ATLS Post Test 2025 Study Guide Rated A+

1. A 22-year-old man is hypotensive and tachycardic after a shotgun wound to the left shoulder. His blood pressure is initially 80/40 mm Hg. After initial fluid resuscitation his blood pressure increases to 122/84 mm Hg. His heart rate is now 100 beats per minute and his respiratory rate is 28 breaths per minute. A tube thoracostomy is performed for decreased left chest breath sounds with the return of a small amount of blood and no air leak. After chest tube insertion, the most appropriate next step is: re-examine the chest 2. A construction worker falls two stories from a building and sustains bilateral calcaneal fractures. In the emergency department, he is alert, vital signs are normal, and he is complaining of severe pain in both heels and his lower back. Lower extremity pulses are strong and there is no other deformity. The suspected diagnosis is most likely to be confirmed by: complete spine x-ray series 3. What is true regarding the initial resuscitation of a trauma patient? Evidence of improved perfusion after fluid resuscitation could include improvement in Glasgow Coma Scale score on reevaluation 4. In managing a patient with a severe traumatic brain injury, the most important initial step is to: secure the airway 5. A previously healthy, 70-kg (154-pound) man suffers an estimated acute blood loss of 2 liters. What applies to this patient? An ABG would demonstrate a base deficit between -6 and -10 mEq/L. 6. The physiological hypervolemia of pregnancy has clinical significance in the management of the severely injured, gravid woman by: increasing the volume of blood loss to produce maternal hypotension. 7. The best assessment of fluid resuscitation of the adult burn patient is: urinary output of 0.5 mL/kg/hr 8. The diagnosis of shock must include: evidence of inadequate organ perfusion 9. A 7-year-old boy is brought to the emergency department by his parents several minutes after he fell through a window. He is bleeding profusely from a 6-cm wound of his medial right thigh. Immediate management of the wound should consist of: direct pressure on the wound 10. For the patient with severe traumatic brain injury, profound hypocarbia should be avoided to prevent: cerebral vasoconstriction with diminished perfusion 11. After being involved in a motor vehicle crash, a 25-year-old man is brought to a hospital that has surgery capabilities available.. Computed tomography of the chest and abdomen shows an aortic injury and splenic laceration with free abdominal fluid. His blood pressure falls to 70 mm Hg after CT. The next step is: perform an exploratory laparotomy 12. What statements regarding abdominal trauma in the pregnant patient is TRUE? Leakage of amniotic fluid is an indication for hospital admission. 13. The first maneuver to improve oxygenation after chest injury is: administer supplemental oxygen 14. A 25-year-old man, injured in a motor vehicular crash, is admitted to the emergency department. His pupils react sluggishly and his eyes open to pressure. He does not follow commands, but he does moan periodically. His right arm is deformed and does not respond to pressure; however, his left hand reaches purposefully toward the stimulus. Both legs are stiffly extended. His GCS score is: 9 15. A 20-year-old woman who is at 32 weeks gestation, is stabbed in the upper right chest. In the emergency department, her blood pressure is 80/60 mm Hg. She is gasping for breath, extremely anxious, and yelling for help. Breath sounds are diminished in the right chest. The most appropriate first step is to: perform needle or finger decompression of the right chest 16. What findings in an adult is most likely to require immediate management during the primary survey? respiratory rate of 40 breaths per minute 17. The most important, immediate step in the management of an open pneumothorax is: placement of an occlusive dressing over the wound 18. The following are contraindications for tetanus toxoid administration: history of neurological reaction or severe hypersensitivity to the product 19. A 56-year-old man is thrown violently against the steering wheel of his truck during a motor vehicle crash. On arrival in the emergency department he is diaphoretic and complaining of chest pain. His blood pressure is 60/40 mm Hg and his respiratory rate is 40 breaths per minute. What best differentiates cardiac tamponade from tension pneumothorax as the cause of his hypotension? breath sounds 20. Bronchial intubation of the right or left mainstem bronchus can easily occur during infant endotracheal intubation because: The trachea is relatively short. 21. A 23-year-old man sustains 4 stab wounds to the upper right chest during an altercation and is brought by ambulance to a hospital that has full surgical capabilities. His wounds are all above the nipple. He is endotracheally intubated, closed tube thoracostomy is performed, fluid resuscitation is initiated through 2 large-caliber IVs. FAST exam does not reveal intraabdominal injuries. His blood pressure now is 60/0 mm Hg, heart rate is 160 beats per minute, and respiratory rate is 14 breaths per minute (ventilated with 100% O2). 1500 mL of blood has drained from the right chest. The most appropriate next step in managing this patient is to: urgently transfer the patient to the operating room 22. A 39-year-old man is admitted to the emergency department after an automobile collision. He is cyanotic, has insufficient respiratory effort, and has a GCS score of 6. His full beard makes it difficult to fit the oxygen facemask to his face. The most appropriate next step is to: restrict cervical motion and attempt orotracheal intubation using 2 people 23. A patient is brought to the emergency department after a motor vehicle crash. He is conscious and there is no obvious external trauma. He arrives at the hospital completely immobilized on a long spine board. His blood pressure is 60/40 mm Hg and his heart rate is 70 beats per minute. His skin is warm. What do you expect to see with the patient? Flaccidity of the lower extremities and loss of deep tendon reflexes are expected. 24. What is the most effective method for initially treating frostbite? Moist heat 25. A 32-year-old man's right leg is trapped beneath his overturned car for nearly 2 hours before he is extricated. On arrival in the emergency department, his right lower extremity is cool, mottled, insensate, and motionless. Despite normal vital signs, pulses cannot be palpated below the right femoral artery and the muscles of the lower extremity are firm and hard. During the management of this patient, what is most likely to improve the chances for limb salvage? surgical consultation for right lower extremity fasciotomy 26. A patient arrives in the emergency department after being beaten about the head and face with a wooden club. He is comatose and has a palpable depressed skull fracture. His face is swollen and ecchymotic. He has gurgling respirations and vomitus on his face and clothing. The most appropriate step after providing supplemental oxygen and elevating his jaw is to: suction the oropharynx 27. A 22-year-old man sustains a gunshot wound to the left chest and is transported to a small community hospital no surgical capabilities are available. In the emergency department, a chest tube is inserted and 700 mL of blood is evacuated. The trauma center accepts the patient in transfer. Just before the patient is placed in the ambulance for transfer, his blood pressure decreases to 80/68 mm Hg and his heart rate increases to 136 beats per minute. The next step should be to: repeat the primary survey and proceed with transfer 28. A 64-year-old man involved in a high-speed car crash, is resuscitated initially in a small hospital without surgical capabilities. He has a closed head injury with a GCS score of 13. He has a widened mediastinum on chest x-ray with fractures of left ribs 2 through 4, but no pneumothorax. After initiating fluid resuscitation, his blood pressure is 110/74 mm Hg, heart rate is 100 beats per minute, and respiratory rate is 18 breaths per minute. He has gross hematuria and a pelvic fracture. You decide to transfer this patient to a facility capable of providing a higher level of care. The facility is 128 km (80 miles) away. Before transfer, you should first: call the receiving hospital and speak to the surgeon on call 29. Hemorrhage of 20% of the patient's blood volume is associated usually with Tachycardia 30. What statement concerning intraosseous infusion is TRUE? Aspiration of bone marrow confirms appropriate positioning of the needle. 31. A young woman sustains a severe head injury as the result of a motor vehicle crash. In the emergency department, her GCS is 6. Her blood pressure is 140/90 mm Hg and her heart rate is 80 beats per minute. She is intubated and mechanically ventilated. Her pupils are 3 mm in size and equally reactive to light. There is no other apparent injury. The most important principle to follow in the early management of her head injury is to avoid hypotension 32. A 33-year-old woman is involved in a head-on motor vehicle crash. It took 30 minutes to extricate her from the car. Upon arrival in the emergency department, her heart rate is 120 beats per minute, BP is 90/70 mm Hg, respiratory rate is 16 breaths per minute, and her GCS score is 15. Examination reveals bilaterally equal breath sounds, anterior chest wall ecchymosis, and distended neck veins. Her abdomen is flat, soft, and not tender. Her pelvis is stable. Palpable distal pulses are found in all 4 extremities. Of the following, the most likely diagnosis is: cardiac tamponade 33. A hemodynamically normal 10-year-old girl is hospitalized for observation after a Grade III (moderately severe) splenic injury has been confirmed by computed tomography (CT). What mandates prompt celiotomy (laparotomy)? development of peritonitis on physical exam 34. A 40-year-old woman who was a restrained driver in a motor vehicle crash is evaluated in the emergency department. She is hemodynamically normal and found to be paraplegic at the level of T10. What precaution should be taken during evaluation and management? Log rolling using 4 people is a safe approach to restrict spinal motion when moving her. 35. A trauma patient presents to your emergency department with inspiratory stridor and a suspected c-spine injury. Oxygen saturation is 88% on high-flow oxygen via a nonrebreathing mask. The most appropriate next step is to: restrict cervical motion and establish a definitive airway 36. When applying the Rule of Nines to infants The head is proportionally larger in infants than in adults 37. A healthy young male is brought to the emergency department following a motor vehicle crash. His vital signs are a blood pressure of 84/60, pulse 123, GCS 10. The patient moans when his pelvis is palpated. After initiating fluid resuscitation, the next step in management is: placement of a pelvic binder 38. What situations requires Rh immunoglobulin administration to an injured woman? positive pregnancy test, Rh negative, and has torso trauma 39. A 22-year-old female athlete is stabbed in her left chest at the third interspace in the anterior axillary line. On admission to the emergency department and 15 minutes after the incident, she is awake and alert. Her heart rate is 100 beats per minute, blood pressure 80/60 mm Hg, and respiratory rate 20 breaths per minute. A chest x-ray reveals a large left hemothorax. A left chest tube is placed with an immediate return of 1600 mL of blood. The next management step for this patient is: prepare for an exploratory thoracotomy 40. A 6-year-old boy walking across the street is struck by the front bumper of a sports utility vehicle traveling at 32 kph (20 mph). What's true about this patient? A pulmonary contusion may be present in the absence of rib fractures. 41. Adjuncts used during the primary survey ECG Pulse ox CO2 monitoringV Ventilatory rate ABGs Foleys (UOP) Gastric catheter FAST or eFAST DPL 42. Urinary output is sensitive for Patient's volume status and renal perfusion 43. "Golden hour" The time from injury to definitive care, during which treatment of shock and traumatic injuries should occur because survival potential is best; also called the Golden Period. 44. Leading cause of trauma deaths worldwide MVCs 45. Trimodal death distribution 1st: seconds to minutes of injury (apnea) 2nd: minutes to several hours (EDH, SDH, liver lac, pelvic fractures, spleen ruptures) 3rd: several days to weeks after injury (sepsis and multi-organ failure) 46. An 18-year-old male was the unrestrained driver in a MVC involving contact with a tree, He is being transported to the ED by ambulance after a prolonged extrication process. He is receive oxygen by mask and IVF via one large-bore IV, and he is immobilized on a long spine board. How would you prepare for arrival of this patient? Airway equipment for possible intubation IV equipment to place a second IV and get blood work Lab/Xray available Monitor equipment ready Notify blood bank and have transfusion protocol available Consider appropriate transfer 47. AMPLE hx Allergies Medications currently used Past illnesses/Pregnancy Last meal Events/Environment related to the injury 48. Blunt trauma MOI Seatbelt use Steering wheel deofrmation Presence/activation of airbags Direction of impact Damage to vehicle Patient position Ejection from vehicle? 49. Penetrating trauma MOI Body region Velocity of weapon Caliber 50. Heat loss can occur at moderated temperatures 59 to 68 F (15-20 C) 51. Prehospital phase should include what interventions and considerations? Airway maintenance Breathing support Control of bleeding and shock Immobilization Immediate transport to closest appropriate facility 52. Hospital preparation for trauma Resuscitation area Airway équipement Warmed IV crystalloid solution Monitoring devices Protocol for requesting additional assistance Transfer agreements 53. Primary survey Airway maintenance with restriction of cervical spine motion Breathing Circulation Disability Exposure/Environmental control 54. Patients with maxillofacial or head trauma should be presumed to have A cervical pine injury and cervical spine motion must be restricted 55. PITFALL: equipment failure Test regularly Ensure spare equipment and batteries are readily available 56. PITFALL: unsuccessful intubation Identify patients with difficult anatomy Identify the most experienced/skilled airway manager on team Ensure appropriate equipment is available Be prepared to prefer a surgical airway 57. PITFALL: progressive airway loss Recognize the dynamic status of the airway Recognize the injuries that can result in progressive airway loss Frequently reassess the patient for signs of deterioration of the airway 58. In a trauma patient with hypotension, what are the two most important causes to consider in order of importance? Tension pneumothorax Hemorrhage 59. What is the best way to manage rapid external blood loss? Direct manual pressure on the wound 60. What are the major areas of internal hemorrhage? Chest Abdomen Retroperitoneum Pelvis Long bones 61. How should fluids be administered in trauma patients with shock? Warm IVFs If unresponsive to initial IVF, give blood transfusion immediately 62. What are the uses for ETCO2? Detect ROSC Confirm ET intubation Help avoid hypoventilation and hyperventilation 63. You'd like to insert a foley catheter for a trauma patient but you notice urethras injury. What test should be performed prior to the insertion of a urinary catheter? Retrograde urethrogram 64. DDX for blood in gastric aspirate in a trauma patient Swallowed blood Traumatic gastric tube placement UGI injury 65. What's a C/I to NGT insertion? Fracture of the cribriform/midface fracture (insert OG instead) 66. What injuries are at high risk of compartment syndrome in trauma patients? Long bones Crush injuries Circumferential thermal burns Prolonged ischemia to the limb 67. What's normal UOP? Adult: 0.5 ml/kg/hr Child: 1-2 ml/kg/hr 68. MIST for obtaining info from EMS Mechanism and time of injury Injuries found and suspected Symptoms and signs Treatment initiated 69. Retroperitoneal organs Abdominal aorta IVC Duodeum Pancreas Kidneys Ureters Posterior aspects of ascending/descending colon Bladder Rectum Reproductive organs 70. What's the most frequently injured abdominal organ in blunt trauma? Followed by? Spleen (40-55%) Liver (35-45%) Small bowel (5-10%) 71. Which patients should you consider transferring, and what tests should be performed prior to transfer? The patients whose injuries exceed your ability to care for them, either sue to specialize needs, or resource availably. Only perform testing that enables the referring physician to resuscitate, stabilize, and ensure the safer transfer of the patient 72. What's a pulse oximetry measure? Oxygen saturation by relative absorption of light by oxyhemoglobin and deoxyhemoglobin 73. Gastric catheter placement can induce vomiting Be prepared to logroll Ensure suction is immediately available 74. Special populations that may have physiological responses that do not follow expected patterns Children Pregnant females Elderly Obese individuals Athletes 75. Why is info about mechanism of injury so important? The patient's condition is greatly influenced by MOI. It can enhance the understanding of the patient's condition and anticipated injuries 76. Possible adjuncts to secondary survey X-rays of spine and extremities CT scans of head, chest, abdomen, spine Contrast urography and angiography TEE Bronchoscopy Esophagoscopy 77. Frontal impact MVC Cervical spine fracture Flail chest Myocardial contusion Pneumothroax Traumatic aortic disruption Fractured spleen or liver Posterior fracture/dislocation hip/knee Head injury Facial fractures 78. Side impact MVC Contralateral neck sprain Head injury Cervical spine fracture Flail chest Pneumothorax Traumatic aortic disrution Diaphragmatic rupture Fractured spleen/liver/kidney Fractured pelvis or acetabulum 79. Rear impact MVC Cervical spine injury Head injury Soft tissue injury to neck 80. MVC vs pedestrian Head injury Traumatic aortic disruption Abdominal visceral injuries Fractured lower extremities/ pelvis 81. Fall from heigh Head injury Axial spine injury Abdominal visceral injuries Fractured pelvis or acetabulum Bilateral LE fractures 82. Anterior stab wound Cardiac tamponade Hemothorax Pneumothorax Hemopneumothorax 83. Left stab wound Left diaphragm injury Spleen injury Hemopneumothoax 84. Abdomen stab wound Visceral injury 85. Extremity GSW Neurovascular injury Fractures Compartment syndrome 86. Thermal burns Eschar on extremities or chest 87. Electrical burns Cardiac arrhythmias Myonecrosis Compartment syndrome 88. Inhalation burns CO poisoning Upper airway swelling Pulmonary edema 89. What is your first step when a patient condition changes? ABCDEs 90. What's the importance of meticulous record keeping? Crucial during patient assessment and management because often more than one clinician cares for an individual patient and allows those to evaluate the patient's needs and clinical status 91. What info should be provided to the receiving facility for a transferring patient? As much info as possible! Event of injury, patient exam, treatments done, responses of treatments, tests and results, and possible injuries 92. What key information should prehospital providers obtain and report to the receiving hospital? Events associated with injury 93. What patient sign can be quickly observed to assess a patient's hemodynamic status? Skin perfusion 94. Definitive airway A tube placed in the trachea with the cuff inflated below the vocal cords, the tube connected to a form of oxygen-enriched assisted ventilation and the airway secured in place with an appropriate stabilizing method 95. What's critical management for trauma patients, especially those with sustained head injuries? Maintaining oxygenation and printing hypercarbia 96. Triad of largyneal fracture Hoarseness Subcutaneous emphysema Palpable fracture 97. In a conscious trauma patient, airway adequacy can quickly be assessed by Talking to the patient-- A positive verbal response with clear voice indicated patent airways, ventilation, and brain perfusion 98. What can conform a suspected laryngeal fracture? CT scan 99. For a patient who is gurgling, initial assessment for ventilation should include Looking for symmetrical chest rise and listening for breath sounds 100. Decreased or absent breath sounds over one or both hemithoraxes should alert the examiner to the presence of? Pneumothorax, hemothoax, contusion, or flail chest 101. Adjuncts of ventilation problems Pulse ox to measure oxygen saturation and gauge peripheral perfusion Capnography to assess adequacy fo ventilation 102. What are the symptoms of inadequate ventilation? Difficulty breathing SOB Request to sit up to breath 103. LEMON assessment of difficult intubation Look externally Evaluate the 3-3-2 rule Mallampati Obstruction Neck mobility 104. Types of definitive airways Orotracheal tube Nasotracheal tube Surgical airways (cricothyroidotomy and tracheostomy) 105. Laryngeal manipulation for visualization Backward, upward, and rightward pressure on thyroid cartilage can aid in visualizing vocal cords 106. Which surgical airway is recommended in children under 12? Needle cricothyroidotomy 107. What're adjuncts that might be used during intubation? Suction Manual laryngealmanipulation (BURP) Elastic bougie Anesthetics, analgesics, and neuromuscular blocking agents 108. Why is continual pulse ox monitoring necessary in critically injured patients? Because changes in oxygenation occur rapidly and are impossible to detect clinically 109. What indicates that the endotracheal tube is in the proper position? Equal breath sounds bilaterally Carbon dioxide monitor (capnograph or colorimetric CO2 device) Confirmed with CXR 110. What suggests sufficient ventilation? ABG or continual end-tidal carbon dioxide analysis 111. On exam, an unrestrained driver is hoards and has minimal subcutaneous neck emphysema. This patient likely has a/an Obstructed airway 112. In an agitated trauma patient who refuses to lay down Assessment of airway adequacy may include suctioning 113. What's an indication for rapid sequence intubation? Patients who need airway control, have intact gag reflex, especially those who have sustained head injury 114. A surgical airway is indicated in the presence of Edema of the glottis Fracture of larynx Severe oropharyngeal hemorrhage that obstructs airway Inability to place an endotracheal tube 115. Possible causes of confusion after traumatic event? Hemorrhage Brain injury Stroke Intoxication 116. What's the most common cause of shock after an injury? Hemorrhage 117. What're the early clinical manifestations of shock? Tachycardia and cutaneous vasoconstriction 118. What's the preferred method of vascular access for a patient involved in a MVC? 2 large bore PIVs in the antecubital veins 119. What's the most appropriate means to restore cardiac output and end organ perfusion in hemorrhagic shock? Stopping the source of bleeding and ensuring appropriate volume repletion 120. A 24-year-old male arrives in ED already intubated. He has significant crepitus of the right chest wall and diminished breath sounds. You place a chest tube and note a large amount of bubbling in the water seal chamber. His O2 saturation remains at 85% and he has goodCO2 return on capnography. The most likely cause of his low oxygen saturation is Tracheobronchial tree injury 121. Most injuries to the tracheobronchial tree occur where? Within 2.5 cm from the carina 122. Do the vast majority of thoracic injuries (blunt and penetrating) require operative intervention? No, most are treated with technical procedures 123. Airway thoracic injuries Airway obstruction (laryngeal injury, posterior dislocation of clavicular head, or penetrating trauma) Tracheobronchial tree injury 124. Breathing thoracic injuries Tension pneumothorax Open pneumothorax Massive hemothorax 125. Circulation thoracic injuries Massive hemothorax Cardiac tamponade Traumatic circulatory arrest 126. What's the most common cause of a tension pneumothorax? Mechanical positive-pressure ventilation in patients with a visceral pleural injury 127. Where is the ideal location for needle decompression of a tension pneumothorax? 5th intercostal space, slightly anterior to midaxillary line 128. What do you need to remember when treating an open pneumothorax? Place a dressing on the site and only secure is on 3 sides so air can escape, then place a chest tube 129. Massive hemothorax Accumulation of 1500 ml of blood in one side of chest 130. Causes of PEA? Hypovolemia Hypoxia Hydrogen acidosis Hypo/hyperkalemia Hypoglycemia Hypothermia Toxins Tamponade Tension pneumo Thrombosis 131. Indications of a thoracotomy Immediate return of 1500 ml of blood or significant bleeding Persistent blood transfusions Penetrating anterior chest wounds medial to the nipple line Posterior wounds medial to the scapula 132. A 26-year-old male sustained a posterior stab wound. Blood and bubbling are coming from the wound. Open pneumothorax 133. A 46-year-old male sustained a gunshot wound to the chest Massive hemothorax 135. A 65-year-old female who takes warfarin was involved in a MVC. She initially presented complaining of sternal pain. BP deteriorated to 90/60 after arriving to the ED Cardiac tamponade