ATLS 10 EDITION
1. Which of the following statements about PTX treatment is correct?
A) Current ATLS recommendations state that selected patients with a small, occult PTX can be safely transported by air without a
chest tube.
B) The needle should be placed in the 2nd intercostal space in the
midclavicular line during needle decompression of tension PTX, according to current ATLS recommendations.
C) The needle should not be longer than 6cm during needle decompression of tension PTX, according to current ATLS recommendations, to avoid potential damage to vessels and other
structures.
D) The needle should be placed in the 5th intercostal space, just anterior to the mid axillary line, during needle decompression of tension PTX, according to current ATLS recommendations.
Explanation : Because of the frequent incorrect placement of the needle too far medial in the field, the needle placement recommendation in the 2nd intercostal space in the midclavicular line has changed in ATLS 10. The needle should be inserted into the 5th intercostal space, just anterior to the mid axillary line, according to current recommendations. A longer needle, such as an 8cm, has a better chance of entering the pleural space than a shorter needle and is therefore preferred. Patients with a small, occult PTX can be safely observed unless they are being transported by air or require mechanical ventilation, in which case
a chest tube should be inserted. T ension PTX should be diagnosed
clinically and treated right away rather than waiting for radiographic confirmation.
2. A patient who is mildly hypotensive, tachycardic, blood
pressure returns to normal after 1L fluid bolus but then drops again. What are you going to do?
A) Begin transfusing blood.
B) Transfer to higher level of care.
C) Distribute a 2nd liter bolus of crystalloid.
D) Obtain a CT scan to determine the source of the bleeding.
Explanation : ATLS 10 emphasizes the early administration of blood and blood products. Instead of 2L, a 1L crystalloid bolus is now administered. Simultaneously, you will be treating additional sources of bleeding and searching for unknown sources of ongoing bleeding, but while the patient is unstable, this will involve a FAST or DPL rather than a CT scan. You would also be re-
examining the patient for tension pneumothorax and other non-
hemorrhagic causes of shock. This patient may need to be transferred and/or monitored invasively, but your immediate priorities should be to stabilize the patient by identifying & stopping the bleeding and replacing lost volume of blood.
1. Which of the following statements about PTX treatment is correct?
A) Current ATLS recommendations state that selected patients with a small, occult PTX can be safely transported by air without a
chest tube.
B) The needle should be placed in the 2nd intercostal space in the
midclavicular line during needle decompression of tension PTX, according to current ATLS recommendations.
C) The needle should not be longer than 6cm during needle decompression of tension PTX, according to current ATLS recommendations, to avoid potential damage to vessels and other
structures.
D) The needle should be placed in the 5th intercostal space, just anterior to the mid axillary line, during needle decompression of tension PTX, according to current ATLS recommendations.
Explanation : Because of the frequent incorrect placement of the needle too far medial in the field, the needle placement recommendation in the 2nd intercostal space in the midclavicular line has changed in ATLS 10. The needle should be inserted into the 5th intercostal space, just anterior to the mid axillary line, according to current recommendations. A longer needle, such as an 8cm, has a better chance of entering the pleural space than a shorter needle and is therefore preferred. Patients with a small, occult PTX can be safely observed unless they are being transported by air or require mechanical ventilation, in which case
a chest tube should be inserted. T ension PTX should be diagnosed
clinically and treated right away rather than waiting for radiographic confirmation.
2. A patient who is mildly hypotensive, tachycardic, blood
pressure returns to normal after 1L fluid bolus but then drops again. What are you going to do?
A) Begin transfusing blood.
B) Transfer to higher level of care.
C) Distribute a 2nd liter bolus of crystalloid.
D) Obtain a CT scan to determine the source of the bleeding.
Explanation : ATLS 10 emphasizes the early administration of blood and blood products. Instead of 2L, a 1L crystalloid bolus is now administered. Simultaneously, you will be treating additional sources of bleeding and searching for unknown sources of ongoing bleeding, but while the patient is unstable, this will involve a FAST or DPL rather than a CT scan. You would also be re-
examining the patient for tension pneumothorax and other non-
hemorrhagic causes of shock. This patient may need to be transferred and/or monitored invasively, but your immediate priorities should be to stabilize the patient by identifying & stopping the bleeding and replacing lost volume of blood.
