ATLS Test WITH SIMPLE VERIFIED
SOLUTIONS
A l22-year-old lman lis lhypotensive land ltachycardic lafter la lshotgun lwound lto lthe lleft
lshoulder. lHis lblood lpressure lis linitially l80/40 lmm lHg. lAfter linitial lfluid lresuscitation lhis
lblood lpressure lincreases lto l122/84 lmm lHg. lHis lheart lrate lis lnow l100 lbeats lper
lminute land lhis lrespiratory lrate lis l28 lbreaths lper lminute. lA ltube lthoracostomy lis
lperformed lfor ldecreased lleft lchest lbreath lsounds lwith lthe lreturn lof la lsmall lamount lof
lblood land lno lair lleak. lAfter lchest ltube linsertion, lthe lmost lappropriate lnext lstep lis:
Select lone:
a.
reexamine lthe lchest
b.
perform lan laortogram
c.
obtain la lCT lscan lof lthe lchest
d.
obtain larterial lblood lgas lanalyses
e.
perform ltransesophageal lechocardiography l- lCorrect l lAnswer l- lA) lReexamine lthe
lchest
A lconstruction lworker lfalls ltwo lstories lfrom la lbuilding land lsustains lbilateral lcalcaneal
lfractures. lIn lthe lemergency ldepartment, lhe lis lalert, lvital lsigns lare lnormal, land lhe lis
lcomplaining lof lsevere lpain lin lboth lheels land lhis llower lback. lLower lextremity lpulses
lare lstrong land lthere lis lno lother ldeformity. lThe lsuspected ldiagnosis lis lmost llikely lto
lbe lconfirmed lby:
Select lone:
a.
angiography
b.
compartment lpressures
c.
retrograde lurethrogram
d.
Doppler lultrasound lstudies
e.
complete lspine lx-ray lseries l- lCorrect l lAnswer l- le) lComplete lspine lx-ray lseries
Which lof lthe lfollowing lis ltrue lregarding lthe linitial lresuscitation lof la ltrauma lpatient?
Select lone:
a.
,A lpatient lthat lpresents lwith la ltorso lgunshot lwound land lis lhypotensive lshould lreceive
lcrystalloid lfluid lresuscitation luntil lthe lblood lpressure lis lnormal
b.
Evidence lof limproved lperfusion lafter lfluid lresuscitation lcould linclude limprovement lin
lGlasgow lcoma lscale lscore lon lreevaluation
c.
Massive ltransfusion lis ldefined las ltransfusion lof lmore lthan l>10 lof lpacked lred lblood
lcells land lplasma lin l24 lhours
d.
When ltranexamic lacid lis ladministered lby lpre-hospital lproviders la lsecond ldose lis
lrequired lwithin l24 lhours
e.
Fluid lresuscitation lis lfar lmore limportant lthan lbleeding lcontrol lin ltrauma lpatients l-
lCorrect l lAnswer l- lb.
Evidence lof limproved lperfusion lafter lfluid lresuscitation lcould linclude limprovement lin
lGlasgow lcoma lscale lscore lon lreevaluation
In lmanaging la lpatient lwith la lsevere ltraumatic lbrain linjury, lthe lmost limportant linitial
lstep lis lto:
Select lone:
a.
Secure lthe lairway
b.
obtain la lc-spine lfilm
c.
support lthe lcirculation
d.
control lscalp lhemorrhage
e.
determine lthe lGCS lscore
Feedback
Your lanswer lis lcorr l- lCorrect l lAnswer l- la.
Secure lthe lairway
A lpreviously lhealthy, l70-kg l(154-pound) lman lsuffers lan lestimated lacute lblood lloss lof
l2 lliters.
Which lone lof lthe lfollowing lstatements lapplies lto lthis lpatient?
Select lone:
a.
His lpulse lpressure lwill lbe lwidened.
b.
His lurinary loutput lwill lbe lat lthe llower llimits lof lnormal.
c.
He lwill lhave ltachycardia, lbut lno lchange lin lhis lsystolic lblood lpressure.
d.
An lABG lwould ldemonstrate la lbase ldeficit lbetween l-6 land l-10 lmEq/L
e.
,His lsystolic lblood lpressure lwill lbe lmaintained lwith lan lelevated ldiastolic lpressure. l-
lCorrect l lAnswer l- ld.
An lABG lwould ldemonstrate la lbase ldeficit lbetween l-6 land l-10 lmEq/L
The lphysiologic lhypervolemia lof lpregnancy lhas lclinical lsignificance lin lthe
lmanagement lof lthe lseverely linjured, lgravid lwoman lby:
Select lone:
a.
reducing lthe lneed lfor lblood ltransfusion
b.
resulting lin lan lelevated lhematocrit
c.
complicating lthe lmanagement lof lclosed lhead linjury
d.
reducing lthe lvolume lof lcrystalloid lrequired lfor lresuscitation
e.
increasing lthe lvolume lof lblood lloss lto lproduce lmaternal lhypotension l- lCorrect l
lAnswer l- le.
increasing lthe lvolume lof lblood lloss lto lproduce lmaternal lhypotension
The lbest lassessment lof lfluid lresuscitation lof lthe ladult lburn lpatient lis:
Select lone:
a.
Urine loutput lof l0.5 lmL/kg/hr
b.
normalization lof lblood lpressure
c.
normalization lof lthe lheart lrate
d.
measuring la lnormal lcentral lvenous lpressure
e.
providing l4 lmL/kg/percent lbody lburn/24 lhours lof lcrystalloid lfluid l- lCorrect l lAnswer l- la.
Urine loutput lof l0.5 lmL/kg/hr
The ldiagnosis lof lshock lmust linclude:
Select lone:
a.
hypoxemia
b.
acidosis
c.
hypotension
d.
increased lvascular lresistance
e.
evidence lof linadequate lorgan lperfusion l- lCorrect l lAnswer l- le.
evidence lof linadequate lorgan lperfusion
, A l7-year-old lboy lis lbrought lto lthe lemergency ldepartment lby lhis lparents lseveral
lminutes lafter lhe lfell lthrough la lwindow. lHe lis lbleeding lprofusely lfrom la l6-cm lwound
lof lhis lmedial lright lthigh. lImmediate lmanagement lof lthe lwound lshould lconsist lof:
Select lone:
a.
application lof la ltourniquet
b.
direct lpressure lon lthe lwound
c.
packing lthe lwound lwith lgauze
d.
direct lpressure lon lthe lfemoral lartery lat lthe lgroin
e.
debridement lof ldevitalized ltissue l- lCorrect l lAnswer l- lb.
direct lpressure lon lthe lwound
For lthe lpatient lwith lsevere ltraumatic lbrain linjury, lprofound lhypocarbia lshould lbe
lavoided lto lprevent:
Select lone:
a.
respiratory lacidosis
b.
metabolic lacidosis
c.
cerebral lvasoconstriction lwith ldiminished lperfusion
d.
neurogenic lpulmonary ledema
e.
shift lof lthe loxyhemoglobin ldissociation lcurve l- lCorrect l lAnswer l- lc.
cerebral lvasoconstriction lwith ldiminished lperfusion
After lbeing linvolved lin la lmotor lvehicle lcrash, la l25-year-old lman lis lbrought lto la
lhospital lthat lhas lsurgery lcapabilities lavailable.. lComputed ltomography lof lthe lchest
land labdomen lshows lan laortic linjury land lsplenic llaceration lwith lfree labdominal lfluid.
lHis lblood lpressure lfalls lto l70 lmm lHg lafter lCT. lThe lnext lstep lis:
Select lone:
a.
obtain lcontrast langiography
b.
transfer lto la lhigher llevel ltrauma lcenter
c.
perform lan lexploratory llaparotomy
d.
infuse ladditional lcrystalloid lfluids
e.
Obtain ltransesophageal lechocardiography l- lCorrect l lAnswer l- lc.
perform lan lexploratory llaparotomy
SOLUTIONS
A l22-year-old lman lis lhypotensive land ltachycardic lafter la lshotgun lwound lto lthe lleft
lshoulder. lHis lblood lpressure lis linitially l80/40 lmm lHg. lAfter linitial lfluid lresuscitation lhis
lblood lpressure lincreases lto l122/84 lmm lHg. lHis lheart lrate lis lnow l100 lbeats lper
lminute land lhis lrespiratory lrate lis l28 lbreaths lper lminute. lA ltube lthoracostomy lis
lperformed lfor ldecreased lleft lchest lbreath lsounds lwith lthe lreturn lof la lsmall lamount lof
lblood land lno lair lleak. lAfter lchest ltube linsertion, lthe lmost lappropriate lnext lstep lis:
Select lone:
a.
reexamine lthe lchest
b.
perform lan laortogram
c.
obtain la lCT lscan lof lthe lchest
d.
obtain larterial lblood lgas lanalyses
e.
perform ltransesophageal lechocardiography l- lCorrect l lAnswer l- lA) lReexamine lthe
lchest
A lconstruction lworker lfalls ltwo lstories lfrom la lbuilding land lsustains lbilateral lcalcaneal
lfractures. lIn lthe lemergency ldepartment, lhe lis lalert, lvital lsigns lare lnormal, land lhe lis
lcomplaining lof lsevere lpain lin lboth lheels land lhis llower lback. lLower lextremity lpulses
lare lstrong land lthere lis lno lother ldeformity. lThe lsuspected ldiagnosis lis lmost llikely lto
lbe lconfirmed lby:
Select lone:
a.
angiography
b.
compartment lpressures
c.
retrograde lurethrogram
d.
Doppler lultrasound lstudies
e.
complete lspine lx-ray lseries l- lCorrect l lAnswer l- le) lComplete lspine lx-ray lseries
Which lof lthe lfollowing lis ltrue lregarding lthe linitial lresuscitation lof la ltrauma lpatient?
Select lone:
a.
,A lpatient lthat lpresents lwith la ltorso lgunshot lwound land lis lhypotensive lshould lreceive
lcrystalloid lfluid lresuscitation luntil lthe lblood lpressure lis lnormal
b.
Evidence lof limproved lperfusion lafter lfluid lresuscitation lcould linclude limprovement lin
lGlasgow lcoma lscale lscore lon lreevaluation
c.
Massive ltransfusion lis ldefined las ltransfusion lof lmore lthan l>10 lof lpacked lred lblood
lcells land lplasma lin l24 lhours
d.
When ltranexamic lacid lis ladministered lby lpre-hospital lproviders la lsecond ldose lis
lrequired lwithin l24 lhours
e.
Fluid lresuscitation lis lfar lmore limportant lthan lbleeding lcontrol lin ltrauma lpatients l-
lCorrect l lAnswer l- lb.
Evidence lof limproved lperfusion lafter lfluid lresuscitation lcould linclude limprovement lin
lGlasgow lcoma lscale lscore lon lreevaluation
In lmanaging la lpatient lwith la lsevere ltraumatic lbrain linjury, lthe lmost limportant linitial
lstep lis lto:
Select lone:
a.
Secure lthe lairway
b.
obtain la lc-spine lfilm
c.
support lthe lcirculation
d.
control lscalp lhemorrhage
e.
determine lthe lGCS lscore
Feedback
Your lanswer lis lcorr l- lCorrect l lAnswer l- la.
Secure lthe lairway
A lpreviously lhealthy, l70-kg l(154-pound) lman lsuffers lan lestimated lacute lblood lloss lof
l2 lliters.
Which lone lof lthe lfollowing lstatements lapplies lto lthis lpatient?
Select lone:
a.
His lpulse lpressure lwill lbe lwidened.
b.
His lurinary loutput lwill lbe lat lthe llower llimits lof lnormal.
c.
He lwill lhave ltachycardia, lbut lno lchange lin lhis lsystolic lblood lpressure.
d.
An lABG lwould ldemonstrate la lbase ldeficit lbetween l-6 land l-10 lmEq/L
e.
,His lsystolic lblood lpressure lwill lbe lmaintained lwith lan lelevated ldiastolic lpressure. l-
lCorrect l lAnswer l- ld.
An lABG lwould ldemonstrate la lbase ldeficit lbetween l-6 land l-10 lmEq/L
The lphysiologic lhypervolemia lof lpregnancy lhas lclinical lsignificance lin lthe
lmanagement lof lthe lseverely linjured, lgravid lwoman lby:
Select lone:
a.
reducing lthe lneed lfor lblood ltransfusion
b.
resulting lin lan lelevated lhematocrit
c.
complicating lthe lmanagement lof lclosed lhead linjury
d.
reducing lthe lvolume lof lcrystalloid lrequired lfor lresuscitation
e.
increasing lthe lvolume lof lblood lloss lto lproduce lmaternal lhypotension l- lCorrect l
lAnswer l- le.
increasing lthe lvolume lof lblood lloss lto lproduce lmaternal lhypotension
The lbest lassessment lof lfluid lresuscitation lof lthe ladult lburn lpatient lis:
Select lone:
a.
Urine loutput lof l0.5 lmL/kg/hr
b.
normalization lof lblood lpressure
c.
normalization lof lthe lheart lrate
d.
measuring la lnormal lcentral lvenous lpressure
e.
providing l4 lmL/kg/percent lbody lburn/24 lhours lof lcrystalloid lfluid l- lCorrect l lAnswer l- la.
Urine loutput lof l0.5 lmL/kg/hr
The ldiagnosis lof lshock lmust linclude:
Select lone:
a.
hypoxemia
b.
acidosis
c.
hypotension
d.
increased lvascular lresistance
e.
evidence lof linadequate lorgan lperfusion l- lCorrect l lAnswer l- le.
evidence lof linadequate lorgan lperfusion
, A l7-year-old lboy lis lbrought lto lthe lemergency ldepartment lby lhis lparents lseveral
lminutes lafter lhe lfell lthrough la lwindow. lHe lis lbleeding lprofusely lfrom la l6-cm lwound
lof lhis lmedial lright lthigh. lImmediate lmanagement lof lthe lwound lshould lconsist lof:
Select lone:
a.
application lof la ltourniquet
b.
direct lpressure lon lthe lwound
c.
packing lthe lwound lwith lgauze
d.
direct lpressure lon lthe lfemoral lartery lat lthe lgroin
e.
debridement lof ldevitalized ltissue l- lCorrect l lAnswer l- lb.
direct lpressure lon lthe lwound
For lthe lpatient lwith lsevere ltraumatic lbrain linjury, lprofound lhypocarbia lshould lbe
lavoided lto lprevent:
Select lone:
a.
respiratory lacidosis
b.
metabolic lacidosis
c.
cerebral lvasoconstriction lwith ldiminished lperfusion
d.
neurogenic lpulmonary ledema
e.
shift lof lthe loxyhemoglobin ldissociation lcurve l- lCorrect l lAnswer l- lc.
cerebral lvasoconstriction lwith ldiminished lperfusion
After lbeing linvolved lin la lmotor lvehicle lcrash, la l25-year-old lman lis lbrought lto la
lhospital lthat lhas lsurgery lcapabilities lavailable.. lComputed ltomography lof lthe lchest
land labdomen lshows lan laortic linjury land lsplenic llaceration lwith lfree labdominal lfluid.
lHis lblood lpressure lfalls lto l70 lmm lHg lafter lCT. lThe lnext lstep lis:
Select lone:
a.
obtain lcontrast langiography
b.
transfer lto la lhigher llevel ltrauma lcenter
c.
perform lan lexploratory llaparotomy
d.
infuse ladditional lcrystalloid lfluids
e.
Obtain ltransesophageal lechocardiography l- lCorrect l lAnswer l- lc.
perform lan lexploratory llaparotomy
