ATLS REVIEW QUESTIONS WITH ANSWERS VERIFIED CORRECT

A 22yo M is hypotensive and tachycardia after a shotgun wound to the L shoulder. His BP is initially 80/40. After 2L of fluids his BP increases to 122/84. HR is 100bpm and his RR is 28. Breath sounds are decreased in the left hemithorax, and a closed tube thoracotomy is performed with a small amount of blood return and no air leak. What is the next step? - Reexamine the chest A construction worker falls 2 stories and suffers bilateral calcanea fractures. He now is having back pain. What would confirm diagnosis? - Complete spine x-ray series What is the principle of balanced resuscitation? - permissive hypotension and early plasma infusion In managing a head-injured patient, what is the most important initial step? - Secure the airway A previously healthy 70kg man suffered ~2L of acute blood loss. Which appropriately applies to this patient? - His systolic BP will be decreased with a narrowed pulse pressure NOT his pulse pressure will be widened, urinary output at lower level of normal, tachy but no BP change, or maintained systolic BP with elevated diastolic BP The physiologic hypovolemia of pregnancy has clinical significance in the management of severely injured, gravid woman by: - increasing the volume of blood to produce maternal hypotension The best assessment of fluid resuscitation of the burn patient is - adequate urinary output The diagnosis of shock MUST include: - evidence of inadequate organ perfusion A 7yo M is brought to the ED by his parents several minutes after falling through a window. He is bleeding from a 6cm wound on the medial right thigh. Immediate management of the wound should include? - Direct pressure on the wound **For the patient with severe traumatic brain injury, around HYPOCARBIA (dec CO2) should be avoided in order to prevent what? - cerebral vasoconstriction with diminished perfusion. **A 25yo M is brought in to a facility with a general surgeon after being in an MVA, CT shows aortic injury and spe=lenic lac with abdominal fluid, BP is 70mm Hg after CT. What is the next step? - exploratory laparotomy Which one of the following statements regarding abdominal trauma in the pregnant patient is true? - leakage of amniotic fluid is indication for hospital admission What is the first maneuver to improve oxygenation after chest injury? - administer supplemental O2 25yo M in an MVC is admitted to the ED. Pupils react sluggishly and he opens his eyes to painful stimuli. He does not follow commands, but he does moan periodically. His R arm is performed and does not respond to pain, however his L hand reaches purposefully toward the pain. Both legs are stiffened. What is his GCS? - 9 20yo F is 32w gestation and stabbed in the R upper chest. In the ED her BP is 80/60. She is gasping for breath, anxious, and yelling for help. BS are diminished in the right chest. Next step? - perform needle compression in the right chest Which one of the following findings in an adult is most likely to require immediate management during the primary survey? - RR of 44 The most important, immediate step in the management of open PTX is? - placement of an occlusive dressing on the wound What is a contraindication for tDap? - history of neurological reaction or severe hypersensitivity to the product 56yo M is thrown in against a steering wheel during MVC. On arrival to the ED he is diaphoretic and having chest pain. BP is 60/40 and his RR is 40. Which of the following best differentiates cardiac tamponade from tension PTX? - breath sounds Bronchial intubation of the right or left mainstream bronchus can easily occur during infant endotracheal intubation because : - the trachea is short 23yo M sustains 4 stab wounds to the right upper chest and is brought to a facility with full surgical capabilities. All wounds are above the nipple. 2 IVs are placed, BP is 60/0, HR of 160, and RR of 14 on a ventilator. 1500cc of blood is drained from the right chest. The most appropriate next step is what? - urgent transfer to the OR 39yo M comes to the ED after MVC. Pt is cyanotic, has insufficient respiratory effort and GCS of 6. His beard makes him difficult to use oxygen face mask. What is the next step? - Attempt orotracheal intubation with 2 people and inline stabilization of C-Spine Patient is brought to the ED after MVC. He is conscious with no obvious trauma. He arrives completely immobilized on a long board. His BP is 60/40 and HR is 70. Skin is warm. Which statement is true? - flaccidity of the lower extremities and loss of deep tendon reflexes are expected. Which of the following in the most effective initial treatment for frostbite? - moist heat 32yo M who's right leg is trapped beneath his overturned car for 2 hours before he is extricated. On arrival to the ED, RLE is cool, mottled, insensate, and motionless. Despite normal vital signs, pulses are not palpated below the femoral vessel and the muscles of the lower extremity are firm and hard. During the management of this patient, which of the following is likely to improve the changes for limb salvage? - Perform RLE fasciotomy Pt arrives to the ED after being beaten in 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 vomit on his face. What is an appropriate next step to provide oxygenation? - Suction the oropharynx 22yo M sustains a GSW to the left chest and is transported to a small community hospital at which there are NO surgical capabiities. In the ED a chest tube is inserted and 700mL of blood is evacuated. Trauma center accepts patient. Before transfer, BP decreases to 80/68 and HR increases to 136. What is the next step? - Repeat primary survey and proceed with transfer 64yo M involved in high-speed MVA is resuscitated in a small hospital with limited resources. He has a closed head injury with a GCS of 13. He has a widened mediastinum on CXR and fractures of the left ribs 2 through 4, but no pneumothorax. After 2L, his BP is 110/74 and HR is 100, RR is 18. He has gross hematuria and a pelvic fracture. The facility is 128km away. Before you transfer, what should you do? - call the receiving hospital and speak to the trauma surgeon. Hemorrhage of 20% of the patient's blood is usually associated with... - tachycardia Which one of the following statement concerning intraosseous infusion is TRUE? - aspiration of bone marrow confirms appropriate positioning of the needle A young woman sustains a severe head injury as the result of a MVC. In the ED her GCS is 6, BP 140/90, HR 80bpm. She is intubated and mechanically ventilated. Her pupils are 3mm 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 33yo F involved in an MVC. It took 30 minutes to extricate her from the car. Upon arrival, her HR is 120bpm, BP is 90/70, RR is 16, and HCS is 15. On exam there are equal breath sounds, anterior chest wall ecchymosis, and distended neck veins. Her abdomen is flat, soft, and non-tender. Pelvis is stable. Palpable distal pulses are found in all four extremities. Most likely diagnosis? - Cardiac tamponade A hemodynamically normal 10yo F is admitted to the PICU for ohs due to high grade III splenic injury confirmed on CT. What would prompt urgent laparotomy? - Free retroperitoneal air demonstrated on CT 40yo F restrained driver is transported to the ED in full spinal immobilization. She is hemodynamically normal and paraplegic at T10. Neuro exam also determines that there is loss of pain and temperature sensation with preservation of proprioception and vibration. There findings are consistent with what? - Anterior cord syndrome A trauma patient presents to the ED 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: - maintain inline immobilization and establish a definitive airway When is applying the rule of nine to infants: - the head is proportionally larger in infants than in adults Healthy young male in MVC is brought to the ED with BP of 84/60, HR of 123, and GCS of 10. Patient moans when pelvis is palpated. After initiating fluid resuscitation, what is the next step in management? - Place a pelvic binder Which of the following situations requires Rh immunoglobulin administration to an injured woman? - Positive urinary pregnancy, Rh negative, has torso trauma 22yo F athlete is stabbed in the left chest at the 3rd ICS in the anterior axillary line. On ED arrival 15 minutes after, she is awake and alert. HR is 100bpm. BP is 80/60, RR is 20. CXR reveals large hemothorax. L chest tube is placed with immediate return of 1600mL. Next step is? - prepare for exploratory thoracotomy 6yo M walking across the street is struck by the front bumper of a sports utility vehicle traveling at 32kph. Which statement is true? - Pulmonary contusion may be present in the absence of rib fractures A 24yo M sustains severely, comminuted, open, distal tibia and fibula fractures in a construction incident. Pulses are weakly palpable in the posterior tibial and dorsals pedis arteries. The patient complains of severe, agonizing pain in the area of the injury. The most effective and safest method relieving the patient's pain is: - immobilization of the fractured extremity. What is a definitive airway? - cuffed endotracheal tube **Priorities in the initial trauma management of children... - are the same as those for adults A 60yo M is stabbed in the left anterior chest during a robbery attempt. In the ED, he is diaphoretic. The finding that could signify that the shock state may have a cause other than hypovolemia is... - distended neck veins A 32yo M is brought to the ED with a BP of 80/60 and HR of 130 ppm. He sustained a left, open femoral neck fracture with angulation and a profusely bleeding lac over the fracture site. Immediate management of this patient should be: - application of direct pressure to the bleeding wound The extent of hypoxemia resulting from a flail chest is primarily due to: - underlying lung contusion The most important determinant of fetal outcome in the traumatized pregnant patient is: - hemodynamic status of the mother A motorcycle rider loses control of his bike and tumbles down an embankment. After full spinal immobilization, he is brought to the ED. The patient is unresponsive, demonstrates cerebral posturing to painful stimuli, and does not open his eyes. BP. is 158.94, HR is 66, and RR is 12. No obvious external trauma. Before obtaining CT, what MUST be done? - establish a definitive airway 17yo M was injured in a motorcycle crash. He was endotracheal intubated and ventilated at the scene. In the ED BP responded to infusion with an increase from 88/60 to 122/70. Now his HR is 135bpm and BP again decreased to 90/60. Next step in management is? - repeat primary survey An adolescent sustains a head injury during a fall from her skateboard. Her GCS is 6. Her pupils are equal and reactive to light. Her BP is 130/80 and HR is 80. For optimal outcome, early management of her head injury should include what? - prevention of hypoxia and hypoperfusion The cause of upper airway obstruction most likely to be alleviated by a properly placed oral airway is: - copious, tenacious oral secretions 10yo M falls while riding his bike sustaining a painful straddle injury. On arrival in the ED a drop of blood is visualized at the urethral meatus. The next step in assessment of the GU system should be? - Retrograde urethrogram