
resultingsinsdrugsdosingsforsrenalsinsufficiency,sdecreasedsabilitystosconcentratesurine,sincr
easedsrisksforsAKIsandsurinesflowsmaysbesnormalswithshypovolemia
FunctionalschangesstosMSKsincludeslosssofsleansbodysmass,sosteoporosis,schangessinsjoint
ssandscartilage,scsspinesdegenerativeschangessandslosssofsskinselastinsandssubcutaneoussf
ats-sans--
resultingsinsincreasedsrisksforsfractures,sdecreasedsmobility,sdifficultysforsoralsintubation,sris
ksofsskinsinjury,sincreasedsrisksforshypothermia,schallengessinsrehabiliation
FunctionalschangessinsEndocrinessystemsincludesdecreasedsproductionsandsresponsestost
hyroxinsandsdecreasedsdehydroepiandrosterones(DHEA)s-sans--
resultingsinsoccultshypothyroidism,srelativeshypercortisonesstatessandsincreasedsrisksofsinfe
ction
Truesorsfalse:sArthritisscanscomplicatesthesairwaysandscervicalsspine.sPatientsscanshavesmu
ltilevelsdegenerativeschangessaffectingsdisksspacessandsposteriorselementssassociatedswit
hsseverescentralscanalsstenosis,scordscompression,sandsmyelomalacias-sans--true
Inselderlyspopulation,sduestostheirschangessinspulmonaryssystem,splacingsasgauzesbetweens
gumssandscheekstosachievessealswhensusingsbagsvalvesmasksventilationsissokay.sInsadditio
n,sbecausesagingscausessassuppressedsheartsratesresponsestoshypoxia......s-sans--
respiratorysfailuresmayspresentsinsidiouslysinsoldersadults.
Agesrelatedschangessinsthescardiovascularssystemsplacestheselderlystraumaspatientsatssigni
ficantsrisksforsbeingsinaccuratelyscategorizedsasshemodynamicallysstable.s-sans--
Elderlyspatientsshavesasfixedsheartsratesandsfixedscardiacsoutput,sthus,stheirsresponsestoshy
povolemiaswillsinvolvesincreasingstheirssystemicsvascularsresistance.sFurthermore,ssincesol
derspatientsshavesHTN,sansacceptablesBPsmaystrulysreflectsashypotensivesstate.sAssystolics
, BPsofs110sisstosbesutilizedsassthesthresholdsforsidentifyingshypotensionsinspatientss65sandsol
der.
Dosnosequatesbloodspressureswithsshocksinsolderspatientss-sans--
BPsinsolderspatientssmayslooksnormalsduestosthesmedicationsstheysareson.sUseslactatesands
basesdeficitstosevaluatesforsevidencesofsshock
whats2sfactorssplaceselderlyspatientssatsrisksforsintracranialshemorrhage?s-sans--
agingscausessdurastosbecomesmoresadherentstosthesskullsincreasingsrisksofsinjurysandsolder
spatientssaresonsanticoagulantsandsantiplateletsmedications.
Losssofssubcutaneoussfat,snutritionalsdeficiencies,schronicsmedicalsconditionssplaceselderly
spatientssassrisksforshypothermiasandscomplicationssforsimmobility.s-sans--
Rapidsevaluationsandswhenspossiblesearlysliberationsfromsspinesboardssandscervicalscollar
sswillsminimizescomplications.
TruesorsFalse:sFallspreventionsissthesmainstaysofsreducingsthesmortalitysassociatedswithspel
vicsfractures.s-sans--true
poorshygiene,sdehydration,soralsinjury,scontusionssaffectingsthesinnersarms,sinnersthighs,sp
alms,ssoles,sscalp,sear,snasalsbridgesandstemplesinjurysfromsbeingsstruckswhileswearingsgla
sses,scontactsburnssandsscalds.sThesesaresallssignssof.......?s-sans--
Eldersmaltreatment.sThespresencesofsphysicalsfindingssofsmaltreatmentsshouldspromptsasd
etailedshistory.sifshistorysconflictsswithsfindings,simmediatelysreportsfindingsstosauthorities.
Truesofsfalse:searlysactivationsofsthestraumasteamsmaysbesrequiredsforselderlyspatientsswhos
dosnotsmeetstraditionalscriteriasforsactivations-sans--
True.sAssimplesinjuryssuchsassansopenstibiasfracturesinsasfrailselderlyspatientsmaysbecomeslif
esthreatening.
Commonsmechanismssofsinjurysincludesfalls,sMVC,sburns,sandspenetratingsinjuriess-sans--
commonsinjuriessinstheselderlysincludesribsfractures,sTBI,spelvicsfractures
Thesbestsinitialstreatmentsforsthesfetussisstosprovidesoptimalsresuscitationsofsthesmother.sTru
esorsFalse?s-sans--
True.sAlsosifsxraysexaminationsissindicatedsduringsthespregnantspatient'sstreatment,sitsshoul
dsnotsbeswithheldsbecausesofsthespregnancy.
Whatshappenssassthesuterussenlargedsandsthesbowelsisspushedscephalad.s-sans--
Whensthesuterussenlargessitspushessthesbowelscephaladsandsthesuterussliessinsthesuppersab
domen.sAssasresult,sthesbowelsisssomewhatsprotectedsfromsbluntsabdominalstrauma,swhere
assthesuterussandsitsscontentss(fetussandsplacenta)sbecomesmoresvulnerable.sUterussremai
nssintrapelvicsuntils12sweekssandsthensats20sweekssitsissatsthesumbilicus,sandsats34-
36sweekssitsreachessthescostalsmargin.
ANSWERS
Truesorsfalse?sAlthoughsthesmechanismsofsinjurysmaysbessimilarstosthosesforsthesyoungersp
opulation,sdatasshowssincreasedsmortalityswithssimilarsseveritysofsinjurysinsoldersadults.s-
sans--True
Instheselderlyspopulation,swhatsissdecreasedsphysiologicalsreserve?s-sans--
agingsisscharacterizedsbysimpairedsadaptivesandshomeostaticsmechanismssthatscausedsan
sincreasedssusceptibilitystosthesstresssofsinjury.sInsultsstoleratedsbysthesyoungerspopulations
cansleadstosdevastatingsresultssinselderlyspatients.
Pre-existingsconditionssthatsaffectsmorbiditysandsmortalitysinclude:s-sans--
cirrhosis,scoagulopathy,sCOPD,sischemicsheartsdisease,sDM
Whatsissthesmostscommonsmechanismsofsinjurysinstheselderly?s-sans--
Fall.sNonfatalsfallssarescommonsinswomensandsfracturessarescommonsinswomenswhosfall.sF
allssaresthesmostscommonscausesofsTBI.
Instheselderlyspopulation,swhatsaresrisksfactorssforsfalls?s-sans--
advancedsage,sphysicalsimpairment,shistorysofsprevioussfall,smedicationsuse,sdementia,sun
steadysgait,sandsvisual,scognitivesimpairment
Mostsofselderlystrafficsfatalitiessoccursinsthesdaytimesandsonsweekendssandstypicallysinvolves
othersvehicles.sWhy?s-sans--
Olderspeoplesdrivesonsmoresfamiliarsroadssandsatslowersspeedssandstendstosdrivesduringsthe
sday. sOlderspeopleshavesslowersreactionstime,saslargersblindsspot,slimitedscervical smobility, s
decreasedshearing,sandscognitivesimpairment.
TruesorsFalse?sMortalitysassociatedswithssmallstosmoderatessizedsburnssinsoldersadultssrem
ainsshighs-sans--True
Spilledshotsliquidssonsthesleg,swhichsinsyoungerspatientssmaysre-
epithelializesduestosansadequatesnumbersofshairsfollicles,swillsresultsinsasfullsthicknesssburnsi
nsolderspatients.s-sans--thississtrue
Airway-
patientssmayshavesdenturessthatsmaysloosensorsobstructsthesairway.sIfsdenturessaresnotsobs
tructingsthesairway,sleavesthemsinsplacesforswhat?s-sans--
bagsmasksventilation,sassitsimprovessmasksfitting.
,Whenspreformingsrapidssequencesintubation,sthesdosesofsbenzos,sbarbiturates,sandsotherss
edativessshouldsbesreducedstoswhatspercentagestosminimizesthesrisksofscardiovascularsdep
ression?s-sans--20-40%
Functionalschangessinscardiacssystemsincludesdecliningsfunction,sdecreasedssensitivitystos
catecholamines,satherosclerosissofscoronarysvessels,sincreasedsafterload,sfixedsheartsrates
(betasblockers)s-sans--
thissresultssinslacksofsclassicsresponsestoshypovolemia,srisksforscardiacsischemia,selevateds
BPsatsbaseline,sandsincreasedsrisksofsdysrythmias.
Functionalschangessinspulmonaryssystemsincludesdecreasedselasticsrecoil,sreducedsresidu
alscapacity,sdecreasedsgassexchangesandsdecreasedscoughsreflexs-sans--
thusstheysaresatsincreasedsrisksforsrespiratorysfailure,sincreasedsrisksforspneumonia,sandspo
orstolerancestosribsfractures
Functionalschangessinsrenalssystemsincludeslosssofsrenalsmass,sdecreasedsGFR,sandsdecr
easedssensitivitystosADHsandsaldosterones-sans--
resultingsinsdrugsdosingsforsrenalsinsufficiency,sdecreasedsabilitystosconcentratesurine,sincr
easedsrisksforsAKIsandsurinesflowsmaysbesnormalswithshypovolemia
FunctionalschangesstosMSKsincludeslosssofsleansbodysmass,sosteoporosis,schangessinsjoint
ssandscartilage,scsspinesdegenerativeschangessandslosssofsskinselastinsandssubcutaneoussf
ats-sans--
resultingsinsincreasedsrisksforsfractures,sdecreasedsmobility,sdifficultysforsoralsintubation,sris
ksofsskinsinjury,sincreasedsrisksforshypothermia,schallengessinsrehabiliation
FunctionalschangessinsEndocrinessystemsincludesdecreasedsproductionsandsresponsestost
hyroxinsandsdecreasedsdehydroepiandrosterones(DHEA)s-sans--
resultingsinsoccultshypothyroidism,srelativeshypercortisonesstatessandsincreasedsrisksofsinfe
ction
Truesorsfalse:sArthritisscanscomplicatesthesairwaysandscervicalsspine.sPatientsscanshavesmu
ltilevelsdegenerativeschangessaffectingsdisksspacessandsposteriorselementssassociatedswit
hsseverescentralscanalsstenosis,scordscompression,sandsmyelomalacias-sans--true
Inselderlyspopulation,sduestostheirschangessinspulmonaryssystem,splacingsasgauzesbetweens
gumssandscheekstosachievessealswhensusingsbagsvalvesmasksventilationsissokay.sInsadditio
n,sbecausesagingscausessassuppressedsheartsratesresponsestoshypoxia......s-sans--
respiratorysfailuresmayspresentsinsidiouslysinsoldersadults.
Agesrelatedschangessinsthescardiovascularssystemsplacestheselderlystraumaspatientsatssigni
ficantsrisksforsbeingsinaccuratelyscategorizedsasshemodynamicallysstable.s-sans--
Elderlyspatientsshavesasfixedsheartsratesandsfixedscardiacsoutput,sthus,stheirsresponsestoshy
povolemiaswillsinvolvesincreasingstheirssystemicsvascularsresistance.sFurthermore,ssincesol
derspatientsshavesHTN,sansacceptablesBPsmaystrulysreflectsashypotensivesstate.sAssystolics
, BPsofs110sisstosbesutilizedsassthesthresholdsforsidentifyingshypotensionsinspatientss65sandsol
der.
Dosnosequatesbloodspressureswithsshocksinsolderspatientss-sans--
BPsinsolderspatientssmayslooksnormalsduestosthesmedicationsstheysareson.sUseslactatesands
basesdeficitstosevaluatesforsevidencesofsshock
whats2sfactorssplaceselderlyspatientssatsrisksforsintracranialshemorrhage?s-sans--
agingscausessdurastosbecomesmoresadherentstosthesskullsincreasingsrisksofsinjurysandsolder
spatientssaresonsanticoagulantsandsantiplateletsmedications.
Losssofssubcutaneoussfat,snutritionalsdeficiencies,schronicsmedicalsconditionssplaceselderly
spatientssassrisksforshypothermiasandscomplicationssforsimmobility.s-sans--
Rapidsevaluationsandswhenspossiblesearlysliberationsfromsspinesboardssandscervicalscollar
sswillsminimizescomplications.
TruesorsFalse:sFallspreventionsissthesmainstaysofsreducingsthesmortalitysassociatedswithspel
vicsfractures.s-sans--true
poorshygiene,sdehydration,soralsinjury,scontusionssaffectingsthesinnersarms,sinnersthighs,sp
alms,ssoles,sscalp,sear,snasalsbridgesandstemplesinjurysfromsbeingsstruckswhileswearingsgla
sses,scontactsburnssandsscalds.sThesesaresallssignssof.......?s-sans--
Eldersmaltreatment.sThespresencesofsphysicalsfindingssofsmaltreatmentsshouldspromptsasd
etailedshistory.sifshistorysconflictsswithsfindings,simmediatelysreportsfindingsstosauthorities.
Truesofsfalse:searlysactivationsofsthestraumasteamsmaysbesrequiredsforselderlyspatientsswhos
dosnotsmeetstraditionalscriteriasforsactivations-sans--
True.sAssimplesinjuryssuchsassansopenstibiasfracturesinsasfrailselderlyspatientsmaysbecomeslif
esthreatening.
Commonsmechanismssofsinjurysincludesfalls,sMVC,sburns,sandspenetratingsinjuriess-sans--
commonsinjuriessinstheselderlysincludesribsfractures,sTBI,spelvicsfractures
Thesbestsinitialstreatmentsforsthesfetussisstosprovidesoptimalsresuscitationsofsthesmother.sTru
esorsFalse?s-sans--
True.sAlsosifsxraysexaminationsissindicatedsduringsthespregnantspatient'sstreatment,sitsshoul
dsnotsbeswithheldsbecausesofsthespregnancy.
Whatshappenssassthesuterussenlargedsandsthesbowelsisspushedscephalad.s-sans--
Whensthesuterussenlargessitspushessthesbowelscephaladsandsthesuterussliessinsthesuppersab
domen.sAssasresult,sthesbowelsisssomewhatsprotectedsfromsbluntsabdominalstrauma,swhere
assthesuterussandsitsscontentss(fetussandsplacenta)sbecomesmoresvulnerable.sUterussremai
nssintrapelvicsuntils12sweekssandsthensats20sweekssitsissatsthesumbilicus,sandsats34-
36sweekssitsreachessthescostalsmargin.
