ATLS Written Review Exam – All
Questions & Answers 2025 (Graded A+)
What are more common brain injury: epidural or subdural? - ANSWER - subdural 30%
epidural 0.5%
Subdural hematoma occur from tear of _________. - ANSWER - bridging vessels of the
cerebral cortex
Contusion occur in ___% of TBI. They often occur in _____ or ______ lobes of brain.
They may coalesce to form ______ in as many as 20$%. - ANSWER - 20-30%
frontal or temporal
intracerebral hematoma.
What is the imaging protocol for a patient with cerebral contusion? - ANSWER - get CT
at presentation. then get another within 24 hours to assess for coalesced hematoma.
What factors would require a CT in minor brain injury? - ANSWER - 1. suspected open
skull frac
2. basilar frac
3. >2 episode vomitting
4. pt older than 65
5. LOC >5 min
6. amnesia before impact of >30 min
How long after discharge should patient with mild brain injury be observed by friend? -
ANSWER - 24 hours
What type of brain injury requires serial GCS? - ANSWER - ALL. minor. moderate.
major
What imaging is done in all patient with moderate brain injury? - ANSWER - CT
What factor of ABCDE must be monitored closely in moderate brain injury? - ANSWER
- Airway and breathing. rapid deterioration may occur. hypoventilation and hypercapnia
may ensue requiring intubation. close monitoring in ICU is required.
What should immediately follow the secondary survey in major/severe brain injury? -
ANSWER - CT.
REMEMBER: CT should never delay patient transfer
When assessing ABCDE of severe brain injury, when does DPL or FAST come before
neuro exam? - ANSWER - if the systolic blood pressure cannot be brought above 100,
DPL or FAST is done first as to assess source of hypotension
, Spinal cord injury has what result in blood pressure? - ANSWER - hypotension. This
may also occur in terminal brain injury with medullary failure
What needs to be cleared before Doll's eye testing is conducted? - ANSWER - cervical
spine must cleared.
What tests should be performed before sedation? - ANSWER - GCS and pupillary rxn
A midline shift of _____mm or greater on the CT is indicative of need for neurosurgery
to evacuate the clot or contusion causing the shift - ANSWER - 5mm
What type of fluids should be used? - ANSWER - hypertonic (ringers lactate or normal
saline). NO GLUCOSE.
What electrolyte abnormality is associated with brain edema and must be monitored? -
ANSWER - hyponatremia
What are the physiologic consequences of PaCO2 >45?
PaCO2 <30? - ANSWER - f PaCO2 >45 = vasodilation = inc ICP
PaCO2 <30 (hyperventilation) = constriction = ischemia
What is the preferred PaCO2 in brain injury? - ANSWER - 35 mm Hg
If ICP is rapidly increasing, what can be done while preparing for craniotomy? -
ANSWER - hyperventilation. NOTE: this must be monitored closely and is only done
very short periods at a time
Does hypertonic saline lower ICP in hypovolemia?
Does mannitol lower ICP in hypovolemia? - ANSWER - No
NO
After administration of mannitol what should be monitored closely? - ANSWER - ICP!
mannitol has a substantial rebound effect on ICP
What is the role of muscle relaxants (vecuronium or succinylcholine) in seizures with
TBI? - ANSWER - NONE.
these may mask tonic-clonic seizures and prevent anticonvulsant intervention (30-60
min of seizure = secondary brain injury)
What meningeal tear would a CSF leakage of a head laceration indicate? - ANSWER -
dural tear
What is the treatment of any intracranial mass lesion? - ANSWER - Must be evacuated
by neurosurgeon. transfer if not available.
Questions & Answers 2025 (Graded A+)
What are more common brain injury: epidural or subdural? - ANSWER - subdural 30%
epidural 0.5%
Subdural hematoma occur from tear of _________. - ANSWER - bridging vessels of the
cerebral cortex
Contusion occur in ___% of TBI. They often occur in _____ or ______ lobes of brain.
They may coalesce to form ______ in as many as 20$%. - ANSWER - 20-30%
frontal or temporal
intracerebral hematoma.
What is the imaging protocol for a patient with cerebral contusion? - ANSWER - get CT
at presentation. then get another within 24 hours to assess for coalesced hematoma.
What factors would require a CT in minor brain injury? - ANSWER - 1. suspected open
skull frac
2. basilar frac
3. >2 episode vomitting
4. pt older than 65
5. LOC >5 min
6. amnesia before impact of >30 min
How long after discharge should patient with mild brain injury be observed by friend? -
ANSWER - 24 hours
What type of brain injury requires serial GCS? - ANSWER - ALL. minor. moderate.
major
What imaging is done in all patient with moderate brain injury? - ANSWER - CT
What factor of ABCDE must be monitored closely in moderate brain injury? - ANSWER
- Airway and breathing. rapid deterioration may occur. hypoventilation and hypercapnia
may ensue requiring intubation. close monitoring in ICU is required.
What should immediately follow the secondary survey in major/severe brain injury? -
ANSWER - CT.
REMEMBER: CT should never delay patient transfer
When assessing ABCDE of severe brain injury, when does DPL or FAST come before
neuro exam? - ANSWER - if the systolic blood pressure cannot be brought above 100,
DPL or FAST is done first as to assess source of hypotension
, Spinal cord injury has what result in blood pressure? - ANSWER - hypotension. This
may also occur in terminal brain injury with medullary failure
What needs to be cleared before Doll's eye testing is conducted? - ANSWER - cervical
spine must cleared.
What tests should be performed before sedation? - ANSWER - GCS and pupillary rxn
A midline shift of _____mm or greater on the CT is indicative of need for neurosurgery
to evacuate the clot or contusion causing the shift - ANSWER - 5mm
What type of fluids should be used? - ANSWER - hypertonic (ringers lactate or normal
saline). NO GLUCOSE.
What electrolyte abnormality is associated with brain edema and must be monitored? -
ANSWER - hyponatremia
What are the physiologic consequences of PaCO2 >45?
PaCO2 <30? - ANSWER - f PaCO2 >45 = vasodilation = inc ICP
PaCO2 <30 (hyperventilation) = constriction = ischemia
What is the preferred PaCO2 in brain injury? - ANSWER - 35 mm Hg
If ICP is rapidly increasing, what can be done while preparing for craniotomy? -
ANSWER - hyperventilation. NOTE: this must be monitored closely and is only done
very short periods at a time
Does hypertonic saline lower ICP in hypovolemia?
Does mannitol lower ICP in hypovolemia? - ANSWER - No
NO
After administration of mannitol what should be monitored closely? - ANSWER - ICP!
mannitol has a substantial rebound effect on ICP
What is the role of muscle relaxants (vecuronium or succinylcholine) in seizures with
TBI? - ANSWER - NONE.
these may mask tonic-clonic seizures and prevent anticonvulsant intervention (30-60
min of seizure = secondary brain injury)
What meningeal tear would a CSF leakage of a head laceration indicate? - ANSWER -
dural tear
What is the treatment of any intracranial mass lesion? - ANSWER - Must be evacuated
by neurosurgeon. transfer if not available.
