ATLS
A 23-year-old man is brought immediately to the ED from the hospitals parking lot where he was
shot in the lower abdomen. Examination reveals a single bullet wound. He is breathing and has
a thready pulse. However, he is unconsious and has no detectable blood pressure. Optimale
immediate management is to:
A. Perform a FAST
B. Initiate infusion of packed red blood cells
C. Insert a nasogastric tube and urinary catheter
D. Transfer the patient to the operating room, while initiating fluid therapy
E. Initiate fluid therapy to return his blood pressure to normotensive - ANSD. Transfer the
patient to the operating room, while initiating fluid therapy
A 22 year old male present following a motorcycle crash. He complains of the inability to move
his legs. His BP is 80/50, HR 70, RR 18 and GCS 15. Oxygen saturation is 99% on 21 nasal
prongs. Chest x-ray, pelvic x-ray and FAST are normal. Extremities are normal. His
management should be:
A: 1L of iv . crystalloid and two units of pRBCs
B. 1L of iv. crystalloid, mannitol and iv steroids
C. 1 unit of albumin and compression stockings
D. Vasopressors and laparotomy
E. 1 L of cystalloid and vasopressors if blood pressure does not respond - ANSE. 1 L of
cystalloid and vasopressors if blood pressure does not respond
Which of the following is MOST RELIABLE to confirm endotracheal intubation?
a. presence of breath sounds bilaterally
b. absence of borborygmi in the epigatrium on ascultation
c. presence of CO2 in exhaled air via capnography
d. appearance of fog in the endotracheal tube
e. chest xray with endotracheal tube tip appearing above the carina - ANSe. chest xray with
endotracheal tube tip appearing above the carina
A 6 month old infant, being held in her mothers arms, is ejected on impact from a vehicle that is
struck head on by an oncoming car traveling at 64kph. The infant arrives in the ED with multiple
facial injuries, is lethargic, and is in severe respiratoy distress. Respiratory support is not
effective using a bag mask device, and her oxygen saturation is falling. Repeated attempts at
orotracheal intubation are unsuccessful. the most appropriate procedure to perform next is:
A.Administer heliox and racemic epinephrine
B. Perform nasotracheal intubation
C.Perform surgical cricothyroidotomy
D.Repeat orotracheal intubation
, E. Perform needle cricothyroidotomy with jet insufflation - ANSE. Perform needle
cricothyroidotomy with jet insufflation
A 28 year olf male is brought to the ED. He was involved in a fight, during which he was beaten
with a wooden stick. His chest shows multiple severe bruises. His arway is clear, resp rate is 22,
hear rate 126, and systolic blood pressure is 90 mmHG. Which of the following should be
performed during the primary survey
a. glasgow coma
b. tetanus status
c. cervical spine xray
d. blood alcohol level
e. rectal exam - ANSa. glasgow coma
an 18yo male is brought to the emergency department after being dumped by a large wave
while surfing. He landed head first on the firm beach sand. His vital signs are blood pressure
85/60 mmHg, heart rate 60, and respiratory rate 18; he is unable to move his lower extremities.
He appears calm and asks if he will ever walk again. The most appropriate next step is to:
a. reassure patient that he will walk again
b. proceed to a more detailed neuro exam
c. obtain c spin xrays
d. begin infusion of vasopressors
e. begin bolus of warm IV crystalloid - ANSe. begin bolus of warm IV crystalloid
Whic one of the following statements is true regarding access in pediatric resuscitation?
a. intraosseous access should be considered only after 5 percutaneous attempts
b. cutdown at teh ankle is the preferred initial access technique
c. internal jugular cannulation is the next preferred option when percutaneous venous access
fails
d. intraosseous cannulation should be the first choice
e. blood transfusion can be delivered through intraosseous access - ANSe. blood transfusion
can be delivered through intraosseous access
a 35 year old female ustains multiple linjuries in a MVA and is transported to a small hospital.
She has a GCS of V2E2M2. Spinal motion restrictions are in place. ET is performed, IV and
wamred fluids are administered. She remains hemodynamically normal, and preparations are
made to transfer to another facility for definitive neuro care. Which of the following tests or
treatment should occur before transport?
a. ct abdomen and chest
b. chest xray
c. lateral cervical spine xray
d. admin of methlyprednisolone
e. transfusion of 2 units packed RBCs - ANSb. chest xray
A 23-year-old man is brought immediately to the ED from the hospitals parking lot where he was
shot in the lower abdomen. Examination reveals a single bullet wound. He is breathing and has
a thready pulse. However, he is unconsious and has no detectable blood pressure. Optimale
immediate management is to:
A. Perform a FAST
B. Initiate infusion of packed red blood cells
C. Insert a nasogastric tube and urinary catheter
D. Transfer the patient to the operating room, while initiating fluid therapy
E. Initiate fluid therapy to return his blood pressure to normotensive - ANSD. Transfer the
patient to the operating room, while initiating fluid therapy
A 22 year old male present following a motorcycle crash. He complains of the inability to move
his legs. His BP is 80/50, HR 70, RR 18 and GCS 15. Oxygen saturation is 99% on 21 nasal
prongs. Chest x-ray, pelvic x-ray and FAST are normal. Extremities are normal. His
management should be:
A: 1L of iv . crystalloid and two units of pRBCs
B. 1L of iv. crystalloid, mannitol and iv steroids
C. 1 unit of albumin and compression stockings
D. Vasopressors and laparotomy
E. 1 L of cystalloid and vasopressors if blood pressure does not respond - ANSE. 1 L of
cystalloid and vasopressors if blood pressure does not respond
Which of the following is MOST RELIABLE to confirm endotracheal intubation?
a. presence of breath sounds bilaterally
b. absence of borborygmi in the epigatrium on ascultation
c. presence of CO2 in exhaled air via capnography
d. appearance of fog in the endotracheal tube
e. chest xray with endotracheal tube tip appearing above the carina - ANSe. chest xray with
endotracheal tube tip appearing above the carina
A 6 month old infant, being held in her mothers arms, is ejected on impact from a vehicle that is
struck head on by an oncoming car traveling at 64kph. The infant arrives in the ED with multiple
facial injuries, is lethargic, and is in severe respiratoy distress. Respiratory support is not
effective using a bag mask device, and her oxygen saturation is falling. Repeated attempts at
orotracheal intubation are unsuccessful. the most appropriate procedure to perform next is:
A.Administer heliox and racemic epinephrine
B. Perform nasotracheal intubation
C.Perform surgical cricothyroidotomy
D.Repeat orotracheal intubation
, E. Perform needle cricothyroidotomy with jet insufflation - ANSE. Perform needle
cricothyroidotomy with jet insufflation
A 28 year olf male is brought to the ED. He was involved in a fight, during which he was beaten
with a wooden stick. His chest shows multiple severe bruises. His arway is clear, resp rate is 22,
hear rate 126, and systolic blood pressure is 90 mmHG. Which of the following should be
performed during the primary survey
a. glasgow coma
b. tetanus status
c. cervical spine xray
d. blood alcohol level
e. rectal exam - ANSa. glasgow coma
an 18yo male is brought to the emergency department after being dumped by a large wave
while surfing. He landed head first on the firm beach sand. His vital signs are blood pressure
85/60 mmHg, heart rate 60, and respiratory rate 18; he is unable to move his lower extremities.
He appears calm and asks if he will ever walk again. The most appropriate next step is to:
a. reassure patient that he will walk again
b. proceed to a more detailed neuro exam
c. obtain c spin xrays
d. begin infusion of vasopressors
e. begin bolus of warm IV crystalloid - ANSe. begin bolus of warm IV crystalloid
Whic one of the following statements is true regarding access in pediatric resuscitation?
a. intraosseous access should be considered only after 5 percutaneous attempts
b. cutdown at teh ankle is the preferred initial access technique
c. internal jugular cannulation is the next preferred option when percutaneous venous access
fails
d. intraosseous cannulation should be the first choice
e. blood transfusion can be delivered through intraosseous access - ANSe. blood transfusion
can be delivered through intraosseous access
a 35 year old female ustains multiple linjuries in a MVA and is transported to a small hospital.
She has a GCS of V2E2M2. Spinal motion restrictions are in place. ET is performed, IV and
wamred fluids are administered. She remains hemodynamically normal, and preparations are
made to transfer to another facility for definitive neuro care. Which of the following tests or
treatment should occur before transport?
a. ct abdomen and chest
b. chest xray
c. lateral cervical spine xray
d. admin of methlyprednisolone
e. transfusion of 2 units packed RBCs - ANSb. chest xray
