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ATLS Study Guide/ Over 150 Questions
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A 6-year-o boy is struck by an automobile and brought to the ED. He is lethargic, but withdraws purposefully from painful stimuli. His blood pressure is 90mmHg systolic, heart rate 140 beats per minute and his respiratory rate is 36 breaths per minute. The preferred route of venous access in this patient is: A. Percutaneous femoral vein cannulation B. Cutdown on the saphenous vein at the ankle C. Intraosseous catheter placement in the proximal tibia D. Percutaneous peripheral veins in the upper extremities E. Central venous access via the subclavian or internal jugular vein - Answer: D. Percutaneous peripheral veins in the upper extremities
A young man sustains a gunshot wound to the abdomen and is brought promptly to the ED by prehospital personnel. His skin is cool and diaphoretic, and he is confused. His pulse is thready and his femoral pulse is only weakly palpable. The definitive treatment in managing this patient is to: A. Administer O-negative blood B. Apply external warming devices C. Control internal hemorrhage operatively D. Apply a pneumatic antishock garment (PASG) E. Infuse large volumes of intravenous crystalloid solutions. - Answer: C. Control internal hemorrhage operatively Regarding shock in the child, which of the following is FALSE? A. Vital signs are age-related B. Children have greater physiologic reserves than do adults C. Tachycardia is the primary physiologic response to hypovolemia D. The absolute volume of blood loss required to produce shock is the same as in adults E. An initial fluid bolus for resuscitation should approximate 20ml/kg Ringers Lactate - Answer: D. The absolute volume of blood loss required to produce shock is the same as in adults A 33-year-old man is struck by a car travelling at 56km/h (35mph). He has obvious fractures of the left tibia near the knee, pain in the pelvic area, and severe dyspnea. His heart rate is 182 beats per minute, and his respiratory rate is 48 breaths per minute with no breath sounds heard in the left chest. A tension
A 30-year-old man sustains a severely comminuted, open, distal right femur fracture in a motorcycle crash. The wound is actively bleeding. Normal sensation is present over the lateral aspect of the foot but decreased over the medial foot and great toe. Normal motion of the foot is observed. Dorsalis pedis and posterior tibial pulses are easily palpable on the left, but heard only by Doppler on the right. Immediate efforts to improve circulation to the injured extremity should involve: A. Immediate angiography B. Tamponade of the wound with a pressure dressing C. Wound exploration and removal of bony fragments D. Realignment of the fracture segments with a traction splint E. Fasciotomy of all four compartments in the lower extremity - Answer: B. Tamponade of the wound with a pressure dressing An 18-yeard-old, unhelmeted motorcyclist is brought by ambulance to the ED following a crash. He had decreased level of consciousness at the scene, but then was alert and conversational during transportation. Now his GCS is only 11. Which of the following statements is TRUE? A. Cerebral perfusion is intact B. Intravascular volume status is normal C. The patient is in a postictal state D. Intra-abdominal visceral injury is unlikely E. The patient probably has an acute epidural hematoma - Answer: E. The patient probably has an acute epidural hematoma
A previously healthy, 70kg (175 pound) man suffers an estimated acute blood loss of two liters. Which one of the following statements apply to this patient? A. His pulse pressure will be widened B. His urinary output will be at the lower limits of normal C. He will have tachycardia, but no change in systolic blood pressure D. His systolic blood pressure will be decreased with a narrowed, pulse pressure E. His systolic blood pressure will be maintained with an elevated diastolic pressure. - Answer: E. His systolic blood pressure will be maintained with an elevated diastolic pressure. The physioclogic hypervolemia of pregnancy has clinical significance in the management of the severely injured gravid woman by A. Reducing the need for blood transfusion B. Increasing the risk of pulmonary edema C. Complicating the management of closed head injury D. Increasing the volume of blood loss to produce shock/maternal hypotension E. Reducing the volume of crystalloid required for resuscitation - Answer: D. Increasing the volume of blood loss to produce shock A 17-year-old helmeted motorcyclist loses consciousness when he is struck broad side by an automobile at an intersection. He arrives in the ED with a blood pressure of 140/92, pulse rate 88 beats per minute, a respiratory rate of 18 breaths per minue, and a GCS of 7. Appropriate initial immobilization of this patient should include a semi-rigid cervical collar and: A. A scoop stretcher
D. Left diaphragmatic rupture E. Right tension pneumothorax - Answer: A. Left hemothorax A 23-year-old man is brought immediately to the ED from the hospitals parking lot where he was shot in the lower abdomen. Examination reveals a single bullet wound. He is breathing and has a thready pulse. However, he is unconsious and has no detectable blood pressure. Optimale immediate management is to: A. Perform a diagnostic peritoneal lavage B. Initiate infusion of packed red blood cells C. Insert a nasogastric tube and urinary catheter D. Transfer the patient to the operating room, while initiating fluid therapy E. Initiate fluid therapy to return his blood pressure to normotensive - Answer: D. Transfer the patient to the operating room, while initiating fluid therapy A teen-aged bicycle rider is hit by a truck traveling at high speed. In the ED, she is actively bleeding from open fractures of her legs, and has abrasions on her chest and abdominal wall. Her blood pressure is 80/50 mmHg, heart rate is 140 beats per minute, respiratory rate is 8 breaths per minute, and GCS score is 6. The first step in managing this patient is to: A. Obtain a lateral cervical spine x-ray B. Insert av central venous pressure line C. Adminster 2 liters of crystalloid solution D. Perform endotracheal intubation and ventilation E. Apply a pneumatic antishock garment (PASG) and inflate the leg compartments.
- Answer: D. Perform endotracheal intubation and ventilation
An 8-year-old boy falls 4,5 meters (15 feet) from a tree and is brought to the ED by his family. His vital signs are normal, but he complains of left upper quadrant pain. An abdominal CT-scan reveals a moderately severe laceration of the spleen. The receiving institution does not have 24-hour-a-day operating room capabilities. The most appropriate management of this patient would be to A. Type and crossmatch for blood B. Request consultation of a pediatrician C. Transfer the patient to a trauma center D. Admit the patient to the intensive care unit E. Prepare the patient for surgery the next day - Answer: D. Admit the patient to the intensive care unit Which of the following statements regarding injury to the central nervous system in children is TRUE? A. Children suffer spinal cord injury without x-ray abnormality more commonly than adults. B. An infant with a traumatic brain injury may become hypotensive from cerebral edema C. Initial therapy for the child with traumatic brain injury includes the administration of methylprednisolone intravenously D. Children have more focal mass lesions as a result for traumatic brain injury when compared to adults.
An electrician is eletrocuted by a downed power line after a thunderstorm. He apparently made contact with the wire at the level of the right mid thigh. In the ED, his vital signs are normal and no dysrythmia is noted on ECG. On examination, there is an exit wound on the bottom of the right foot. His urine is positive for blood by dipstick but not RBCs are seen microscopically. Initial management should include: A. Immediate angiography B. Aggressive fluid infusion C. Intravenous pyelography D. Debridement of necrotic muscle E. Admission to the ICU for observation - Answer: B. Aggressive fluid infusion - suspected rhabdomyolyse A young woman sustains a severe head injury as the result of a motor vehicular crash. In the ED, her GCS is 6. Her blood pressure is 140/90 mmHg and her heart rate 80 beats per minute. She is intubated and is being 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 early management of her head injury is to: A. Administer an osmotic diuretic B. Prevent secondary brain injury C. Agressively treat systemic hypertension D. Reduce meatbolic requirements of the brain E. Distinguish between intracranial hematoma and cerebral edema. - Answer: B. Prevent secondary brain injury
To establish a diagnosis of shock, A. Systolic blood pressure must be below 90mmHg B. The presence of a closed head injury should be excluded C. Acidosis should be present by arterial blood gas analysis D. The patient must fail to respond to intravenous fluid infusion E. Clinical evidence of inadequate organ perfusion must be present. - Answer: E. Clinical evidence of inadequate organ perfusion must be present. A 32-year-old is brought to the hospital unconscious with severe facial injuries and noisy respirations after an automobile collision. In the ED, he has no apparent injury to the anterior aspect of his neck. He suddenly becomes apneic, and attempted ventilation with a face mask is unsuccessful. Examination of his mouth reveals a large hematoma of the pharynx with loss of normal anatomic landmarks. Initial management of his airways should be consist of: A. Inserting an oropharyngeal airway B. Inserting a nasopharyngeal airway C. Performing a surgical cricothyroidotomy D. Performing fiberoptic-guided nasotracheal intubation E. Performin orotracheal intubation after obtaining a lateral c-spine x-ray - Answer: A. Inserting an oropharyngeal airway A 25-year-old woman is brought to the ED after a motor vehicle crash. She was initially lucid at the scene and then developed a dilated pupil and contralateral
E. Is unlikely because of the incomplete calcification of the vertebral bodies. - Answer: D. May exist in the abscence of objective findings on x-ray studies Immediate chest tube insertion is indicated for which of the following conditions? A. Pneumothorax B. Pneumomediastinum C. Massive hemothorax D. Diaphragmatic rupture E. Subcutaneous emphysema - Answer: C. Massive hemothorax Cardiac tamponade after trauma: A. Is seldom life-threating B. Can be excluded by an upright, AP chest x-ray C. Can be confused with a tension pneumthorax D. Causes a fall in systolic pressure of > 15mmHg with expiration E. Most commonly occurs after blunt injury to the anterior chest wall - Answer: C. Can be confused with a tension pneumthorax A 22-year-old man is brought to the hospital after crashing his motorcycle into a telephone pole. He is unconscious and in profound shock. He has no open wounds or obvious fractures. The cause of his shock is MOST LIKELY caused by: A. A subdural hematoma B. An epidural hematoma C. A transected lumbar spinal cord D. A basilar skull fracture
E. Hemorrhage into the chest or abdomen - Answer: E. Hemorrhage into the chest or abdomen Which of the following statements is FALSE concerning Rh-isoimmunization in the pregnant trauma patient? A. It occurs in blunt or penetrating abdominal trauma B. Minor degrees of fetomaternal hemorrhage produce it C. A negative Kleihauer-Betke test excludes Rh-Isoimmunzation D. This is not a problem in the traumatized Rh-positive pregnant patient E. Initiation of Rh-immunoglobulin therapy does not require proof of fetomaternal hemorrhage - Answer: C. A negative Kleihauer-Betke test excludes Rh- Isoimmunzation All of the following signs on the chest x-ray of a blunt injury victim may suggest aortic rupture EXCEPT: A. Mediastinal emphysema B. Presence of a "pleural cap" C. Obliteration of the aortic knob D. Deviation of the trachea to the right E. Depression of the left mainstem bronchus - Answer: A. Mediastinal emphysema Early central venous pressure monitoring during fluid resusciation in the ED has the greatest utility in a: A. Patient with a splenic laceration B. Patient with a inhalation injury
E. Endotracheal intubation and mechanical ventilation. - Answer: E. Endotracheal intubation and mechanical ventilation Which of the following statements regarding patients with thoracic spine injuries is TRUE? A. Log-rolling may be destabilizing to fractures from T12 to L B. Adequate immobilization can be accomplished with the scoop stretcher C. Spinal cord injury below T10 usually spares bowel and bladder function D. Hyperflexion fractures in the upper thoracic spine are inherently unstable E. These patients rarely present with neurogenic shock in association with cord injury. - Answer: A. Log-rolling may be destabilizing to fractures from T12 to L During resuscitation, which one of the following is the most reliable as a guide to volume replacement? A. Heart rate B. Hematocrit C. Blood pressure D. Urinary output E. Jugular venous pressure - Answer: D. Urinary out A 24-year-old woman passenger in an automobile strikes the wind screen with her face during a head-on collision. In the ED, she is talking and has marked facial edema and crepitus. The highest priority should be given to: A. Lateral c-spine x-ray B. Upper airway protection
C. Carotid pulse assessment D. Management of blod loss E. Determination of associated injuries - Answer: B. Upper airway protection The driver of a single car crash is orotracheally intubated in the field by prehospital personnel after they identify a closed head injury and determine that the patient is unable to protect his airway. In the ED, the patient demonstrate decorticate posturing bilaterally. He is being ventilated with a bag-valve device, but his breath sounds are absent in the left hemithorax. His blood pressure is 160/80mmHg, heart rate is 70 beats per minute, and the pulse oximeter displays a hemoglobin oxygen saturation of 96%. The next step in assessing and managing this patient should be to: A. Determine the arterial blood gases B. Obtain a lateral cervical spine x-ray C. Assess placement of the endotracheal tube D. Perform needle decompression of the left chest E. Insert a thoracostomy in the left hemithorax. - Answer: C. Assess placement of the endotracheal tube The response to catecholamines in an injured, hypovolemic pregnant woman can be expected to result in: A. Placental abruption B. Fetal hypoxia and distress C. Fetal/maternal dysrhytmia D. Improved uterine blood flow
E. Distinguish between intracranial hematoma and cerebral edema. - Answer: A. Avoid hypotension A 6-year-old boy walking across the street is struck by the front bumper of a sports utility vehicle traveling at 32kph (20mph). Which one of the following statements is TRUE? A. A flail chest is probable B. A symptomatic cardiac contusion is expected C. A pulmonary contusion may be present in the absence of rib fractures D. Transection of the thoracic aorta is more likely than in an adult patient E. Rib fractures are commonly found in children with this mechanism of injury - Answer: C. A pulmonary contusion may be present in the absence of rib fractures A 39-year-old man is admitted to the ED 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: A. Perform a surgical cricothyroidotomy B. Attempt nasotracheal intubation C. Ventilate him with a bag-mask device until c-spine injury can be excluded D. Attempt orotracheal intubation using 2 people and inline stabilization of the cervical spine E. Ventilate the patient with a bag-mask device until his beard can be shaved for a better mask fit. - Answer: D. Attempt orotracheal intubation using 2 people and inline stabilization of the cervical spine
A patient is brought to the ED 20 minutes 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 60/40mmHg and his heart rate is 70 beats per minute. His skin is warm. Which one of the following statements is true? A. Vasoactive medications have no role in the patients management B. The hypotension should be managed with volume resuscitation alone C. Flexion and extension views on the c-spine should be performed early D. Occult abdominal visceral injuries can be excluded as a cause of hypotension E. Flaccidity of the lower extremities and loss of deep tendon reflexes are expected. - Answer: E. Flaccidity of the lower extremities and loss of deep tendon reflexes are expected. The following are contraindications for tetanus toxoid administration: A. History of neurological reaction or severe hypersensitivity to the product B. Local side effects C. Muscular spasm D. Pregnancy E. All of the above - Answer: A. History of neurological reaction or severe hypersensitivity to the product After being involved in a motor vehicle crash, a 25-year-old man is brought to a hospital with a general surgeon on duty. He has a GCS of 13 and complains of abdominal pain. His blood pressure was 80mmHg systolic by palpation on arrival
