ATLS Exam Set (Case Studies) – With
Complete Answers 2025 (Graded A+)
A 22 year old male sustains a shotgun wound to the left shoulder and chest at close
range. His BP is 80/40mmHg and his HR is 130bpm. Fluid resusciation is initiated, his
BP increases to 122/84, and HR decreases to 100bpm. He is tachypneic with RR of 28.
On physical examination, his breath sounds are decreased at the left upper chest with
dullness on percussion. A tube thoracostomy is inserted in the fifth intercostal space
with the return of 200ml of blood and no air leak. The most appropriate next step is to:
a. measure blood pressure again
b. begin transfuse O negative blood
c. wait until the chest xray is completed
d. obtain a CT scan of the chest and abdomen
e. repeat the physical exam of the chest - ANSWER - e. repeat the physical exam of the
chest
A 22 yo male is brought to the ED after being assaulted in a bar. On intial exam, his vital
signs are normal and his Glasgow Coma scale is V5E4M6. A definite indication for a
head CT is
a. prescence of hemotympanum
b. complains of headache
c. prescense of 10cm scapl laceration
d. prescence of mandibular fracture
e. history of assault - ANSWER - a. prescence of hemotympanum
a 23 yo construction worker is brought to the ED after falling more than 9 meters from
scaffolding. He is reported to have landed on his feet and then been unable to bear
weight. His vital signs are heart 140, blood pressure 96/60 mmHg, resp rate 36. He is
complaining of lower abdbominal and lower limb pain, and has obvious deformity of
both lower legs with bilateral open tibial fractures. WHich one of the following
statements concerning this patient is true?
a. pelvic injury can be ruled out, based on the MOI
b. blood loss from the lower limbs is the most likely cause of his tachycardia
c. xrays of the patient chest and pevlic are important adjuncts in the inital assessment
d. spinal cord injury is the most likely cause of hypotension
e. aortic injury is likely - ANSWER - c. xrays of the patient chest and pevlic are
important adjuncts in the inital assessment
25 yo female in the third trimester of preganacy is brought to the ED following a high
speed MVA. She is conscious, and her vital signs are RR 16, HR 120, BP 70/50. The
laboratory results show a PaCO2 of 50mmHg/5.3kPa (normal range 35-45). Which one
of the following statments concerning this patient is true?
a. fetal assessment should take priority
, b. logrolling the patient to the right will decompress the vena cava
c. Rh immuno therapy sshould be immediately adminstered
d. normal PaCO2 is concerning for impending RR
e. vasopressors should be given to the patient - ANSWER - d. normal PaCO2 is
concerning for impending RR
a 30 year old male is stabbed in the right chest. on arrival in the ED he is very short of
breath. His heart rate is 120, and blood pressure is 80/50 mmHg. His neck veins are
flat. On auscultation of the chest, there is diminished air entry on the right side and on
percussion there is dullness posteriorly. These findings are most consistent with
a. tension pneumothorax
b. pericardial tamponade
c. hypovolemia from liver injury
d. massive hemothorax
e. spinal cord injury - ANSWER - d. massive hemothorax
which one of the following is true regarding burns?
a. alkali chemica burns should be neutralized with a dilute acid rather than irrigated with
warm water
b. patients who sustain thermal burns are at a lower risk for hypothermia
c. initial treatment of partial thickness thermal burns should include antibiotic cream and
cold compress
d. an electrical burn with only a small external injury associated with a clenched hand
indicates deep ST injury
e. The parkland formula should be used to determine adequacy of resuscitation -
ANSWER - d. an electrical burn with only a small external injury associated with a
clenched hand indicates deep ST injury
A 15 year old is brought to the ED after being involved in a MVA. He was intubated by
emergency medical personnal with subsequent bilateral breath sounds per their report.
Upon arrival to the ED the patients O2 saat is 92%, heart 96, and blood pressure
150/85. Breath sounds are decreased in the left side of the thorax. The next step is
a. immediate needle cricothyroidotomy
b. immediate needle thoracentesis
c. chest tube insertion
d. reassess the position of the endotracheal tube
e. obtain a chest CT - ANSWER - d. reassess the position of the endotracheal tube
Which one of the following statements is true regrading patients with severe traumatic
brain injuries
a. Dextrose is the IV fluid of choice
b. prescence of hypoxia and hypotension significantly increase the risk of mortality
c. Benzodiazepines are the medications of choice for sedation
d. In a unresponsive patient, mannitol should be the first line therapy to treat increased
ICP - ANSWER - b. prescence of hypoxia and hypotension significantly increase the
risk of mortality
Complete Answers 2025 (Graded A+)
A 22 year old male sustains a shotgun wound to the left shoulder and chest at close
range. His BP is 80/40mmHg and his HR is 130bpm. Fluid resusciation is initiated, his
BP increases to 122/84, and HR decreases to 100bpm. He is tachypneic with RR of 28.
On physical examination, his breath sounds are decreased at the left upper chest with
dullness on percussion. A tube thoracostomy is inserted in the fifth intercostal space
with the return of 200ml of blood and no air leak. The most appropriate next step is to:
a. measure blood pressure again
b. begin transfuse O negative blood
c. wait until the chest xray is completed
d. obtain a CT scan of the chest and abdomen
e. repeat the physical exam of the chest - ANSWER - e. repeat the physical exam of the
chest
A 22 yo male is brought to the ED after being assaulted in a bar. On intial exam, his vital
signs are normal and his Glasgow Coma scale is V5E4M6. A definite indication for a
head CT is
a. prescence of hemotympanum
b. complains of headache
c. prescense of 10cm scapl laceration
d. prescence of mandibular fracture
e. history of assault - ANSWER - a. prescence of hemotympanum
a 23 yo construction worker is brought to the ED after falling more than 9 meters from
scaffolding. He is reported to have landed on his feet and then been unable to bear
weight. His vital signs are heart 140, blood pressure 96/60 mmHg, resp rate 36. He is
complaining of lower abdbominal and lower limb pain, and has obvious deformity of
both lower legs with bilateral open tibial fractures. WHich one of the following
statements concerning this patient is true?
a. pelvic injury can be ruled out, based on the MOI
b. blood loss from the lower limbs is the most likely cause of his tachycardia
c. xrays of the patient chest and pevlic are important adjuncts in the inital assessment
d. spinal cord injury is the most likely cause of hypotension
e. aortic injury is likely - ANSWER - c. xrays of the patient chest and pevlic are
important adjuncts in the inital assessment
25 yo female in the third trimester of preganacy is brought to the ED following a high
speed MVA. She is conscious, and her vital signs are RR 16, HR 120, BP 70/50. The
laboratory results show a PaCO2 of 50mmHg/5.3kPa (normal range 35-45). Which one
of the following statments concerning this patient is true?
a. fetal assessment should take priority
, b. logrolling the patient to the right will decompress the vena cava
c. Rh immuno therapy sshould be immediately adminstered
d. normal PaCO2 is concerning for impending RR
e. vasopressors should be given to the patient - ANSWER - d. normal PaCO2 is
concerning for impending RR
a 30 year old male is stabbed in the right chest. on arrival in the ED he is very short of
breath. His heart rate is 120, and blood pressure is 80/50 mmHg. His neck veins are
flat. On auscultation of the chest, there is diminished air entry on the right side and on
percussion there is dullness posteriorly. These findings are most consistent with
a. tension pneumothorax
b. pericardial tamponade
c. hypovolemia from liver injury
d. massive hemothorax
e. spinal cord injury - ANSWER - d. massive hemothorax
which one of the following is true regarding burns?
a. alkali chemica burns should be neutralized with a dilute acid rather than irrigated with
warm water
b. patients who sustain thermal burns are at a lower risk for hypothermia
c. initial treatment of partial thickness thermal burns should include antibiotic cream and
cold compress
d. an electrical burn with only a small external injury associated with a clenched hand
indicates deep ST injury
e. The parkland formula should be used to determine adequacy of resuscitation -
ANSWER - d. an electrical burn with only a small external injury associated with a
clenched hand indicates deep ST injury
A 15 year old is brought to the ED after being involved in a MVA. He was intubated by
emergency medical personnal with subsequent bilateral breath sounds per their report.
Upon arrival to the ED the patients O2 saat is 92%, heart 96, and blood pressure
150/85. Breath sounds are decreased in the left side of the thorax. The next step is
a. immediate needle cricothyroidotomy
b. immediate needle thoracentesis
c. chest tube insertion
d. reassess the position of the endotracheal tube
e. obtain a chest CT - ANSWER - d. reassess the position of the endotracheal tube
Which one of the following statements is true regrading patients with severe traumatic
brain injuries
a. Dextrose is the IV fluid of choice
b. prescence of hypoxia and hypotension significantly increase the risk of mortality
c. Benzodiazepines are the medications of choice for sedation
d. In a unresponsive patient, mannitol should be the first line therapy to treat increased
ICP - ANSWER - b. prescence of hypoxia and hypotension significantly increase the
risk of mortality
