ATLS Test 1
A 20-year-old woman that is 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:
Select one:
a.
perform tracheal intubation
b.
insert an oropharyngeal airway
c.
perform needle or finger decompression of the right chest
d.
manually displace the gravid uterus to the left side of the abdomen
e.
initiate 2, large-caliber peripheral IV lines and crystalloid infusion - ANS-c.
perform needle or finger decompression of the right chest
A 22-year-old female athlete is stabbed in her left chest at the third interspace in the anterior axillary
line. On admission to the ED and 15 minutes after the incident, she is awake and alert. Her heart rate is
100 beats per minute, blood pressure is 80/60 mm Hg, and respiratory rate is 20 breaths per minute. A
chest x-ray reveals a large left hemothorax. A left chest tube is placed with an immediate return of 1600
mL of blood. The next management step for this patient is to:
Select one:
a.
perform a thoracoscopy
b.
perform an arch aortogram
c.
insert a second left chest tube
,d.
prepare for an exploratory thoracotomy
e.
perform a chest CT - ANS-d.
prepare for an exploratory thoracotomy
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:
Select one:
a.
reexamine the chest
b.
perform an aortogram
c.
obtain a CT scan of the chest
d.
obtain arterial blood gas analyses
e.
perform transesophageal echocardiography - ANS-A) Reexamine the chest
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:
Select one:
a.
clamp the chest tube
b.
, cancel the patient's transfer
c.
perform an emergency department thoracotomy
d.
repeat the primary survey and proceed with transfer
e.
delay the transfer until the referring doctor can contact a thoracic surgeon - ANS-d.
repeat the primary survey and proceed with transfer
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
Select one:
a.
perform diagnostic peritoneal lavage
b.
obtain a CT of the chest
c.
perform an angiography
d.
urgently transfer the patient to the operating room
e.
immediately transfer the patient to a trauma center - ANS-d.
urgently transfer the patient to the operating room
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
A 20-year-old woman that is 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:
Select one:
a.
perform tracheal intubation
b.
insert an oropharyngeal airway
c.
perform needle or finger decompression of the right chest
d.
manually displace the gravid uterus to the left side of the abdomen
e.
initiate 2, large-caliber peripheral IV lines and crystalloid infusion - ANS-c.
perform needle or finger decompression of the right chest
A 22-year-old female athlete is stabbed in her left chest at the third interspace in the anterior axillary
line. On admission to the ED and 15 minutes after the incident, she is awake and alert. Her heart rate is
100 beats per minute, blood pressure is 80/60 mm Hg, and respiratory rate is 20 breaths per minute. A
chest x-ray reveals a large left hemothorax. A left chest tube is placed with an immediate return of 1600
mL of blood. The next management step for this patient is to:
Select one:
a.
perform a thoracoscopy
b.
perform an arch aortogram
c.
insert a second left chest tube
,d.
prepare for an exploratory thoracotomy
e.
perform a chest CT - ANS-d.
prepare for an exploratory thoracotomy
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:
Select one:
a.
reexamine the chest
b.
perform an aortogram
c.
obtain a CT scan of the chest
d.
obtain arterial blood gas analyses
e.
perform transesophageal echocardiography - ANS-A) Reexamine the chest
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:
Select one:
a.
clamp the chest tube
b.
, cancel the patient's transfer
c.
perform an emergency department thoracotomy
d.
repeat the primary survey and proceed with transfer
e.
delay the transfer until the referring doctor can contact a thoracic surgeon - ANS-d.
repeat the primary survey and proceed with transfer
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
Select one:
a.
perform diagnostic peritoneal lavage
b.
obtain a CT of the chest
c.
perform an angiography
d.
urgently transfer the patient to the operating room
e.
immediately transfer the patient to a trauma center - ANS-d.
urgently transfer the patient to the operating room
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
