ATLS EXAM QUESTIONS AND
ANSWERS WITH VERIFIED STUDY
SOLUTIONS
A clenched hand with a small electrical entrance wound should alert the clinician that a
deep soft tissue injury is likely much more extensive than is visable to the naked eye -
Answer-true. patients with severe electrical injuries require fasciotomies. Electricity can
cause forced contraction of muscles, doctors need to examine patient for skeletal and
muscular damage, especially for fractures of the spine and rhabdomyolysis
How do you dissolve a tar burn? - Answer-Use mineral oil
Abuse and burns - Answer-circular burns and burns with clear edges and unique
patterns may reflect cigarette burns or iron. Burns on the sole of the feet usually
suggest child was placed in hot water. A burn on the posterior aspect of the LE and
buttocks
Patient with electrical burn can develop for acute renal failure - Answer-remember these
burns can cause serious muscle damage without showing signs outright. Test urine for
hemochromogen and administer proper volume. Assess for compartment syndrome and
attach EKG leads as electrical injury can cause arrhythmias.
Frostbite is due to freezing of tissue with intracellular ice crystal formation,
microvascular occlusion, and subsequent tissue anoxia. - Answer-first degree:
hyperemia and edema are present w/o skin necrosis
second degree: large clear vesicles accompany the hyperemia and edema with partial
thickness skin necrosis.
third degree frostbite: full thickness skin necrosis including muscle and bone with later
necrosis
treatment is circulating water at constant 40 degrees C or 104F until pink color and
perfusion return in 20-30 minutes.
In frostbite injury, warming large areas can result in reperfusion syndrome, with
acidosis, hyperK and local swelling. - Answer-therefore monitor the patient's cardiac
status and peripheral perfusion during rewarming.
Sympathetic blockade agents and vasodilating agents have shown to be effective in
altering the progression of acute cold injury - Answer-false
,hypothermia is a core temp below 36C or 96.8F - Answer-hypothermia can worsen
coagulopathy and affect organ function.
Rhabdomyolysis can lead to metabolic acidosis, hyperK, hypoC, and DIC. - Answer-
Myoglobin induced renal failure can be prevented with intravascular fluid expansion,
alkalinization of the urine by IV administration of Bicarbonate and osmotic diuresis.
For MSK trauma, loss of sensation in a stocking or glove distribution is an early sign
of.... - Answer-early sign of vascular impairment
Knee dislocations can reduce spontaneously and may not present with any gross
external or radiographic anomalies until a physical exam of is joint is perfromed. -
Answer-an ankle brachial index of less than 0.9 indicates abnormal arterial flow
secondary to injury or peripheral vascular disease
Blanched skin associated with fractures and dislocations can lead to soft tissue
necrosis. The purpose of promptly reducing this injury is to prevent pressure necrosis of
the lateral left ankle soft tissue - Answer-the only reason to forgo an xray exam before
treating a dislocation or fracture is the presence of vascular compromise or impending
skin breakdown, often seen with fracture dislocations of the ankle
Treat all patients with open fractures as soon as possible with iv antibiotics - Answer-
cephalosporins are necessary for all open fractures
operative revascularization to an avascular extremity is important to treat emergently. -
Answer-muscle necrosis begins where there is a lack of blood flow for 6 hours. is there
is an associated fracture deformity, correct it by gently pulling the limb out to length,
realigning the fracture and splinting the injured extremity. This maneuver can restore the
blood flow
High risk activities that can cause compartment syndrome include: - Answer-excessive
exercise
burns
severe crush injury to muscle
localized prolonged external pressure to an extremity
increased capillary permeability secondary to reperfusion of ischemic muscle.
Compartment syndrome is a clinical diagnosis and pressure measurements are only an
adjunct to aid in its diagnosis. a pressure greater than 30 can cause anoxia. - Answer-
the absence of a palpable distal pulse is an uncommon or late finding and is not
necessary to diagnose compartment syndrome.
Capillary refill times are also unreliable
weakness or paralysis of the involved muscle is a late sign and indicates nerve or
muscle damage
, the lower the systemic pressure, the lower the compartment pressure that causes
compartment syndrome
risk of tetanus: - Answer-wounds that are more than 6 hours old
contused or abraded
more than 1cm in depth
from high velocity missiles
due to burns or cold
significantly contaminated
ischemic tissue or denervated wounds
True or false? on page 162. To exclude occult dislocation and concomitant injury, x ray
films must include the joints above and below the suspected fracture site - Answer-true.
unless life threatening, splinting of extremity injuries should be done during the
secondary survey.
do not apply traction to patients with an ipsilateral tibia shaft fracture. - Answer-true
Laryngeal Trauma presents as hoarseness, subcutaneous emphysema, and palpable
fracture - Answer-true. sounds of airway obstruction and include snoring, gurgling,
stridor, hoarseness, cyanosis, agitation
LEMON assessment for difficult airway - Answer-Look, evaluate 3-3-2 rule, mallampati,
obstruction, neck mobility
Do not give a nasopharyngeal airway to someone suspected of having a cribriform plate
fracture. - Answer-also do not give nasotracheal intubation to patients with basillar skull
fracture
A tube placed in the trachea with the cuff inflated below the vocal cords and the tube
connected to oxygen enriched assisted ventilation and airway secured in place. -
Answer-definitive airway
patients use the gum elastic bougie when vocal cords cannot be visualized on direct
laryngoscopy. - Answer-using the GEB has allowed for rapid intubation of nearly 80% of
prehospital patients in whom laryngoscopy was difficult. A GEB inserted into the
esophagus will pass its full length without resistance
Reliable ways to detect proper intubation - Answer-proper placement of the tube is
suggested but not confirmed:
1. hearing equal breath sounds bilaterally
2. detecting no borborygmi (rumbling or gurgling noises) in the epigastrium. the
presence of this with inspiration suggestion esophageal intubation and warrants
removal of tube
ANSWERS WITH VERIFIED STUDY
SOLUTIONS
A clenched hand with a small electrical entrance wound should alert the clinician that a
deep soft tissue injury is likely much more extensive than is visable to the naked eye -
Answer-true. patients with severe electrical injuries require fasciotomies. Electricity can
cause forced contraction of muscles, doctors need to examine patient for skeletal and
muscular damage, especially for fractures of the spine and rhabdomyolysis
How do you dissolve a tar burn? - Answer-Use mineral oil
Abuse and burns - Answer-circular burns and burns with clear edges and unique
patterns may reflect cigarette burns or iron. Burns on the sole of the feet usually
suggest child was placed in hot water. A burn on the posterior aspect of the LE and
buttocks
Patient with electrical burn can develop for acute renal failure - Answer-remember these
burns can cause serious muscle damage without showing signs outright. Test urine for
hemochromogen and administer proper volume. Assess for compartment syndrome and
attach EKG leads as electrical injury can cause arrhythmias.
Frostbite is due to freezing of tissue with intracellular ice crystal formation,
microvascular occlusion, and subsequent tissue anoxia. - Answer-first degree:
hyperemia and edema are present w/o skin necrosis
second degree: large clear vesicles accompany the hyperemia and edema with partial
thickness skin necrosis.
third degree frostbite: full thickness skin necrosis including muscle and bone with later
necrosis
treatment is circulating water at constant 40 degrees C or 104F until pink color and
perfusion return in 20-30 minutes.
In frostbite injury, warming large areas can result in reperfusion syndrome, with
acidosis, hyperK and local swelling. - Answer-therefore monitor the patient's cardiac
status and peripheral perfusion during rewarming.
Sympathetic blockade agents and vasodilating agents have shown to be effective in
altering the progression of acute cold injury - Answer-false
,hypothermia is a core temp below 36C or 96.8F - Answer-hypothermia can worsen
coagulopathy and affect organ function.
Rhabdomyolysis can lead to metabolic acidosis, hyperK, hypoC, and DIC. - Answer-
Myoglobin induced renal failure can be prevented with intravascular fluid expansion,
alkalinization of the urine by IV administration of Bicarbonate and osmotic diuresis.
For MSK trauma, loss of sensation in a stocking or glove distribution is an early sign
of.... - Answer-early sign of vascular impairment
Knee dislocations can reduce spontaneously and may not present with any gross
external or radiographic anomalies until a physical exam of is joint is perfromed. -
Answer-an ankle brachial index of less than 0.9 indicates abnormal arterial flow
secondary to injury or peripheral vascular disease
Blanched skin associated with fractures and dislocations can lead to soft tissue
necrosis. The purpose of promptly reducing this injury is to prevent pressure necrosis of
the lateral left ankle soft tissue - Answer-the only reason to forgo an xray exam before
treating a dislocation or fracture is the presence of vascular compromise or impending
skin breakdown, often seen with fracture dislocations of the ankle
Treat all patients with open fractures as soon as possible with iv antibiotics - Answer-
cephalosporins are necessary for all open fractures
operative revascularization to an avascular extremity is important to treat emergently. -
Answer-muscle necrosis begins where there is a lack of blood flow for 6 hours. is there
is an associated fracture deformity, correct it by gently pulling the limb out to length,
realigning the fracture and splinting the injured extremity. This maneuver can restore the
blood flow
High risk activities that can cause compartment syndrome include: - Answer-excessive
exercise
burns
severe crush injury to muscle
localized prolonged external pressure to an extremity
increased capillary permeability secondary to reperfusion of ischemic muscle.
Compartment syndrome is a clinical diagnosis and pressure measurements are only an
adjunct to aid in its diagnosis. a pressure greater than 30 can cause anoxia. - Answer-
the absence of a palpable distal pulse is an uncommon or late finding and is not
necessary to diagnose compartment syndrome.
Capillary refill times are also unreliable
weakness or paralysis of the involved muscle is a late sign and indicates nerve or
muscle damage
, the lower the systemic pressure, the lower the compartment pressure that causes
compartment syndrome
risk of tetanus: - Answer-wounds that are more than 6 hours old
contused or abraded
more than 1cm in depth
from high velocity missiles
due to burns or cold
significantly contaminated
ischemic tissue or denervated wounds
True or false? on page 162. To exclude occult dislocation and concomitant injury, x ray
films must include the joints above and below the suspected fracture site - Answer-true.
unless life threatening, splinting of extremity injuries should be done during the
secondary survey.
do not apply traction to patients with an ipsilateral tibia shaft fracture. - Answer-true
Laryngeal Trauma presents as hoarseness, subcutaneous emphysema, and palpable
fracture - Answer-true. sounds of airway obstruction and include snoring, gurgling,
stridor, hoarseness, cyanosis, agitation
LEMON assessment for difficult airway - Answer-Look, evaluate 3-3-2 rule, mallampati,
obstruction, neck mobility
Do not give a nasopharyngeal airway to someone suspected of having a cribriform plate
fracture. - Answer-also do not give nasotracheal intubation to patients with basillar skull
fracture
A tube placed in the trachea with the cuff inflated below the vocal cords and the tube
connected to oxygen enriched assisted ventilation and airway secured in place. -
Answer-definitive airway
patients use the gum elastic bougie when vocal cords cannot be visualized on direct
laryngoscopy. - Answer-using the GEB has allowed for rapid intubation of nearly 80% of
prehospital patients in whom laryngoscopy was difficult. A GEB inserted into the
esophagus will pass its full length without resistance
Reliable ways to detect proper intubation - Answer-proper placement of the tube is
suggested but not confirmed:
1. hearing equal breath sounds bilaterally
2. detecting no borborygmi (rumbling or gurgling noises) in the epigastrium. the
presence of this with inspiration suggestion esophageal intubation and warrants
removal of tube
