ATLS Review Exam – Updated Questions
& Solutions 2025 (100% Verified)
Why does shock actually reduce the total volume of circulating blood? - ANSWER -
Anaerobic metabolism --> can't make more ATP --> Endoplasmic then mitochondrial
damage --> lysosomes rupture --> sodium and WATER enter the cell, which SWELLS
and dies.
Which vasopressors should you use to treat hemorrhagic shock? What are the drug
doses? - ANSWER - NEVER use pressors for hypovolemic shock - use VOLUME
replacement. Pressors will worsen tissue perfusion in hemorrhagic shock.
Compensatory mechanisms may preclude a measurable fall in systolic blood pressure
until up to __% of the patient's blood volume is lost. - ANSWER - 30
Any patient who is cool and is tachycardic is considered to be ______ until proven
otherwise. - ANSWER - in shock
The definition of tachycardia depends on the patient's age. What heart rate is
considered tachycardic for infants, toddlers/preschoolers, school age/prebuscent, and
adults? - ANSWER - Infants >160, toddlers/preschoolers >140, school age/prebuscent
>120, adults >100
Elderly patients may not exhibit tachycardia in response to hypovolemia because of
limited cardiac response to catecholamines. Why else might not they get tachy? -
ANSWER - They might be on a beta-blocker or have a pacemaker.
A FAST scan is an excellent way to diagnose cardiac tamponade. What signs suggest
tamponade? - ANSWER - Becks's Triad: JVD, muffled heart sounds, and hypotension
(will be resistant to fluid therapy). Will also likely be tachycardic.
Patients with a tension pneumo and patients with cardiac tamponade may present with
many of the same signs. What findings will you see with a tension pneumo that you will
NOT see with tamponade? - ANSWER - Absent breath sounds and hyperresonance to
percussion over the affected hemithorax.
Immediate thoracic decompression is warranted for anyone with absent breath sounds,
hyperresonance to percussion, tracheal deviation, ____, and ____. - ANSWER - Acute
respiratory distress & subcutaneous emphysema
Can isolated intracranial injuries cause neurogenic shock? - ANSWER - NO
,How do you calculate total blood volume in an adult? - ANSWER - 70 mL per kg body
weight. A 70 kg person has about 5 liters of circulating blood. (70*70=4900)
How do you calculate total blood volume in an child? - ANSWER - Body weight in kg x
80-90 mL
The blood volume of an obese person is calculated based upon their ______ weight. -
ANSWER - ideal
Fluid replacement should be guided by ________, not simply by the initial classification
(Class I-IV). - ANSWER - The patient's response to initial replacment
How much blood volume is lost with Class I Hemorrhage? - ANSWER - Up to 15%
Donating 1 pint, or ~500 mL of blood is about a 10% volume loss and would qualify as
Class I Hemorrhage!
How do you treat a Class I Hemorrhage? - ANSWER - You don't (usually).
Transcapillary refill and other compensatory mechanisms usually restore blood volume
within 24 hours.
How much blood volume is lost with Class II Hemorrhage? - ANSWER - 15-30% (750-
1500 mL in a 70 kg adult)
How do you treat a Class II Hemorrhage? - ANSWER - Usually just crystalloid
resuscitation
Subtle CNS changes such as anxiety, fright, and hostility would be expected in a patient
with a Class __ Hemorrhage. - ANSWER - II
How much blood volume is lost with Class III Hemorrhage? - ANSWER - 30-40% (2000
mL in a 70 kg adult)
A patient with inadequate perfusion, marked tachycardia and tachypnea, significant
mental status change, and a measurable fall in systolic blood pressure likely has a
Class ___ Hemorrhage. - ANSWER - III or IV - These patients almost always require a
blood transfusion, which depends on their response to initial fluid resuscitation. The first
priority is stopping the hemorrhage.
Loss of more than ___% of blood volume results in loss of consciousness. - ANSWER -
50
How much blood volume is lost with Class IV Hemorrhage? - ANSWER - More than
40%. Unless very aggressive measures are taken the patient will die within minutes.
A Class ___ Hemorrhage represents the smallest volume of blood loss that is
consistently associated wiht a drop in systolic blood pressure. - ANSWER - III
, Up to ______ mL of blood loss is commonly associated with femur fractures. -
ANSWER - 1500
Unexplained hypotension or cardiac dysrhythmias (usually bradycardia from excessive
vagal stimulation) are often caused by ______, especially in children. - ANSWER -
gastric distention
Patients with a GSC of less than ___ usually require intubation. - ANSWER - 8
The "A" in ABCD stands for _______. - ANSWER - Airway maintenance with
CERVICAL SPINE PROTECTION
You should assume that any patient in a multisystem trauma with an altered level of
consciousness or blunt injury above the clavicle has what type of injury? - ANSWER -
Cervical spine injury
Flail chest is invariably accompanied by ______ which can interfere with blood
oxygenation. - ANSWER - pulmonary contusion - do NOT over fluid resuscitate these
patients!
Hypotension is caused by _____ until proven otherwise. - ANSWER - hypovolemia
When you don't have/can't get a blood pressure, what are three things to look for when
evaluating perfusion. - ANSWER - 1. Level of consciousness (brain perfusion), 2. Skin
color (ashen face/grey extremities) 3. Pulse (bilateral femoral - thready/tachy)
Elderly patients have a limited ability to ______ to compensate for blood loss. -
ANSWER - increase heart rate
Resuscitation fluids should be warmed 39 degrees Celsius (102.2 F). Can you use a
microwave to do this? - ANSWER - YES - for CRYSTALLOID ONLY (but NOT for blood
products).
Urinary catheters are good for assessing renal perfusion and volume status. List 5 signs
of urethral injury that might prevent you from inserting one. - ANSWER - Blood at
urethral meatus, perineal ecchymosis, blood in scrotum, high-riding/non-palpable
prostate, pelvic fracture
Which arm should you NOT put a pulse-ox on? - ANSWER - The arm with a blood
pressure cuff on it
Name two anatomical things that can interfere with doing a FAST scan. - ANSWER -
Obesity & intraluminal bowel gas
When should radiographs be obtained? - ANSWER - During the SECONDARY survey.
& Solutions 2025 (100% Verified)
Why does shock actually reduce the total volume of circulating blood? - ANSWER -
Anaerobic metabolism --> can't make more ATP --> Endoplasmic then mitochondrial
damage --> lysosomes rupture --> sodium and WATER enter the cell, which SWELLS
and dies.
Which vasopressors should you use to treat hemorrhagic shock? What are the drug
doses? - ANSWER - NEVER use pressors for hypovolemic shock - use VOLUME
replacement. Pressors will worsen tissue perfusion in hemorrhagic shock.
Compensatory mechanisms may preclude a measurable fall in systolic blood pressure
until up to __% of the patient's blood volume is lost. - ANSWER - 30
Any patient who is cool and is tachycardic is considered to be ______ until proven
otherwise. - ANSWER - in shock
The definition of tachycardia depends on the patient's age. What heart rate is
considered tachycardic for infants, toddlers/preschoolers, school age/prebuscent, and
adults? - ANSWER - Infants >160, toddlers/preschoolers >140, school age/prebuscent
>120, adults >100
Elderly patients may not exhibit tachycardia in response to hypovolemia because of
limited cardiac response to catecholamines. Why else might not they get tachy? -
ANSWER - They might be on a beta-blocker or have a pacemaker.
A FAST scan is an excellent way to diagnose cardiac tamponade. What signs suggest
tamponade? - ANSWER - Becks's Triad: JVD, muffled heart sounds, and hypotension
(will be resistant to fluid therapy). Will also likely be tachycardic.
Patients with a tension pneumo and patients with cardiac tamponade may present with
many of the same signs. What findings will you see with a tension pneumo that you will
NOT see with tamponade? - ANSWER - Absent breath sounds and hyperresonance to
percussion over the affected hemithorax.
Immediate thoracic decompression is warranted for anyone with absent breath sounds,
hyperresonance to percussion, tracheal deviation, ____, and ____. - ANSWER - Acute
respiratory distress & subcutaneous emphysema
Can isolated intracranial injuries cause neurogenic shock? - ANSWER - NO
,How do you calculate total blood volume in an adult? - ANSWER - 70 mL per kg body
weight. A 70 kg person has about 5 liters of circulating blood. (70*70=4900)
How do you calculate total blood volume in an child? - ANSWER - Body weight in kg x
80-90 mL
The blood volume of an obese person is calculated based upon their ______ weight. -
ANSWER - ideal
Fluid replacement should be guided by ________, not simply by the initial classification
(Class I-IV). - ANSWER - The patient's response to initial replacment
How much blood volume is lost with Class I Hemorrhage? - ANSWER - Up to 15%
Donating 1 pint, or ~500 mL of blood is about a 10% volume loss and would qualify as
Class I Hemorrhage!
How do you treat a Class I Hemorrhage? - ANSWER - You don't (usually).
Transcapillary refill and other compensatory mechanisms usually restore blood volume
within 24 hours.
How much blood volume is lost with Class II Hemorrhage? - ANSWER - 15-30% (750-
1500 mL in a 70 kg adult)
How do you treat a Class II Hemorrhage? - ANSWER - Usually just crystalloid
resuscitation
Subtle CNS changes such as anxiety, fright, and hostility would be expected in a patient
with a Class __ Hemorrhage. - ANSWER - II
How much blood volume is lost with Class III Hemorrhage? - ANSWER - 30-40% (2000
mL in a 70 kg adult)
A patient with inadequate perfusion, marked tachycardia and tachypnea, significant
mental status change, and a measurable fall in systolic blood pressure likely has a
Class ___ Hemorrhage. - ANSWER - III or IV - These patients almost always require a
blood transfusion, which depends on their response to initial fluid resuscitation. The first
priority is stopping the hemorrhage.
Loss of more than ___% of blood volume results in loss of consciousness. - ANSWER -
50
How much blood volume is lost with Class IV Hemorrhage? - ANSWER - More than
40%. Unless very aggressive measures are taken the patient will die within minutes.
A Class ___ Hemorrhage represents the smallest volume of blood loss that is
consistently associated wiht a drop in systolic blood pressure. - ANSWER - III
, Up to ______ mL of blood loss is commonly associated with femur fractures. -
ANSWER - 1500
Unexplained hypotension or cardiac dysrhythmias (usually bradycardia from excessive
vagal stimulation) are often caused by ______, especially in children. - ANSWER -
gastric distention
Patients with a GSC of less than ___ usually require intubation. - ANSWER - 8
The "A" in ABCD stands for _______. - ANSWER - Airway maintenance with
CERVICAL SPINE PROTECTION
You should assume that any patient in a multisystem trauma with an altered level of
consciousness or blunt injury above the clavicle has what type of injury? - ANSWER -
Cervical spine injury
Flail chest is invariably accompanied by ______ which can interfere with blood
oxygenation. - ANSWER - pulmonary contusion - do NOT over fluid resuscitate these
patients!
Hypotension is caused by _____ until proven otherwise. - ANSWER - hypovolemia
When you don't have/can't get a blood pressure, what are three things to look for when
evaluating perfusion. - ANSWER - 1. Level of consciousness (brain perfusion), 2. Skin
color (ashen face/grey extremities) 3. Pulse (bilateral femoral - thready/tachy)
Elderly patients have a limited ability to ______ to compensate for blood loss. -
ANSWER - increase heart rate
Resuscitation fluids should be warmed 39 degrees Celsius (102.2 F). Can you use a
microwave to do this? - ANSWER - YES - for CRYSTALLOID ONLY (but NOT for blood
products).
Urinary catheters are good for assessing renal perfusion and volume status. List 5 signs
of urethral injury that might prevent you from inserting one. - ANSWER - Blood at
urethral meatus, perineal ecchymosis, blood in scrotum, high-riding/non-palpable
prostate, pelvic fracture
Which arm should you NOT put a pulse-ox on? - ANSWER - The arm with a blood
pressure cuff on it
Name two anatomical things that can interfere with doing a FAST scan. - ANSWER -
Obesity & intraluminal bowel gas
When should radiographs be obtained? - ANSWER - During the SECONDARY survey.
