ATLS Test 2025 QUESTIONS AND ANSWERS

1. Patients with a GSC of less than usually require intubation. - 8 2. The "A" in ABCD stands for . - Airway maintenance with CERVICAL SPINE PROTECTION 3. You should assume that any patient in a multisystem trauma with an altered level of consciousness or blunt injury above the clavicle has what type of injury? - Cervical spine injury 4. Flail chest is invariably accompanied by which can interfere with blood oxygenation. - pulmonary contusion - do NOT over fluid resuscitate these patients! 5. Hypotension is caused by until proven otherwise. - hypovolemia 6. When you don't have/can't get a blood pressure, what are three things to look for when evaluating perfusion. - 1. Level of consciousness (brain perfusion), 2. Skin color (ashen face/grey extremities) 3. Pulse (bilateral femoral - thready/tachy) 7. Elderly patients have a limited ability to to compensate for blood loss. - increase heart rate 8. Resuscitation fluids should be warmed 39 degrees Celsius (102.2 F). Can you use a microwave to do this? - YES - for CRYSTALLOID ONLY (but NOT for blood products). 9. Urinary catheters are good for assessing renal perfusion and volume status. List 5 signs of urethral injury that might prevent you from inserting one. - Blood at urethral meatus, perineal ecchymosis, blood in scrotum, high- riding/non-palpable prostate, pelvic fracture 10. Which arm should you NOT put a pulse-ox on? - The arm with a blood pressure cuff on it 11. Name two anatomical things that can interfere with doing a FAST scan. - Obesity & intraluminal bowel gas 12. When should radiographs be obtained? - During the SECONDARY survey. 13. How do you get an ample patient history? - A=Allergies, M=Medications, P=PMH/Pregnancy, L=Last meal, E=Events/Environment of injury 14. Why might you want a Bair Hugger for a patient who smells of alcohol? - Vasodilation can lead to hypothermia 15. What things are you looking for when you do a DRE in a trauma? - Blood, high-riding prostate (in males), and sphincter tone 16. What should you do for every female patient? - Pregnancy test (females of childbearing age) 17. Adult patients should maintain UOP of at least mL/kg/hr. Kids should have at least mL/kg/hr. - Adults 0.5 mL/kg/hr, Kids 1.0 ml/kg/hr 18. Preventing hypercarbia is critical in patients who have sustained a injury. - head 19. What two places would you LOOK at a patient if you suspect hypoxemia? - Lips and fingernail beds 20. Patients may be abusive and belligerent because of , so don't just assume it's due to drugs, alcohol, or the fact that they are just inherently a jerk. - hypoxia 21. Can a patient breathe on their own after complete cervical cord transection? ] - Yes, if the phrenic nerves (C3-C5) are spared. This will result in "abdominal" breathing. The intercostal muscles will be paralyzed though. 22. Can you use an OPA (Guedel) in a conscious patient? - No, it could make them vomit. An NPA (trumpet) would be okay. 23. Bougies are typically inserted blindly, how do you know you are in the trachea and not the esophagus? - You can feel the "clicks" as the distal tip rubs against the cartilaginous tracheal rings, or it will deviate right or left when entering either bronchus (usually at 50 cm). 24. What do you NOT want to hear if you ascultate a patient after placement of an ET tube? - Borborygmi - rumbling or gurgling noises suggesting esophageal insertion. 25. What is the RSI dose for etomidate? - 0.3 mg/kg (usually 20 mg) 26. What is the RSI dose for sux? - 1-2 mg/kg (usually 100 mg) 27. How does etomidate affect blood pressure? - It doesn't - at least it SHOULDN'T have any significant effect on BP. Ketamine will increase BP, and propofol and thiopental will both drop BP. 28. A RSI dose of sux usually lasts about minutes. - 5 29. What hypnotic/sedative/induction agent do you NOT want to use for a severely burned patient? - SUX - patients with severe burns, crush injuries, hyperkalemia, or chronic paralytic/neuromuscular diseases should NOT get sux because of hyperkalemia risk. 30. Oxygen should flow at 15L for needle cricothyroidotomy, and have a Y-connector for insufflation if possible. What size needle do you use for adults? Kids? - Adults 12-14 gauge, kids 16-18 gauge 31. Cricoid cartilage is the only circumferential support for the upper trachea in kids, therefore surgical cricothyroidotomy is not recommended in kids under the age of . - 12 32. In a "normal" patient without significant chest wall injury or lung disease, needle cricothyroidotomy can provide adequate oxygenation for approximately minutes. - 30-45 33. For a patient with difficulty breathing, what things might you try before you provide a surgical airway? - Chin-lift, jaw-thrust (NOT head-tilt while maintaining c-spine precautions), OPA (guedel), NPA (trumpet), LMA, Combitube, ET tube +/- bougie 34. How do you know if an OPA/Guedel is the correct size for the patient? - A correctly sized OPA will extend from the corner of the patient's mouth to the external auditory canal. 35. What should do with the balloon on an ET tube/LMA/foley before you insert it? - Inflate it to make sure it doesn't leak - then deflate and insert. 36. What size LMA do you use for kid, woman/small man, large woman/man? - Kid: 3, Woman/small man: 4, Large woman/man: 5 (C3,4,5 keep the diaphragm alive) 37. The proper size ET tube for an infant is . - The same size as the infant's nostril or little finger. (Usually size 3 for neonates, 3.5 for infants) 38. What size cuffed endotracheal tube do you use for an emergency cricothyroidotomy? - 5 or 6 39. Use size 3 ET tubes for neonates, 3.5 for infants 0-6 months, and size 4 for infants 6-12 months. How do you calculate what size ET tube to use for toddlers and kids? - Age/4 + 4 mm = internal diameter 40. Shock is defined as an abnormality of the circulatory system that results in inadequate organ perfusion and tissue oxygenation. What are the 4 different types? - Neurogenic, cardiogenic, hypovolemic, septic 41. The most common cause of shock in the injured trauma patient is . - hemorrhage 42. Approximately % of the body's total blood volume is located in the venous circuit. - 70 43. Why does shock actually reduce the total volume of circulating blood? - Anaerobic metabolism -- can't make more ATP -- Endoplasmic then mitochondrial damage -- lysosomes rupture -- sodium and WATER enter the cell, which SWELLS and dies. 44. Which vasopressors should you use to treat hemorrhagic shock? What are the drug doses? - NEVER use pressors for hypovolemic shock - use VOLUME replacement. Pressors will worsen tissue perfusion in hemorrhagic shock. 45. Compensatory mechanisms may preclude a measurable fall in systolic blood pressure until up to % of the patient's blood volume is lost. - 30 46. Any patient who is cool and is tachycardic is considered to be until proven otherwise. - in shock 47. The definition of tachycardia depends on the patient's age. What heart rate is considered tachycardic for infants, toddlers/preschoolers, school age/prebuscent, and adults? - Infants 160, toddlers/preschoolers 140, school age/prebuscent 120, adults 100 48. Elderly patients may not exhibit tachycardia in response to hypovolemia because of limited cardiac response to catecholamines. Why else might not they get tachy? - They might be on a beta-blocker or have a pacemaker. 49. A FAST scan is an excellent way to diagnose cardiac tamponade. What signs suggest tamponade? - Becks's Triad: JVD, muffled heart sounds, and hypotension (will be resistant to fluid therapy). Will also likely be tachycardic. 50. Patients with a tension pneumo and patients with cardiac tamponade may present with many of the same signs. What findings will you see with a tension pneumo that you will NOT see with tamponade? - Absent breath sounds and hyperresonance to percussion over the affected hemithorax.