ADVANCED TRAUMA LIFE SUPPORT EXAM AND PRACTICE EXAM NEWEST 2025
ACTUAL EXAM 400 QUESTIONS AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) |ALREADY GRADED A+
How should you position the patient before placing a subclavian or IJ line?
- ....ANSWER....Supine, head down 15 degrees to distend neck neck veins and
prevent embolism, only turn head away is C-spine has been cleared first.
How long can you keep and IO line in -
....ANSWER....Intraosseous infusions should be limited to emergency
resuscitation and should be discontinued as soon as other venous access is
obtained
Where do you want to make an incision for a saphenous vein cutdown and
how long should your incisions be? -
....ANSWER....1 cm superior, 1 cm anterior to medial malleolus. 2.5 cm
transverse incusion through the skin and SQ, careful to not to inure the
vessel.
A patient arrives to the trauma bay intubated and there are absent
breath sounds over the left hemithorax, where should you place your
decompression needle? - ....ANSWER. .........................................................................This
,may NOT be a pneumothorax, for intubated patients always suspect a right
main-stem before attempting needle decompression.
Where would you insert a large caliber needle to decompress a tension
pneumo - ....ANSWER....2nd IC space in the midclavicular line of affected
hemithorax
For an open pneumothorax, (sucking chest wound) air passes
preferentially through the chest wall defect (least resistance) if the
diameter of the defect is at least .................................. the diameter of the
trachea. - ....ANSWER ............................................................. 2/3
Flail chest results from multiple rib fractures - by definition this would be
or more ribs, fractured in or more
places. - ....ANSWER....2 or more ribs fractured in 2 or more places
Both tension pneumothorax and massive hemothorax are associated with
decreased breath sounds on auscultation, so you can tell which it is by . -
....ANSWER....Percussion - hyperresonant with pnuemo, dull with hemothorax.
If a patient doesn't have JVD, does this mean they don't have a tension pneumo
or tamponade? - ....ANSWER....No, they might have a massive internal
hemorrhage and be hypovolemic.
By definition, how much blood is in the chest cavity to call it a "massive
hemothorax"? - ....ANSWER....1500 mL or 1/3 or more of the patient's total
blood volume. (Some also
,define it as continued blood loss of 200 mL/hr for 2-4 hours- but ATLS does NOT
use this rate for any mandatory treatment decisions).
What size chest tube might you use to evacuate a massive hemothorax? -
....ANSWER....#38 French - inserted at the 4th or 5th intercostal space, just
anterior to the midaxillary line.
What is Kussmaul's sign? - ....ANSWER....A rise in venous pressure with
inspiration while breathing spontaneously, and is a true paradoxical
venous pressure abnormality associated with cardiac tamponade.
How well do CPR compressions work on someone with a penetrating chest
injury and hypovolemia? -
....ANSWER...."Closed heart massage for cardiac arrest or PEA is INEFFECTIVE
in patients with hypovolemia." Patients with PENETRATING thoracic injuries
who arrive pulseless, but with myocardial electrial activity, may be
candidates for an ED thoacotomy.
Are patients with PEA who have sustained blunt thoracic injuries
candidates for an ED thoracotomy? -
....ANSWER....NO - Only PEA with PENETRATING
thoracic injuries should get an ED thoracotomy.
An ED thoracotomy can allow you to do what? -
....ANSWER....Evacuate pericardial blood, directly control hemorrhage,
cardiac massage, cross-clamp the descending aorta to slow blood loss
below the diaphragm and increase perfusion to the heart and brain.
, For a patient with a traumatic simple pneumothorax, what should you do
BEFORE you start positive pressure ventilation or take them to surgery
for a GA? -
....ANSWER....Chest tube - positive pressure ventilation can turn a sumple
pneumo into a tension pneumo, so put in a chest tube first.
Should you evacuate a simple hemothorax if it is not causing any
respiratory problems? - ....ANSWER....YES - A simple hemothorax, if not fully
evacuated, may result in a retained, clotted hemothroax with lung
entrapment or, if infected, develop into an empyema.
A pneumothorax associated with a persistent large air leak after tube
thoracostomy suggests a injury. -
....ANSWER....tracheobronchial - Use bronchoscopy to confirm, you may
need more than one chest tube before definitive operative
management.
What radiographic findings are suggestive of traumatic aortic disruption?
- ....ANSWER....Widened mediastinum, obliteration of aortic knob, deviation of
trachea to the right, depression of left mainstem bronchus, deviation of
esophagus (NG tube) to right, widened paratracheal stripe, fx'd 1st/2nd
ribs or scapula.
A deceleration injury victim with a left pnuemothorax or
hemothorax without rib fractures, is in pain or shock out of
proportion to the apparent injury, and has particulate matter
in their chest tube may have . - ....ANSWER. .. an
ESOPHAGEAL RUPTURE - a forceful blow causes
ACTUAL EXAM 400 QUESTIONS AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) |ALREADY GRADED A+
How should you position the patient before placing a subclavian or IJ line?
- ....ANSWER....Supine, head down 15 degrees to distend neck neck veins and
prevent embolism, only turn head away is C-spine has been cleared first.
How long can you keep and IO line in -
....ANSWER....Intraosseous infusions should be limited to emergency
resuscitation and should be discontinued as soon as other venous access is
obtained
Where do you want to make an incision for a saphenous vein cutdown and
how long should your incisions be? -
....ANSWER....1 cm superior, 1 cm anterior to medial malleolus. 2.5 cm
transverse incusion through the skin and SQ, careful to not to inure the
vessel.
A patient arrives to the trauma bay intubated and there are absent
breath sounds over the left hemithorax, where should you place your
decompression needle? - ....ANSWER. .........................................................................This
,may NOT be a pneumothorax, for intubated patients always suspect a right
main-stem before attempting needle decompression.
Where would you insert a large caliber needle to decompress a tension
pneumo - ....ANSWER....2nd IC space in the midclavicular line of affected
hemithorax
For an open pneumothorax, (sucking chest wound) air passes
preferentially through the chest wall defect (least resistance) if the
diameter of the defect is at least .................................. the diameter of the
trachea. - ....ANSWER ............................................................. 2/3
Flail chest results from multiple rib fractures - by definition this would be
or more ribs, fractured in or more
places. - ....ANSWER....2 or more ribs fractured in 2 or more places
Both tension pneumothorax and massive hemothorax are associated with
decreased breath sounds on auscultation, so you can tell which it is by . -
....ANSWER....Percussion - hyperresonant with pnuemo, dull with hemothorax.
If a patient doesn't have JVD, does this mean they don't have a tension pneumo
or tamponade? - ....ANSWER....No, they might have a massive internal
hemorrhage and be hypovolemic.
By definition, how much blood is in the chest cavity to call it a "massive
hemothorax"? - ....ANSWER....1500 mL or 1/3 or more of the patient's total
blood volume. (Some also
,define it as continued blood loss of 200 mL/hr for 2-4 hours- but ATLS does NOT
use this rate for any mandatory treatment decisions).
What size chest tube might you use to evacuate a massive hemothorax? -
....ANSWER....#38 French - inserted at the 4th or 5th intercostal space, just
anterior to the midaxillary line.
What is Kussmaul's sign? - ....ANSWER....A rise in venous pressure with
inspiration while breathing spontaneously, and is a true paradoxical
venous pressure abnormality associated with cardiac tamponade.
How well do CPR compressions work on someone with a penetrating chest
injury and hypovolemia? -
....ANSWER...."Closed heart massage for cardiac arrest or PEA is INEFFECTIVE
in patients with hypovolemia." Patients with PENETRATING thoracic injuries
who arrive pulseless, but with myocardial electrial activity, may be
candidates for an ED thoacotomy.
Are patients with PEA who have sustained blunt thoracic injuries
candidates for an ED thoracotomy? -
....ANSWER....NO - Only PEA with PENETRATING
thoracic injuries should get an ED thoracotomy.
An ED thoracotomy can allow you to do what? -
....ANSWER....Evacuate pericardial blood, directly control hemorrhage,
cardiac massage, cross-clamp the descending aorta to slow blood loss
below the diaphragm and increase perfusion to the heart and brain.
, For a patient with a traumatic simple pneumothorax, what should you do
BEFORE you start positive pressure ventilation or take them to surgery
for a GA? -
....ANSWER....Chest tube - positive pressure ventilation can turn a sumple
pneumo into a tension pneumo, so put in a chest tube first.
Should you evacuate a simple hemothorax if it is not causing any
respiratory problems? - ....ANSWER....YES - A simple hemothorax, if not fully
evacuated, may result in a retained, clotted hemothroax with lung
entrapment or, if infected, develop into an empyema.
A pneumothorax associated with a persistent large air leak after tube
thoracostomy suggests a injury. -
....ANSWER....tracheobronchial - Use bronchoscopy to confirm, you may
need more than one chest tube before definitive operative
management.
What radiographic findings are suggestive of traumatic aortic disruption?
- ....ANSWER....Widened mediastinum, obliteration of aortic knob, deviation of
trachea to the right, depression of left mainstem bronchus, deviation of
esophagus (NG tube) to right, widened paratracheal stripe, fx'd 1st/2nd
ribs or scapula.
A deceleration injury victim with a left pnuemothorax or
hemothorax without rib fractures, is in pain or shock out of
proportion to the apparent injury, and has particulate matter
in their chest tube may have . - ....ANSWER. .. an
ESOPHAGEAL RUPTURE - a forceful blow causes
