ATLS EXAM 2
1. A 32-year-old man's right leg is trapped beneath his overturned car for nearly 2
hours before he is extricated. On arrival in the emergency department, his right lower
extremity is cool, mottled, insensate, and motionless. Despite normal vital signs,
pulses cannot be palpated below the right femoral artery and the muscles of the
lower extremity are firm and hard. During the management of this patient, what is
most likely to improve the chances for limb salvage?
Answer: surgical consultation for right lower extremity fasciotomy
2. A patient arrives in the emergency department after being beaten about the
head and face with a wooden club. He is comatose and has a palpable depressed
skull fracture. His face is swollen and ecchymotic. He has gurgling respirations and
vomitus on his face and clothing.The most appropriate step after providing
supplemental oxygen and elevating his jaw is to:
Answer: suction the oropharynx
3. A 22-year-old man sustains a gunshot wound to the left chest and is trans- ported
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:
Answer: repeat the primary survey and proceed with transfer
4. A 64-year-old man involved in a high-speed car crash, is resuscitated initially
in a small hospital without surgical capabilities. He has a closed head injury with a
GCS score of 13. He has a widened mediastinum on chest x-ray with fractures of
left ribs 2 through 4, but no pneumothorax. After initiating fluid resuscitation, his
blood pressure is 110/74 mm Hg, heart rate is 100 beats per minute, and respiratory
rate is 18 breaths per minute. He has gross hematuria and a pelvic fracture.You
decide to transfer this patient to a facility capable of providing a higher level of care.
The facility is 128 km (80 miles) away. Before transfer, you should first:
Answer: call the receiving hospital and speak to the surgeon on call
5. Hemorrhage of 20% of the patient's blood volume is associated usually with
Answer: tachycardia
6. What statement concerning intraosseous infusion is TRUE?
Answer: Aspiration of bone marrow confirms appropriate positioning of the needle.
7. A young woman sustains a severe head injury as the result of a motor vehicle
crash. In the emergency department, her GCS is 6. Her blood pressure is 140/90 mm
Hg and her heart rate is 80 beats per minute. She is intubated and mechanically
ventilated. Her pupils are 3 mm in size and equally reactive to light.There is no
,other apparent injury.The most important principle to follow in the early
management of her head injury is to
Answer: avoid hypotension
8. A 33-year-old woman is involved in a head-on motor vehicle crash. It took 30
minutes to extricate her from the car. Upon arrival in the emergency department, her
heart rate is 120 beats per minute, BP is 90/70 mm Hg, respiratory rate is 16 breaths
per minute, and her GCS score is 15. Examination reveals bilaterally equal breath
sounds, anterior chest wall ecchymosis, and distended neck veins. Her abdomen is
flat, soft, and not tender. Her pelvis is stable. Palpable distal pulses are found in all 4
extremities. Of the following, the most likely diagnosis is:
Answer: cardiac tamponade
9. A hemodynamically normal 10-year-old girl is hospitalized for observation after
a Grade III (moderately severe) splenic injury has been confirmed by computed
tomography (CT).What mandates prompt celiotomy (laparotomy)?-
Answer: development of peritonitis on physical exam
10. A 40-year-old woman who was a restrained driver in a motor vehicle crash is
evaluated in the emergency department. She is hemodynamically normal and found
to be paraplegic at the level of T10. What precaution should be taken during
evaluation and management?
Answer: Log rolling using 4 people is a safe approach to restrict spinal motion
when moving her.
11. A trauma patient presents to your emergency department with inspiratory stridor
and a suspected c-spine injury. Oxygen saturation is 88% on high-flow oxygen via a
nonrebreathing mask. The most appropriate next step is to:
Answer: re- strict cervical motion and establish a definitive airway
12. When applying the Rule of Nines to infants
Answer: The head is proportionally larger in infants than in adults
13. A healthy young male is brought to the emergency department following a motor
vehicle crash. His vital signs are a blood pressure of 84/60, pulse 123, GCS 10. The
patient moans when his pelvis is palpated. After initiating fluid resuscitation, the
next step in management is:
Answer: placement of a pelvic binder
14. What situations requires Rh immunoglobulin administration to an injured
woman?
Answer: positive pregnancy test, Rh negative, and has torso trauma
15. A 22-year-old female athlete is stabbed in her left chest at the third inter- space
in the anterior axillary line. On admission to the emergency department and 15
minutes after the incident, she is awake and alert. Her heart rate is 100 beats per
,minute, blood pressure 80/60 mm Hg, and respiratory rate 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:
Answer: prepare for an exploratory thoracotomy
16. A 6-year-old boy walking across the street is struck by the front bumper of a
sports utility vehicle traveling at 32 kph (20 mph). What's true about this patient?
Answer: A pulmonary contusion may be present in the absence of rib fractures.
17. Adjuncts used during the primary survey
Answer:
ECG Pulse ox
CO2 monitoringV Ventilatory rate ABGs
Foleys (UOP) Gastric catheter FAST or eFAST DPL
18. Urinary output is sensitive for
Answer: Patient's volume status and renal perfusion
19. "Golden hour"
Answer: The time from injury to definitive care, during which treatment of shock
and traumatic injuries should occur because survival potential is best; also called the
Golden Period.
20. Leading cause of trauma deaths worldwide
Answer: MVCs
21. Trimodal death distribution
Answer:
1st: seconds to minutes of injury (apnea)
2nd: minutes to several hours (EDH, SDH, liver lac, pelvic fractures, spleen ruptures)
3rd: several days to weeks after injury (sepsis and multi-organ failure)
22. 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:
Answer: re-examine the chest
23. A construction worker falls two stories from a building and sustains bilateral
calcaneal fractures. In the emergency department, he is alert, vital signs are normal,
and he is complaining of severe pain in both heels and his lower back. Lower
, extremity pulses are strong and there is no other deformity. The suspected diagnosis
is most likely to be confirmed by:
Answer: complete spine x-ray series
24. What is true regarding the initial resuscitation of a trauma patient?
Answer: Evidence of improved perfusion after fluid resuscitation could include
improvement in Glasgow Coma Scale score on reevaluation
25. In managing a patient with a severe traumatic brain injury, the most
importantinitial step is to:
Answer: secure the airway
26. A previously healthy, 70-kg (154-pound) man suffers an estimated acute
bloodloss of 2 liters. What applies to this patient?
Answer: An ABG would demonstrate a base deficit between -6 and -10 mEq/L.
27. The physiological hypervolemia of pregnancy has clinical significance in
themanagement of the severely injured, gravid woman by:
Answer: increasing the volume of blood loss to produce maternal hypotension.
28. The best assessment of fluid resuscitation of the adult burn patient is:
Answer: urinary output of 0.5 mL/kg/hr
29. The diagnosis of shock must include:
Answer: evidence of inadequate organ perfusion
30. A 7-year-old boy is brought to the emergency department by his parents
several minutes after he fell through a window. He is bleeding profusely from a 6-cm
woundof his medial right thigh. Immediate management of the wound should
consist of: Answer: direct pressure on the wound
31. For the patient with severe traumatic brain injury, profound hypocarbia should
be avoided to prevent:
Answer: cerebral vasoconstriction with diminished perfusion
32. After being involved in a motor vehicle crash, a 25-year-old man is brought to a
hospital that has surgery capabilities available.. Computed tomography of the chest
and abdomen shows an aortic injury and splenic laceration with free abdominal
fluid. His blood pressure falls to 70 mm Hg after CT. The next step is:
Answer: perform an exploratory laparotomy
33. What statements regarding abdominal trauma in the pregnant patient is TRUE?
Answer: Leakage of amniotic fluid is an indication for hospital admission.
34. The first maneuver to improve oxygenation after chest injury is:
Answer: administer supplemental oxygen
1. A 32-year-old man's right leg is trapped beneath his overturned car for nearly 2
hours before he is extricated. On arrival in the emergency department, his right lower
extremity is cool, mottled, insensate, and motionless. Despite normal vital signs,
pulses cannot be palpated below the right femoral artery and the muscles of the
lower extremity are firm and hard. During the management of this patient, what is
most likely to improve the chances for limb salvage?
Answer: surgical consultation for right lower extremity fasciotomy
2. A patient arrives in the emergency department after being beaten about the
head and face with a wooden club. He is comatose and has a palpable depressed
skull fracture. His face is swollen and ecchymotic. He has gurgling respirations and
vomitus on his face and clothing.The most appropriate step after providing
supplemental oxygen and elevating his jaw is to:
Answer: suction the oropharynx
3. A 22-year-old man sustains a gunshot wound to the left chest and is trans- ported
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:
Answer: repeat the primary survey and proceed with transfer
4. A 64-year-old man involved in a high-speed car crash, is resuscitated initially
in a small hospital without surgical capabilities. He has a closed head injury with a
GCS score of 13. He has a widened mediastinum on chest x-ray with fractures of
left ribs 2 through 4, but no pneumothorax. After initiating fluid resuscitation, his
blood pressure is 110/74 mm Hg, heart rate is 100 beats per minute, and respiratory
rate is 18 breaths per minute. He has gross hematuria and a pelvic fracture.You
decide to transfer this patient to a facility capable of providing a higher level of care.
The facility is 128 km (80 miles) away. Before transfer, you should first:
Answer: call the receiving hospital and speak to the surgeon on call
5. Hemorrhage of 20% of the patient's blood volume is associated usually with
Answer: tachycardia
6. What statement concerning intraosseous infusion is TRUE?
Answer: Aspiration of bone marrow confirms appropriate positioning of the needle.
7. A young woman sustains a severe head injury as the result of a motor vehicle
crash. In the emergency department, her GCS is 6. Her blood pressure is 140/90 mm
Hg and her heart rate is 80 beats per minute. She is intubated and mechanically
ventilated. Her pupils are 3 mm in size and equally reactive to light.There is no
,other apparent injury.The most important principle to follow in the early
management of her head injury is to
Answer: avoid hypotension
8. A 33-year-old woman is involved in a head-on motor vehicle crash. It took 30
minutes to extricate her from the car. Upon arrival in the emergency department, her
heart rate is 120 beats per minute, BP is 90/70 mm Hg, respiratory rate is 16 breaths
per minute, and her GCS score is 15. Examination reveals bilaterally equal breath
sounds, anterior chest wall ecchymosis, and distended neck veins. Her abdomen is
flat, soft, and not tender. Her pelvis is stable. Palpable distal pulses are found in all 4
extremities. Of the following, the most likely diagnosis is:
Answer: cardiac tamponade
9. A hemodynamically normal 10-year-old girl is hospitalized for observation after
a Grade III (moderately severe) splenic injury has been confirmed by computed
tomography (CT).What mandates prompt celiotomy (laparotomy)?-
Answer: development of peritonitis on physical exam
10. A 40-year-old woman who was a restrained driver in a motor vehicle crash is
evaluated in the emergency department. She is hemodynamically normal and found
to be paraplegic at the level of T10. What precaution should be taken during
evaluation and management?
Answer: Log rolling using 4 people is a safe approach to restrict spinal motion
when moving her.
11. A trauma patient presents to your emergency department with inspiratory stridor
and a suspected c-spine injury. Oxygen saturation is 88% on high-flow oxygen via a
nonrebreathing mask. The most appropriate next step is to:
Answer: re- strict cervical motion and establish a definitive airway
12. When applying the Rule of Nines to infants
Answer: The head is proportionally larger in infants than in adults
13. A healthy young male is brought to the emergency department following a motor
vehicle crash. His vital signs are a blood pressure of 84/60, pulse 123, GCS 10. The
patient moans when his pelvis is palpated. After initiating fluid resuscitation, the
next step in management is:
Answer: placement of a pelvic binder
14. What situations requires Rh immunoglobulin administration to an injured
woman?
Answer: positive pregnancy test, Rh negative, and has torso trauma
15. A 22-year-old female athlete is stabbed in her left chest at the third inter- space
in the anterior axillary line. On admission to the emergency department and 15
minutes after the incident, she is awake and alert. Her heart rate is 100 beats per
,minute, blood pressure 80/60 mm Hg, and respiratory rate 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:
Answer: prepare for an exploratory thoracotomy
16. A 6-year-old boy walking across the street is struck by the front bumper of a
sports utility vehicle traveling at 32 kph (20 mph). What's true about this patient?
Answer: A pulmonary contusion may be present in the absence of rib fractures.
17. Adjuncts used during the primary survey
Answer:
ECG Pulse ox
CO2 monitoringV Ventilatory rate ABGs
Foleys (UOP) Gastric catheter FAST or eFAST DPL
18. Urinary output is sensitive for
Answer: Patient's volume status and renal perfusion
19. "Golden hour"
Answer: The time from injury to definitive care, during which treatment of shock
and traumatic injuries should occur because survival potential is best; also called the
Golden Period.
20. Leading cause of trauma deaths worldwide
Answer: MVCs
21. Trimodal death distribution
Answer:
1st: seconds to minutes of injury (apnea)
2nd: minutes to several hours (EDH, SDH, liver lac, pelvic fractures, spleen ruptures)
3rd: several days to weeks after injury (sepsis and multi-organ failure)
22. 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:
Answer: re-examine the chest
23. A construction worker falls two stories from a building and sustains bilateral
calcaneal fractures. In the emergency department, he is alert, vital signs are normal,
and he is complaining of severe pain in both heels and his lower back. Lower
, extremity pulses are strong and there is no other deformity. The suspected diagnosis
is most likely to be confirmed by:
Answer: complete spine x-ray series
24. What is true regarding the initial resuscitation of a trauma patient?
Answer: Evidence of improved perfusion after fluid resuscitation could include
improvement in Glasgow Coma Scale score on reevaluation
25. In managing a patient with a severe traumatic brain injury, the most
importantinitial step is to:
Answer: secure the airway
26. A previously healthy, 70-kg (154-pound) man suffers an estimated acute
bloodloss of 2 liters. What applies to this patient?
Answer: An ABG would demonstrate a base deficit between -6 and -10 mEq/L.
27. The physiological hypervolemia of pregnancy has clinical significance in
themanagement of the severely injured, gravid woman by:
Answer: increasing the volume of blood loss to produce maternal hypotension.
28. The best assessment of fluid resuscitation of the adult burn patient is:
Answer: urinary output of 0.5 mL/kg/hr
29. The diagnosis of shock must include:
Answer: evidence of inadequate organ perfusion
30. A 7-year-old boy is brought to the emergency department by his parents
several minutes after he fell through a window. He is bleeding profusely from a 6-cm
woundof his medial right thigh. Immediate management of the wound should
consist of: Answer: direct pressure on the wound
31. For the patient with severe traumatic brain injury, profound hypocarbia should
be avoided to prevent:
Answer: cerebral vasoconstriction with diminished perfusion
32. After being involved in a motor vehicle crash, a 25-year-old man is brought to a
hospital that has surgery capabilities available.. Computed tomography of the chest
and abdomen shows an aortic injury and splenic laceration with free abdominal
fluid. His blood pressure falls to 70 mm Hg after CT. The next step is:
Answer: perform an exploratory laparotomy
33. What statements regarding abdominal trauma in the pregnant patient is TRUE?
Answer: Leakage of amniotic fluid is an indication for hospital admission.
34. The first maneuver to improve oxygenation after chest injury is:
Answer: administer supplemental oxygen
