ATLS combined with latest questions and
answers
Which of the following is the recommended Method for trestemt frostbite?
A. Vasodilators
B. Anticigulants
C. Warm (40 degrees) water
D. Padding and elevation
E. Application of heat from a hairdryer - ANSWER-C. Warm (40 degrees) water
Which of the following physical findings suggest a cause of hypotension other than spinal cord injury?
A. Prispism
B. Bradycardia
C. Diaphragmatic breathing
D. Presence of deep tendon reflexes
E. Ability to flex forearms but not extend them - ANSWER-D. Presence of deep tendon reflexes. Spinal
shock refers to loss of muscle toe (flaccidty) and loss of reflexes.
The primary indication for transferring A patient to a higher level trauma center is:
A. Unavailibility of surgeon or operating staff
B. Multiple system injuries, including severe head injury
C. Resource limitations as determined by the transferring doctor
D. Resource limitations as determined by the hospital administration
E. Widened mediastinum on chest x-ray following blunt trauma - ANSWER-C. Resource limitations as
determined by the transferring doctor (MÅ SJEKKES)
A young man sustains a rifle wound to the mid-abdomen. He is brought promptly to the ED by
prehospital personnel. His skin is cool and diaphoretic, and his systolic blood pressure is 58mmHg.
Warmed crystalloid fluids are initiated without improvement in his vital signs. The next, most
appropriate, step is to perform:
A. a laparotomy
B. An abdominal CT-scan
C. Diagnostic laparoscopy
D. Abdominal ultrasonography
E. A diagnostic peritoneal lavage - ANSWER-A. Laparotomy because of hemodynamic abnormality
A 42-year-old man is trapped from the waist down beneath his overturned tractor for several hours
before medical assistance arrives. He is awake and alert until just before arriving in the ED. He is now
unconscious and responds only to painful stimuli by moaning. His pupils are 3mm in diameter and
symmetrically reactive to light. Prehospital personnel indicate that they have not seen the patient
move either of his lower extremities. On examination in the ED, no movement of his lower
extremities are detected, even in response to painful stimuli. The most likely cause for this finding is:
A. An epidural hematoma
B. A pelvic fracture
C. Central cord syndrome
D. Intracerebral hemorrhage
E. Bilateral compartment syndrome - ANSWER-MÅ SJEKKES
A 6-year-o boy is struck by an automobile and brought to the ED. He is lethargic, but withdraws
purposefully from painful stimuli. His blood pressure is 90mmHg systolic, heart rate 140 beats per
,minute and his respiratory rate is 36 breaths per minute. The preferred route of venous access in this
patient is:
A. Percutaneous femoral vein cannulation
B. Cutdown on the saphenous vein at the ankle
C. Intraosseous catheter placement in the proximal tibia
D. Percutaneous peripheral veins in the upper extremities
E. Central venous access via the subclavian or internal jugular vein - ANSWER-D. Percutaneous
peripheral veins in the upper extremities
A young man sustains a gunshot wound to the abdomen and is brought promptly to the ED by
prehospital personnel. His skin is cool and diaphoretic, and he is confused. His pulse is thready and his
femoral pulse is only weakly palpable. The definitive treatment in managing this patient is to:
A. Administer O-negative blood
B. Apply external warming devices
C. Control internal hemorrhage operatively
D. Apply a pneumatic antishock garment (PASG)
E. Infuse large volumes of intravenous crystalloid solutions. - ANSWER-C. Control internal hemorrhage
operatively
Regarding shock in the child, which of the following is FALSE?
A. Vital signs are age-related
B. Children have greater physiologic reserves than do adults
C. Tachycardia is the primary physiologic response to hypovolemia
D. The absolute volume of blood loss required to produce shock is the same as in adults
E. An initial fluid bolus for resuscitation should approximate 20ml/kg Ringers Lactate - ANSWER-D. The
absolute volume of blood loss required to produce shock is the same as in adults
A 33-year-old man is struck by a car travelling at 56km/h (35mph). He has obvious fractures of the left
tibia near the knee, pain in the pelvic area, and severe dyspnea. His heart rate is 182 beats per minute,
and his respiratory rate is 48 breaths per minute with no breath sounds heard in the left chest. A
tension pneumothorax is relieved by immediate needle decompression and tube thoracostomy.
Subsequently, his heart rate decreases to 144 beats per minute, his respirartory rate decreases to 36
breaths per minute and his blood pressure is 81/53 mmHg. Warmed Ringers lactate is adminstered
intravenously. The next priority should be to:
A. Perform external fixation of the pelvis
B. Obtain abdominal and pelvic CT-scans
C. Perform arterial embolization of the pelvic vessel
D. Perform diagnostic peritoneal lavage or FAST
E. Perform a urethrogram and cystogram - ANSWER-D. Perform diagnostic peritoneal lavage or FAST
A 42-year-old man, injured in a motor vehicle crash, suffers a closed head injury, multiple palpable
left rib fractures, and bilateral femur fractures. He is intubated orotracheally without difficulty.
Initially, his ventilations are easily assisted with a bag-mask device. It becomes more difficult to
ventilate the patient over the next 5 minutes, and his hemoglobin oxygen saturation level decreases
from 98% to 89%. The most appropriate next step is to:
A. Obtain a chest x-ray
B. Decrease the tidal volume
C. Decrease PEEP
D. Increase the rate of assisted ventilations
E. Perform needle decompression of the left chest. - ANSWER-A. Obtain a chest x-ray (MÅ SJEKKES)
A 30-year-old man sustains a severely comminuted, open, distal right femur fracture in a motorcycle
crash. The wound is actively bleeding. Normal sensation is present over the lateral aspect of the foot
but decreased over the medial foot and great toe. Normal motion of the foot is observed. Dorsalis
pedis and posterior tibial pulses are easily palpable on the left, but heard only by Doppler on the right.
Immediate efforts to improve circulation to the injured extremity should involve:
A. Immediate angiography
,B. Tamponade of the wound with a pressure dressing
C. Wound exploration and removal of bony fragments
D. Realignment of the fracture segments with a traction splint
E. Fasciotomy of all four compartments in the lower extremity - ANSWER-B. Tamponade of the wound
with a pressure dressing
An 18-yeard-old, unhelmeted motorcyclist is brought by ambulance to the ED following a crash. He
had decreased level of consciousness at the scene, but then was alert and conversational during
transportation. Now his GCS is only 11. Which of the following statements is TRUE?
A. Cerebral perfusion is intact
B. Intravascular volume status is normal
C. The patient is in a postictal state
D. Intra-abdominal visceral injury is unlikely
E. The patient probably has an acute epidural hematoma - ANSWER-E. The patient probably has an
acute epidural hematoma
A previously healthy, 70kg (175 pound) man suffers an estimated acute blood loss of two liters. Which
one of the following statements apply to this patient?
A. His pulse pressure will be widened
B. His urinary output will be at the lower limits of normal
C. He will have tachycardia, but no change in systolic blood pressure
D. His systolic blood pressure will be decreased with a narrowed, pulse pressure
E. His systolic blood pressure will be maintained with an elevated diastolic pressure. - ANSWER-E. His
systolic blood pressure will be maintained with an elevated diastolic pressure.
The physioclogic hypervolemia of pregnancy has clinical significance in the management of the
severely injured gravid woman by
A. Reducing the need for blood transfusion
B. Increasing the risk of pulmonary edema
C. Complicating the management of closed head injury
D. Increasing the volume of blood loss to produce shock/maternal hypotension
E. Reducing the volume of crystalloid required for resuscitation - ANSWER-D. Increasing the volume of
blood loss to produce shock
A 17-year-old helmeted motorcyclist loses consciousness when he is struck broad side by an
automobile at an intersection. He arrives in the ED with a blood pressure of 140/92, pulse rate 88
beats per minute, a respiratory rate of 18 breaths per minue, and a GCS of 7. Appropriate initial
immobilization of this patient should include a semi-rigid cervical collar and:
A. A scoop stretcher
B. A long spine board
C. A short spine board
D. Cervical traction tongs
E. Pneumatic antishock garment - ANSWER-B. A long spine board
During an altercation, a 36-year-old man sustains a gunshot wound above the nipple line on the right,
with an exit wound posteriorly above the scapula on the right. He is transported by ambulance to a
community hospital. He is endotracheally intubated, close tube thoracostomy is performed, and 2
liters Ringers lactate solution are infused via 2 large-caliber IV´s. His blood pressure now is 60/0mmHg,
heart rate is 160 beats per minute, and respiratory rate is 14 breaths per minute (ventilated with
100% O2). The most appropriate next step in managin this patient is:
A. Laparotomy
B. Diagnostic peritoneal lavage
C. Arterial blood gas determination
D. Administer packed red blood cells
E. Chest X-ray to confirm tube placement - ANSWER-E. Chest X-ray to confirm tube placement
, Abscence of breath sounds and dullness to percussion over the left hemithorax are findings best
explained by:
A. Left hemothorax
B. Cardiac contusion
C. Left simple pneumothorax
D. Left diaphragmatic rupture
E. Right tension pneumothorax - ANSWER-A. Left hemothorax
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 diagnostic peritoneal lavage
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 - ANSWER-D. Transfer the
patient to the operating room, while initiating fluid therapy
A teen-aged bicycle rider is hit by a truck traveling at high speed. In the ED, she is actively bleeding
from open fractures of her legs, and has abrasions on her chest and abdominal wall. Her blood
pressure is 80/50 mmHg, heart rate is 140 beats per minute, respiratory rate is 8 breaths per minute,
and GCS score is 6. The first step in managing this patient is to:
A. Obtain a lateral cervical spine x-ray
B. Insert av central venous pressure line
C. Adminster 2 liters of crystalloid solution
D. Perform endotracheal intubation and ventilation
E. Apply a pneumatic antishock garment (PASG) and inflate the leg compartments. - ANSWER-D.
Perform endotracheal intubation and ventilation
An 8-year-old boy falls 4,5 meters (15 feet) from a tree and is brought to the ED by his family. His vital
signs are normal, but he complains of left upper quadrant pain. An abdominal CT-scan reveals a
moderately severe laceration of the spleen. The receiving institution does not have 24-hour-a-day
operating room capabilities. The most appropriate management of this patient would be to
A. Type and crossmatch for blood
B. Request consultation of a pediatrician
C. Transfer the patient to a trauma center
D. Admit the patient to the intensive care unit
E. Prepare the patient for surgery the next day - ANSWER-D. Admit the patient to the intensive care
unit
Which of the following statements regarding injury to the central nervous system in children is TRUE?
A. Children suffer spinal cord injury without x-ray abnormality more commonly than adults.
B. An infant with a traumatic brain injury may become hypotensive from cerebral edema
C. Initial therapy for the child with traumatic brain injury includes the administration of
methylprednisolone intravenously
D. Children have more focal mass lesions as a result for traumatic brain injury when compared to
adults.
E. Young children are less tolerant of expanding intracranial mass lesions than adults - ANSWER-A.
Children suffer spinal cord injury without x-ray abnormality more commonly than adults.
A 17-year-old helmeted motorcyclist is struck broadside by an automobile at an intersection. He is
unconscious at the scene with a blood pressure of 140/90mmHg, heart rate of 90 beats per minute,
and respiratory rate of 22 breaths per minute. His respirations are sonorous and deep. His GCS score
is 6. Immobilization of the entire patient may include the use of all the following EXCEPT:
A. Air splints
B. Bolstering devices
answers
Which of the following is the recommended Method for trestemt frostbite?
A. Vasodilators
B. Anticigulants
C. Warm (40 degrees) water
D. Padding and elevation
E. Application of heat from a hairdryer - ANSWER-C. Warm (40 degrees) water
Which of the following physical findings suggest a cause of hypotension other than spinal cord injury?
A. Prispism
B. Bradycardia
C. Diaphragmatic breathing
D. Presence of deep tendon reflexes
E. Ability to flex forearms but not extend them - ANSWER-D. Presence of deep tendon reflexes. Spinal
shock refers to loss of muscle toe (flaccidty) and loss of reflexes.
The primary indication for transferring A patient to a higher level trauma center is:
A. Unavailibility of surgeon or operating staff
B. Multiple system injuries, including severe head injury
C. Resource limitations as determined by the transferring doctor
D. Resource limitations as determined by the hospital administration
E. Widened mediastinum on chest x-ray following blunt trauma - ANSWER-C. Resource limitations as
determined by the transferring doctor (MÅ SJEKKES)
A young man sustains a rifle wound to the mid-abdomen. He is brought promptly to the ED by
prehospital personnel. His skin is cool and diaphoretic, and his systolic blood pressure is 58mmHg.
Warmed crystalloid fluids are initiated without improvement in his vital signs. The next, most
appropriate, step is to perform:
A. a laparotomy
B. An abdominal CT-scan
C. Diagnostic laparoscopy
D. Abdominal ultrasonography
E. A diagnostic peritoneal lavage - ANSWER-A. Laparotomy because of hemodynamic abnormality
A 42-year-old man is trapped from the waist down beneath his overturned tractor for several hours
before medical assistance arrives. He is awake and alert until just before arriving in the ED. He is now
unconscious and responds only to painful stimuli by moaning. His pupils are 3mm in diameter and
symmetrically reactive to light. Prehospital personnel indicate that they have not seen the patient
move either of his lower extremities. On examination in the ED, no movement of his lower
extremities are detected, even in response to painful stimuli. The most likely cause for this finding is:
A. An epidural hematoma
B. A pelvic fracture
C. Central cord syndrome
D. Intracerebral hemorrhage
E. Bilateral compartment syndrome - ANSWER-MÅ SJEKKES
A 6-year-o boy is struck by an automobile and brought to the ED. He is lethargic, but withdraws
purposefully from painful stimuli. His blood pressure is 90mmHg systolic, heart rate 140 beats per
,minute and his respiratory rate is 36 breaths per minute. The preferred route of venous access in this
patient is:
A. Percutaneous femoral vein cannulation
B. Cutdown on the saphenous vein at the ankle
C. Intraosseous catheter placement in the proximal tibia
D. Percutaneous peripheral veins in the upper extremities
E. Central venous access via the subclavian or internal jugular vein - ANSWER-D. Percutaneous
peripheral veins in the upper extremities
A young man sustains a gunshot wound to the abdomen and is brought promptly to the ED by
prehospital personnel. His skin is cool and diaphoretic, and he is confused. His pulse is thready and his
femoral pulse is only weakly palpable. The definitive treatment in managing this patient is to:
A. Administer O-negative blood
B. Apply external warming devices
C. Control internal hemorrhage operatively
D. Apply a pneumatic antishock garment (PASG)
E. Infuse large volumes of intravenous crystalloid solutions. - ANSWER-C. Control internal hemorrhage
operatively
Regarding shock in the child, which of the following is FALSE?
A. Vital signs are age-related
B. Children have greater physiologic reserves than do adults
C. Tachycardia is the primary physiologic response to hypovolemia
D. The absolute volume of blood loss required to produce shock is the same as in adults
E. An initial fluid bolus for resuscitation should approximate 20ml/kg Ringers Lactate - ANSWER-D. The
absolute volume of blood loss required to produce shock is the same as in adults
A 33-year-old man is struck by a car travelling at 56km/h (35mph). He has obvious fractures of the left
tibia near the knee, pain in the pelvic area, and severe dyspnea. His heart rate is 182 beats per minute,
and his respiratory rate is 48 breaths per minute with no breath sounds heard in the left chest. A
tension pneumothorax is relieved by immediate needle decompression and tube thoracostomy.
Subsequently, his heart rate decreases to 144 beats per minute, his respirartory rate decreases to 36
breaths per minute and his blood pressure is 81/53 mmHg. Warmed Ringers lactate is adminstered
intravenously. The next priority should be to:
A. Perform external fixation of the pelvis
B. Obtain abdominal and pelvic CT-scans
C. Perform arterial embolization of the pelvic vessel
D. Perform diagnostic peritoneal lavage or FAST
E. Perform a urethrogram and cystogram - ANSWER-D. Perform diagnostic peritoneal lavage or FAST
A 42-year-old man, injured in a motor vehicle crash, suffers a closed head injury, multiple palpable
left rib fractures, and bilateral femur fractures. He is intubated orotracheally without difficulty.
Initially, his ventilations are easily assisted with a bag-mask device. It becomes more difficult to
ventilate the patient over the next 5 minutes, and his hemoglobin oxygen saturation level decreases
from 98% to 89%. The most appropriate next step is to:
A. Obtain a chest x-ray
B. Decrease the tidal volume
C. Decrease PEEP
D. Increase the rate of assisted ventilations
E. Perform needle decompression of the left chest. - ANSWER-A. Obtain a chest x-ray (MÅ SJEKKES)
A 30-year-old man sustains a severely comminuted, open, distal right femur fracture in a motorcycle
crash. The wound is actively bleeding. Normal sensation is present over the lateral aspect of the foot
but decreased over the medial foot and great toe. Normal motion of the foot is observed. Dorsalis
pedis and posterior tibial pulses are easily palpable on the left, but heard only by Doppler on the right.
Immediate efforts to improve circulation to the injured extremity should involve:
A. Immediate angiography
,B. Tamponade of the wound with a pressure dressing
C. Wound exploration and removal of bony fragments
D. Realignment of the fracture segments with a traction splint
E. Fasciotomy of all four compartments in the lower extremity - ANSWER-B. Tamponade of the wound
with a pressure dressing
An 18-yeard-old, unhelmeted motorcyclist is brought by ambulance to the ED following a crash. He
had decreased level of consciousness at the scene, but then was alert and conversational during
transportation. Now his GCS is only 11. Which of the following statements is TRUE?
A. Cerebral perfusion is intact
B. Intravascular volume status is normal
C. The patient is in a postictal state
D. Intra-abdominal visceral injury is unlikely
E. The patient probably has an acute epidural hematoma - ANSWER-E. The patient probably has an
acute epidural hematoma
A previously healthy, 70kg (175 pound) man suffers an estimated acute blood loss of two liters. Which
one of the following statements apply to this patient?
A. His pulse pressure will be widened
B. His urinary output will be at the lower limits of normal
C. He will have tachycardia, but no change in systolic blood pressure
D. His systolic blood pressure will be decreased with a narrowed, pulse pressure
E. His systolic blood pressure will be maintained with an elevated diastolic pressure. - ANSWER-E. His
systolic blood pressure will be maintained with an elevated diastolic pressure.
The physioclogic hypervolemia of pregnancy has clinical significance in the management of the
severely injured gravid woman by
A. Reducing the need for blood transfusion
B. Increasing the risk of pulmonary edema
C. Complicating the management of closed head injury
D. Increasing the volume of blood loss to produce shock/maternal hypotension
E. Reducing the volume of crystalloid required for resuscitation - ANSWER-D. Increasing the volume of
blood loss to produce shock
A 17-year-old helmeted motorcyclist loses consciousness when he is struck broad side by an
automobile at an intersection. He arrives in the ED with a blood pressure of 140/92, pulse rate 88
beats per minute, a respiratory rate of 18 breaths per minue, and a GCS of 7. Appropriate initial
immobilization of this patient should include a semi-rigid cervical collar and:
A. A scoop stretcher
B. A long spine board
C. A short spine board
D. Cervical traction tongs
E. Pneumatic antishock garment - ANSWER-B. A long spine board
During an altercation, a 36-year-old man sustains a gunshot wound above the nipple line on the right,
with an exit wound posteriorly above the scapula on the right. He is transported by ambulance to a
community hospital. He is endotracheally intubated, close tube thoracostomy is performed, and 2
liters Ringers lactate solution are infused via 2 large-caliber IV´s. His blood pressure now is 60/0mmHg,
heart rate is 160 beats per minute, and respiratory rate is 14 breaths per minute (ventilated with
100% O2). The most appropriate next step in managin this patient is:
A. Laparotomy
B. Diagnostic peritoneal lavage
C. Arterial blood gas determination
D. Administer packed red blood cells
E. Chest X-ray to confirm tube placement - ANSWER-E. Chest X-ray to confirm tube placement
, Abscence of breath sounds and dullness to percussion over the left hemithorax are findings best
explained by:
A. Left hemothorax
B. Cardiac contusion
C. Left simple pneumothorax
D. Left diaphragmatic rupture
E. Right tension pneumothorax - ANSWER-A. Left hemothorax
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 diagnostic peritoneal lavage
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 - ANSWER-D. Transfer the
patient to the operating room, while initiating fluid therapy
A teen-aged bicycle rider is hit by a truck traveling at high speed. In the ED, she is actively bleeding
from open fractures of her legs, and has abrasions on her chest and abdominal wall. Her blood
pressure is 80/50 mmHg, heart rate is 140 beats per minute, respiratory rate is 8 breaths per minute,
and GCS score is 6. The first step in managing this patient is to:
A. Obtain a lateral cervical spine x-ray
B. Insert av central venous pressure line
C. Adminster 2 liters of crystalloid solution
D. Perform endotracheal intubation and ventilation
E. Apply a pneumatic antishock garment (PASG) and inflate the leg compartments. - ANSWER-D.
Perform endotracheal intubation and ventilation
An 8-year-old boy falls 4,5 meters (15 feet) from a tree and is brought to the ED by his family. His vital
signs are normal, but he complains of left upper quadrant pain. An abdominal CT-scan reveals a
moderately severe laceration of the spleen. The receiving institution does not have 24-hour-a-day
operating room capabilities. The most appropriate management of this patient would be to
A. Type and crossmatch for blood
B. Request consultation of a pediatrician
C. Transfer the patient to a trauma center
D. Admit the patient to the intensive care unit
E. Prepare the patient for surgery the next day - ANSWER-D. Admit the patient to the intensive care
unit
Which of the following statements regarding injury to the central nervous system in children is TRUE?
A. Children suffer spinal cord injury without x-ray abnormality more commonly than adults.
B. An infant with a traumatic brain injury may become hypotensive from cerebral edema
C. Initial therapy for the child with traumatic brain injury includes the administration of
methylprednisolone intravenously
D. Children have more focal mass lesions as a result for traumatic brain injury when compared to
adults.
E. Young children are less tolerant of expanding intracranial mass lesions than adults - ANSWER-A.
Children suffer spinal cord injury without x-ray abnormality more commonly than adults.
A 17-year-old helmeted motorcyclist is struck broadside by an automobile at an intersection. He is
unconscious at the scene with a blood pressure of 140/90mmHg, heart rate of 90 beats per minute,
and respiratory rate of 22 breaths per minute. His respirations are sonorous and deep. His GCS score
is 6. Immobilization of the entire patient may include the use of all the following EXCEPT:
A. Air splints
B. Bolstering devices
