ATLS Test with questions and answers
Order of Initial Assessment - CORRECT ANSWER-1. Preparation -prehospital and hospital
2. Triage
3. Primary Survey- ABCDEs
4. Adjuncts to primary
5. Consider transfer
6. Secondary Survey- head to toe exam and pt history
7. Continue post-resuscitation and re-evalution
8. Definitive care
Why should primary and secondary surveys be repeated frequently? - CORRECT ANSWER-Identify any
change in the patient's status and need for additional intervention
Prehospital Phase Preparation - CORRECT ANSWER-- notify receiving hospital to allow for mobilization of
trauma team to be there when pt arrives
- provide airway maintenance, control of bleeding, assess shock, immobilize c-spine/other injuries
- transport to the closest facility, preferred trauma center
- minimize scene time
- obtain report needed for triage at the hospital
Hospital Phase Preparation - CORRECT ANSWER-- resuscitation area available for patients
- proper airway equipment
- warmed IV crystalloid solutions
- a protocol to summon additional medical equipment
- transfers agreements w/ verified trauma centers are established
**Consider wearing protection (face mask, gloves, eye care) due to concern for hepatitis and AIDs in
patients
Triage - CORRECT ANSWER-sorting patients based on resources required for treatment and the resources
that are actually available
,- order of patient is based on ABC priorities
Multiple Casualties vs Mass Casualties - CORRECT ANSWER-multiple: incidents are those in which the
number of patients and the severity of their injures DO NOT exceed the capability of the facility
mass: the number of patients and severity of their injuries DO exceed the capability of the facility
Primary Survey - CORRECT ANSWER-Vitals must be assessed quickly and efficiently using the ABCDE
method
Airway maintenance w/ restriction of c-spine
Breathing and Ventilation
Circulation w/ hemorrhage control
Disability - neurologic status
Exposure/Environmental control
How can you assess ABCD in a patient in under 10 seconds? - CORRECT ANSWER-Identify yourself
Ask the patient their name
Ask the patient what happened
If the patient is able to give an appropriate response during the primary survey what does that mean
about their ABCD status - CORRECT ANSWER-the patient likely doesn't have an extreme airway or
breathing compromise and not a markedly decreased level of consciousness
A trauma patient with a known head injury has a compromised airway, do you assess the head trauma or
airway - CORRECT ANSWER-Airway - clear, suction, administer oxygen, open and secure airway
What is important with airway maintenance? - CORRECT ANSWER-Restrict the cervical spine, ALWAYS
assume a cervical spinal injury exists
Airway Maintenance - CORRECT ANSWER-assess airway's patency, inspect any form of obstruction
including foreign bodies or fractures, suction blood and secretions
,*if the patient is able to communicate verbally, the airway is likely not compromised --> UNLESS GCS less
than 8, then will still likely have to intubate
Trauma patient is able to speak so you are not worried about airway compromise, what is a scenario in
which you should still be concerned even with verbal communication? - CORRECT ANSWER-Head injuries
with altered level of consciousness, GCS less than 8 usually required definitive airway
Trauma patient with non-purposeful motor responses would strongly suggest the need for what? -
CORRECT ANSWER-a definitive airway
*non-purposeful would include decorticate or decerebrate positions
A c-collar is placed on a trauma patient in the field but once the patient arrives to the hospital it is
determined that the patient needs to be intubated, however there have not been any imaging on the c-
spine. What should you do? - CORRECT ANSWER-Open the cervical collar and have a team member
manually restrict motion of the c-spine
Breathing and Ventilation - CORRECT ANSWER-Required adequate gas exchanged to maximize oxygen
and eliminate carbon dioxide
- requires lungs, chest wall, and diaphragm
Important aspects of assessing breathing and ventilation - CORRECT ANSWER-- look for JVD
- listen to the lungs
- visual inspection of the chest wall
- palpate chest wall
What are some major injuries that can impair ventilation? - CORRECT ANSWER-tension pneumothorax,
massive hemothorax, open pneumothorax, tracheal or bronchial injuries
What can a simple pneumothorax turn into after the patient is intubated? - CORRECT ANSWER-A tension
pneumothorax due to positive pressure if the patient isn't decompressed before intubated
, Does a normal neurologic exam exclude a cervical spine injury? - CORRECT ANSWER-No, the cervical
spine needs to be protected until imaging is done
Blood Volume and Cardiac Output - CORRECT ANSWER-Identifying, quickly controlling hemorrhage, and
initiating resuscitation
-once tension pneumo has been excluded as a cause of shock, it is blood loss until proven otherwise
What is the predominant cause of preventable deaths after injury? - CORRECT ANSWER-Hemorrhage
What elements of clinical observation yield important information within seconds when assessing blood
volume and cardiac output? - CORRECT ANSWER-Level of Consciousness - if cerebral perfusion is
impaired, may alter consciousness
Skin Perfusion- a patient with pink skin, especially in the face and extremities rarely have hypovolemia
Pulse- rapid pulse is a sign of hypovolemia
What pulses should be assessed? - CORRECT ANSWER-Carotid or femoral
What is the mainstay treatment for external blood loss but what can this result in? - CORRECT ANSWER-
Direct manual pressure, possible tourniquets are effective but has risk for ischemic injury - only
tourniquet if direct pressure is not working
- blind clamping can result in damage to nerves and veins
What are major areas of internal hemorrhage? - CORRECT ANSWER-chest, abdomen, retroperitoneum,
pelvis, long bones
What is essential with a patient actively bleeding? - CORRECT ANSWER-Definitive control - may need
chest decompression, pelvic stabilizing device, surgery, etc.
AND replacing intravascular volume
Order of Initial Assessment - CORRECT ANSWER-1. Preparation -prehospital and hospital
2. Triage
3. Primary Survey- ABCDEs
4. Adjuncts to primary
5. Consider transfer
6. Secondary Survey- head to toe exam and pt history
7. Continue post-resuscitation and re-evalution
8. Definitive care
Why should primary and secondary surveys be repeated frequently? - CORRECT ANSWER-Identify any
change in the patient's status and need for additional intervention
Prehospital Phase Preparation - CORRECT ANSWER-- notify receiving hospital to allow for mobilization of
trauma team to be there when pt arrives
- provide airway maintenance, control of bleeding, assess shock, immobilize c-spine/other injuries
- transport to the closest facility, preferred trauma center
- minimize scene time
- obtain report needed for triage at the hospital
Hospital Phase Preparation - CORRECT ANSWER-- resuscitation area available for patients
- proper airway equipment
- warmed IV crystalloid solutions
- a protocol to summon additional medical equipment
- transfers agreements w/ verified trauma centers are established
**Consider wearing protection (face mask, gloves, eye care) due to concern for hepatitis and AIDs in
patients
Triage - CORRECT ANSWER-sorting patients based on resources required for treatment and the resources
that are actually available
,- order of patient is based on ABC priorities
Multiple Casualties vs Mass Casualties - CORRECT ANSWER-multiple: incidents are those in which the
number of patients and the severity of their injures DO NOT exceed the capability of the facility
mass: the number of patients and severity of their injuries DO exceed the capability of the facility
Primary Survey - CORRECT ANSWER-Vitals must be assessed quickly and efficiently using the ABCDE
method
Airway maintenance w/ restriction of c-spine
Breathing and Ventilation
Circulation w/ hemorrhage control
Disability - neurologic status
Exposure/Environmental control
How can you assess ABCD in a patient in under 10 seconds? - CORRECT ANSWER-Identify yourself
Ask the patient their name
Ask the patient what happened
If the patient is able to give an appropriate response during the primary survey what does that mean
about their ABCD status - CORRECT ANSWER-the patient likely doesn't have an extreme airway or
breathing compromise and not a markedly decreased level of consciousness
A trauma patient with a known head injury has a compromised airway, do you assess the head trauma or
airway - CORRECT ANSWER-Airway - clear, suction, administer oxygen, open and secure airway
What is important with airway maintenance? - CORRECT ANSWER-Restrict the cervical spine, ALWAYS
assume a cervical spinal injury exists
Airway Maintenance - CORRECT ANSWER-assess airway's patency, inspect any form of obstruction
including foreign bodies or fractures, suction blood and secretions
,*if the patient is able to communicate verbally, the airway is likely not compromised --> UNLESS GCS less
than 8, then will still likely have to intubate
Trauma patient is able to speak so you are not worried about airway compromise, what is a scenario in
which you should still be concerned even with verbal communication? - CORRECT ANSWER-Head injuries
with altered level of consciousness, GCS less than 8 usually required definitive airway
Trauma patient with non-purposeful motor responses would strongly suggest the need for what? -
CORRECT ANSWER-a definitive airway
*non-purposeful would include decorticate or decerebrate positions
A c-collar is placed on a trauma patient in the field but once the patient arrives to the hospital it is
determined that the patient needs to be intubated, however there have not been any imaging on the c-
spine. What should you do? - CORRECT ANSWER-Open the cervical collar and have a team member
manually restrict motion of the c-spine
Breathing and Ventilation - CORRECT ANSWER-Required adequate gas exchanged to maximize oxygen
and eliminate carbon dioxide
- requires lungs, chest wall, and diaphragm
Important aspects of assessing breathing and ventilation - CORRECT ANSWER-- look for JVD
- listen to the lungs
- visual inspection of the chest wall
- palpate chest wall
What are some major injuries that can impair ventilation? - CORRECT ANSWER-tension pneumothorax,
massive hemothorax, open pneumothorax, tracheal or bronchial injuries
What can a simple pneumothorax turn into after the patient is intubated? - CORRECT ANSWER-A tension
pneumothorax due to positive pressure if the patient isn't decompressed before intubated
, Does a normal neurologic exam exclude a cervical spine injury? - CORRECT ANSWER-No, the cervical
spine needs to be protected until imaging is done
Blood Volume and Cardiac Output - CORRECT ANSWER-Identifying, quickly controlling hemorrhage, and
initiating resuscitation
-once tension pneumo has been excluded as a cause of shock, it is blood loss until proven otherwise
What is the predominant cause of preventable deaths after injury? - CORRECT ANSWER-Hemorrhage
What elements of clinical observation yield important information within seconds when assessing blood
volume and cardiac output? - CORRECT ANSWER-Level of Consciousness - if cerebral perfusion is
impaired, may alter consciousness
Skin Perfusion- a patient with pink skin, especially in the face and extremities rarely have hypovolemia
Pulse- rapid pulse is a sign of hypovolemia
What pulses should be assessed? - CORRECT ANSWER-Carotid or femoral
What is the mainstay treatment for external blood loss but what can this result in? - CORRECT ANSWER-
Direct manual pressure, possible tourniquets are effective but has risk for ischemic injury - only
tourniquet if direct pressure is not working
- blind clamping can result in damage to nerves and veins
What are major areas of internal hemorrhage? - CORRECT ANSWER-chest, abdomen, retroperitoneum,
pelvis, long bones
What is essential with a patient actively bleeding? - CORRECT ANSWER-Definitive control - may need
chest decompression, pelvic stabilizing device, surgery, etc.
AND replacing intravascular volume
