ATLS Test 1 New update with complete SOLUTIONS
2025
A 22-year-old man is hypotensive and tachycardic after a shotgun wound to the left shoulder. His
blood pressure is initially 80/40 mm Hg. After initial fluid resuscitation his blood pressure increases to
122/84 mm Hg. His heart rate is now 100 beats per minute and his respiratory rate is 28 breaths per
minute. A tube thoracostomy is performed for decreased left chest breath sounds with the return of a
small amount of blood and no air leak. After chest tube insertion, the most appropriate next step is: -
ANSWER-re-examine the chest
A construction worker falls two stories from a building and sustains bilateral calcaneal fractures. In
the emergency department, he is alert, vital signs are normal, and he is complaining of severe pain in
both heels and his lower back. Lower extremity pulses are strong and there is no other deformity. The
suspected diagnosis is most likely to be confirmed by: - ANSWER-complete spine x-ray series
Which of the following is true regarding the initial resuscitation of a trauma patient? - ANSWER-
Evidence of improved perfusion after fluid resuscitation could include improvement in Glasgow Coma
Scale score on reevaluation.
In managing a patient with a severe traumatic brain injury, the most important initial step is to: -
ANSWER-secure the airway
A previously healthy, 70-kg (154-pound) man suffers an estimated acute blood loss of 2 liters. Which
one of the following statements applies to this patient? - ANSWER-An ABG would demonstrate a base
deficit between -6 and -10 mEq/L.
The physiological hypervolemia of pregnancy has clinical significance in the management of the
severely injured, gravid woman by: - ANSWER-increasing the volume of blood loss to produce
maternal hypotension
The best assessment of fluid resuscitation of the adult burn patient is: - ANSWER-urinary output of 0.5
mL/kg/hr
The diagnosis of shock must include: - ANSWER-evidence of inadequate organ perfusion
A 7-year-old boy is brought to the emergency department by his parents several minutes after he fell
through a window. He is bleeding profusely from a 6-cm wound of his medial right thigh. Immediate
management of the wound should consist of: - ANSWER-direct pressure on the wound
For the patient with severe traumatic brain injury, profound hypocarbia should be avoided to prevent:
- ANSWER-cerebral vasoconstriction with diminished perfusion
After being involved in a motor vehicle crash, a 25-year-old man is brought to a hospital that has
surgery capabilities available.. Computed tomography of the chest and abdomen shows an aortic
injury and splenic laceration with free abdominal fluid. His blood pressure falls to 70 mm Hg after CT.
The next step is: - ANSWER-perform an exploratory laparotomy
Which one of the following statements regarding abdominal trauma in the pregnant patient is TRUE?
- ANSWER-Leakage of amniotic fluid is an indication for hospital admission.
The first maneuver to improve oxygenation after chest injury is: - ANSWER-administer supplemental
oxygen
,A 25-year-old man, injured in a motor vehicular crash, is admitted to the emergency department. His
pupils react sluggishly and his eyes open to pressure. He does not follow commands, but he does
moan periodically. His right arm is deformed and does not respond to pressure; however, his left
hand reaches purposefully toward the stimulus. Both legs are stiffly extended. His GCS score is: -
ANSWER-9
A 20-year-old woman who is at 32 weeks gestation, is stabbed in the upper right chest. In the
emergency department, her blood pressure is 80/60 mm Hg. She is gasping for breath, extremely
anxious, and yelling for help. Breath sounds are diminished in the right chest. The most appropriate
first step is to: - ANSWER-perform needle or finger decompression of the right chest
Which one of the following findings in an adult is most likely to require immediate management
during the primary survey? - ANSWER-respiratory rate of 40 breaths per minute
The most important, immediate step in the management of an open pneumothorax is: - ANSWER-
placement of an occlusive dressing over the wound
The following are contraindications for tetanus toxoid administration: - ANSWER-history of
neurological reaction or severe hypersensitivity to the product
A 56-year-old man is thrown violently against the steering wheel of his truck during a motor vehicle
crash. On arrival in the emergency department he is diaphoretic and complaining of chest pain. His
blood pressure is 60/40 mm Hg and his respiratory rate is 40 breaths per minute. Which of the
following best differentiates cardiac tamponade from tension pneumothorax as the cause of his
hypotension? - ANSWER-breath sounds
Bronchial intubation of the right or left mainstem bronchus can easily occur during infant
endotracheal intubation because: - ANSWER-The trachea is relatively short.
A 23-year-old man sustains 4 stab wounds to the upper right chest during an altercation and is
brought by ambulance to a hospital that has full surgical capabilities. His wounds are all above the
nipple. He is endotracheally intubated, closed tube thoracostomy is performed, fluid resuscitation is
initiated through 2 large-caliber IVs. FAST exam does not reveal intraabdominal injuries. His blood
pressure now is 60/0 mm Hg, heart rate is 160 beats per minute, and respiratory rate is 14 breaths
per minute (ventilated with 100% O2). 1500 mL of blood has drained from the right chest. The most
appropriate next step in managing this patient is to: - ANSWER-urgently transfer the patient to the
operating room
A 39-year-old man is admitted to the emergency department after an automobile collision. He is
cyanotic, has insufficient respiratory effort, and has a GCS score of 6. His full beard makes it difficult
to fit the oxygen facemask to his face. The most appropriate next step is to: - ANSWER-restrict cervical
motion and attempt orotracheal intubation using 2 people
A patient is brought to the emergency department after a motor vehicle crash. He is conscious and
there is no obvious external trauma. He arrives at the hospital completely immobilized on a long spine
board. His blood pressure is 60/40 mm Hg and his heart rate is 70 beats per minute. His skin is warm.
Which one of the following statements is TRUE? - ANSWER-Flaccidity of the lower extremities and loss
of deep tendon reflexes are expected.
Which one of the following is the most effective method for initially treating frostbite? - ANSWER-
moist heat
A 32-year-old man's right leg is trapped beneath his overturned car for nearly 2 hours before he is
extricated. On arrival in the emergency department, his right lower extremity is cool, mottled,
insensate, and motionless. Despite normal vital signs, pulses cannot be palpated below the right
femoral artery and the muscles of the lower extremity are firm and hard. During the management of
, this patient, which of the following is most likely to improve the chances for limb salvage? - ANSWER-
surgical consultation for right lower extremity fasciotomy
A patient arrives in the emergency department after being beaten about the head and face with a
wooden club. He is comatose and has a palpable depressed skull fracture. His face is swollen and
ecchymotic. He has gurgling respirations and vomitus on his face and clothing. The most appropriate
step after providing supplemental oxygen and elevating his jaw is to: - ANSWER-suction the
oropharynx
A 22-year-old man sustains a gunshot wound to the left chest and is transported to a small
community hospital no surgical capabilities are available. In the emergency department, a chest tube
is inserted and 700 mL of blood is evacuated. The trauma center accepts the patient in transfer. Just
before the patient is placed in the ambulance for transfer, his blood pressure decreases to 80/68 mm
Hg and his heart rate increases to 136 beats per minute. The next step should be to: - ANSWER-repeat
the primary survey and proceed with transfer
A 64-year-old man involved in a high-speed car crash, is resuscitated initially in a small hospital
without surgical capabilities. He has a closed head injury with a GCS score of 13. He has a widened
mediastinum on chest x-ray with fractures of left ribs 2 through 4, but no pneumothorax. After
initiating fluid resuscitation, his blood pressure is 110/74 mm Hg, heart rate is 100 beats per minute,
and respiratory rate is 18 breaths per minute. He has gross hematuria and a pelvic fracture. You
decide to transfer this patient to a facility capable of providing a higher level of care. The facility is 128
km (80 miles) away. Before transfer, you should first: - ANSWER-call the receiving hospital and speak
to the surgeon on call
Hemorrhage of 20% of the patient's blood volume is associated usually with: - ANSWER-tachycardia
Which one of the following statements concerning intraosseous infusion is TRUE? - ANSWER-
Aspiration of bone marrow confirms appropriate positioning of the needle.
A young woman sustains a severe head injury as the result of a motor vehicle crash. In the emergency
department, her GCS is 6. Her blood pressure is 140/90 mm Hg and her heart rate is 80 beats per
minute. She is intubated and mechanically ventilated. Her pupils are 3 mm in size and equally reactive
to light. There is no other apparent injury. The most important principle to follow in the early
management of her head injury is to: - ANSWER-avoid hypotension
A 33-year-old woman is involved in a head-on motor vehicle crash. It took 30 minutes to extricate her
from the car. Upon arrival in the emergency department, her heart rate is 120 beats per minute, BP is
90/70 mm Hg, respiratory rate is 16 breaths per minute, and her GCS score is 15. Examination reveals
bilaterally equal breath sounds, anterior chest wall ecchymosis, and distended neck veins. Her
abdomen is flat, soft, and not tender. Her pelvis is stable. Palpable distal pulses are found in all 4
extremities. Of the following, the most likely diagnosis is: - ANSWER-cardiac tamponade
A hemodynamically normal 10-year-old girl is hospitalized for observation after a Grade III
(moderately severe) splenic injury has been confirmed by computed tomography (CT). Which of the
following mandates prompt celiotomy (laparotomy)? - ANSWER-development of peritonitis on
physical exam
A 40-year-old woman who was a restrained driver in a motor vehicle crash is evaluated in the
emergency department. She is hemodynamically normal and found to be paraplegic at the level of
T10. Which of the following are true regarding her evaluation and management? - ANSWER-Log
rolling using 4 people is a safe approach to restrict spinal motion when moving her.
A trauma patient presents to your emergency department with inspiratory stridor and a suspected c-
spine injury. Oxygen saturation is 88% on high-flow oxygen via a nonrebreathing mask. The most
appropriate next step is to: - ANSWER-restrict cervical motion and establish a definitive airway
2025
A 22-year-old man is hypotensive and tachycardic after a shotgun wound to the left shoulder. His
blood pressure is initially 80/40 mm Hg. After initial fluid resuscitation his blood pressure increases to
122/84 mm Hg. His heart rate is now 100 beats per minute and his respiratory rate is 28 breaths per
minute. A tube thoracostomy is performed for decreased left chest breath sounds with the return of a
small amount of blood and no air leak. After chest tube insertion, the most appropriate next step is: -
ANSWER-re-examine the chest
A construction worker falls two stories from a building and sustains bilateral calcaneal fractures. In
the emergency department, he is alert, vital signs are normal, and he is complaining of severe pain in
both heels and his lower back. Lower extremity pulses are strong and there is no other deformity. The
suspected diagnosis is most likely to be confirmed by: - ANSWER-complete spine x-ray series
Which of the following is true regarding the initial resuscitation of a trauma patient? - ANSWER-
Evidence of improved perfusion after fluid resuscitation could include improvement in Glasgow Coma
Scale score on reevaluation.
In managing a patient with a severe traumatic brain injury, the most important initial step is to: -
ANSWER-secure the airway
A previously healthy, 70-kg (154-pound) man suffers an estimated acute blood loss of 2 liters. Which
one of the following statements applies to this patient? - ANSWER-An ABG would demonstrate a base
deficit between -6 and -10 mEq/L.
The physiological hypervolemia of pregnancy has clinical significance in the management of the
severely injured, gravid woman by: - ANSWER-increasing the volume of blood loss to produce
maternal hypotension
The best assessment of fluid resuscitation of the adult burn patient is: - ANSWER-urinary output of 0.5
mL/kg/hr
The diagnosis of shock must include: - ANSWER-evidence of inadequate organ perfusion
A 7-year-old boy is brought to the emergency department by his parents several minutes after he fell
through a window. He is bleeding profusely from a 6-cm wound of his medial right thigh. Immediate
management of the wound should consist of: - ANSWER-direct pressure on the wound
For the patient with severe traumatic brain injury, profound hypocarbia should be avoided to prevent:
- ANSWER-cerebral vasoconstriction with diminished perfusion
After being involved in a motor vehicle crash, a 25-year-old man is brought to a hospital that has
surgery capabilities available.. Computed tomography of the chest and abdomen shows an aortic
injury and splenic laceration with free abdominal fluid. His blood pressure falls to 70 mm Hg after CT.
The next step is: - ANSWER-perform an exploratory laparotomy
Which one of the following statements regarding abdominal trauma in the pregnant patient is TRUE?
- ANSWER-Leakage of amniotic fluid is an indication for hospital admission.
The first maneuver to improve oxygenation after chest injury is: - ANSWER-administer supplemental
oxygen
,A 25-year-old man, injured in a motor vehicular crash, is admitted to the emergency department. His
pupils react sluggishly and his eyes open to pressure. He does not follow commands, but he does
moan periodically. His right arm is deformed and does not respond to pressure; however, his left
hand reaches purposefully toward the stimulus. Both legs are stiffly extended. His GCS score is: -
ANSWER-9
A 20-year-old woman who is at 32 weeks gestation, is stabbed in the upper right chest. In the
emergency department, her blood pressure is 80/60 mm Hg. She is gasping for breath, extremely
anxious, and yelling for help. Breath sounds are diminished in the right chest. The most appropriate
first step is to: - ANSWER-perform needle or finger decompression of the right chest
Which one of the following findings in an adult is most likely to require immediate management
during the primary survey? - ANSWER-respiratory rate of 40 breaths per minute
The most important, immediate step in the management of an open pneumothorax is: - ANSWER-
placement of an occlusive dressing over the wound
The following are contraindications for tetanus toxoid administration: - ANSWER-history of
neurological reaction or severe hypersensitivity to the product
A 56-year-old man is thrown violently against the steering wheel of his truck during a motor vehicle
crash. On arrival in the emergency department he is diaphoretic and complaining of chest pain. His
blood pressure is 60/40 mm Hg and his respiratory rate is 40 breaths per minute. Which of the
following best differentiates cardiac tamponade from tension pneumothorax as the cause of his
hypotension? - ANSWER-breath sounds
Bronchial intubation of the right or left mainstem bronchus can easily occur during infant
endotracheal intubation because: - ANSWER-The trachea is relatively short.
A 23-year-old man sustains 4 stab wounds to the upper right chest during an altercation and is
brought by ambulance to a hospital that has full surgical capabilities. His wounds are all above the
nipple. He is endotracheally intubated, closed tube thoracostomy is performed, fluid resuscitation is
initiated through 2 large-caliber IVs. FAST exam does not reveal intraabdominal injuries. His blood
pressure now is 60/0 mm Hg, heart rate is 160 beats per minute, and respiratory rate is 14 breaths
per minute (ventilated with 100% O2). 1500 mL of blood has drained from the right chest. The most
appropriate next step in managing this patient is to: - ANSWER-urgently transfer the patient to the
operating room
A 39-year-old man is admitted to the emergency department after an automobile collision. He is
cyanotic, has insufficient respiratory effort, and has a GCS score of 6. His full beard makes it difficult
to fit the oxygen facemask to his face. The most appropriate next step is to: - ANSWER-restrict cervical
motion and attempt orotracheal intubation using 2 people
A patient is brought to the emergency department after a motor vehicle crash. He is conscious and
there is no obvious external trauma. He arrives at the hospital completely immobilized on a long spine
board. His blood pressure is 60/40 mm Hg and his heart rate is 70 beats per minute. His skin is warm.
Which one of the following statements is TRUE? - ANSWER-Flaccidity of the lower extremities and loss
of deep tendon reflexes are expected.
Which one of the following is the most effective method for initially treating frostbite? - ANSWER-
moist heat
A 32-year-old man's right leg is trapped beneath his overturned car for nearly 2 hours before he is
extricated. On arrival in the emergency department, his right lower extremity is cool, mottled,
insensate, and motionless. Despite normal vital signs, pulses cannot be palpated below the right
femoral artery and the muscles of the lower extremity are firm and hard. During the management of
, this patient, which of the following is most likely to improve the chances for limb salvage? - ANSWER-
surgical consultation for right lower extremity fasciotomy
A patient arrives in the emergency department after being beaten about the head and face with a
wooden club. He is comatose and has a palpable depressed skull fracture. His face is swollen and
ecchymotic. He has gurgling respirations and vomitus on his face and clothing. The most appropriate
step after providing supplemental oxygen and elevating his jaw is to: - ANSWER-suction the
oropharynx
A 22-year-old man sustains a gunshot wound to the left chest and is transported to a small
community hospital no surgical capabilities are available. In the emergency department, a chest tube
is inserted and 700 mL of blood is evacuated. The trauma center accepts the patient in transfer. Just
before the patient is placed in the ambulance for transfer, his blood pressure decreases to 80/68 mm
Hg and his heart rate increases to 136 beats per minute. The next step should be to: - ANSWER-repeat
the primary survey and proceed with transfer
A 64-year-old man involved in a high-speed car crash, is resuscitated initially in a small hospital
without surgical capabilities. He has a closed head injury with a GCS score of 13. He has a widened
mediastinum on chest x-ray with fractures of left ribs 2 through 4, but no pneumothorax. After
initiating fluid resuscitation, his blood pressure is 110/74 mm Hg, heart rate is 100 beats per minute,
and respiratory rate is 18 breaths per minute. He has gross hematuria and a pelvic fracture. You
decide to transfer this patient to a facility capable of providing a higher level of care. The facility is 128
km (80 miles) away. Before transfer, you should first: - ANSWER-call the receiving hospital and speak
to the surgeon on call
Hemorrhage of 20% of the patient's blood volume is associated usually with: - ANSWER-tachycardia
Which one of the following statements concerning intraosseous infusion is TRUE? - ANSWER-
Aspiration of bone marrow confirms appropriate positioning of the needle.
A young woman sustains a severe head injury as the result of a motor vehicle crash. In the emergency
department, her GCS is 6. Her blood pressure is 140/90 mm Hg and her heart rate is 80 beats per
minute. She is intubated and mechanically ventilated. Her pupils are 3 mm in size and equally reactive
to light. There is no other apparent injury. The most important principle to follow in the early
management of her head injury is to: - ANSWER-avoid hypotension
A 33-year-old woman is involved in a head-on motor vehicle crash. It took 30 minutes to extricate her
from the car. Upon arrival in the emergency department, her heart rate is 120 beats per minute, BP is
90/70 mm Hg, respiratory rate is 16 breaths per minute, and her GCS score is 15. Examination reveals
bilaterally equal breath sounds, anterior chest wall ecchymosis, and distended neck veins. Her
abdomen is flat, soft, and not tender. Her pelvis is stable. Palpable distal pulses are found in all 4
extremities. Of the following, the most likely diagnosis is: - ANSWER-cardiac tamponade
A hemodynamically normal 10-year-old girl is hospitalized for observation after a Grade III
(moderately severe) splenic injury has been confirmed by computed tomography (CT). Which of the
following mandates prompt celiotomy (laparotomy)? - ANSWER-development of peritonitis on
physical exam
A 40-year-old woman who was a restrained driver in a motor vehicle crash is evaluated in the
emergency department. She is hemodynamically normal and found to be paraplegic at the level of
T10. Which of the following are true regarding her evaluation and management? - ANSWER-Log
rolling using 4 people is a safe approach to restrict spinal motion when moving her.
A trauma patient presents to your emergency department with inspiratory stridor and a suspected c-
spine injury. Oxygen saturation is 88% on high-flow oxygen via a nonrebreathing mask. The most
appropriate next step is to: - ANSWER-restrict cervical motion and establish a definitive airway
