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ATLS TEST 1 LATEST EXAM 2025 /ADVANCED
TRAUMA LIFE SUPPORT TEST 1 LATEST 2025
QUESTIONS AND ANSWERS
What is the Golden hour --ANSWER- refers to the first hour after an injury until definitive care at the Trauma Center 50% of mortality immediately after injury, within the first hour. Most trauma deaths occur immediately at scene and within the GOLDEN HOUR How much time, in reality, do you have of the golden hour once a pt hits the ED door -- ANSWER- about 30 minutes, called platinum half hour When someone has trauma, but they die later from it (within days to weeks) what is it typically due to? --ANSWER- hemorrhagic shock- most common Hypovolemic shock What is the mneumonic for Hand-off to trauma team? --ANSWER- MIST Mechanism of injury- need high index of suspicion for dx after getting MOI Injuries found and suspected Symptoms and signs Treatment: Usually treat before definitive dx via tests! Objectives of the Advanced Trauma Life Support (ATLS ) --ANSWER-
- initial evaluation of the trauma pt
- Identify life threatening injuries and initiate tx
- Stabilize the trauma pt What is the mnemonic for history taking โ ANSWER- "SAMPLE" Signs/Sx
Allergies Medication Past medical illness Last meal Event/Environment related to injury Test that you give to all female pts of childbearing age? --ANSWER- BHCG What are the complications of initial trauma? -- ANSWER- hemorrhage, acidosis, hypothermia, coagulopathy, hypoxia Primary survey in a trauma situation --ANSWER- ABCDE Airway maintenance with c-spine restriction of spinal motion Breathing and ventilation Circulation Disability: Neurological status Exposure/Environmental control Gold Standard to get definitive airway --ANSWER- endotracheal intubation What do you use if someone is presenting with tracheal injury, flail chest, or sucking chest wound with decreased breath sounds? --ANSWER- insert a chest tube (28-32 Fr) Pneumonic for circulation and hemorrhage control
- ANSWER
- Direct pressure Elevation Pressure point Tourniquet aka DEPT Hypovolemia tx in emergency situations --ANSWER- Start with two large bore IVs (14-gauge catheter), one below and one above the site of injury Infuse 1 liter of lactate ringers 3:1 ratio
A 22-year-old man is hypotensive and tachycardic after a shotgun wound to the left shoulder. His blood pressure is initially 80/40 mm Hg. After initial fluid resuscitation his blood pressure increases to 122/84 mm Hg. His heart rate is now 100 beats per minute and his respiratory rate is 28 breaths per minute. A tube thoracostomy is performed for decreased left chest breath sounds with the return of a small amount of blood and no air leak. After chest tube insertion, the most appropriate next step is: Select one: a. reexamine the chest b. perform an aortogram c. obtain a CT scan of the chest d. obtain arterial blood gas analyses e. perform transesophageal echocardiography --ANSWER- A) Reexamine the chest A construction worker falls two stories from a building and sustains bilateral calcaneal fractures. In the emergency department, he is alert, vital signs are normal, and he is complaining of severe pain in both heels and his lower back. Lower extremity pulses are strong and there is no other deformity. The suspected diagnosis is most likely to be confirmed by: Select one: a. angiography b. compartment pressures c. retrograde urethrogram d. Doppler ultrasound studies e. complete spine x-ray series --ANSWER- e) Complete spine x-ray series Which of the following is true regarding the initial resuscitation of a trauma patient?
Select one: a. A patient that presents with a torso gunshot wound and is hypotensive should receive crystalloid fluid resuscitation until the blood pressure is normal b. Evidence of improved perfusion after fluid resuscitation could include improvement in Glasgow coma scale score on reevaluation c. Massive transfusion is defined as transfusion of more than >10 of packed red blood cells and plasma in 24 hours d. When tranexamic acid is administered by pre-hospital providers a second dose is required within 24 hours e. Fluid resuscitation is far more important than bleeding control in trauma patients -- ANSWER- b. Evidence of improved perfusion after fluid resuscitation could include improvement in Glasgow coma scale score on reevaluation In managing a patient with a severe traumatic brain injury, the most important initial step is to: Select one: a. Secure the airway b. obtain a c-spine film c. support the circulation d. control scalp hemorrhage e. determine the GCS score Feedback Your answer is corr --ANSWER- a. Secure the airway A previously healthy, 70-kg (154-pound) man suffers an estimated acute blood loss of 2 liters. Which one of the following statements applies to this patient? Select one:
providing 4 mL/kg/percent body burn/24 hours of crystalloid fluid --ANSWER- a. Urine output of 0.5 mL/kg/hr The diagnosis of shock must include: Select one: a. hypoxemia b. acidosis c. hypotension d. increased vascular resistance e. evidence of inadequate organ perfusion --ANSWER- e. evidence of inadequate organ perfusion A 7-year-old boy is brought to the emergency department by his parents several minutes after he fell through a window. He is bleeding profusely from a 6-cm wound of his medial right thigh. Immediate management of the wound should consist of: Select one: a. application of a tourniquet b. direct pressure on the wound c. packing the wound with gauze d. direct pressure on the femoral artery at the groin e. debridement of devitalized tissue --ANSWER- b. direct pressure on the wound For the patient with severe traumatic brain injury, profound hypocarbia should be avoided to prevent: Select one: a. respiratory acidosis b.
metabolic acidosis c. cerebral vasoconstriction with diminished perfusion d. neurogenic pulmonary edema e. shift of the oxyhemoglobin dissociation curve --ANSWER- c. cerebral vasoconstriction with diminished perfusion After being involved in a motor vehicle crash, a 25-year-old man is brought to a hospital that has surgery capabilities available.. Computed tomography of the chest and abdomen shows an aortic injury and splenic laceration with free abdominal fluid. His blood pressure falls to 70 mm Hg after CT. The next step is: Select one: a. obtain contrast angiography b. transfer to a higher level trauma center c. perform an exploratory laparotomy d. infuse additional crystalloid fluids e. Obtain transesophageal echocardiography --ANSWER- c. perform an exploratory laparotomy Which one of the following statements regarding abdominal trauma in the pregnant patient is TRUE? Select one: a. The fetus is in jeopardy only with major maternal abdominal trauma. b. Leakage of amniotic fluid is an indication for hospital admission. c. Indications for peritoneal lavage are different from those in the nonpregnant patient. d. With penetrating trauma, injury to the mother's abdominal hollow viscus is more common in late than in early pregnancy. e.
deformity of the right thigh e. respiratory rate of 40 breaths per minute --ANSWER- e. respiratory rate of 40 breaths per minute A 20-year-old woman that is 32 weeks gestation , is stabbed in the upper right chest. In the emergency department, her blood pressure is 80/60 mm Hg. She is gasping for breath, extremely anxious, and yelling for help. Breath sounds are diminished in the right chest. The most appropriate first step is to: Select one: a. perform tracheal intubation b. insert an oropharyngeal airway c. perform needle or finger decompression of the right chest d. manually displace the gravid uterus to the left side of the abdomen e. initiate 2, large-caliber peripheral IV lines and crystalloid infusion --ANSWER- c. perform needle or finger decompression of the right chest An important, immediate step in the management of an open pneumothorax is: Select one: a. endotracheal intubation b. operation to close the wound c. placing a chest tube through the chest wound d. placement of an occlusive dressing over the wound secured on three sides e. initiation of 2, large-caliber IVs and infusing crystalloid solution --ANSWER- d. placement of an occlusive dressing over the wound secured on three sides Which of the following is a contraindication for tetanus toxoid administration? Select one: a. history of neurological reaction or severe hypersensitivity to the product
b. Local side effects c. muscular spasms d. pregnancy e. all of the above --ANSWER- a. history of neurological reaction or severe hypersensitivity to the product A 56-year-old man is thrown violently against the steering wheel of his truck during a motor vehicle crash. On arrival to the emergency department he is diaphoretic and complaining of chest pain. His blood pressure is 60/40 mm Hg and his respiratory rate is 40 breaths per minute. Which of the following best differentiates cardiac tamponade from tension pneumothorax as the cause of his hypotension? Select one: a. tachycardia b. pulse volume c. breath sounds d. pulse pressure e. jugular venous pressure --ANSWER- c. breath sounds Bronchial intubation of the right or left mainstem bronchus can easily occur during infant endotracheal intubation because: Select one: a. The trachea is relatively short. b. The distance from the lips to the larynx is relatively short. c. The use of cuffed endotracheal tubes eliminates this issue. d. The mainstem bronchi are less angulated in their relation to the trachea.
e. ventilate the patient with a bag-mask device until his beard can be shaved for better mask fit 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. restrict cervical motion and attempt orotracheal intubation using 2 people e. ventilate the patient with a bag-mask device until his beard can be shaved for better mask fit --ANSWER- d. restrict cervical motion and attempt orotracheal intubation using 2 people A patient is brought to the emergency department after a motor vehicle crash. He is conscious and there is no obvious external trauma. His blood pressure is 60/40 mm Hg and his heart rate is 70 beats per minute. His skin is warm. Which one of the following statements is TRUE? Select one: a. Vasoactive medications have no role in this patient's management. b. The hypotension should be managed with volume resuscitation alone. c. Flexion and extension views of the c-spine should be performed early. d. 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 Which one of the following is the most effective method for initially treating frostbite? Select one: a. moist heat b.
early amputation c. padding and elevation d. vasodilators and heparin e. topical application of silver sulfadiazine --ANSWER- a. moist heat A 32-year-old man's right leg is trapped beneath his overturned car for nearly 2 hours before he is extricated. On arrival to the emergency department, his right lower extremity is cool, mottled, insensate, and motionless. Despite normal vital signs, a pulse cannot be palpated below the right femoral artery and the muscles of the lower extremity are firm and hard. During the management of this patient, which of the following is most likely to improve the chances for limb salvage? Select one: a. applying skeletal traction b. administering anticoagulant drugs c. administering thrombolytic therapy d. surgical consultation for right lower extremity fasciotomy e. transferring the patient to the trauma center 120 km away --ANSWER- d. surgical consultation for right lower extremity fasciotomy A patient arrives in the emergency department after being beaten about 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 vomitus on his face and clothing. The most appropriate step after providing supplemental oxygen and elevating his jaw is to: Select one: a. request a CT scan b. insert a gastric tube c. suction the oropharynx
insert a left chest tube d. call the receiving hospital and speak to the surgeon on call e. discuss the advisability of transfer with the patient's family --ANSWER- d. call the receiving hospital and speak to the surgeon on call Hemorrhage of 20% of the patient's blood volume is associated usually with: Select one: a. oliguria b. confusion c. hypotension d. tachycardia e. blood transfusion requirement --ANSWER- d. tachycardia Which one of the following statements concerning intraosseous infusion is TRUE? Select one: a. Only crystalloid solutions may be safely infused through the needle. b. Aspiration of bone marrow confirms appropriate positioning of the needle. c. Intraosseous infusion is the preferred route for volume resuscitation in small children. d. Intraosseous infusion may be utilized indefinitely. e. Swelling in the soft tissues around the intraosseous site is not a reason to discontinue infusion. --ANSWER- b. Aspiration of bone marrow confirms appropriate positioning of the needle. A young female sustains a severe head injury as the result of a motor vehicle crash. In the emergency department, her GCS is 6, blood pressure is 140/90 mm Hg, and her heart rate is 80 beats per minute. She is intubated and mechanically ventilated.
Her pupils are 3 mm 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: Select one: a. avoid hypotension b. administer an osmotic diuretic c. aggressively treat systemic hypertension d. reduce metabolic requirements of the brain e. distinguish between intracranial hematoma and cerebral edema --ANSWER- a. avoid hypotension A 33-year-old female is involved in a head-on motor vehicle crash. It took 30 minutes to extricate her from the car. Upon arrival in the emergency department, her heart rate is 120 beats per minute, BP is 90/70 mm Hg, respiratory rate is 16 breaths per minute, and her GCS score is 15. Examination reveals bilaterally equal breath sounds, anterior chest wall ecchymosis, and distended neck veins. Her abdomen is flat, soft, and not tender. Her pelvis is stable. Palpable distal pulses are found in all 4 extremities. Of the following, the most likely diagnosis is: Select one: a. hemorrhagic shock b. cardiac tamponade c. massive hemothorax d. tension pneumothorax e. diaphragmatic rupture --ANSWER- b. cardiac tamponade A hemodynamically normal 10-year-old girl is hospitalized for observation after a Grade III (moderately severe) splenic injury has been confirmed by computed
apply cervical traction b. perform immediate tracheostomy c. insert bilateral thoracostomy tubes d. maintain 100% oxygen and obtain immediate c-spine x-rays e. restrict cervical motion and establish a definitive airway --ANSWER- e. restrict cervical motion and establish a definitive airway When applying the Rule of Nines to infants: Select one: a. It is not reliable. b. The body is proportionally larger in infants than in adults. c. The head is proportionally larger in infants than in adults. d. The legs are proportionally larger in infants than in adults. e. The arms are proportionally larger in infants than in adults. --ANSWER- c. The head is proportionally larger in infants than in adults. A healthy young male is brought to the emergency department following a motor vehicle crash. His vital signs are a blood pressure of 84/60, pulse 123, GCS 10. The patient moans when his pelvis is palpated. After initiating fluid resuscitation, the next step in management is: Select one: a. placement of a pelvic binder b. transfer to a trauma center c. pelvic x-ray d. insert urinary catheter e. repeat examination of pelvis --ANSWER- a.
placement of a pelvic binder Which situation requires Rh immunoglobulin administration to an injured female? Select one: a. negative pregnancy test, Rh negative, and has torso trauma b. positive pregnancy test, Rh positive, and has torso trauma c. positive pregnancy test, Rh negative, and has torso trauma d. positive pregnancy test, Rh positive, and has an isolated wrist fracture e. positive pregnancy test, Rh negative, and has an isolated wrist fracture -- ANSWER- c. positive pregnancy test, Rh negative, and has torso trauma A 22-year-old female athlete is stabbed in her left chest at the third interspace in the anterior axillary line. On admission to the ED and 15 minutes after the incident, she is awake and alert. Her heart rate is 100 beats per minute, blood pressure is 80/60 mm Hg, and respiratory rate is 20 breaths per minute. A chest x- ray reveals a large left hemothorax. A left chest tube is placed with an immediate return of 1600 mL of blood. The next management step for this patient is to: Select one: a. perform a thoracoscopy b. perform an arch aortogram c. insert a second left chest tube d. prepare for an exploratory thoracotomy e. perform a chest CT --ANSWER- d. prepare for an exploratory thoracotomy A 6-year-old boy walking across the street is struck by the front bumper of a sports utility vehicle traveling at 32 kph (20 mph). Which one of the following statements is TRUE about this patient? Select one:
