Page 1 of 36
ITLS 9TH EDITION EXAM LATEST 2024-2025 ACTUAL EXAM
COMPLEETE 250 QUESTIONS AND DETAILED CORRECT
ANSWERS JUST RELEASED
1. Bag-valve-mask ventilation:
A. Rarely causes gastric distention due to low airway pressures
B. Is more effective in patients whose dentures have been removed
C. Is easily accomplished by one rescuer at the head
D. May exceed 60 cm H2O pressure in the airway - ANSWER-D. May exceed 60 cm H2O
pressure in the airway
Rationale: Bag-valve-mask ventilation has challenges because pressures generated by squeezing
the bag may equal or exceed 60 cm H2O.
2. Which of the following is true regarding pulmonary contusion?
A. It is uncommon in chest trauma
B. It is caused by hemorrhage into the lung parenchyma
C. It is only caused by blunt force trauma
D. It rapidly develops after injury - ANSWER-B. It is caused by hemorrhage into the lung
parenchyma
1
,Page 2 of 36
Rationale: Pulmonary contusion is a very common chest injury. It is caused by hemorrhage into
lung parenchyma secondary to blunt force trauma or penetrating injury such as a missile. It
occurs commonly with flail segment or multiple rib fractures. A pulmonary contusion takes
hours to develop and rarely develops during prehospital care.
3. A 25-year-old female was stabbed in the left arm. She presents with an altered mental status
and signs of shock. Bleeding is controlled by direct pressure and use of a tourniquet. Which
intravenous fluid therapy is appropriate?
A. Estimate blood loss and administer fluid at a 3:1 ratio
B. Fluid administration of 250 ml
C. Fluid administration to maintain systolic pressure of 60 mmHg
D. Intravenous fluid administration bolus of 500-1000 mL, then reassess - ANSWER-D.
Intravenous fluid administration bolus of 500-1000 mL, then reassess
Rationale: When bleeding is controlled, give normal saline as a bolus (500 to 1,000 mL in adults;
20 mL/kg in pediatric patients) rapidly and then repeat the ITLS Ongoing Exam.
4. In the absence of herniation syndrome, adult patients with suspected traumatic brain injury
should be ventilated as a rate of:
A. 8-10 per minute
B. 12-14 per minute
C. 16-18 per minute
2
,Page 3 of 36
D. 20-22 per minute - ANSWER-A. 8-10 per minute
Rationale: Hyperventilation and hypoventilation can cause cerebral ischemia and increased
mortality in the TBI patient. Maintaining normal ventilation (not hyperventilation) with high-
flow oxygen at a rate of about one breath every 6 to 8 seconds (8 to 10 per minute) to maintain
an end-tidal CO2 (ETCO2) of 35-45 mmHg.
5. A 56-year-old male sustains a gunshot wound to the abdomen. Vital signs are BP 74/32, P
136 present only at the carotid, and R 24 and shallow. The target of fluid resuscitation is:
A. Return of peripheral pulses
B. Maintenance of central pulses
C. Systolic blood pressure of 110-120
D. Pulse rate of 100 - ANSWER-A. Return of peripheral pulses
Rationale: This is an example of internal, uncontrolled hemorrhage. Administer sufficient
normal saline to maintain peripheral perfusion, following local or EMS agency medical direction
policies. Maintaining peripheral perfusion is generally defined as giving enough fluid—usually in
boluses—to return a peripheral pulse, such as a radial pulse.
6. An unconscious 15-year-old male was struck on the head with a baseball bat. His arms and
legs are extended and his right pupil is dilated and fixed. You should:
3
, Page 4 of 36
A. Insert an oropharyngeal airway, administer oxygen, and restrict fluids
B. Apply a non-rebreather mask, restrict fluids, and administer Mannitol
C. Perform nasotracheal intubation, restrict fluids, and provide adequate ventilation
D. Perform bag-mask ventilation at 20 per minute Exam - ANSWER-D. Perform bag-mask
ventilation at 20 per minute Exam
Rationale: The classic findings of this life-threatening situation are a decreasing level of
consciousness (LOC) that rapidly progresses to coma, dilation of the pupil and an outward-
downward deviation of the eye on the side of the injury, paralysis of the arm and leg on the
side opposite the injury, or decerebrate posturing (arms and legs extended). The danger of
immediate herniation outweighs the risk of cerebral ischemia that can follow hyperventilation.
The cerebral herniation syndrome is the only situation in which hyperventilation is still
indicated. (You must ventilate every three seconds [20/minute] for adults.)
7. Which of the following mechanisms of injury does not commonly cause damage to the spinal
cord?
A. Hyperextension
B. Hyperflexion
C. Lateral stress
D. Compression - ANSWER-C. Lateral stress
4
ITLS 9TH EDITION EXAM LATEST 2024-2025 ACTUAL EXAM
COMPLEETE 250 QUESTIONS AND DETAILED CORRECT
ANSWERS JUST RELEASED
1. Bag-valve-mask ventilation:
A. Rarely causes gastric distention due to low airway pressures
B. Is more effective in patients whose dentures have been removed
C. Is easily accomplished by one rescuer at the head
D. May exceed 60 cm H2O pressure in the airway - ANSWER-D. May exceed 60 cm H2O
pressure in the airway
Rationale: Bag-valve-mask ventilation has challenges because pressures generated by squeezing
the bag may equal or exceed 60 cm H2O.
2. Which of the following is true regarding pulmonary contusion?
A. It is uncommon in chest trauma
B. It is caused by hemorrhage into the lung parenchyma
C. It is only caused by blunt force trauma
D. It rapidly develops after injury - ANSWER-B. It is caused by hemorrhage into the lung
parenchyma
1
,Page 2 of 36
Rationale: Pulmonary contusion is a very common chest injury. It is caused by hemorrhage into
lung parenchyma secondary to blunt force trauma or penetrating injury such as a missile. It
occurs commonly with flail segment or multiple rib fractures. A pulmonary contusion takes
hours to develop and rarely develops during prehospital care.
3. A 25-year-old female was stabbed in the left arm. She presents with an altered mental status
and signs of shock. Bleeding is controlled by direct pressure and use of a tourniquet. Which
intravenous fluid therapy is appropriate?
A. Estimate blood loss and administer fluid at a 3:1 ratio
B. Fluid administration of 250 ml
C. Fluid administration to maintain systolic pressure of 60 mmHg
D. Intravenous fluid administration bolus of 500-1000 mL, then reassess - ANSWER-D.
Intravenous fluid administration bolus of 500-1000 mL, then reassess
Rationale: When bleeding is controlled, give normal saline as a bolus (500 to 1,000 mL in adults;
20 mL/kg in pediatric patients) rapidly and then repeat the ITLS Ongoing Exam.
4. In the absence of herniation syndrome, adult patients with suspected traumatic brain injury
should be ventilated as a rate of:
A. 8-10 per minute
B. 12-14 per minute
C. 16-18 per minute
2
,Page 3 of 36
D. 20-22 per minute - ANSWER-A. 8-10 per minute
Rationale: Hyperventilation and hypoventilation can cause cerebral ischemia and increased
mortality in the TBI patient. Maintaining normal ventilation (not hyperventilation) with high-
flow oxygen at a rate of about one breath every 6 to 8 seconds (8 to 10 per minute) to maintain
an end-tidal CO2 (ETCO2) of 35-45 mmHg.
5. A 56-year-old male sustains a gunshot wound to the abdomen. Vital signs are BP 74/32, P
136 present only at the carotid, and R 24 and shallow. The target of fluid resuscitation is:
A. Return of peripheral pulses
B. Maintenance of central pulses
C. Systolic blood pressure of 110-120
D. Pulse rate of 100 - ANSWER-A. Return of peripheral pulses
Rationale: This is an example of internal, uncontrolled hemorrhage. Administer sufficient
normal saline to maintain peripheral perfusion, following local or EMS agency medical direction
policies. Maintaining peripheral perfusion is generally defined as giving enough fluid—usually in
boluses—to return a peripheral pulse, such as a radial pulse.
6. An unconscious 15-year-old male was struck on the head with a baseball bat. His arms and
legs are extended and his right pupil is dilated and fixed. You should:
3
, Page 4 of 36
A. Insert an oropharyngeal airway, administer oxygen, and restrict fluids
B. Apply a non-rebreather mask, restrict fluids, and administer Mannitol
C. Perform nasotracheal intubation, restrict fluids, and provide adequate ventilation
D. Perform bag-mask ventilation at 20 per minute Exam - ANSWER-D. Perform bag-mask
ventilation at 20 per minute Exam
Rationale: The classic findings of this life-threatening situation are a decreasing level of
consciousness (LOC) that rapidly progresses to coma, dilation of the pupil and an outward-
downward deviation of the eye on the side of the injury, paralysis of the arm and leg on the
side opposite the injury, or decerebrate posturing (arms and legs extended). The danger of
immediate herniation outweighs the risk of cerebral ischemia that can follow hyperventilation.
The cerebral herniation syndrome is the only situation in which hyperventilation is still
indicated. (You must ventilate every three seconds [20/minute] for adults.)
7. Which of the following mechanisms of injury does not commonly cause damage to the spinal
cord?
A. Hyperextension
B. Hyperflexion
C. Lateral stress
D. Compression - ANSWER-C. Lateral stress
4
