Advanced Trauma Life Support (ATLS) 2025
Actual Exam + 2026 Questions and Answers
Scored A+
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:
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:
complete spine x-ray series
Which of the following is true regarding the initial resuscitation of a trauma patient?
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:
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?
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:
increasing the volume of blood loss to produce maternal hypotension
The best assessment of fluid resuscitation of the adult burn patient is:
urinary output of 0.5 mL/kg/hr
The diagnosis of shock must include:
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:
direct pressure on the wound
For the patient with severe traumatic brain injury, profound hypocarbia should be avoided to
prevent:
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:
perform an exploratory laparotomy
Which one of the following statements regarding abdominal trauma in the pregnant patient is
TRUE?
Leakage of amniotic fluid is an indication for hospital admission.
The first maneuver to improve oxygenation after chest injury is:
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:
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:
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?
respiratory rate of 40 breaths per minute
The most important, immediate step in the management of an open pneumothorax is:
,placement of an occlusive dressing over the wound
The following are contraindications for tetanus toxoid administration:
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?
breath sounds
Bronchial intubation of the right or left mainstem bronchus can easily occur during infant
endotracheal intubation because:
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:
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:
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?
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?
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?
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:
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:
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:
call the receiving hospital and speak to the surgeon on call
Hemorrhage of 20% of the patient's blood volume is associated usually with:
tachycardia
Which one of the following statements concerning intraosseous infusion is TRUE?
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:
avoid hypotension
Actual Exam + 2026 Questions and Answers
Scored A+
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:
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:
complete spine x-ray series
Which of the following is true regarding the initial resuscitation of a trauma patient?
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:
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?
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:
increasing the volume of blood loss to produce maternal hypotension
The best assessment of fluid resuscitation of the adult burn patient is:
urinary output of 0.5 mL/kg/hr
The diagnosis of shock must include:
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:
direct pressure on the wound
For the patient with severe traumatic brain injury, profound hypocarbia should be avoided to
prevent:
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:
perform an exploratory laparotomy
Which one of the following statements regarding abdominal trauma in the pregnant patient is
TRUE?
Leakage of amniotic fluid is an indication for hospital admission.
The first maneuver to improve oxygenation after chest injury is:
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:
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:
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?
respiratory rate of 40 breaths per minute
The most important, immediate step in the management of an open pneumothorax is:
,placement of an occlusive dressing over the wound
The following are contraindications for tetanus toxoid administration:
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?
breath sounds
Bronchial intubation of the right or left mainstem bronchus can easily occur during infant
endotracheal intubation because:
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:
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:
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?
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?
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?
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:
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:
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:
call the receiving hospital and speak to the surgeon on call
Hemorrhage of 20% of the patient's blood volume is associated usually with:
tachycardia
Which one of the following statements concerning intraosseous infusion is TRUE?
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:
avoid hypotension
