ATLS
A 25 you female in the third trimester of pregnancy 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 statements 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 immunotherapy should be immediately administered
d. normal PaCO2 is concerning for impending RR
e. vasopressors should be given to the patient - ANS-d. normal PaCO2 is concerning for
impending RR
\30 year old male present with a stab wound to the abdomen. BP is 60/34, HR 130, RR 25
and GCS 13 E3V4M6. Neck veins are flat and chest examination is clear with bilateral
breath sounds. Optimal resuscitation should include:
A. Transfusion of FFP and platelets
B. 500ml of hypertonic saline and transfusion of pRBCs
C. Resuscitation with crystalloid and pRBC until base excess is normal
D. Fluid resuscitation and angioembolization
E. Preparation for laparotomy while initiating fluid resuscitation - ANS-E. Preparation for
laparotomy while initiating fluid resuscitation
\A 14 year old female is brought to the ED after falling from a horse. Cervical spinal motion is
restricted wit ha hard collar and cervical blocks and she is immobilized on a long spine
board. Which of the following IS TRUE REGARDING Cervical spine x-ray:
A. More than 20% of these patients will have cervical spine injury
B. Cervical spine injury is excluded if no abnormalities are found on lateral cervical spine
xray
C. Are not needed if she is awake, alert, neurologically normal, and has no neck pain or
midline tenderness
D. Should be performed before adressing potential breating or circulatory problems
E. She should reamin on teh long spine board until imaging excluded injuries - ANS-C. Are
not needed if she is awake, alert, neurologically normal, and has no neck pain or midline
tenderness
\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 - ANS-d. reassess the position of the endotracheal tube
\A 15 year old male present following a motorcycle crash. INitial examinations reveals
normal vital signs. There is a large bruise over his epigastrium that extends to the left flank.
He has no other apparent injuries. A CT-scan of the abdomen demonstrate a ruptured
, spleen surrounded by a large hematoma and fluid in the pelvis. The next step in the patients
management is:
A. Splenic artery embolization
B. Pneumococcal vaccine
C. Urgent laparotomy
D. Surgical consult
E. Transfer to a pediatrician - ANS-D. Surgical consult
\A 22 year old male present following a motorcycle crash. He complains of the inability to
move his legs. His BP is 80/50, HR 70, RR 18 and GCS 15. Oxygen saturation is 99% on 21
nasal prongs. Chest x-ray, pelvic x-ray and FAST are normal. Extremities are normal. His
management should be:
A: 1L of iv . crystalloid and two units of pRBCs
B. 1L of iv. crystalloid, mannitol and iv steroids
C. 1 unit of albumin and compression stockings
D. Vasopressors and laparotomy
E. 1 L of cystalloid and vasopressors if blood pressure does not respond - ANS-E. 1 L of
cystalloid and vasopressors if blood pressure does not respond
\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 - ANS-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 - ANS-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 - ANS-c. xrays of the patient chest and pevlic are important adjuncts
in the inital assessment
A 25 you female in the third trimester of pregnancy 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 statements 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 immunotherapy should be immediately administered
d. normal PaCO2 is concerning for impending RR
e. vasopressors should be given to the patient - ANS-d. normal PaCO2 is concerning for
impending RR
\30 year old male present with a stab wound to the abdomen. BP is 60/34, HR 130, RR 25
and GCS 13 E3V4M6. Neck veins are flat and chest examination is clear with bilateral
breath sounds. Optimal resuscitation should include:
A. Transfusion of FFP and platelets
B. 500ml of hypertonic saline and transfusion of pRBCs
C. Resuscitation with crystalloid and pRBC until base excess is normal
D. Fluid resuscitation and angioembolization
E. Preparation for laparotomy while initiating fluid resuscitation - ANS-E. Preparation for
laparotomy while initiating fluid resuscitation
\A 14 year old female is brought to the ED after falling from a horse. Cervical spinal motion is
restricted wit ha hard collar and cervical blocks and she is immobilized on a long spine
board. Which of the following IS TRUE REGARDING Cervical spine x-ray:
A. More than 20% of these patients will have cervical spine injury
B. Cervical spine injury is excluded if no abnormalities are found on lateral cervical spine
xray
C. Are not needed if she is awake, alert, neurologically normal, and has no neck pain or
midline tenderness
D. Should be performed before adressing potential breating or circulatory problems
E. She should reamin on teh long spine board until imaging excluded injuries - ANS-C. Are
not needed if she is awake, alert, neurologically normal, and has no neck pain or midline
tenderness
\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 - ANS-d. reassess the position of the endotracheal tube
\A 15 year old male present following a motorcycle crash. INitial examinations reveals
normal vital signs. There is a large bruise over his epigastrium that extends to the left flank.
He has no other apparent injuries. A CT-scan of the abdomen demonstrate a ruptured
, spleen surrounded by a large hematoma and fluid in the pelvis. The next step in the patients
management is:
A. Splenic artery embolization
B. Pneumococcal vaccine
C. Urgent laparotomy
D. Surgical consult
E. Transfer to a pediatrician - ANS-D. Surgical consult
\A 22 year old male present following a motorcycle crash. He complains of the inability to
move his legs. His BP is 80/50, HR 70, RR 18 and GCS 15. Oxygen saturation is 99% on 21
nasal prongs. Chest x-ray, pelvic x-ray and FAST are normal. Extremities are normal. His
management should be:
A: 1L of iv . crystalloid and two units of pRBCs
B. 1L of iv. crystalloid, mannitol and iv steroids
C. 1 unit of albumin and compression stockings
D. Vasopressors and laparotomy
E. 1 L of cystalloid and vasopressors if blood pressure does not respond - ANS-E. 1 L of
cystalloid and vasopressors if blood pressure does not respond
\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 - ANS-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 - ANS-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 - ANS-c. xrays of the patient chest and pevlic are important adjuncts
in the inital assessment
