ATLS 10TH EDITION COMPREHENSIVE PRACTICE EXAM
QUESTIONS WITH ANSWERS AND EXPLANATIONS
1. During a structured trauma reassessment, the team reviews the following information. The patient has
penetrating precordial trauma causes shock with distended neck veins and pericardial fluid on focused
ultrasound. Which diagnosis-or-priority and management pairing best fits this situation?
A. Adult burn urine-output target - adjust the fluid rate to maintain urine output around 0.5 mL/kg/hr while
following the overall clinical response
B. Spinal shock - support ABCs and perform serial neurologic examinations while spinal shock evolves
C. Unstable patient with positive FAST - continue resuscitation and proceed urgently to operative hemorrhage
control
D. Cardiac tamponade - expedite definitive operative relief of tamponade, using pericardial decompression only
as a temporizing step when necessary
Correct Answer: D. Cardiac tamponade - expedite definitive operative relief of tamponade, using pericardial
decompression only as a temporizing step when necessary
Explanation: The findings are most consistent with cardiac tamponade, and the appropriate ATLS response is to
expedite definitive operative relief of tamponade, using pericardial decompression only as a temporizing step
when necessary. tamponade is a mechanical obstruction to cardiac filling and definitive treatment is surgical.
2. The team is considering the following management step: manage nonoperatively in an appropriately
monitored setting when no other indication for laparotomy exists. Which clinical presentation most
strongly supports using that step?
A. a child younger than 14 years has a large flame burn and weighs less than 30 kg
B. a stable adult has a CT-confirmed splenic laceration without ongoing shock or peritonitis
C. a trauma patient requiring spinal motion restriction has not yet had the back inspected
D. significant anterior blunt chest trauma raises concern for myocardial injury
Correct Answer: B. a stable adult has a CT-confirmed splenic laceration without ongoing shock or peritonitis
Explanation: The matching presentation is a stable adult has a CT-confirmed splenic laceration without ongoing
shock or peritonitis. In that setting, the recommended priority is to manage nonoperatively in an appropriately
monitored setting when no other indication for laparotomy exists. many stable solid-organ injuries can be treated
nonoperatively with close observation and access to rescue intervention.
3. The patient initially has a hemodynamically stable trauma patient has persistent altered mental status
after head injury. After the team acts by obtain noncontrast CT of the head while continuing serial
neurologic assessment, which finding best demonstrates that the immediate treatment objective has been
achieved?
A. oxygenation is restored through the surgical airway
B. intracranial hemorrhage, mass effect, and skull injury are rapidly identified
C. urethral disruption is defined without converting a partial injury into a worse one
D. definitive-care resources are mobilized without avoidable delay
Correct Answer: B. intracranial hemorrhage, mass effect, and skull injury are rapidly identified
Explanation: The strongest immediate evidence of success is that intracranial hemorrhage, mass effect, and skull
injury are rapidly identified. This reflects correction of the targeted life threat or physiologic problem.
4. The team is considering the following management step: apply an occlusive or vented dressing and place
a chest tube at a separate site, with definitive wound closure. Which clinical presentation most strongly
supports using that step?
A. significant anterior blunt chest trauma raises concern for myocardial injury
B. penetrating chest trauma is followed by hypotension, jugular venous distention, and an eFAST showing
pericardial fluid
C. a head-injured patient has a Glasgow Coma Scale score of 7 and cannot reliably protect the airway
D. a large sucking chest wound produces obvious air movement through the defect with respiratory distress
Correct Answer: D. a large sucking chest wound produces obvious air movement through the defect with
respiratory distress
Explanation: The matching presentation is a large sucking chest wound produces obvious air movement through
the defect with respiratory distress. In that setting, the recommended priority is to apply an occlusive or vented
dressing and place a chest tube at a separate site, with definitive wound closure. a large open chest defect prevents
effective ventilation unless the wound is sealed and the pleural space drained.
,5. A trauma team is reviewing the next decision for a newly injured patient. The patient has a head-injured
patient develops hypertension, bradycardia, and irregular respirations. Which management step should be
integrated into the trauma team's immediate plan?
A. use aggressive suction, manual airway maneuvers with cervical motion restriction, and secure a definitive
airway when needed
B. treat this as a late warning of critically raised intracranial pressure and impending herniation
C. use age-appropriate neutral positioning, often with padding under the torso, while maintaining spinal motion
restriction
D. fully expose the patient for examination while actively preventing heat loss with warm blankets, warmed
fluids, and a warm environment
Correct Answer: B. treat this as a late warning of critically raised intracranial pressure and impending herniation
Explanation: The priority is to treat this as a late warning of critically raised intracranial pressure and impending
herniation. the Cushing response is a late and ominous manifestation of intracranial hypertension.
6. A trauma team is reviewing the next decision for a newly injured patient. The patient has a hypotensive
patient has severe dyspnea, unilateral absent breath sounds, and rapidly worsening oxygenation. Which
diagnosis-or-priority and management pairing best fits this situation?
A. Obstructive shock from tension pneumothorax - decompress the affected chest immediately, then perform tube
thoracostomy
B. Traumatic diaphragmatic injury - avoid delays, decompress the stomach when appropriate, and obtain
definitive surgical evaluation
C. Abdominal evisceration - cover the bowel with warm sterile saline-moistened dressings and obtain urgent
surgical management
D. Avoiding unnecessary pre-transfer imaging - omit nonessential studies and transfer once required stabilization
for transport is achieved
Correct Answer: A. Obstructive shock from tension pneumothorax - decompress the affected chest immediately,
then perform tube thoracostomy
Explanation: The findings are most consistent with obstructive shock from tension pneumothorax, and the
appropriate ATLS response is to decompress the affected chest immediately, then perform tube thoracostomy.
tension pneumothorax obstructs venous return and must be treated immediately on clinical grounds.
7. During preparation for definitive management, the team revisits the patient findings. The patient has a
head-injured patient has Battle sign, periorbital ecchymosis, and cerebrospinal fluid rhinorrhea. Which
management step should be integrated into the trauma team's immediate plan?
A. arrange immediate definitive surgical management, using temporizing decompression only when required by
the situation
B. titrate ongoing resuscitation while targeting urine output of about 0.5 mL/kg/hr together with other perfusion
indicators
C. avoid nasal instrumentation and evaluate the intracranial injury with CT
D. expose and assess the chest immediately and treat any life-threatening thoracic injury as it is identified
Correct Answer: C. avoid nasal instrumentation and evaluate the intracranial injury with CT
Explanation: The priority is to avoid nasal instrumentation and evaluate the intracranial injury with CT. nasal
tubes can enter the cranial vault when a basilar skull fracture disrupts the cribriform region.
8. Consider the following trauma presentation: a hemodynamically stable patient has abdominal
tenderness after a high-energy crash. Which ATLS problem or priority best organizes the team's
interpretation of these findings?
A. Adult burn urine-output target
B. Stable blunt abdominal trauma
C. Electrical burn with myoglobinuria
D. Simple traumatic pneumothorax requiring drainage
Correct Answer: B. Stable blunt abdominal trauma
Explanation: The findings fit stable blunt abdominal trauma. CT provides detailed anatomic evaluation in stable
patients and guides operative versus nonoperative management; management should therefore include obtain
contrast-enhanced CT of the abdomen and pelvis when indicated.
9. During handoff within the trauma bay, the following findings are emphasized. The patient has an
unconscious trauma patient snores and has possible cervical spine injury. Which diagnosis-or-priority and
,management pairing best fits this situation?
A. Airway maneuver with suspected cervical spine injury - use a jaw-thrust maneuver while maintaining cervical
motion restriction and provide adjuncts as needed
B. Blunt thoracic aortic injury - obtain CT angiography of the chest and involve aortic specialists early
C. Airway contamination from maxillofacial trauma - use aggressive suction, manual airway maneuvers with
cervical motion restriction, and secure a definitive airway when needed
D. Acute subdural hematoma - reverse correctable coagulopathy when appropriate and obtain urgent
neurosurgical management
Correct Answer: A. Airway maneuver with suspected cervical spine injury - use a jaw-thrust maneuver while
maintaining cervical motion restriction and provide adjuncts as needed
Explanation: The findings are most consistent with airway maneuver with suspected cervical spine injury, and
the appropriate ATLS response is to use a jaw-thrust maneuver while maintaining cervical motion restriction and
provide adjuncts as needed. jaw thrust opens the airway while minimizing cervical movement compared with a
head-tilt maneuver.
10. The patient initially has a patient with severe traumatic brain injury has no other indication for
systemic steroids. After the team acts by do not use corticosteroids to treat the traumatic brain injury itself,
which finding best demonstrates that the immediate treatment objective has been achieved?
A. any vascular or nerve change related to the injury or reduction is recognized immediately
B. the characteristic upper-extremity-predominant neurologic deficit is documented and managed
C. the patient is managed with evidence-based oxygenation, perfusion, ICP, and surgical strategies instead
D. urine output remains near the target and perfusion indicators improve
Correct Answer: C. the patient is managed with evidence-based oxygenation, perfusion, ICP, and surgical
strategies instead
Explanation: The strongest immediate evidence of success is that the patient is managed with evidence-based
oxygenation, perfusion, ICP, and surgical strategies instead. This reflects correction of the targeted life threat or
physiologic problem.
11. During preparation for definitive management, the team revisits the patient findings. The patient has a
severely injured adult has no existing IV access and requires immediate resuscitation. Which
diagnosis-or-priority and management pairing best fits this situation?
A. Spinal shock - support ABCs and perform serial neurologic examinations while spinal shock evolves
B. Exposure with hypothermia prevention - fully expose the patient for examination while actively preventing
heat loss with warm blankets, warmed fluids, and a warm environment
C. Femoral shaft fracture hemorrhage - splint the femur appropriately and continue evaluating and resuscitating
for blood loss
D. Rapid vascular access for shock - place two large-bore peripheral IV catheters, using intraosseous access if
peripheral access cannot be obtained quickly
Correct Answer: D. Rapid vascular access for shock - place two large-bore peripheral IV catheters, using
intraosseous access if peripheral access cannot be obtained quickly
Explanation: The findings are most consistent with rapid vascular access for shock, and the appropriate ATLS
response is to place two large-bore peripheral IV catheters, using intraosseous access if peripheral access cannot
be obtained quickly. rapid high-flow access is needed for trauma resuscitation and should not be delayed by
difficult central-line placement.
12. A patient presents with bright red blood is rapidly pooling from a mangled extremity and direct
pressure is initially ineffective, and the team plans to apply effective hemorrhage control, escalating from
direct pressure and wound packing to a tourniquet when indicated. Which ATLS principle provides the
strongest justification for this priority?
A. catastrophic external blood loss is a circulation threat that must be controlled immediately
B. blood at the meatus after pelvic trauma is a classic warning sign for urethral injury
C. corticosteroids do not improve traumatic brain injury outcomes and can increase harm
D. progressive edema can make later intubation impossible, so a threatened burn airway should be secured early
Correct Answer: A. catastrophic external blood loss is a circulation threat that must be controlled immediately
Explanation: catastrophic external blood loss is a circulation threat that must be controlled immediately. That
principle supports the planned action: apply effective hemorrhage control, escalating from direct pressure and
wound packing to a tourniquet when indicated.
, 13. Consider the following trauma presentation: blunt lower-chest trauma is followed by bowel sounds in
the chest and an abnormal elevated hemidiaphragm. Which ATLS problem or priority best organizes the
team's interpretation of these findings?
A. Secondary survey timing
B. Cushing response as a late sign
C. Stable pediatric solid-organ injury
D. Traumatic diaphragmatic injury
Correct Answer: D. Traumatic diaphragmatic injury
Explanation: The findings fit traumatic diaphragmatic injury. diaphragmatic rupture can compromise respiration
and abdominal organs and requires operative repair; management should therefore include avoid delays,
decompress the stomach when appropriate, and obtain definitive surgical evaluation.
14. The patient initially has a patient with a high spinal cord injury is hypotensive with warm skin and
relative bradycardia after hemorrhage has been excluded. After the team acts by support perfusion with
judicious volume and vasopressors while treating the spinal injury, which finding best demonstrates that
the immediate treatment objective has been achieved?
A. the neurologic classification reflects preserved sacral function
B. exposed viscera remain protected and viable until operative repair
C. the aortic injury is defined without delaying stabilization of other life threats
D. blood pressure and organ perfusion improve without evidence of uncontrolled hemorrhage
Correct Answer: D. blood pressure and organ perfusion improve without evidence of uncontrolled hemorrhage
Explanation: The strongest immediate evidence of success is that blood pressure and organ perfusion improve
without evidence of uncontrolled hemorrhage. This reflects correction of the targeted life threat or physiologic
problem.
15. Consider the following trauma presentation: multiple attempts at endotracheal intubation fail and
bag-mask ventilation no longer provides adequate oxygenation. Which ATLS problem or priority best
organizes the team's interpretation of these findings?
A. Suspected urethral injury
B. Safe packaging for interfacility transport
C. Cannot intubate, cannot oxygenate situation
D. Reduced physiologic reserve in older adults
Correct Answer: C. Cannot intubate, cannot oxygenate situation
Explanation: The findings fit cannot intubate, cannot oxygenate situation. when ventilation and intubation fail, a
surgical airway is a time-critical rescue intervention; management should therefore include establish an
emergency surgical airway through the cricothyroid membrane.
16. A senior clinician asks the team to connect the findings with the most appropriate ATLS response. The
patient has a restrained crash patient develops worsening abdominal pain, guarding, and free
intraperitoneal air. Which management step should be integrated into the trauma team's immediate plan?
A. obtain urgent surgical evaluation and proceed to operative management
B. secure a definitive airway and aggressively prevent hypoxia and hypotension while arranging CT and
neurosurgical care
C. secure the airway and lines, provide adequate oxygen and medications, maintain spinal motion restriction
when indicated, send records and images, and anticipate deterioration en route
D. obtain contrast-enhanced CT of the abdomen and pelvis when indicated
Correct Answer: A. obtain urgent surgical evaluation and proceed to operative management
Explanation: The priority is to obtain urgent surgical evaluation and proceed to operative management.
peritoneal signs or free air after trauma strongly suggest perforation requiring surgery.
17. The team is considering the following management step: use active warming measures and warmed
fluids and blood while continuing hemorrhage control. Which clinical presentation most strongly supports
using that step?
A. a patient with cervical cord injury is hypotensive, relatively bradycardic, and warm after major bleeding has
been excluded
B. a bleeding trauma patient is receiving multiple units of blood and becomes progressively cold
C. a restrained crash patient develops worsening abdominal pain, guarding, and free intraperitoneal air
D. a shocked trauma patient remains hypotensive despite initial blood-product resuscitation
QUESTIONS WITH ANSWERS AND EXPLANATIONS
1. During a structured trauma reassessment, the team reviews the following information. The patient has
penetrating precordial trauma causes shock with distended neck veins and pericardial fluid on focused
ultrasound. Which diagnosis-or-priority and management pairing best fits this situation?
A. Adult burn urine-output target - adjust the fluid rate to maintain urine output around 0.5 mL/kg/hr while
following the overall clinical response
B. Spinal shock - support ABCs and perform serial neurologic examinations while spinal shock evolves
C. Unstable patient with positive FAST - continue resuscitation and proceed urgently to operative hemorrhage
control
D. Cardiac tamponade - expedite definitive operative relief of tamponade, using pericardial decompression only
as a temporizing step when necessary
Correct Answer: D. Cardiac tamponade - expedite definitive operative relief of tamponade, using pericardial
decompression only as a temporizing step when necessary
Explanation: The findings are most consistent with cardiac tamponade, and the appropriate ATLS response is to
expedite definitive operative relief of tamponade, using pericardial decompression only as a temporizing step
when necessary. tamponade is a mechanical obstruction to cardiac filling and definitive treatment is surgical.
2. The team is considering the following management step: manage nonoperatively in an appropriately
monitored setting when no other indication for laparotomy exists. Which clinical presentation most
strongly supports using that step?
A. a child younger than 14 years has a large flame burn and weighs less than 30 kg
B. a stable adult has a CT-confirmed splenic laceration without ongoing shock or peritonitis
C. a trauma patient requiring spinal motion restriction has not yet had the back inspected
D. significant anterior blunt chest trauma raises concern for myocardial injury
Correct Answer: B. a stable adult has a CT-confirmed splenic laceration without ongoing shock or peritonitis
Explanation: The matching presentation is a stable adult has a CT-confirmed splenic laceration without ongoing
shock or peritonitis. In that setting, the recommended priority is to manage nonoperatively in an appropriately
monitored setting when no other indication for laparotomy exists. many stable solid-organ injuries can be treated
nonoperatively with close observation and access to rescue intervention.
3. The patient initially has a hemodynamically stable trauma patient has persistent altered mental status
after head injury. After the team acts by obtain noncontrast CT of the head while continuing serial
neurologic assessment, which finding best demonstrates that the immediate treatment objective has been
achieved?
A. oxygenation is restored through the surgical airway
B. intracranial hemorrhage, mass effect, and skull injury are rapidly identified
C. urethral disruption is defined without converting a partial injury into a worse one
D. definitive-care resources are mobilized without avoidable delay
Correct Answer: B. intracranial hemorrhage, mass effect, and skull injury are rapidly identified
Explanation: The strongest immediate evidence of success is that intracranial hemorrhage, mass effect, and skull
injury are rapidly identified. This reflects correction of the targeted life threat or physiologic problem.
4. The team is considering the following management step: apply an occlusive or vented dressing and place
a chest tube at a separate site, with definitive wound closure. Which clinical presentation most strongly
supports using that step?
A. significant anterior blunt chest trauma raises concern for myocardial injury
B. penetrating chest trauma is followed by hypotension, jugular venous distention, and an eFAST showing
pericardial fluid
C. a head-injured patient has a Glasgow Coma Scale score of 7 and cannot reliably protect the airway
D. a large sucking chest wound produces obvious air movement through the defect with respiratory distress
Correct Answer: D. a large sucking chest wound produces obvious air movement through the defect with
respiratory distress
Explanation: The matching presentation is a large sucking chest wound produces obvious air movement through
the defect with respiratory distress. In that setting, the recommended priority is to apply an occlusive or vented
dressing and place a chest tube at a separate site, with definitive wound closure. a large open chest defect prevents
effective ventilation unless the wound is sealed and the pleural space drained.
,5. A trauma team is reviewing the next decision for a newly injured patient. The patient has a head-injured
patient develops hypertension, bradycardia, and irregular respirations. Which management step should be
integrated into the trauma team's immediate plan?
A. use aggressive suction, manual airway maneuvers with cervical motion restriction, and secure a definitive
airway when needed
B. treat this as a late warning of critically raised intracranial pressure and impending herniation
C. use age-appropriate neutral positioning, often with padding under the torso, while maintaining spinal motion
restriction
D. fully expose the patient for examination while actively preventing heat loss with warm blankets, warmed
fluids, and a warm environment
Correct Answer: B. treat this as a late warning of critically raised intracranial pressure and impending herniation
Explanation: The priority is to treat this as a late warning of critically raised intracranial pressure and impending
herniation. the Cushing response is a late and ominous manifestation of intracranial hypertension.
6. A trauma team is reviewing the next decision for a newly injured patient. The patient has a hypotensive
patient has severe dyspnea, unilateral absent breath sounds, and rapidly worsening oxygenation. Which
diagnosis-or-priority and management pairing best fits this situation?
A. Obstructive shock from tension pneumothorax - decompress the affected chest immediately, then perform tube
thoracostomy
B. Traumatic diaphragmatic injury - avoid delays, decompress the stomach when appropriate, and obtain
definitive surgical evaluation
C. Abdominal evisceration - cover the bowel with warm sterile saline-moistened dressings and obtain urgent
surgical management
D. Avoiding unnecessary pre-transfer imaging - omit nonessential studies and transfer once required stabilization
for transport is achieved
Correct Answer: A. Obstructive shock from tension pneumothorax - decompress the affected chest immediately,
then perform tube thoracostomy
Explanation: The findings are most consistent with obstructive shock from tension pneumothorax, and the
appropriate ATLS response is to decompress the affected chest immediately, then perform tube thoracostomy.
tension pneumothorax obstructs venous return and must be treated immediately on clinical grounds.
7. During preparation for definitive management, the team revisits the patient findings. The patient has a
head-injured patient has Battle sign, periorbital ecchymosis, and cerebrospinal fluid rhinorrhea. Which
management step should be integrated into the trauma team's immediate plan?
A. arrange immediate definitive surgical management, using temporizing decompression only when required by
the situation
B. titrate ongoing resuscitation while targeting urine output of about 0.5 mL/kg/hr together with other perfusion
indicators
C. avoid nasal instrumentation and evaluate the intracranial injury with CT
D. expose and assess the chest immediately and treat any life-threatening thoracic injury as it is identified
Correct Answer: C. avoid nasal instrumentation and evaluate the intracranial injury with CT
Explanation: The priority is to avoid nasal instrumentation and evaluate the intracranial injury with CT. nasal
tubes can enter the cranial vault when a basilar skull fracture disrupts the cribriform region.
8. Consider the following trauma presentation: a hemodynamically stable patient has abdominal
tenderness after a high-energy crash. Which ATLS problem or priority best organizes the team's
interpretation of these findings?
A. Adult burn urine-output target
B. Stable blunt abdominal trauma
C. Electrical burn with myoglobinuria
D. Simple traumatic pneumothorax requiring drainage
Correct Answer: B. Stable blunt abdominal trauma
Explanation: The findings fit stable blunt abdominal trauma. CT provides detailed anatomic evaluation in stable
patients and guides operative versus nonoperative management; management should therefore include obtain
contrast-enhanced CT of the abdomen and pelvis when indicated.
9. During handoff within the trauma bay, the following findings are emphasized. The patient has an
unconscious trauma patient snores and has possible cervical spine injury. Which diagnosis-or-priority and
,management pairing best fits this situation?
A. Airway maneuver with suspected cervical spine injury - use a jaw-thrust maneuver while maintaining cervical
motion restriction and provide adjuncts as needed
B. Blunt thoracic aortic injury - obtain CT angiography of the chest and involve aortic specialists early
C. Airway contamination from maxillofacial trauma - use aggressive suction, manual airway maneuvers with
cervical motion restriction, and secure a definitive airway when needed
D. Acute subdural hematoma - reverse correctable coagulopathy when appropriate and obtain urgent
neurosurgical management
Correct Answer: A. Airway maneuver with suspected cervical spine injury - use a jaw-thrust maneuver while
maintaining cervical motion restriction and provide adjuncts as needed
Explanation: The findings are most consistent with airway maneuver with suspected cervical spine injury, and
the appropriate ATLS response is to use a jaw-thrust maneuver while maintaining cervical motion restriction and
provide adjuncts as needed. jaw thrust opens the airway while minimizing cervical movement compared with a
head-tilt maneuver.
10. The patient initially has a patient with severe traumatic brain injury has no other indication for
systemic steroids. After the team acts by do not use corticosteroids to treat the traumatic brain injury itself,
which finding best demonstrates that the immediate treatment objective has been achieved?
A. any vascular or nerve change related to the injury or reduction is recognized immediately
B. the characteristic upper-extremity-predominant neurologic deficit is documented and managed
C. the patient is managed with evidence-based oxygenation, perfusion, ICP, and surgical strategies instead
D. urine output remains near the target and perfusion indicators improve
Correct Answer: C. the patient is managed with evidence-based oxygenation, perfusion, ICP, and surgical
strategies instead
Explanation: The strongest immediate evidence of success is that the patient is managed with evidence-based
oxygenation, perfusion, ICP, and surgical strategies instead. This reflects correction of the targeted life threat or
physiologic problem.
11. During preparation for definitive management, the team revisits the patient findings. The patient has a
severely injured adult has no existing IV access and requires immediate resuscitation. Which
diagnosis-or-priority and management pairing best fits this situation?
A. Spinal shock - support ABCs and perform serial neurologic examinations while spinal shock evolves
B. Exposure with hypothermia prevention - fully expose the patient for examination while actively preventing
heat loss with warm blankets, warmed fluids, and a warm environment
C. Femoral shaft fracture hemorrhage - splint the femur appropriately and continue evaluating and resuscitating
for blood loss
D. Rapid vascular access for shock - place two large-bore peripheral IV catheters, using intraosseous access if
peripheral access cannot be obtained quickly
Correct Answer: D. Rapid vascular access for shock - place two large-bore peripheral IV catheters, using
intraosseous access if peripheral access cannot be obtained quickly
Explanation: The findings are most consistent with rapid vascular access for shock, and the appropriate ATLS
response is to place two large-bore peripheral IV catheters, using intraosseous access if peripheral access cannot
be obtained quickly. rapid high-flow access is needed for trauma resuscitation and should not be delayed by
difficult central-line placement.
12. A patient presents with bright red blood is rapidly pooling from a mangled extremity and direct
pressure is initially ineffective, and the team plans to apply effective hemorrhage control, escalating from
direct pressure and wound packing to a tourniquet when indicated. Which ATLS principle provides the
strongest justification for this priority?
A. catastrophic external blood loss is a circulation threat that must be controlled immediately
B. blood at the meatus after pelvic trauma is a classic warning sign for urethral injury
C. corticosteroids do not improve traumatic brain injury outcomes and can increase harm
D. progressive edema can make later intubation impossible, so a threatened burn airway should be secured early
Correct Answer: A. catastrophic external blood loss is a circulation threat that must be controlled immediately
Explanation: catastrophic external blood loss is a circulation threat that must be controlled immediately. That
principle supports the planned action: apply effective hemorrhage control, escalating from direct pressure and
wound packing to a tourniquet when indicated.
, 13. Consider the following trauma presentation: blunt lower-chest trauma is followed by bowel sounds in
the chest and an abnormal elevated hemidiaphragm. Which ATLS problem or priority best organizes the
team's interpretation of these findings?
A. Secondary survey timing
B. Cushing response as a late sign
C. Stable pediatric solid-organ injury
D. Traumatic diaphragmatic injury
Correct Answer: D. Traumatic diaphragmatic injury
Explanation: The findings fit traumatic diaphragmatic injury. diaphragmatic rupture can compromise respiration
and abdominal organs and requires operative repair; management should therefore include avoid delays,
decompress the stomach when appropriate, and obtain definitive surgical evaluation.
14. The patient initially has a patient with a high spinal cord injury is hypotensive with warm skin and
relative bradycardia after hemorrhage has been excluded. After the team acts by support perfusion with
judicious volume and vasopressors while treating the spinal injury, which finding best demonstrates that
the immediate treatment objective has been achieved?
A. the neurologic classification reflects preserved sacral function
B. exposed viscera remain protected and viable until operative repair
C. the aortic injury is defined without delaying stabilization of other life threats
D. blood pressure and organ perfusion improve without evidence of uncontrolled hemorrhage
Correct Answer: D. blood pressure and organ perfusion improve without evidence of uncontrolled hemorrhage
Explanation: The strongest immediate evidence of success is that blood pressure and organ perfusion improve
without evidence of uncontrolled hemorrhage. This reflects correction of the targeted life threat or physiologic
problem.
15. Consider the following trauma presentation: multiple attempts at endotracheal intubation fail and
bag-mask ventilation no longer provides adequate oxygenation. Which ATLS problem or priority best
organizes the team's interpretation of these findings?
A. Suspected urethral injury
B. Safe packaging for interfacility transport
C. Cannot intubate, cannot oxygenate situation
D. Reduced physiologic reserve in older adults
Correct Answer: C. Cannot intubate, cannot oxygenate situation
Explanation: The findings fit cannot intubate, cannot oxygenate situation. when ventilation and intubation fail, a
surgical airway is a time-critical rescue intervention; management should therefore include establish an
emergency surgical airway through the cricothyroid membrane.
16. A senior clinician asks the team to connect the findings with the most appropriate ATLS response. The
patient has a restrained crash patient develops worsening abdominal pain, guarding, and free
intraperitoneal air. Which management step should be integrated into the trauma team's immediate plan?
A. obtain urgent surgical evaluation and proceed to operative management
B. secure a definitive airway and aggressively prevent hypoxia and hypotension while arranging CT and
neurosurgical care
C. secure the airway and lines, provide adequate oxygen and medications, maintain spinal motion restriction
when indicated, send records and images, and anticipate deterioration en route
D. obtain contrast-enhanced CT of the abdomen and pelvis when indicated
Correct Answer: A. obtain urgent surgical evaluation and proceed to operative management
Explanation: The priority is to obtain urgent surgical evaluation and proceed to operative management.
peritoneal signs or free air after trauma strongly suggest perforation requiring surgery.
17. The team is considering the following management step: use active warming measures and warmed
fluids and blood while continuing hemorrhage control. Which clinical presentation most strongly supports
using that step?
A. a patient with cervical cord injury is hypotensive, relatively bradycardic, and warm after major bleeding has
been excluded
B. a bleeding trauma patient is receiving multiple units of blood and becomes progressively cold
C. a restrained crash patient develops worsening abdominal pain, guarding, and free intraperitoneal air
D. a shocked trauma patient remains hypotensive despite initial blood-product resuscitation
