ATLS Exam Study Guide with Complete solutions |
Latest 2025 Graded A+
Functional changes in cardiac system include declining function, decreased sensitivity to catecholamines,
atherosclerosis of coronary vessels, increased afterload, fixed heart rate (beta blockers) - Answer- this
results in lack of classic response to hypovolemia, risk for cardiac ischemia, elevated BP at baseline, and
increased risk of dysrythmias.
Functional changes in pulmonary system include decreased elastic recoil, reduced residual capacity,
decreased gas exchange and decreased cough reflex - Answer- thus they are at increased risk for
respiratory failure, increased risk for pneumonia, and poor tolerance to rib fractures
Functional changes in renal system include loss of renal mass, decreased GFR, and decreased sensitivity
to ADH and aldosterone - Answer- resulting in drug dosing for renal insufficiency, decreased ability to
concentrate urine, increased risk for AKI and urine flow may be normal with hypovolemia
Functional changes to MSK include loss of lean body mass, osteoporosis, changes in joints and cartilage,
c spine degenerative changes and loss of skin elastin and subcutaneous fat - Answer- resulting in
increased risk for fractures, decreased mobility, difficulty for oral intubation, risk of skin injury, increased
risk for hypothermia, challenges in rehabiliation
Definitive control of the airway is achieved by ____________ - Answer- Endotracheal intubation
How do you treat hypothermia in the ED? - Answer- crystalloid fluids at 102.2 degrees F and warmed
treatment area
What does definitive hemorrhage control refer to?
(3) - Answer- 1) Possible surgery
2) Stabilizing of pelvis
3) Angioembolization
What are rates of fluid administration measured by? - Answer- Size and length of catheter
Minimum flow rate of oxygen reservoir mask - Answer- 11 L/min
,MCC of shock in trauma pt - Answer- Hypovolemia due to hemorrhage
Describe the 3 for 1 rule - Answer- Replace each mL of blood loss with 3 ml of crystalloid solution
True or false? Although the mechanism of injury may be similar to those for the younger population, data
shows increased mortality with similar severity of injury in older adults. - Answer- True
In the elderly population, what is decreased physiological reserve? - Answer- aging is characterized by
impaired adaptive and homeostatic mechanisms that caused an increased susceptibility to the stress of
injury. Insults tolerated by the younger population can lead to devastating results in elderly patients.
Pre-existing conditions that affect morbidity and mortality include: - Answer- cirrhosis, coagulopathy,
COPD, ischemic heart disease, DM
What is the most common mechanism of injury in the elderly? - Answer- Fall. Nonfatal falls are common
in women and fractures are common in women who fall. Falls are the most common cause of TBI.
In the elderly population, what are risk factors for falls? - Answer- advanced age, physical impairment,
history of previous fall, medication use, dementia, unsteady gait, and visual, cognitive impairment
Most of elderly traffic fatalities occur in the daytime and on weekends and typically involve other
vehicles. Why? - Answer- Older people drive on more familiar roads and at lower speeds and tend to
drive during the day. Older people have slower reaction time, a larger blind spot, limited cervical
mobility, decreased hearing, and cognitive impairment.
True or False? Mortality associated with small to moderate sized burns in older adults remains high -
Answer- True
Spilled hot liquids on the leg, which in younger patients may re-epithelialize due to an adequate number
of hair follicles, will result in a full thickness burn in older patients. - Answer- this is true
Airway-patients may have dentures that may loosen or obstruct the airway. If dentures are not obstructing
the airway, leave them in place for what? - Answer- bag mask ventilation, as it improves mask fitting.
,In a traumatic aortic rupture, heart rate and blood pressure control can decrease the likelihood of rupture. -
Answer- definitive treatment is surgery.
Diaphragmatic injury-displaced bowel, stomach, and nasogastric tube on left side. - Answer- The
appearance of peritoneal lavage fluid in the chest tube also confirms diagnosis
esophageal injury- clinical picture is a patient with a left pneumothorax or hemothorax without a rib
fracture who has received a severe blow to the lower sternum or epigastrum and is in pain or shock out of
proportion to the apparent injury - Answer- presence of mediastinal air also suggests diagnosis and
definitive treatment is direct repair of the injury.
injuries to the retroperitoneal structures are difficult to recognize because they occur deep within the
abdomen and may not initially present with signs or symptoms of peritonitis. - Answer- the
retroperitoneal space is NOT sampled by DPL or FAST
physical exam findings suggestive of a pelvic fracture include: - Answer- ruptured urethra, scrotal
hematoma or blood at the urethral meatus, discrepancy in limb length and rotational deformity of a leg
w/o obvious fracture. use pelvic binder that is centered at the greater trochanters rather than over the iliac
crests.
signs of urethral injury include: - Answer- blood at the uretheral meatus, ecchymosis or hematoma of the
scrotum and perineum. Palpation of the prostate gland is NOT a reliable sign of urethral injury.
a retrograde urethorgram is mandatory when the patient is unable to void, requires a pelvic binder, or has
blood at the meatus, scrotal hematoma, or perineal ecchymosis. confirm an intact urethra before inserting
a urinary catheter.
DPL: Aspiration of gastrointestinal contents, vegetable fibers, or bile through the lavage mandate
laparotomy. Aspiration of 10cc or more of blood in hemodynamically abnormal patients requires
laporotomy. - Answer- performed rapidly, invasive procedure
sensitive for detecting intraperitoneal hemorrhage
low specificity
requires gastric and urinary decompression
not repeatable
, a positive DPL is an indication for laparotomy
contraindications include previous abdominal operations, morbid obesity, advanced cirrhosis, pre-existing
coagulopathy.
FAST - Answer- noninvas and can be done rapidly
repeatable
does not assess retroperitoneal structures.
obesity can degrade images obtained by FAST
indications for a laparotomy: - Answer- Blunt abdominal trauma with hypotension, positive FAST
hypotension with an abdominal wound that penetrates anterior fascia
gunshot wounds that traverse the peritoneal cavity
evisceration
bleeding from stomach, rectum, or GU tract
peritonitis
free air of hemidiaphragm
contrast CT showing rupture GI tract, bladder injury
Aspiration of gastrointestinal contents, vegetable fibers, or bile through the lavage mandate laparotomy.
Aspiration of 10cc or more of blood in hemodynamically abnormal patients requires laparotomy.
Diaphragm injuries - Answer- elevation or blurring of the hemidiaphragm, hemothorax, an abnormal gas
shadow that obscures the hemidiaphragm, or a gastric tube in the chest
Duodenal injuries- a bloody gastric aspirate or retroperitoneal air on abdominal CT or radiograph should
raise suspicion - Answer- classically seen in unrestrained drives involved in frontal-impact MVC and
patients who sustain direct blows to the abdomen from bicycle handlebars.
Any early normal serum amylase level or an elevated amylase level does not conclude pancreas injury -
Answer-
Latest 2025 Graded A+
Functional changes in cardiac system include declining function, decreased sensitivity to catecholamines,
atherosclerosis of coronary vessels, increased afterload, fixed heart rate (beta blockers) - Answer- this
results in lack of classic response to hypovolemia, risk for cardiac ischemia, elevated BP at baseline, and
increased risk of dysrythmias.
Functional changes in pulmonary system include decreased elastic recoil, reduced residual capacity,
decreased gas exchange and decreased cough reflex - Answer- thus they are at increased risk for
respiratory failure, increased risk for pneumonia, and poor tolerance to rib fractures
Functional changes in renal system include loss of renal mass, decreased GFR, and decreased sensitivity
to ADH and aldosterone - Answer- resulting in drug dosing for renal insufficiency, decreased ability to
concentrate urine, increased risk for AKI and urine flow may be normal with hypovolemia
Functional changes to MSK include loss of lean body mass, osteoporosis, changes in joints and cartilage,
c spine degenerative changes and loss of skin elastin and subcutaneous fat - Answer- resulting in
increased risk for fractures, decreased mobility, difficulty for oral intubation, risk of skin injury, increased
risk for hypothermia, challenges in rehabiliation
Definitive control of the airway is achieved by ____________ - Answer- Endotracheal intubation
How do you treat hypothermia in the ED? - Answer- crystalloid fluids at 102.2 degrees F and warmed
treatment area
What does definitive hemorrhage control refer to?
(3) - Answer- 1) Possible surgery
2) Stabilizing of pelvis
3) Angioembolization
What are rates of fluid administration measured by? - Answer- Size and length of catheter
Minimum flow rate of oxygen reservoir mask - Answer- 11 L/min
,MCC of shock in trauma pt - Answer- Hypovolemia due to hemorrhage
Describe the 3 for 1 rule - Answer- Replace each mL of blood loss with 3 ml of crystalloid solution
True or false? Although the mechanism of injury may be similar to those for the younger population, data
shows increased mortality with similar severity of injury in older adults. - Answer- True
In the elderly population, what is decreased physiological reserve? - Answer- aging is characterized by
impaired adaptive and homeostatic mechanisms that caused an increased susceptibility to the stress of
injury. Insults tolerated by the younger population can lead to devastating results in elderly patients.
Pre-existing conditions that affect morbidity and mortality include: - Answer- cirrhosis, coagulopathy,
COPD, ischemic heart disease, DM
What is the most common mechanism of injury in the elderly? - Answer- Fall. Nonfatal falls are common
in women and fractures are common in women who fall. Falls are the most common cause of TBI.
In the elderly population, what are risk factors for falls? - Answer- advanced age, physical impairment,
history of previous fall, medication use, dementia, unsteady gait, and visual, cognitive impairment
Most of elderly traffic fatalities occur in the daytime and on weekends and typically involve other
vehicles. Why? - Answer- Older people drive on more familiar roads and at lower speeds and tend to
drive during the day. Older people have slower reaction time, a larger blind spot, limited cervical
mobility, decreased hearing, and cognitive impairment.
True or False? Mortality associated with small to moderate sized burns in older adults remains high -
Answer- True
Spilled hot liquids on the leg, which in younger patients may re-epithelialize due to an adequate number
of hair follicles, will result in a full thickness burn in older patients. - Answer- this is true
Airway-patients may have dentures that may loosen or obstruct the airway. If dentures are not obstructing
the airway, leave them in place for what? - Answer- bag mask ventilation, as it improves mask fitting.
,In a traumatic aortic rupture, heart rate and blood pressure control can decrease the likelihood of rupture. -
Answer- definitive treatment is surgery.
Diaphragmatic injury-displaced bowel, stomach, and nasogastric tube on left side. - Answer- The
appearance of peritoneal lavage fluid in the chest tube also confirms diagnosis
esophageal injury- clinical picture is a patient with a left pneumothorax or hemothorax without a rib
fracture who has received a severe blow to the lower sternum or epigastrum and is in pain or shock out of
proportion to the apparent injury - Answer- presence of mediastinal air also suggests diagnosis and
definitive treatment is direct repair of the injury.
injuries to the retroperitoneal structures are difficult to recognize because they occur deep within the
abdomen and may not initially present with signs or symptoms of peritonitis. - Answer- the
retroperitoneal space is NOT sampled by DPL or FAST
physical exam findings suggestive of a pelvic fracture include: - Answer- ruptured urethra, scrotal
hematoma or blood at the urethral meatus, discrepancy in limb length and rotational deformity of a leg
w/o obvious fracture. use pelvic binder that is centered at the greater trochanters rather than over the iliac
crests.
signs of urethral injury include: - Answer- blood at the uretheral meatus, ecchymosis or hematoma of the
scrotum and perineum. Palpation of the prostate gland is NOT a reliable sign of urethral injury.
a retrograde urethorgram is mandatory when the patient is unable to void, requires a pelvic binder, or has
blood at the meatus, scrotal hematoma, or perineal ecchymosis. confirm an intact urethra before inserting
a urinary catheter.
DPL: Aspiration of gastrointestinal contents, vegetable fibers, or bile through the lavage mandate
laparotomy. Aspiration of 10cc or more of blood in hemodynamically abnormal patients requires
laporotomy. - Answer- performed rapidly, invasive procedure
sensitive for detecting intraperitoneal hemorrhage
low specificity
requires gastric and urinary decompression
not repeatable
, a positive DPL is an indication for laparotomy
contraindications include previous abdominal operations, morbid obesity, advanced cirrhosis, pre-existing
coagulopathy.
FAST - Answer- noninvas and can be done rapidly
repeatable
does not assess retroperitoneal structures.
obesity can degrade images obtained by FAST
indications for a laparotomy: - Answer- Blunt abdominal trauma with hypotension, positive FAST
hypotension with an abdominal wound that penetrates anterior fascia
gunshot wounds that traverse the peritoneal cavity
evisceration
bleeding from stomach, rectum, or GU tract
peritonitis
free air of hemidiaphragm
contrast CT showing rupture GI tract, bladder injury
Aspiration of gastrointestinal contents, vegetable fibers, or bile through the lavage mandate laparotomy.
Aspiration of 10cc or more of blood in hemodynamically abnormal patients requires laparotomy.
Diaphragm injuries - Answer- elevation or blurring of the hemidiaphragm, hemothorax, an abnormal gas
shadow that obscures the hemidiaphragm, or a gastric tube in the chest
Duodenal injuries- a bloody gastric aspirate or retroperitoneal air on abdominal CT or radiograph should
raise suspicion - Answer- classically seen in unrestrained drives involved in frontal-impact MVC and
patients who sustain direct blows to the abdomen from bicycle handlebars.
Any early normal serum amylase level or an elevated amylase level does not conclude pancreas injury -
Answer-
