ATLS EXAM
1. Common mechanisms of injury include falls, MVC, burns, and penetrating
injuries
Answer: common injuries in the elderly include rib fractures, TBI, pelvic fractures
2. The best initial treatment for the fetus is to provide optimal resuscitation of the
mother.True or False?
Answer: True. Also if xray examination is indicated during thepregnant patient's
treatment, it should not be withheld because of the pregnancy.
3. What happens as the uterus enlarged and the bowel is pushed cephalad.-
Answer: When the uterus enlarges it pushes the bowel cephalad and the uterus lies
in theupper abdomen. As a result, the bowel is somewhat protected from blunt
abdominaltrauma, whereas the uterus and its contents (fetus and placenta) become
more vulnerable. Uterus remains intrapelvic until 12 weeks and then at 20 weeks it
is at the umbilicus, and at 34-36 weeks it reaches the costal margin.
4. Amniotic fluid can cause amniotic fluid embolism and disseminated
intravascular coagulation following trauma if fluid enters maternal intravascularspace.
True or False
Answer: True
5. By the third trimester, what is the complication of trauma to the pelvis ofthe
mother?
Answer: by the third trimester, the uterus is large and thin walled. In vertex
presentation, fetal head is usually in the pelvis and the remainder of the fetus is
exposed above the pelvic brim. Pelvic fractures in late gestation can result in skull
fracture or intracranial injury to the fetus. Also we can have a placental abruption
due to its little elasticity and vulnerability to sheer forces.
6. An abrupt decrease in maternal intravascular volume can result in a profound
increase in uterine vascular resistance reducing fetal oxygenationdespite reasonably
normal maternal vital signs.
Answer: this is true
7. Physiological anemia of pregnancy
Answer: A smaller increase in red blood cell volume can occur resulting in a
decreased hematocrit level. Thus, in late pregnancya hematocrit of 31-33% is
normal.
8. Healthy pregnancy patients can lose 1200-1500 mL of blood before exhibiting
signs and symptoms of hypovolemia. How can this manifest?
Answer: this amountof hemorrhage may be reflected by fetal distress as evidenced by
,an abnormal fetalheart rate.
9. What are some of the lab changes in pregnancy?
Answer: WBC increases to 12000and during labor can be 25000. Fibrinogen and
other clotting factors are mildly elevated and PT and pTT are shortened, but
bleeding time and clotting time are unchanged.
10. After the 10th week of pregnancy, cardiac output can increase 1.0-1.5 L/min
because of the increase in plasma volume and decrease in vascular resistanceof the
uterus and placenta.
Answer: The placenta receives 20% of the patient's cardiac output during the 3rd
trimester. In supine position, vena cava compression can decrease cardiac output by
30% because of decreased venous return from lower extremities.
11. During pregnancy the heart rate increases to a maximum of 10-15 beats perminute
over baseline by the third trimester.
Answer: this heart rate must be consideredwhen interpreting a tachycardic response
to hypovolemia.
12. Blood pressure falls 5-15 mm Hg in systolic and diastolic pressures duringsecond
trimester, although it returns to near normal levels at term.
Answer: some women experience hypotension when placed in the supine position
due to the compression of teh inferior vena cava.
13. hypertension in the pregnant if accompanied by proteinuria may representwhat?
Answer: pre-eclampsia.
14. EKG findings in pregnant patient
Answer: Flatted or inverted T waves in leads III andAVF and the precordial leads
may be normal. Ectopic beats are increased during pregnancy.
15. Minute ventilation increases primarily due to an increase in tidal volume.
Hypocapnia (30 mm Hg) is common in late pregnancy
Answer: Monitor ventilation in late pregnancy with arterial blood gas values. A
PaCO2 of 35-40 mm Hg may indicate impending respiratory failure during
pregnancy. Pregnant patients shouldbe hypocapneic.
16. Anatomical alterations in the thoracic cavity seem to account for the decreased
residual volume associated with diphragmatic elevation and chestx ray reveals
increased lung marking and prominence of the pulmonary vessels.
Answer: oxygen consumption increases during pregnancy and its important when
resuscitating injured pregnant patients to maintain adequate oxygenation above 95%
, 17. In patients with advanced pregnancy, those that require a chest tube placement,
where should the test tube be placed?
Answer: it should be positioned higherto avoid intra-abdominal placement given the
elevation of the diaphragm.
18. Urinary system: what happens to the GFR, serum creatinine and urea nitrogen
levels?
Answer: GFR and renal blood increases during pregnancy, whereas levelsof the serum
creatinine and urea nitrogen fall to one half of the normal pre pregnancylevels.
Glycosuria is common in pregnancy.
19. When interpreting x ray films of the pelvis in a pregnant patient, the symphysis
pubis widens 4-8 mm and the sacroiliac joint spaces increase bythe 7th month
Answer: keep this in mind
20. Eclampsia
Answer: Maintain a high index of suspicion for eclampsia when seizures are
accompanied by HTN, proteinuria, hyperreflexia, and peripheral edema in pregnant
trauma patients. This can mimic head injury.
21. External contusions and abrasions of the abdominal wall are signs of bluntuterine
trauma.
Answer: true. Fetal injuries can occur when the abdominal wall strikes anobject,
such as the dashboard or steering wheel, or when a pregnant patient is struckby a blunt
instrument.
22. Using a shoulder restraints in conjunction with a lap belt reduces the likelihood
of direct and indirect fetal injury, presumably because the shoulderbelt dissipates
deceleration forces over a great surface area and helps preventthe mother from flexing
forward over the gravid uterus.
Answer: the deployment of air bags in vehicles does not appear to increase
pregnancy specific risks. Using lap belt alone allows for forward flexion and uterine
compression with possible uterinerupture or placental abruption. Lap belt worn too
high over uterus may produce uterine rupture.
23. Penetrating injury to pregnant women
Answer: As uterus grows larger, other visceraare protected from penetrating injury.
Dense uterine musculature in early pregnancycan absorb significant amount of
energy from penetrating objects decreasing their velocity and lowering risk of injury
to other viscera. However, fetal outcome is generally poor with penetrating injury to
uterus.
1. Common mechanisms of injury include falls, MVC, burns, and penetrating
injuries
Answer: common injuries in the elderly include rib fractures, TBI, pelvic fractures
2. The best initial treatment for the fetus is to provide optimal resuscitation of the
mother.True or False?
Answer: True. Also if xray examination is indicated during thepregnant patient's
treatment, it should not be withheld because of the pregnancy.
3. What happens as the uterus enlarged and the bowel is pushed cephalad.-
Answer: When the uterus enlarges it pushes the bowel cephalad and the uterus lies
in theupper abdomen. As a result, the bowel is somewhat protected from blunt
abdominaltrauma, whereas the uterus and its contents (fetus and placenta) become
more vulnerable. Uterus remains intrapelvic until 12 weeks and then at 20 weeks it
is at the umbilicus, and at 34-36 weeks it reaches the costal margin.
4. Amniotic fluid can cause amniotic fluid embolism and disseminated
intravascular coagulation following trauma if fluid enters maternal intravascularspace.
True or False
Answer: True
5. By the third trimester, what is the complication of trauma to the pelvis ofthe
mother?
Answer: by the third trimester, the uterus is large and thin walled. In vertex
presentation, fetal head is usually in the pelvis and the remainder of the fetus is
exposed above the pelvic brim. Pelvic fractures in late gestation can result in skull
fracture or intracranial injury to the fetus. Also we can have a placental abruption
due to its little elasticity and vulnerability to sheer forces.
6. An abrupt decrease in maternal intravascular volume can result in a profound
increase in uterine vascular resistance reducing fetal oxygenationdespite reasonably
normal maternal vital signs.
Answer: this is true
7. Physiological anemia of pregnancy
Answer: A smaller increase in red blood cell volume can occur resulting in a
decreased hematocrit level. Thus, in late pregnancya hematocrit of 31-33% is
normal.
8. Healthy pregnancy patients can lose 1200-1500 mL of blood before exhibiting
signs and symptoms of hypovolemia. How can this manifest?
Answer: this amountof hemorrhage may be reflected by fetal distress as evidenced by
,an abnormal fetalheart rate.
9. What are some of the lab changes in pregnancy?
Answer: WBC increases to 12000and during labor can be 25000. Fibrinogen and
other clotting factors are mildly elevated and PT and pTT are shortened, but
bleeding time and clotting time are unchanged.
10. After the 10th week of pregnancy, cardiac output can increase 1.0-1.5 L/min
because of the increase in plasma volume and decrease in vascular resistanceof the
uterus and placenta.
Answer: The placenta receives 20% of the patient's cardiac output during the 3rd
trimester. In supine position, vena cava compression can decrease cardiac output by
30% because of decreased venous return from lower extremities.
11. During pregnancy the heart rate increases to a maximum of 10-15 beats perminute
over baseline by the third trimester.
Answer: this heart rate must be consideredwhen interpreting a tachycardic response
to hypovolemia.
12. Blood pressure falls 5-15 mm Hg in systolic and diastolic pressures duringsecond
trimester, although it returns to near normal levels at term.
Answer: some women experience hypotension when placed in the supine position
due to the compression of teh inferior vena cava.
13. hypertension in the pregnant if accompanied by proteinuria may representwhat?
Answer: pre-eclampsia.
14. EKG findings in pregnant patient
Answer: Flatted or inverted T waves in leads III andAVF and the precordial leads
may be normal. Ectopic beats are increased during pregnancy.
15. Minute ventilation increases primarily due to an increase in tidal volume.
Hypocapnia (30 mm Hg) is common in late pregnancy
Answer: Monitor ventilation in late pregnancy with arterial blood gas values. A
PaCO2 of 35-40 mm Hg may indicate impending respiratory failure during
pregnancy. Pregnant patients shouldbe hypocapneic.
16. Anatomical alterations in the thoracic cavity seem to account for the decreased
residual volume associated with diphragmatic elevation and chestx ray reveals
increased lung marking and prominence of the pulmonary vessels.
Answer: oxygen consumption increases during pregnancy and its important when
resuscitating injured pregnant patients to maintain adequate oxygenation above 95%
, 17. In patients with advanced pregnancy, those that require a chest tube placement,
where should the test tube be placed?
Answer: it should be positioned higherto avoid intra-abdominal placement given the
elevation of the diaphragm.
18. Urinary system: what happens to the GFR, serum creatinine and urea nitrogen
levels?
Answer: GFR and renal blood increases during pregnancy, whereas levelsof the serum
creatinine and urea nitrogen fall to one half of the normal pre pregnancylevels.
Glycosuria is common in pregnancy.
19. When interpreting x ray films of the pelvis in a pregnant patient, the symphysis
pubis widens 4-8 mm and the sacroiliac joint spaces increase bythe 7th month
Answer: keep this in mind
20. Eclampsia
Answer: Maintain a high index of suspicion for eclampsia when seizures are
accompanied by HTN, proteinuria, hyperreflexia, and peripheral edema in pregnant
trauma patients. This can mimic head injury.
21. External contusions and abrasions of the abdominal wall are signs of bluntuterine
trauma.
Answer: true. Fetal injuries can occur when the abdominal wall strikes anobject,
such as the dashboard or steering wheel, or when a pregnant patient is struckby a blunt
instrument.
22. Using a shoulder restraints in conjunction with a lap belt reduces the likelihood
of direct and indirect fetal injury, presumably because the shoulderbelt dissipates
deceleration forces over a great surface area and helps preventthe mother from flexing
forward over the gravid uterus.
Answer: the deployment of air bags in vehicles does not appear to increase
pregnancy specific risks. Using lap belt alone allows for forward flexion and uterine
compression with possible uterinerupture or placental abruption. Lap belt worn too
high over uterus may produce uterine rupture.
23. Penetrating injury to pregnant women
Answer: As uterus grows larger, other visceraare protected from penetrating injury.
Dense uterine musculature in early pregnancycan absorb significant amount of
energy from penetrating objects decreasing their velocity and lowering risk of injury
to other viscera. However, fetal outcome is generally poor with penetrating injury to
uterus.
