ATLS 10 Newest 2026 Test Bank
GERIATRIC TRAUMA
Decreased physiological reserve in the elderly:
Aging reduces the body’s ability to adapt and maintain homeostasis. As a result, older
adults are more vulnerable to injury. Even injuries that are well tolerated in younger patients
can cause severe outcomes in the elderly.
Common pre-existing conditions that increase morbidity and mortality:
Cirrhosis, coagulopathy, COPD, ischemic heart disease, and diabetes mellitus.
True/False:
Similar injury severity causes higher mortality in older adults → True
Most common mechanism of injury in the elderly:
Falls.
Risk factors for falls:
Advanced age, prior falls, physical impairment, medication use, dementia, unsteady gait,
and visual or cognitive impairment.
Elderly traffic injuries:
More often occur during the day and on weekends. Older adults usually drive familiar routes
at lower speeds but have slower reaction time, reduced neck mobility, decreased hearing,
larger blind spots, and cognitive decline.
Burns in elderly patients:
Even small to moderate burns have high mortality.
Hot liquid burns in elderly:
May progress to full-thickness burns due to reduced hair follicles and skin regenerative
capacity.
Airway considerations:
Dentures may obstruct the airway but can be left in place if they improve bag-mask
ventilation.
Sedation in RSI:
Reduce benzodiazepines, barbiturates, and sedatives to 20–40% of normal dose to avoid
cardiovascular depression.
Cardiovascular changes in elderly:
Decreased cardiac reserve, reduced response to catecholamines, atherosclerosis,
increased afterload, and fixed heart rate.
Results: poor compensation for shock, higher risk of ischemia and dysrhythmias, and
baseline hypertension.
,Important clinical point:
A systolic BP of 110 mmHg or less may already indicate hypotension in patients aged 65+.
Respiratory changes:
Decreased lung elasticity, reduced gas exchange, weak cough reflex.
Results: increased risk of pneumonia, respiratory failure, and poor tolerance of rib fractures.
Renal changes:
Decreased GFR, reduced renal mass, and reduced response to ADH/aldosterone.
Results: increased risk of AKI and altered drug clearance.
Musculoskeletal changes:
Osteoporosis, loss of muscle mass, degenerative spine disease, and skin thinning.
Results: fractures, reduced mobility, intubation difficulty, and higher risk of skin injury and
hypothermia.
Endocrine changes:
Reduced thyroid and DHEA production.
Results: higher infection risk and altered stress response.
Arthritis and airway risk:
True. Cervical spine degeneration can cause stenosis, cord compression, and difficult
airway management.
Shock recognition in elderly:
Do not rely on blood pressure alone. Use lactate and base deficit. Normal BP does not
exclude shock.
Intracranial hemorrhage risk:
Increased due to brain atrophy (bridging vein tension) and anticoagulant/antiplatelet use.
Elder abuse signs:
Poor hygiene, dehydration, oral injury, bruises on inner arms/thighs, palms, soles, scalp,
ears, nasal bridge, and temple injuries. Report if suspected.
Early trauma team activation:
Should be considered even for injuries that seem minor (e.g., open tibia fracture) due to
high frailty risk.
Common elderly injuries:
Rib fractures, traumatic brain injury, pelvic fractures.
PREGNANCY AND TRAUMA
Best fetal treatment principle:
Prioritize maternal resuscitation first.
Uterine anatomy changes:
Uterus remains pelvic until ~12 weeks, reaches umbilicus at ~20 weeks, and costal margin
at 34–36 weeks.
,Pregnancy and shock:
Maternal vital signs may remain normal despite significant blood loss. Fetal distress may be
the first sign.
Normal pregnancy changes:
WBC increases up to 12,000 (up to 25,000 in labor).
Fibrinogen and clotting factors increase.
PT and PTT shorten.
Cardiovascular changes:
Cardiac output increases 1.0–1.5 L/min after 10 weeks.
Heart rate increases by 10–15 bpm.
Blood pressure decreases in 2nd trimester then normalizes.
Supine hypotension:
Caused by IVC compression by gravid uterus → reduced venous return and cardiac output.
Respiratory changes:
Increased tidal volume, mild hyperventilation, and low PaCO2 (~30 mmHg).
PaCO2 of 35–40 mmHg may indicate respiratory failure in pregnancy.
Renal changes:
Increased GFR and renal blood flow.
Lower creatinine and BUN (about half normal).
Pregnancy anemia:
Hematocrit of 31–33% may be normal in late pregnancy.
Hypovolemia tolerance:
Pregnant patients may lose 1200–1500 mL before showing signs of shock.
Placental perfusion risk:
Even with stable maternal vitals, fetal hypoxia may be present.
Uterine blood flow:
Maternal hypovolemia increases uterine vascular resistance → fetal hypoxia.
Burns in pregnancy:
Small changes in maternal circulation can significantly reduce fetal oxygenation.
Fetal heart rate:
Normal: 120–160 bpm.
Abnormal FHR suggests hypoxia or maternal compromise.
Monitoring:
Continuous fetal monitoring after 20–24 weeks.
High-risk patients require longer monitoring (up to 24 hours).
, Fetal distress risk factors:
Maternal tachycardia >110, ISS >9, abnormal FHR (<120 or >160), MVC ejection,
motorcycle or pedestrian trauma, placental abruption.
Placental abruption signs:
Vaginal bleeding, uterine tenderness, contractions, uterine irritability (may be silent in 30%
of cases).
Uterine rupture signs:
Abdominal tenderness, rigidity, abnormal fetal position, easily palpable fetal parts, loss of
uterine contour.
Trauma imaging in pregnancy:
CT and X-ray should not be withheld if needed (radiation <50 mGy is generally safe).
IVC compression management:
Left lateral tilt (15–30 degrees) or manual uterine displacement.
Rh incompatibility:
Small exposure (0.01 mL Rh+ blood) can sensitize most Rh-negative women.
All Rh-negative trauma patients should receive Rh immunoglobulin unless clearly not
exposed.
Intimate partner violence signs:
Injury inconsistent with history, frequent ED visits, depression, substance use, abdominal
injuries, controlling partner behavior.
BURNS AND TRAUMA
Key difference in burns:
Severity is driven by inflammatory response; larger/deeper burns cause greater systemic
effects.
Airway risk in burns:
Risk increases with burn size, facial burns, inhalation injury, oral burns, and associated
trauma.
Early airway obstruction signs:
Hoarseness, stridor, accessory muscle use, sternal retractions.
Inhalation injury:
May not show early radiographic changes. Do not delay airway protection.
Carboxyhemoglobin >10%:
Suggests inhalation injury from fire exposure.
Burn decontamination:
Remove clothing immediately.
Do not remove adherent clothing.
Brush dry chemicals off.
GERIATRIC TRAUMA
Decreased physiological reserve in the elderly:
Aging reduces the body’s ability to adapt and maintain homeostasis. As a result, older
adults are more vulnerable to injury. Even injuries that are well tolerated in younger patients
can cause severe outcomes in the elderly.
Common pre-existing conditions that increase morbidity and mortality:
Cirrhosis, coagulopathy, COPD, ischemic heart disease, and diabetes mellitus.
True/False:
Similar injury severity causes higher mortality in older adults → True
Most common mechanism of injury in the elderly:
Falls.
Risk factors for falls:
Advanced age, prior falls, physical impairment, medication use, dementia, unsteady gait,
and visual or cognitive impairment.
Elderly traffic injuries:
More often occur during the day and on weekends. Older adults usually drive familiar routes
at lower speeds but have slower reaction time, reduced neck mobility, decreased hearing,
larger blind spots, and cognitive decline.
Burns in elderly patients:
Even small to moderate burns have high mortality.
Hot liquid burns in elderly:
May progress to full-thickness burns due to reduced hair follicles and skin regenerative
capacity.
Airway considerations:
Dentures may obstruct the airway but can be left in place if they improve bag-mask
ventilation.
Sedation in RSI:
Reduce benzodiazepines, barbiturates, and sedatives to 20–40% of normal dose to avoid
cardiovascular depression.
Cardiovascular changes in elderly:
Decreased cardiac reserve, reduced response to catecholamines, atherosclerosis,
increased afterload, and fixed heart rate.
Results: poor compensation for shock, higher risk of ischemia and dysrhythmias, and
baseline hypertension.
,Important clinical point:
A systolic BP of 110 mmHg or less may already indicate hypotension in patients aged 65+.
Respiratory changes:
Decreased lung elasticity, reduced gas exchange, weak cough reflex.
Results: increased risk of pneumonia, respiratory failure, and poor tolerance of rib fractures.
Renal changes:
Decreased GFR, reduced renal mass, and reduced response to ADH/aldosterone.
Results: increased risk of AKI and altered drug clearance.
Musculoskeletal changes:
Osteoporosis, loss of muscle mass, degenerative spine disease, and skin thinning.
Results: fractures, reduced mobility, intubation difficulty, and higher risk of skin injury and
hypothermia.
Endocrine changes:
Reduced thyroid and DHEA production.
Results: higher infection risk and altered stress response.
Arthritis and airway risk:
True. Cervical spine degeneration can cause stenosis, cord compression, and difficult
airway management.
Shock recognition in elderly:
Do not rely on blood pressure alone. Use lactate and base deficit. Normal BP does not
exclude shock.
Intracranial hemorrhage risk:
Increased due to brain atrophy (bridging vein tension) and anticoagulant/antiplatelet use.
Elder abuse signs:
Poor hygiene, dehydration, oral injury, bruises on inner arms/thighs, palms, soles, scalp,
ears, nasal bridge, and temple injuries. Report if suspected.
Early trauma team activation:
Should be considered even for injuries that seem minor (e.g., open tibia fracture) due to
high frailty risk.
Common elderly injuries:
Rib fractures, traumatic brain injury, pelvic fractures.
PREGNANCY AND TRAUMA
Best fetal treatment principle:
Prioritize maternal resuscitation first.
Uterine anatomy changes:
Uterus remains pelvic until ~12 weeks, reaches umbilicus at ~20 weeks, and costal margin
at 34–36 weeks.
,Pregnancy and shock:
Maternal vital signs may remain normal despite significant blood loss. Fetal distress may be
the first sign.
Normal pregnancy changes:
WBC increases up to 12,000 (up to 25,000 in labor).
Fibrinogen and clotting factors increase.
PT and PTT shorten.
Cardiovascular changes:
Cardiac output increases 1.0–1.5 L/min after 10 weeks.
Heart rate increases by 10–15 bpm.
Blood pressure decreases in 2nd trimester then normalizes.
Supine hypotension:
Caused by IVC compression by gravid uterus → reduced venous return and cardiac output.
Respiratory changes:
Increased tidal volume, mild hyperventilation, and low PaCO2 (~30 mmHg).
PaCO2 of 35–40 mmHg may indicate respiratory failure in pregnancy.
Renal changes:
Increased GFR and renal blood flow.
Lower creatinine and BUN (about half normal).
Pregnancy anemia:
Hematocrit of 31–33% may be normal in late pregnancy.
Hypovolemia tolerance:
Pregnant patients may lose 1200–1500 mL before showing signs of shock.
Placental perfusion risk:
Even with stable maternal vitals, fetal hypoxia may be present.
Uterine blood flow:
Maternal hypovolemia increases uterine vascular resistance → fetal hypoxia.
Burns in pregnancy:
Small changes in maternal circulation can significantly reduce fetal oxygenation.
Fetal heart rate:
Normal: 120–160 bpm.
Abnormal FHR suggests hypoxia or maternal compromise.
Monitoring:
Continuous fetal monitoring after 20–24 weeks.
High-risk patients require longer monitoring (up to 24 hours).
, Fetal distress risk factors:
Maternal tachycardia >110, ISS >9, abnormal FHR (<120 or >160), MVC ejection,
motorcycle or pedestrian trauma, placental abruption.
Placental abruption signs:
Vaginal bleeding, uterine tenderness, contractions, uterine irritability (may be silent in 30%
of cases).
Uterine rupture signs:
Abdominal tenderness, rigidity, abnormal fetal position, easily palpable fetal parts, loss of
uterine contour.
Trauma imaging in pregnancy:
CT and X-ray should not be withheld if needed (radiation <50 mGy is generally safe).
IVC compression management:
Left lateral tilt (15–30 degrees) or manual uterine displacement.
Rh incompatibility:
Small exposure (0.01 mL Rh+ blood) can sensitize most Rh-negative women.
All Rh-negative trauma patients should receive Rh immunoglobulin unless clearly not
exposed.
Intimate partner violence signs:
Injury inconsistent with history, frequent ED visits, depression, substance use, abdominal
injuries, controlling partner behavior.
BURNS AND TRAUMA
Key difference in burns:
Severity is driven by inflammatory response; larger/deeper burns cause greater systemic
effects.
Airway risk in burns:
Risk increases with burn size, facial burns, inhalation injury, oral burns, and associated
trauma.
Early airway obstruction signs:
Hoarseness, stridor, accessory muscle use, sternal retractions.
Inhalation injury:
May not show early radiographic changes. Do not delay airway protection.
Carboxyhemoglobin >10%:
Suggests inhalation injury from fire exposure.
Burn decontamination:
Remove clothing immediately.
Do not remove adherent clothing.
Brush dry chemicals off.
