ATLS Review
A 22yo M is hypotensive and tachycardia after a shotgun wound to the L shoulder. His
BP is initially 80/40. After 2L of fluids his BP increases to 122/84. HR is 100bpm and his
RR is 28. Breath sounds are decreased in the left hemithorax, and a closed tube
thoracotomy is performed with a small amount of blood return and no air leak. What is
the next step? - Answer-Reexamine the chest
A construction worker falls 2 stories and suffers bilateral calcanea fractures. He now is
having back pain. What would confirm diagnosis? - Answer-Complete spine x-ray series
What is the principle of balanced resuscitation? - Answer-permissive hypotension and
early plasma infusion
In managing a head-injured patient, what is the most important initial step? - Answer-
Secure the airway
A previously healthy 70kg man suffered ~2L of acute blood loss. Which appropriately
applies to this patient? - Answer-His systolic BP will be decreased with a narrowed
pulse pressure
NOT his pulse pressure will be widened, urinary output at lower level of normal, tachy
but no BP change, or maintained systolic BP with elevated diastolic BP
The physiologic hypovolemia of pregnancy has clinical significance in the management
of severely injured, gravid woman by: - Answer-increasing the volume of blood to
produce maternal hypotension
The best assessment of fluid resuscitation of the burn patient is - Answer-adequate
urinary output
The diagnosis of shock MUST include: - Answer-evidence of inadequate organ
perfusion
A 7yo M is brought to the ED by his parents several minutes after falling through a
window. He is bleeding from a 6cm wound on the medial right thigh. Immediate
management of the wound should include? - Answer-Direct pressure on the wound
**For the patient with severe traumatic brain injury, around HYPOCARBIA (dec CO2)
should be avoided in order to prevent what? - Answer-cerebral vasoconstriction with
diminished perfusion.
**A 25yo M is brought in to a facility with a general surgeon after being in an MVA, CT
shows aortic injury and spe=lenic lac with abdominal fluid, BP is 70mm Hg after CT.
What is the next step? - Answer-exploratory laparotomy
, Which one of the following statements regarding abdominal trauma in the pregnant
patient is true? - Answer-leakage of amniotic fluid is indication for hospital admission
What is the first maneuver to improve oxygenation after chest injury? - Answer-
administer supplemental O2
25yo M in an MVC is admitted to the ED. Pupils react sluggishly and he opens his eyes
to painful stimuli. He does not follow commands, but he does moan periodically. His R
arm is performed and does not respond to pain, however his L hand reaches
purposefully toward the pain. Both legs are stiffened. What is his GCS? - Answer-9
20yo F is 32w gestation and stabbed in the R upper chest. In the ED her BP is 80/60.
She is gasping for breath, anxious, and yelling for help. BS are diminished in the right
chest. Next step? - Answer-perform needle compression in the right chest
Which one of the following findings in an adult is most likely to require immediate
management during the primary survey? - Answer-RR of 44
The most important, immediate step in the management of open PTX is? - Answer-
placement of an occlusive dressing on the wound
What is a contraindication for tDap? - Answer-history of neurological reaction or severe
hypersensitivity to the product
56yo M is thrown in against a steering wheel during MVC. On arrival to the ED he is
diaphoretic and having chest pain. BP is 60/40 and his RR is 40. Which of the following
best differentiates cardiac tamponade from tension PTX? - Answer-breath sounds
Bronchial intubation of the right or left mainstream bronchus can easily occur during
infant endotracheal intubation because : - Answer-the trachea is short
23yo M sustains 4 stab wounds to the right upper chest and is brought to a facility with
full surgical capabilities. All wounds are above the nipple. 2 IVs are placed, BP is 60/0,
HR of 160, and RR of 14 on a ventilator. 1500cc of blood is drained from the right chest.
The most appropriate next step is what? - Answer-urgent transfer to the OR
39yo M comes to the ED after MVC. Pt is cyanotic, has insufficient respiratory effort and
GCS of 6. His beard makes him difficult to use oxygen face mask. What is the next
step? - Answer-Attempt orotracheal intubation with 2 people and inline stabilization of
C-Spine
Patient is brought to the ED after MVC. He is conscious with no obvious trauma. He
arrives completely immobilized on a long board. His BP is 60/40 and HR is 70. Skin is
warm. Which statement is true? - Answer-flaccidity of the lower extremities and loss of
deep tendon reflexes are expected.
A 22yo M is hypotensive and tachycardia after a shotgun wound to the L shoulder. His
BP is initially 80/40. After 2L of fluids his BP increases to 122/84. HR is 100bpm and his
RR is 28. Breath sounds are decreased in the left hemithorax, and a closed tube
thoracotomy is performed with a small amount of blood return and no air leak. What is
the next step? - Answer-Reexamine the chest
A construction worker falls 2 stories and suffers bilateral calcanea fractures. He now is
having back pain. What would confirm diagnosis? - Answer-Complete spine x-ray series
What is the principle of balanced resuscitation? - Answer-permissive hypotension and
early plasma infusion
In managing a head-injured patient, what is the most important initial step? - Answer-
Secure the airway
A previously healthy 70kg man suffered ~2L of acute blood loss. Which appropriately
applies to this patient? - Answer-His systolic BP will be decreased with a narrowed
pulse pressure
NOT his pulse pressure will be widened, urinary output at lower level of normal, tachy
but no BP change, or maintained systolic BP with elevated diastolic BP
The physiologic hypovolemia of pregnancy has clinical significance in the management
of severely injured, gravid woman by: - Answer-increasing the volume of blood to
produce maternal hypotension
The best assessment of fluid resuscitation of the burn patient is - Answer-adequate
urinary output
The diagnosis of shock MUST include: - Answer-evidence of inadequate organ
perfusion
A 7yo M is brought to the ED by his parents several minutes after falling through a
window. He is bleeding from a 6cm wound on the medial right thigh. Immediate
management of the wound should include? - Answer-Direct pressure on the wound
**For the patient with severe traumatic brain injury, around HYPOCARBIA (dec CO2)
should be avoided in order to prevent what? - Answer-cerebral vasoconstriction with
diminished perfusion.
**A 25yo M is brought in to a facility with a general surgeon after being in an MVA, CT
shows aortic injury and spe=lenic lac with abdominal fluid, BP is 70mm Hg after CT.
What is the next step? - Answer-exploratory laparotomy
, Which one of the following statements regarding abdominal trauma in the pregnant
patient is true? - Answer-leakage of amniotic fluid is indication for hospital admission
What is the first maneuver to improve oxygenation after chest injury? - Answer-
administer supplemental O2
25yo M in an MVC is admitted to the ED. Pupils react sluggishly and he opens his eyes
to painful stimuli. He does not follow commands, but he does moan periodically. His R
arm is performed and does not respond to pain, however his L hand reaches
purposefully toward the pain. Both legs are stiffened. What is his GCS? - Answer-9
20yo F is 32w gestation and stabbed in the R upper chest. In the ED her BP is 80/60.
She is gasping for breath, anxious, and yelling for help. BS are diminished in the right
chest. Next step? - Answer-perform needle compression in the right chest
Which one of the following findings in an adult is most likely to require immediate
management during the primary survey? - Answer-RR of 44
The most important, immediate step in the management of open PTX is? - Answer-
placement of an occlusive dressing on the wound
What is a contraindication for tDap? - Answer-history of neurological reaction or severe
hypersensitivity to the product
56yo M is thrown in against a steering wheel during MVC. On arrival to the ED he is
diaphoretic and having chest pain. BP is 60/40 and his RR is 40. Which of the following
best differentiates cardiac tamponade from tension PTX? - Answer-breath sounds
Bronchial intubation of the right or left mainstream bronchus can easily occur during
infant endotracheal intubation because : - Answer-the trachea is short
23yo M sustains 4 stab wounds to the right upper chest and is brought to a facility with
full surgical capabilities. All wounds are above the nipple. 2 IVs are placed, BP is 60/0,
HR of 160, and RR of 14 on a ventilator. 1500cc of blood is drained from the right chest.
The most appropriate next step is what? - Answer-urgent transfer to the OR
39yo M comes to the ED after MVC. Pt is cyanotic, has insufficient respiratory effort and
GCS of 6. His beard makes him difficult to use oxygen face mask. What is the next
step? - Answer-Attempt orotracheal intubation with 2 people and inline stabilization of
C-Spine
Patient is brought to the ED after MVC. He is conscious with no obvious trauma. He
arrives completely immobilized on a long board. His BP is 60/40 and HR is 70. Skin is
warm. Which statement is true? - Answer-flaccidity of the lower extremities and loss of
deep tendon reflexes are expected.
