ATLS Post Test
An 18 year old helmeted motorcyclist is brought by ambulance to the emergency department
following a high speed crash. Pre-hospital personnel report that he was thrown 50 feet off his
bike. He has a history of hypotension prior to arrival in the ED, but is now awake, alert, and
conversational. Which of the following statements is true? - ANS-The patient probably has
an acute epidural hematoma (lucid interval)
\22 year old man is brought to the hospital after crashing his motorcycle into a telephone
pole. He is unconscious and in profound shock. He has no open wounds or obvious
fractures. The cause of his shocks is most likely caused by: - ANS-Hemorrhage into the
chest or abdomen
nothing visible -> think chest or abdomen
\23 year old man is brought immediately to the emergency department from the hospital
parking lot where he was shot in the lower abdomen. Examination reveals a single bullet
wound. He is breathing and has a thrash pulse. However, he is unconscious and has no
detectable blood pressure. Optimal immediate management is to: - ANS-Transfer the patient
to the operating room while initiating fluid therapy
\24 year old male sustains multiple fractured ribs bilaterally as a result of being crushed in a
press at plywood factory. Examination in the ED revealed a foil segment on the patient's
thorax. Primary resuscitation includes high flow, oxygen administration via a non-breathing
mask, and initiation of ringers lactate solution. The patient exhibits progressive confusion,
cyanosis, and kidney. Management at this time she consist of: - ANS-Endotracheal
intubation and mechanical ventilation
\24 year old woman passenger in an automobile, strikes the windscreen with her face during
a head-on collision. In the emergency apartment, she's talking and has marked artificial
demon crepitus. The highest priority should be given to: - ANS-Upper airway protection
\25 year old woman is brought to the emergency department after a motor vehicle crash.
She was initially lucid at the scene and then developed the dilated people in contralateral
externally weakness. In the emergency department, she's unconscious and has a GCS
score of 6. The initial management step for this patient should be to: - ANS-Perform
endotracheal intubation
\28 year old male is brought to ER. He was involved in a fight in which she was beaten with
a wooden stick. His chest has multiple severe bruises. Airways clear, respiratory rate 22,
heart rate is 126, and systemic blood pressure is 90. Which of the following should be
performed during the primary survey?
A. GCS
B. Cervical spine XR
C. TT administration
D. Blood alcohol level
E. Rectal exam - ANS-A. GCS
\30 year old man is struck by a car traveling 35mph. He has obvious fractures of the left tibia
near the knee, pain in the pelvis area, and severe dyspnea. His HR is 180, RR 48 bpm with
no breath sounds heard in the left chest. A tension PTX is relieved by immediate needle
decompression and tube thoracostomy. Subsequently his HR decreased to 140, his RR
,decreased to 36 bpm, and BP 80/50 mmHg. Warmed LR is administered intravenously. The
next priority should be to: - ANS-Perform external fixation of the pelvis
\30 year old man sustains a severely, communities, open distal right femur fracture in a
motorcycle crash. The wound is actively bleeding. DP and PT are easily palpable on the left,
but heard only by Doppler on the right. Immediate effort to improve circulation the injured
extremity should involve: - ANS-Tamponade of the wound with a pressure dressing
\32 year old male is brought to the hospital unconscious with severe facial injuries and noisy
respirations after an automobile collision. In the emergency department, he has no apparent
injury to the anterior aspect of his neck. He suddenly becomes apneic, and alternative
ventilation with a face mask is unsuccessful. Examination of his mouth reveals a large
hematoma of the fairing with loss of normal atomic landmarks. Initial management of his
airway should consist of:
A. Nasotracheal intubation
B. Emergency tracheostomy
C. Surgical cricothyroidotomy
D. Placement of an oropharyngeal airway
E. Placement of an nasopharyngeal airway - ANS-C. Surgical cricothyroidotomy
\42 year old man injured in a motor vehicle crash, suffers a closed, head injury, multiple
palpable left roof fracture, bilateral femur fracture. He is intubated orotracheally without
difficulty. Initially, has ventilations are easily assisted with a bag device. It becomes more
difficult to ventilate the patient over the next five minutes, and his hemoglobin oxygen
saturation level decreases from 90% to 89%. The most appropriate next step is to: -
ANS-Auscultate the patient's chest
\42 year olds man is trapped from the waist down beneath his overturned tractor for several
hours before Medical systemized. He is awake and alert until just before arriving in
emergency department. He is now unconscious in response only to painful stimulate by
moaning. His pupils are 3 mm in diameter and symmetrically reactive delight. Prehospital
personnel indicate that they have not seen the patient move either of his lower extremities.: -
ANS-A pelvic fracture
\5 year old boy is struck by an automobile and brought to the emergency department. He is
lethargic, but withdraws purposefully from painfully stimuli. His blood pressure is 90 mmHg,
HR 140 BPM, and RR is 36 bpm. The preferred route of venous access in this patient is: -
ANS-Pertained veins in the upper extremities
\8 year old girl is an unrestrained passenger in a vehicle struck from behind. In the ED, her
blood pressure is 80/60, heart rate is 80 bpm, and respiratory rate is 16 breaths per minute.
Her GCS score is 14. She complains that her legs "feel funny and won't move right",
however, her spine x-rays do not show a fracture dislocation. A spinal injury in this child: -
ANS-Can be excluded by obtaining a CT of the entire spine
\A 14 year old female is brought to the ED after falling from a horse. She is immoblized on a
long spine board with a hard collar and blocks. Cervical spine x-ray: - ANS-??
\A 15 year old male presents following a motorcycle crash. Initial exam reveals normal vital
signs. There is a large bruise over his epigastrium that extends to the left flank. He has no
other apparent injuries. A CT scan of the abdomen demonstrates a ruptured spleen
surrounded by a large hematoma and fluid in the pelvis. The next best step in the patient's
management is:
A. Splenic artery embolization
B. Pneumococcal vaccine
C. Urgent laporotomy
, D. Surgical consultation
E. Transfer to a pediatrician - ANS-D. Surgical consultation
vs. peritonitis or abnormal vital signs --> urgent laporotomy
\A 15-year-old male is brought to ER after being involved in a motor vehicle crash. He is
unconscious and was intubated at the scene by EMS. In ER, O2 is 92%. Heart rate is 96 and
BP is 150/85. Breath sounds are decreased on the left side of the thorax. The next step is:
A. Immediate needle cricothyroidectomy
B. Reassess the position of the ETT
C. Chest tube insertion
D. Immediate needle thoracentesis
E. Obtain a chest x-ray - ANS-Reassess the position of the ETT
\A 17 year old female is brought to the ED following a 6 feet fall onto concrete. She is
unresponsive and found to have a RR of 32, BP of 90/60, and HR of 68. The FIRST step in
treatment is:
A. Administering vasopressors
B. Establishing IV access for drug-assisted intubation
C. Seeking the cause of her decreased level of consciousness
D. Applying oxygen and maintaining airway
E. Excluding hemorrhage as a cause of shock - ANS-D. Applying oxygen and maintaining
airway
First = ABCs
\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
C. A long spine board
D. A scoop-style stretcher
E. A semi-rigid cervical collar - ANS-A. Air splints
\A 20 year old athlete is involved in a motorcycle crash. When he arrives in the ED, he
shouts that he cannot move his legs. On physical examination, there are no abnormalities of
the chest, abdomen or pelvis. The patient has no sensation in his legs and cannot move
them, but his arms are moving. The patients RR is 28 bpm, HR is 88bpm and BP is
80/60mmHg. He is pale and sweaty. What is the most likely cause of this condition?
A. Neurogenic shock
B. Cardiogenic shock
C. Abdominal hemorrhage
D. Myocardial contusion
E. Hyperthermia. - ANS-A. Neurogenic shock
\A 20 year old male is brought to the hospital approximately 30 minutes after being stabbed
in the chest. There is 3 cm wound just medial to the left nipple. BP is 70/33 and HR is 140.
Neck and arm veins are distended. Breath sounds are normal. Heart sounds are diminished,
IV access is established and warm crystalloid is infusing. The next most important aspect of
immediate management is:
A. CT Chest
B. EKG
An 18 year old helmeted motorcyclist is brought by ambulance to the emergency department
following a high speed crash. Pre-hospital personnel report that he was thrown 50 feet off his
bike. He has a history of hypotension prior to arrival in the ED, but is now awake, alert, and
conversational. Which of the following statements is true? - ANS-The patient probably has
an acute epidural hematoma (lucid interval)
\22 year old man is brought to the hospital after crashing his motorcycle into a telephone
pole. He is unconscious and in profound shock. He has no open wounds or obvious
fractures. The cause of his shocks is most likely caused by: - ANS-Hemorrhage into the
chest or abdomen
nothing visible -> think chest or abdomen
\23 year old man is brought immediately to the emergency department from the hospital
parking lot where he was shot in the lower abdomen. Examination reveals a single bullet
wound. He is breathing and has a thrash pulse. However, he is unconscious and has no
detectable blood pressure. Optimal immediate management is to: - ANS-Transfer the patient
to the operating room while initiating fluid therapy
\24 year old male sustains multiple fractured ribs bilaterally as a result of being crushed in a
press at plywood factory. Examination in the ED revealed a foil segment on the patient's
thorax. Primary resuscitation includes high flow, oxygen administration via a non-breathing
mask, and initiation of ringers lactate solution. The patient exhibits progressive confusion,
cyanosis, and kidney. Management at this time she consist of: - ANS-Endotracheal
intubation and mechanical ventilation
\24 year old woman passenger in an automobile, strikes the windscreen with her face during
a head-on collision. In the emergency apartment, she's talking and has marked artificial
demon crepitus. The highest priority should be given to: - ANS-Upper airway protection
\25 year old woman is brought to the emergency department after a motor vehicle crash.
She was initially lucid at the scene and then developed the dilated people in contralateral
externally weakness. In the emergency department, she's unconscious and has a GCS
score of 6. The initial management step for this patient should be to: - ANS-Perform
endotracheal intubation
\28 year old male is brought to ER. He was involved in a fight in which she was beaten with
a wooden stick. His chest has multiple severe bruises. Airways clear, respiratory rate 22,
heart rate is 126, and systemic blood pressure is 90. Which of the following should be
performed during the primary survey?
A. GCS
B. Cervical spine XR
C. TT administration
D. Blood alcohol level
E. Rectal exam - ANS-A. GCS
\30 year old man is struck by a car traveling 35mph. He has obvious fractures of the left tibia
near the knee, pain in the pelvis area, and severe dyspnea. His HR is 180, RR 48 bpm with
no breath sounds heard in the left chest. A tension PTX is relieved by immediate needle
decompression and tube thoracostomy. Subsequently his HR decreased to 140, his RR
,decreased to 36 bpm, and BP 80/50 mmHg. Warmed LR is administered intravenously. The
next priority should be to: - ANS-Perform external fixation of the pelvis
\30 year old man sustains a severely, communities, open distal right femur fracture in a
motorcycle crash. The wound is actively bleeding. DP and PT are easily palpable on the left,
but heard only by Doppler on the right. Immediate effort to improve circulation the injured
extremity should involve: - ANS-Tamponade of the wound with a pressure dressing
\32 year old male is brought to the hospital unconscious with severe facial injuries and noisy
respirations after an automobile collision. In the emergency department, he has no apparent
injury to the anterior aspect of his neck. He suddenly becomes apneic, and alternative
ventilation with a face mask is unsuccessful. Examination of his mouth reveals a large
hematoma of the fairing with loss of normal atomic landmarks. Initial management of his
airway should consist of:
A. Nasotracheal intubation
B. Emergency tracheostomy
C. Surgical cricothyroidotomy
D. Placement of an oropharyngeal airway
E. Placement of an nasopharyngeal airway - ANS-C. Surgical cricothyroidotomy
\42 year old man injured in a motor vehicle crash, suffers a closed, head injury, multiple
palpable left roof fracture, bilateral femur fracture. He is intubated orotracheally without
difficulty. Initially, has ventilations are easily assisted with a bag device. It becomes more
difficult to ventilate the patient over the next five minutes, and his hemoglobin oxygen
saturation level decreases from 90% to 89%. The most appropriate next step is to: -
ANS-Auscultate the patient's chest
\42 year olds man is trapped from the waist down beneath his overturned tractor for several
hours before Medical systemized. He is awake and alert until just before arriving in
emergency department. He is now unconscious in response only to painful stimulate by
moaning. His pupils are 3 mm in diameter and symmetrically reactive delight. Prehospital
personnel indicate that they have not seen the patient move either of his lower extremities.: -
ANS-A pelvic fracture
\5 year old boy is struck by an automobile and brought to the emergency department. He is
lethargic, but withdraws purposefully from painfully stimuli. His blood pressure is 90 mmHg,
HR 140 BPM, and RR is 36 bpm. The preferred route of venous access in this patient is: -
ANS-Pertained veins in the upper extremities
\8 year old girl is an unrestrained passenger in a vehicle struck from behind. In the ED, her
blood pressure is 80/60, heart rate is 80 bpm, and respiratory rate is 16 breaths per minute.
Her GCS score is 14. She complains that her legs "feel funny and won't move right",
however, her spine x-rays do not show a fracture dislocation. A spinal injury in this child: -
ANS-Can be excluded by obtaining a CT of the entire spine
\A 14 year old female is brought to the ED after falling from a horse. She is immoblized on a
long spine board with a hard collar and blocks. Cervical spine x-ray: - ANS-??
\A 15 year old male presents following a motorcycle crash. Initial exam reveals normal vital
signs. There is a large bruise over his epigastrium that extends to the left flank. He has no
other apparent injuries. A CT scan of the abdomen demonstrates a ruptured spleen
surrounded by a large hematoma and fluid in the pelvis. The next best step in the patient's
management is:
A. Splenic artery embolization
B. Pneumococcal vaccine
C. Urgent laporotomy
, D. Surgical consultation
E. Transfer to a pediatrician - ANS-D. Surgical consultation
vs. peritonitis or abnormal vital signs --> urgent laporotomy
\A 15-year-old male is brought to ER after being involved in a motor vehicle crash. He is
unconscious and was intubated at the scene by EMS. In ER, O2 is 92%. Heart rate is 96 and
BP is 150/85. Breath sounds are decreased on the left side of the thorax. The next step is:
A. Immediate needle cricothyroidectomy
B. Reassess the position of the ETT
C. Chest tube insertion
D. Immediate needle thoracentesis
E. Obtain a chest x-ray - ANS-Reassess the position of the ETT
\A 17 year old female is brought to the ED following a 6 feet fall onto concrete. She is
unresponsive and found to have a RR of 32, BP of 90/60, and HR of 68. The FIRST step in
treatment is:
A. Administering vasopressors
B. Establishing IV access for drug-assisted intubation
C. Seeking the cause of her decreased level of consciousness
D. Applying oxygen and maintaining airway
E. Excluding hemorrhage as a cause of shock - ANS-D. Applying oxygen and maintaining
airway
First = ABCs
\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
C. A long spine board
D. A scoop-style stretcher
E. A semi-rigid cervical collar - ANS-A. Air splints
\A 20 year old athlete is involved in a motorcycle crash. When he arrives in the ED, he
shouts that he cannot move his legs. On physical examination, there are no abnormalities of
the chest, abdomen or pelvis. The patient has no sensation in his legs and cannot move
them, but his arms are moving. The patients RR is 28 bpm, HR is 88bpm and BP is
80/60mmHg. He is pale and sweaty. What is the most likely cause of this condition?
A. Neurogenic shock
B. Cardiogenic shock
C. Abdominal hemorrhage
D. Myocardial contusion
E. Hyperthermia. - ANS-A. Neurogenic shock
\A 20 year old male is brought to the hospital approximately 30 minutes after being stabbed
in the chest. There is 3 cm wound just medial to the left nipple. BP is 70/33 and HR is 140.
Neck and arm veins are distended. Breath sounds are normal. Heart sounds are diminished,
IV access is established and warm crystalloid is infusing. The next most important aspect of
immediate management is:
A. CT Chest
B. EKG
