}) Vale a6 Be ATLS® Written Pretest #1 10th Edition Discisimer: Note: Rls understood that medical practices vary with institutional polices andl individual references. This test's designed In conjunction with the materia presented in the 10th edition of the ATLS® Course. Please answer the questions accordingly perform an aortogram. © obtain 2 computed tomography (CT) scan of the chest, ¢. obtain arterial blood gas analyses, ©. Perform transesophageal echocardiography. 2-5. Which of the following is true regarding the inital resuscitation of s trauma patient? &. Apatient with @ torso gunshot wound and hypotension should receive crystalloid fluid resuscitation until the blood pressure is normal, 7 ©. Evidence of improved perfusion after fluid resuscitation could Include improvement in Glasgow Coma Scale (GCS) score on reevaluation. © Massive transfusion ls defined as transfusion of more than 10 units Of packed red blood ceils ‘and plasma within 24 hours. a acid ls administered by prehospital providers, « second dose is required within 24 hours, © Fuld resuscitation is far more important than bleeding control in trauma patients, 3-4. In managing » patient with a severe traumatic brain injury, the most Important initial step is to: 4. Secure the alrway. b. obtain @ c-spine film.“Mel” Jom XK4 - wha ore K ks 1-5. previously ety (0 (154-pound) man suffers an estimated acute blood loss of 2 liters. Which statement applies t0 this patient? Re 2. His pulse pressure will be widened Or . His urinary output will be at the lower limits of normal. ¢ He will have tachycardia but no change in his systolic blood pressure, 6. An arterial blood gas would demonstrate a base deficit between -6 and -10 mEq/L. ¢-His systolic blood pressure will be maintained with an elevated diastolic pressure. 1-6. The physiological hypervolemia of pregnancy has clinical significance in the management of the severely injured, gravid woman by: ‘& reducing the need for blood transfusion. 'b resulting In an elevated hematocrit. & complicating the management of closed head injury . reducing the volume of crystalloid required for resuscitation. ©. Increasing the volume of blood loss to produce maternal hypotension 4-7. The best assessment of fluid resuscitation of the adult burn patient is: urinary output of 0.5 mi/ke/hr. ». normalization of blood pressure. ‘ normalization of the heart rate. d. measuring @ normal central venous pressure. providing 4 mi/kg/percent body burned/24 hours of crystalloid fluid. Ads hk AP) € Degen ‘must include: Dob [ks |p 2. hypoxemia, ». acidosis. hypotension. 4. increased vascular resistance. evidence of inadequate organ perfusion. fac rcCGat-ld boy s brought to the ED by his parents several minutes after he fell throu igh 3 window. ceca chan Prefusey from » xm wound in hs medial righ thigh. immediate managonens or re 1. direct pressure on the femoral the \. €. debriding devitalized tissue. ae ee . B— yo (me) ge prevent Patent wth severe raumatic brain injury, profound hypocarba should be avoved to41-11. After being involved in a motor vehicle crash, @ 25-year-old man Is brought to a hospital that has Surgery capabilities available. CT 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 to: ‘8. obtain contrast angiography, 'b, transfer him to a higher-level trauma center. © perform an exploratory laparotomy. 4. infuse additional crystalloid fluids. ©. obtain transesophageal echocardiography. 4-42. Which statement regarding abdominal trauma in the pregnant patient is TRUE? @ The fetus is in Jeopardy only with major abdominal trauma. b, Leakage of amniotic fluld Is an indication for hospital admission. © Indications for peritoneal lavage are different from those in the nonpregnant patient. ¢. With penetrating trauma, injury to the mother’s abdominal hollow viscus Is more common in ate than in early pregnancy. © The secondary survey follows a different pattern from that of the nonpregnant patient. 1-13. The first maneuver to improve oxygenation after chest Injury is: a. intubate the patient. b. assess arterial blood gases. © administer supplemental oxygen. 4. ascertain the need for a chest tube. ©. obtain a chest x-ray. hand rote Purposefully toward the stimulus. Both legs are stiffly extended. His GCS score is: a2. b.4. 6. 4.9. e.12, 2-15, A 20-year-old female who is at 32 weeks gestation is stabbed in the upper right chest In the / In the ED, Drea rac inst 80/60 mm He She gasping for breath, extremely anxious, and yeling for nay Breath sounds are diminished inthe right chest. The most appropriate fist step s to . 2. pertorm tracheal Intubation, b. insert an oropharyngeal airway, chest. of the abdomen, Noid infusion,3-16. Which finding in an adult is most likely to require immediate management during the primary survey? 2. Distended abdomen b. Glasgow Coma Scale score of 11 <) ¢. Temperature of 36.5°C (97.8°F) 4, Deformity of the right thigh @ Respiratory rate of 40 breaths per minute 1-17. The most important, immediate step in the management of an open pneumothorax is: 2, endotracheal intubation, ». operation to close the wound. ©. placing a chest tube through the chest wound. = of an occlusive dressing over the wound. - Initiation of two large-callber IVs with crystalloid solution 2-18. Which of the following is a contraindication for tetanus toxoid administration? ® History of neurological reaction or severe hypersensitivity to the product b. Local side effects © Muscular spasms 4. Pregnancy . ©. All of the above eee 3:18. 4 56-year-old man is thrown violently against the steering wheel of his truck during 8 motor wehicie crash. On arrival in the ED, 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? 2. Tachycardia b. Pulse volume . 5 © Breath sounds Mace 1 eve . 4. Pulse pressure €. Jugular venous pressure 3-20. Bronchial intubation of the right or left mainst fetal ; tem bronchus can easily occur during infant @ the trachea isse - ~2 ena i 3-21. 4 23-year-old man sustains four stab wounds to the upper right chest during an altercation and Is Drought by ambulance to a hospital that has full surgical capabilities. His wounds are all above the nipple. He is endotracheally intubated, closed tube thoracostomy Is performed, and fluid resuscitation Is initiated through two large-caliber IVs. Focused assessment with sonography for trauma (FAST) exam tioes not reveal intra-abdominal injuries. His blood pressure now Is 60/0 mm Hg, his heart rate is 160 beats per minute, his respiratory rate is 14 breaths per minute (ventilated with 100% 02), and 1500 mt Of Blood have drained from the right chest. The most appropriate next step in managing this patient is to: &. perform diagnostic peritoneal lavage. b. obtain a CT of the chest. © perform an angiography. & urgently transfer the patient to the operating room. €. Immediately transfer the patient to a trauma center. 1-22. 4 39-year-old man is admitted to the ED after an automobile collision. He is cyanotic, has insufficient respiratory effort, and has 8 GCS score of 6. His full beardynakes it difficult to fit the oxygen face mask to his face. The most appropriate next step Is to: 2. perform a surgical cricothyr 5 b. attempt nasotracheal intubation, <_ Ventilate him with a bag-mask device until e-spine injury can be excluded. i. @restrict cervical motion and attempt orotracheal intubation using 2 People. . ventilate the patient with a bag-mask device until his beard can be shaved for better mask fit. 1-23. A patient is brought to the ED after a motor vehicle crash. He is conscious and there is no obvious external trauma. He arrives with a cervical collar in place and is secured to a long spine board. His blood Pressure is 60/40 mm Hg and his heart rate is ‘7Q beats per minute. His skin is warm, Which statement |s TRUE? — 2. Vasoactive medications have no role in this patient's Management. b. The hypotension should be managed with volume fesuscitation alone. ¢. Flexion and extension views of the spine should be performed early, 9. Abdominal visceral injuries can be excluded as a ‘cause of hypotension, @ Flaccidity of the lower extremities and loss of deep tendon reflexes are expected. d. Vasodilators and heparin €. Topical application of silver sulfadiazine1:35. A 32-year-old man’s right leg is trapped beneath his overturned car for nearly 2 hours before he is. extricated. On arrival in the ED, his right lower extremity is cool, mottled, insensate, and motionless. Despite normal vital signs, pulses 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? 12 Applying skeletal traction 9 1b. Administering anticonguiant drugs & Administering thrombolytic therapy (@ Setting 2 surgical consultation for right lower extremity fasciotomy © Transferring the patient to the trauma center 120 krn away 1-26. A patient arrives in the ED after being beaten about the head and face with @ wooden club. He is comatose and has 2 palpable depressed skull fracture. His face is swollen and ecchymotic. He has gurgling respirations anc vomitus on his face and clothing. The most appropriate step after providing supplemental oxygen and elevating his jaw Is to: 4 request @ CT scan. b. Insert & gastric tube. @suction the oropharynx. 6. obtain 2 lateral cervical spine x-ray. ©. ventilate the patient with a bag mask. 4-27. A 22-yeer-old man sustains a gunshot wound to the left chest and is transported to 2 small ‘community hospital; no surgical capabilities are available. in the ED, a chest tube is inserted and 700 mi of blood are evacuated. The trauma center accepts the patient in transfer. Just before the patient is placed in the embulance for transfer, his blood pressure decreases to 80/68 mm Hg and his heart rate ‘increases to 136 beats per minute. The next step should be to: @. clamp the chest tube. 9 ¢ perform an ED thoracotomy. ’ repeat the primary survey and proceed with transfer. e Gelay the transfer until the referring doctor can contact a thoracic surgeon. 1-28. A 64-year-old man involved in a high-speed car crash is resuscitated initially in a small hospital without surgical capabilities. He has a closed head injury with a GCS score of 13. He has a widened mediestinum on chest x-ray with fractures of left ribs 2 through 4, but no pneumothorax. after Intuating fluid resuscitation, his blood pressure is 110/74 mm Hg, heart rate is 100 beats per minute, and respiratory rate is 18 breaths per minute. He has gross hematuria and a pelvic fracture. You decide to transfer this patient to a facility capable of providing a higher level of care. The facility is 128 km (80 miles) away. Before transfer, you should first: 2. Intubate the patient. @ perform diagnostic peritoneal lavage or FAST, ¢. insert a left chest tube.f GAbnkan a AM Mam AT el a a 4-29, Hemorrhage of 20% of the patient’s blood volume is usually associated with: 2 ollguri contusion, © hypotension é @ tachycardia 2 ©. blood transfusion requirement 3-80, Which statement concerning Intraosseous infusion is TRUE? Only erystaltold solutions may be safely Infused through the needie Aspiration of bone marrow confirms appropriate positioning of the needle intraosseous infusion isthe preferred route for volume resusctation in small children, ©. Intraosteous Infusion may be utilized indefinitely. © Swelling n the soft tissues around the Intraosseous site Is not a reason to discontinue Infusion. 43-81. 4 young female sustains a severe head injury as the result of a motor vehicle crash. In the ED, her GCS is 6, Mer 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: B 2v0id hypotension, ene 'b. administer an osmotic diuretic. ¥ aggressively treat systemic hypertension. he Mr educe metaboiic requirements of the brain. © Gistinguish between intracranial hematoma and cerebral edema 2. hemorrhagic shock. @ cardiac tamponade. ‘© massive hemothorax. vo flecta! Ted eae Chole Ex ¢,.;Iuated in the ED. 1-34, A 40-year-old female who was a restrained driver in a motor vehicle crash Is eval ‘She is hemodynamically normal and found to be paraplegic at the level of T10. Which of the following are true regarding her eval and management? “Za, Neurogenic shock Is likely to develop. 772 b. Imaging of her complete spine is required before transfer to @ trauma center Given the injury level, knee extension would be expected. Logrolling using four people Is a sate approach to restrict spinal motion when moving her. fe. Presence of bulbocavernous reflex indicates a better prognosis 41-35, A trauma patient presents to your ED with inspl {aridor dnd a suspected c-spine injury. ‘Oxygen saturation is 88% on high-flow oxygen via # non ing mask. The most appropriate next b. perform immediate tracheostomy. ¢ Insert bilateral thoracostomy tubes, 4. maintain 100% oxygen and obtain Immediate c-spine x-rays. @ restrict cervical motion and establish a definitive airway. 41-36. When applying the Rule of Nines to infants: 2. tis not reliable. . the body is proportionally larger in infants than in adults. head is proportionally larger in infants than in adults. | the legs are proportionally larger in infants than in adults. € the arms are proportionally larger in infants than in adults. 1-37. A healthy young male is brought to the ED following a motor vehicle crash. His vital signs are blood pressure of 84/60 mm Hg, heart rate of 123 beats per minute, GCS 10. The patient moans when his elvis is palpated. After initiating fluid resuscitation, the next step in management is: placement of a pelvic binder. ‘transfer to a trauma center. 2 pelvic x-ray. , to insert a urinary catheter. €. repeat the examination of the pelvis. 1-38. Which situation requires Rh immunoglobulin administration to an injured female? 4, Negative pregnancy test, Rh negative, and has torso trauma b. Positive pregnancy test, Rh positive, and has torso trauma Positive pregnancy test, Rh negative, and has torso trauma Positive pregnancy test, Rh positive, and has an isolated eat : wrist fracture1-88, 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 mn Hg, and respiratory rate is 20 breaths per minute, A chest x-ray reveals » large left hemothorax. A left chest tube Is placed with an immediate retum of 1600 mi of blood. The next management step for this patient Is to: 2. perform a thoracoscopy. b. perform an arch aortogram. B insert second left chest tube. . prepare for an exploratory thoracotomy. «©. perform a chest CT. 2-40. A G-year-old boy walking across the street ls struck by the front bumper of a sports utility vehicle ‘traveling at 32 kph (20 mph). Which statement is TRUE about this patient? 8. A flail chest is probable. c b. A symptomatic cardiac contusion is expected. Pulmonary contusion may be present in the absence of rib fractures, . Transection of the thoracic aorta is more likely than In an adult patient. €. Rib fractures are commonly found In children with this mechanism of injury.1-88, 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 mn Hg, and respiratory rate is 20 breaths per minute, A chest x-ray reveals » large left hemothorax. A left chest tube Is placed with an immediate retum of 1600 mi of blood. The next management step for this patient Is to: 2. perform a thoracoscopy. b. perform an arch aortogram. B insert second left chest tube. . prepare for an exploratory thoracotomy. «©. perform a chest CT. 2-40. A G-year-old boy walking across the street ls struck by the front bumper of a sports utility vehicle ‘traveling at 32 kph (20 mph). Which statement is TRUE about this patient? 8. A flail chest is probable. c b. A symptomatic cardiac contusion is expected. Pulmonary contusion may be present in the absence of rib fractures, . Transection of the thoracic aorta is more likely than In an adult patient. €. Rib fractures are commonly found In children with this mechanism of injury.3-16. Which finding in an adult is most likely to require immediate management during the primary survey? 2. Distended abdomen b. Glasgow Coma Scale score of 11 <) ¢. Temperature of 36.5°C (97.8°F) 4, Deformity of the right thigh @ Respiratory rate of 40 breaths per minute 1-17. The most important, immediate step in the management of an open pneumothorax is: 2, endotracheal intubation, ». operation to close the wound. ©. placing a chest tube through the chest wound. = of an occlusive dressing over the wound. - Initiation of two large-callber IVs with crystalloid solution 2-18. Which of the following is a contraindication for tetanus toxoid administration? ® History of neurological reaction or severe hypersensitivity to the product b. Local side effects © Muscular spasms 4. Pregnancy . ©. All of the above eee 3:18. 4 56-year-old man is thrown violently against the steering wheel of his truck during 8 motor wehicie crash. On arrival in the ED, 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? 2. Tachycardia b. Pulse volume . 5 © Breath sounds Mace 1 eve . 4. Pulse pressure €. Jugular venous pressure 3-20. Bronchial intubation of the right or left mainst fetal ; tem bronchus can easily occur during infant @ the trachea is}) Vale a6 Be ATLS® Written Pretest #1 10th Edition Discisimer: Note: Rls understood that medical practices vary with institutional polices andl individual references. This test's designed In conjunction with the materia presented in the 10th edition of the ATLS® Course. Please answer the questions accordingly perform an aortogram. © obtain 2 computed tomography (CT) scan of the chest, ¢. obtain arterial blood gas analyses, ©. Perform transesophageal echocardiography. 2-5. Which of the following is true regarding the inital resuscitation of s trauma patient? &. Apatient with @ torso gunshot wound and hypotension should receive crystalloid fluid resuscitation until the blood pressure is normal, 7 ©. Evidence of improved perfusion after fluid resuscitation could Include improvement in Glasgow Coma Scale (GCS) score on reevaluation. © Massive transfusion ls defined as transfusion of more than 10 units Of packed red blood ceils ‘and plasma within 24 hours. a acid ls administered by prehospital providers, « second dose is required within 24 hours, © Fuld resuscitation is far more important than bleeding control in trauma patients, 3-4. In managing » patient with a severe traumatic brain injury, the most Important initial step is to: 4. Secure the alrway. b. obtain @ c-spine film.“Mel” Jom XK4 - wha ore K ks 1-5. previously ety (0 (154-pound) man suffers an estimated acute blood loss of 2 liters. Which statement applies t0 this patient? Re 2. His pulse pressure will be widened Or . His urinary output will be at the lower limits of normal. ¢ He will have tachycardia but no change in his systolic blood pressure, 6. An arterial blood gas would demonstrate a base deficit between -6 and -10 mEq/L. ¢-His systolic blood pressure will be maintained with an elevated diastolic pressure. 1-6. The physiological hypervolemia of pregnancy has clinical significance in the management of the severely injured, gravid woman by: ‘& reducing the need for blood transfusion. 'b resulting In an elevated hematocrit. & complicating the management of closed head injury . reducing the volume of crystalloid required for resuscitation. ©. Increasing the volume of blood loss to produce maternal hypotension 4-7. The best assessment of fluid resuscitation of the adult burn patient is: urinary output of 0.5 mi/ke/hr. ». normalization of blood pressure. ‘ normalization of the heart rate. d. measuring @ normal central venous pressure. providing 4 mi/kg/percent body burned/24 hours of crystalloid fluid. Ads hk AP) € Degen ‘must include: Dob [ks |p 2. hypoxemia, ». acidosis. hypotension. 4. increased vascular resistance. evidence of inadequate organ perfusion. fac rcCGat-ld boy s brought to the ED by his parents several minutes after he fell throu igh 3 window. ceca chan Prefusey from » xm wound in hs medial righ thigh. immediate managonens or re 1. direct pressure on the femoral the \. €. debriding devitalized tissue. ae ee . B— yo (me) ge prevent Patent wth severe raumatic brain injury, profound hypocarba should be avoved to1:35. A 32-year-old man’s right leg is trapped beneath his overturned car for nearly 2 hours before he is. extricated. On arrival in the ED, his right lower extremity is cool, mottled, insensate, and motionless. Despite normal vital signs, pulses 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? 12 Applying skeletal traction 9 1b. Administering anticonguiant drugs & Administering thrombolytic therapy (@ Setting 2 surgical consultation for right lower extremity fasciotomy © Transferring the patient to the trauma center 120 krn away 1-26. A patient arrives in the ED after being beaten about the head and face with @ wooden club. He is comatose and has 2 palpable depressed skull fracture. His face is swollen and ecchymotic. He has gurgling respirations anc vomitus on his face and clothing. The most appropriate step after providing supplemental oxygen and elevating his jaw Is to: 4 request @ CT scan. b. Insert & gastric tube. @suction the oropharynx. 6. obtain 2 lateral cervical spine x-ray. ©. ventilate the patient with a bag mask. 4-27. A 22-yeer-old man sustains a gunshot wound to the left chest and is transported to 2 small ‘community hospital; no surgical capabilities are available. in the ED, a chest tube is inserted and 700 mi of blood are evacuated. The trauma center accepts the patient in transfer. Just before the patient is placed in the embulance for transfer, his blood pressure decreases to 80/68 mm Hg and his heart rate ‘increases to 136 beats per minute. The next step should be to: @. clamp the chest tube. 9 ¢ perform an ED thoracotomy. ’ repeat the primary survey and proceed with transfer. e Gelay the transfer until the referring doctor can contact a thoracic surgeon. 1-28. A 64-year-old man involved in a high-speed car crash is resuscitated initially in a small hospital without surgical capabilities. He has a closed head injury with a GCS score of 13. He has a widened mediestinum on chest x-ray with fractures of left ribs 2 through 4, but no pneumothorax. after Intuating fluid resuscitation, his blood pressure is 110/74 mm Hg, heart rate is 100 beats per minute, and respiratory rate is 18 breaths per minute. He has gross hematuria and a pelvic fracture. You decide to transfer this patient to a facility capable of providing a higher level of care. The facility is 128 km (80 miles) away. Before transfer, you should first: 2. Intubate the patient. @ perform diagnostic peritoneal lavage or FAST, ¢. insert a left chest tube.f GAbnkan a AM Mam AT el a a 4-29, Hemorrhage of 20% of the patient’s blood volume is usually associated with: 2 ollguri contusion, © hypotension é @ tachycardia 2 ©. blood transfusion requirement 3-80, Which statement concerning Intraosseous infusion is TRUE? Only erystaltold solutions may be safely Infused through the needie Aspiration of bone marrow confirms appropriate positioning of the needle intraosseous infusion isthe preferred route for volume resusctation in small children, ©. Intraosteous Infusion may be utilized indefinitely. © Swelling n the soft tissues around the Intraosseous site Is not a reason to discontinue Infusion. 43-81. 4 young female sustains a severe head injury as the result of a motor vehicle crash. In the ED, her GCS is 6, Mer 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: B 2v0id hypotension, ene 'b. administer an osmotic diuretic. ¥ aggressively treat systemic hypertension. he Mr educe metaboiic requirements of the brain. © Gistinguish between intracranial hematoma and cerebral edema 2. hemorrhagic shock. @ cardiac tamponade. ‘© massive hemothorax. vo flecta! Ted eae Chole Ex ¢,.;41-11. After being involved in a motor vehicle crash, @ 25-year-old man Is brought to a hospital that has Surgery capabilities available. CT 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 to: ‘8. obtain contrast angiography, 'b, transfer him to a higher-level trauma center. © perform an exploratory laparotomy. 4. infuse additional crystalloid fluids. ©. obtain transesophageal echocardiography. 4-42. Which statement regarding abdominal trauma in the pregnant patient is TRUE? @ The fetus is in Jeopardy only with major abdominal trauma. b, Leakage of amniotic fluld Is an indication for hospital admission. © Indications for peritoneal lavage are different from those in the nonpregnant patient. ¢. With penetrating trauma, injury to the mother’s abdominal hollow viscus Is more common in ate than in early pregnancy. © The secondary survey follows a different pattern from that of the nonpregnant patient. 1-13. The first maneuver to improve oxygenation after chest Injury is: a. intubate the patient. b. assess arterial blood gases. © administer supplemental oxygen. 4. ascertain the need for a chest tube. ©. obtain a chest x-ray. hand rote Purposefully toward the stimulus. Both legs are stiffly extended. His GCS score is: a2. b.4. 6. 4.9. e.12, 2-15, A 20-year-old female who is at 32 weeks gestation is stabbed in the upper right chest In the / In the ED, Drea rac inst 80/60 mm He She gasping for breath, extremely anxious, and yeling for nay Breath sounds are diminished inthe right chest. The most appropriate fist step s to . 2. pertorm tracheal Intubation, b. insert an oropharyngeal airway, chest. of the abdomen, Noid infusion,Iuated in the ED. 1-34, A 40-year-old female who was a restrained driver in a motor vehicle crash Is eval ‘She is hemodynamically normal and found to be paraplegic at the level of T10. Which of the following are true regarding her eval and management? “Za, Neurogenic shock Is likely to develop. 772 b. Imaging of her complete spine is required before transfer to @ trauma center Given the injury level, knee extension would be expected. Logrolling using four people Is a sate approach to restrict spinal motion when moving her. fe. Presence of bulbocavernous reflex indicates a better prognosis 41-35, A trauma patient presents to your ED with inspl {aridor dnd a suspected c-spine injury. ‘Oxygen saturation is 88% on high-flow oxygen via # non ing mask. The most appropriate next b. perform immediate tracheostomy. ¢ Insert bilateral thoracostomy tubes, 4. maintain 100% oxygen and obtain Immediate c-spine x-rays. @ restrict cervical motion and establish a definitive airway. 41-36. When applying the Rule of Nines to infants: 2. tis not reliable. . the body is proportionally larger in infants than in adults. head is proportionally larger in infants than in adults. | the legs are proportionally larger in infants than in adults. € the arms are proportionally larger in infants than in adults. 1-37. A healthy young male is brought to the ED following a motor vehicle crash. His vital signs are blood pressure of 84/60 mm Hg, heart rate of 123 beats per minute, GCS 10. The patient moans when his elvis is palpated. After initiating fluid resuscitation, the next step in management is: placement of a pelvic binder. ‘transfer to a trauma center. 2 pelvic x-ray. , to insert a urinary catheter. €. repeat the examination of the pelvis. 1-38. Which situation requires Rh immunoglobulin administration to an injured female? 4, Negative pregnancy test, Rh negative, and has torso trauma b. Positive pregnancy test, Rh positive, and has torso trauma Positive pregnancy test, Rh negative, and has torso trauma Positive pregnancy test, Rh positive, and has an isolated eat : wrist fracturese - ~2 ena i 3-21. 4 23-year-old man sustains four stab wounds to the upper right chest during an altercation and Is Drought by ambulance to a hospital that has full surgical capabilities. His wounds are all above the nipple. He is endotracheally intubated, closed tube thoracostomy Is performed, and fluid resuscitation Is initiated through two large-caliber IVs. Focused assessment with sonography for trauma (FAST) exam tioes not reveal intra-abdominal injuries. His blood pressure now Is 60/0 mm Hg, his heart rate is 160 beats per minute, his respiratory rate is 14 breaths per minute (ventilated with 100% 02), and 1500 mt Of Blood have drained from the right chest. The most appropriate next step in managing this patient is to: &. perform diagnostic peritoneal lavage. b. obtain a CT of the chest. © perform an angiography. & urgently transfer the patient to the operating room. €. Immediately transfer the patient to a trauma center. 1-22. 4 39-year-old man is admitted to the ED after an automobile collision. He is cyanotic, has insufficient respiratory effort, and has 8 GCS score of 6. His full beardynakes it difficult to fit the oxygen face mask to his face. The most appropriate next step Is to: 2. perform a surgical cricothyr 5 b. attempt nasotracheal intubation, <_ Ventilate him with a bag-mask device until e-spine injury can be excluded. i. @restrict cervical motion and attempt orotracheal intubation using 2 People. . ventilate the patient with a bag-mask device until his beard can be shaved for better mask fit. 1-23. A patient is brought to the ED after a motor vehicle crash. He is conscious and there is no obvious external trauma. He arrives with a cervical collar in place and is secured to a long spine board. His blood Pressure is 60/40 mm Hg and his heart rate is ‘7Q beats per minute. His skin is warm, Which statement |s TRUE? — 2. Vasoactive medications have no role in this patient's Management. b. The hypotension should be managed with volume fesuscitation alone. ¢. Flexion and extension views of the spine should be performed early, 9. Abdominal visceral injuries can be excluded as a ‘cause of hypotension, @ Flaccidity of the lower extremities and loss of deep tendon reflexes are expected. d. Vasodilators and heparin €. Topical application of silver sulfadiazineS-1. For an injury victim with severe blunt maxillofacial injuries, the highest priority should be given to Prec samen EO) 00, upper airway protection, = spine roentgenogram assessment determination of associated injurisec ree 5-2. Among the following, the least blood volume loss that consistently produces a dro 8 f ly ps P in systaic blood pressure is pare 2. 5% ofthe total blood volume 15% of the total blood volume <8 ©. 25% of the total blood volume - +d. 35% of the total blood volum d Joo% © 45% of the taal blood volume ae oa ee Fa : & 2 53. A 20-year-old woman is brought to the emergency department after assaulted, She has severe facial fractures and a large scalp laceration. A bruise is noted over the F quadrant of the abdomen where she was ‘peace kicked. She is unconscious ‘only to painful stimuli. Her airway requires frequent “Suctoning (0 remove blood and ober secretions. Which ofthe following isthe LEAST likely explanation for her depressed level of consciousness? Hyponia nV of Right parietal lobe contusion Injury to the reticular activating system ¥~ sere Injury to the cerebral cortices bilaterally ~ Inadequate cerebral perfusion secondary to occult blood loss 9@r rr 5-4. A school bus crash results in injury t0 17 children. The highest priority of managemeat is given to those patients with a il chest. Bi severe shock. loo » © airway compromise, 6 €. major hemorrhage from open wounds.et S-5. A 32-year-old man is trapped beneath his overtumed car from the waist down for an unknown period of time. Prior to extrication he tells the prehospital personnel that the last thing he remembers is getting in his car to go home from the bar at about midnight. Extrication requires 30 minutes. Shortly after placing the patient in the ambulance for transport he loses consciousness and his Liood picssure decicases iw Lo mm Hg by palpation. He arrives at the, hospital at 0800 hours (8:00 am) at which time his blood pressure is 80 mm Hg by palpation, pulse rate is 120 beats per minute, and his respiratory rate is 20 breaths per minute. The only abnormalities identified on examination are the absence of pulses below the femoral vessels and firm hard muscles in both lower extremities. During the initial management of this patient, consideration should be given to etal traction. = ~< 8 ring. vasoactive drugs. © los te jatistering anticoagulant drugs.~ imfediately transferring the patient. « performing lower extremity fasciotomies. ¢—. ~ ie ooe 2 z, $-6-.. The most. common cause of fetal death afier blunt injury to a pregnant woman who survives her injury is_~ fea Real ry. © loo ne placental abniption. cj ‘rupture of the uterus. = © umbilical cord disruption. 5-7. During the primary assessment of a patient who has been brought to the hospital after being involved in an automobile crash, tension pneumothorax is best differentiated from cardiac tamponade by 2. tube thoracastomy b. _pericardiocentesis. physical examination. @ fe obtaining a chest rocntgenogram. (oo fo e insertion of a central venous catheter.$8. A I7-year-old v acinus feo iS te during 2 collision with a tree when swerving to avoid hitting a dog. On srtive! io a ncy-depariment, his blood pressure is 140/94, pulse rate ‘and his respiratory rate is 18 breaths per minute. Painful stir earms over the chest. He is unresponsive to verbal stimuli closed. His pupils are symmetrical, 3 mm in diameter, and react sluggishly to light. He also has a deformed right femur with a cold, mottled, pulseless foot. The nearest facility with surgical speeilty capabilities is only 16_km (10 miles) away. Which of the following lures is the most important to perform before transferring the patient? CT scan of the head Secure definitive airway ae | Blood type and crossmatch 21% Administration of mannitol Lateral c-spine roentgenogram -e ©. @. e. $9. A two-year-old child is brought to the emergency department after being hit by an automobile. Two attempts at peripheral venous access are unsuccessful and the child appears in extremis“Management at this point should consist of fluid infusion via intraperitoneal catheter. ® ol 56 intraosseous cannulation of the tibia. ‘repeated attempts at central venous access. ‘repeated attempts at peripheral venous access. ‘venous cutdown on the greater saphenous vein at the ankle. ‘$-10. In the presence of cerebrospinal fluid rhinorrhea, nasogastric intubation is comnsindioud. ean be accomplished safely. ¢. requires fiberoptic endoscopy. 4. should be done using tubes of a very small caliber. ©. is safe only after preliminary endotracheal intubation, @) (oo eSS-11. A.33-year-old man presents tothe emergency department after being assaulted and kicked in the abdomen and flank. The primary focus of the initial assessment should be on - performing peritoneal lavage. © a foo 4eeu = G —determining if visceral injury has occurred ~ ¢. obtaining plain roentgenograms of the abdomen. a 4. determining the presence of rebound tenderness. €. accurately diagnosing a specific intra-abdominal injury. — 5-12. In all patients transferred with an endotracheal tu ee place, you, as the receiving Physician, shoul assume malposition of the endotracheal tube. ~~ expect barotrauma secondary to prolonged assisted ventilation, consider the airway adequate, but assume assisted ventilation is needed place the patient immediately on a mechanical ventilator and rapidly assess for other injuries s remove the tube, provide supplemental oxygen, and reintubate only upon specific indication. : loo % 5:13, Which of the following injuries will be detected in the primary survey? a Pacumothorax, { ° b.— Pulmonary contusion 90 fy c ‘T-6 compression fracture 4. Thoracic aortic disruption NSiiy- © Open femoral fracture with artery laceration 5:14. A 22-year-old man, involved in an automobile crash one hour ago, is being [prepared for transfer to another facility because of a positive diagnostic peritoneal lavage ee, ae ctuninaicn ern mt iopcnny Rae et __was discovered on the chest roentgenogram. Management of the ‘should consist of = 9 Jeft tube thoracostomy before transfer. . 4. e ‘needle decompression of his left chest before transfer. ‘insertion of bilaicral tube thoracostomies before transfer. ‘needle aspiration of his left chest during transfer if necessary. Hessen} ‘ausculiation of the chest and blood gas determinations during lo PY, BeBe PRR E ReSee wee hehe nad fe S-1S. Major head injury frequently causes shock by itself, rarely causes shock. causes shock if hypoxia is superimposed causes shock when associated with brain stem injury. causes shock which is reversed by very simple measures, 5-16, In the trauma patient, abnormally high intracranial pressure should be suspected when lla = 64 respirations and pulse slow, and blood pressure falls. * respirations and pulse are irregular, and blood pressure rises. respirations and pulse become rapid, and hypertension occurs. respirations and pulse slow, and systolic and pulse pressures rise,/ respirations are rapid and shallow, pulse is rapid, and blood pressure falls. L loo % 5.17. During the primary and secondary surveys, the injured patient should be 2e°@r completely immobilized until eSe&eaeEVEVEYy the patient requires intubation. < b. the patient becomes restless and combative. . ¢ the neurologic examination has been completed. : ‘2 spinal injury has been excluded by rocnigenograms. the patient is able to indicate that he has no neck pain. 40%, iagnosis of clinically significant carbon monoxide poisoning is best madeTt a a ee ——s 5-19. All of the following injuries should alert a physician to the possibility of child abuse EXCEPT re ——* " : rope burns — bcigarete bums. +: =3 c. _mltiple old fractures @ __supracondylar fracture of the humerus. =a trauma to the genital and perianal areas. ee g Z = (A) 100% SS $20. The prefered splint fF Yemora shaft fractures is alan 5 a. airspline me 62h. ) iv — | = long spine board 4) padded board splim. = ©. pneumatic antishock garment L —s 2 Sq. — S21._A 30-year-old man is brought to the hospital after falling 6 meters (20 feet) from == a scaffold onto pile of lumber. Initial assessment reveals injuries apparendy limited to Oo severe pulmonary contusion. X A, 5-34. Which one of the following mancuvers is LEAST desirable when treating hypotension in the pregnant trauma patient? —_— a._~ Elevating the right hip ‘Administering vasopressors Tyee ‘. Turning the patient to her left side °9 6 : d. Manually displacing the uterus to the left i e. Administering EV fluids with the patient in the supine position 5-35. Which one of the following findings indicate the absolute need for a. Elevated amylase b. Elevated diaphragm — *"4@} —Free air under the diaphragm ¢. CT diagnosis of splenic injury loam e. Retroperitoneal bladder rupture dy 5-36. In the blunt, multisystem trauma patient, the most common cause of shock is ate ©) (oorf spinal con nny. tension pneumothorax. cardiac failure due to cardiac contusion,5-37. Chest injuries occupy a high priority in the early management of a multiply injured ‘Patient primarily because they commonly involve ches! severe pain. 2 ©. hypercarbia. 9 4 raise i) Jorn % se ©. major vascular injury. a 5.38. The pathophysiology of neurogenic shock is primarily related to a. bradycardia. xz Joss of vascular tone. = an absolute hypovolemia. @® d. loss of deep tendon reflexes. loo YA ©) decreased cardiac contractility. a ee = 5-39. A motorcyclist is thrown from his vehicle and sustains obvious facial and lower extremity injuries. On admission he is conscious with normal vital signs. He states that hhis neck hurts. ‘The most important appropriate first step is to “@ immobilize the cervical spine.” @ loot secure the airway by nasotracheal intubation. 6 & Isr an orl ivy and employ facemask veniaon of ‘orotracheal intubation with inline cervical immobilization ———— Fe ints via rwo, cg ater igh clea $-40.. Which of the following is lowest in priority in the initial management of the’ injured patient who is in shock? 4. Blood transfusion b. Application of pressure dressings Z c. at Mab fow caren [o 0 h ‘sodium bicarbonate 2 es Incense slo Bia aby um Praha, ATLS SVL (Gg> b OSB SOP > ixbs—) 5 Gml ae F of er tad| eee a tg 4 1. Aa 18-year-old motorcyclist sustains massive facial jiuries in a head-on collision with a pick-up tuck. He is brought to the emergency department completely immobilized ‘ot a [ong spine board and wearing a cervical collaf. His blood pressure is'150/88, heart tate iS $8 beats per minute and regular, and his respiratory rate is{¥@)breaths per mimu=. His respirstions are Iehored and sonorous. His Glasgyw Coma Seale Score is(Z) fu Aflempis at crotracheal intubation with manual inliné stabilization of the c-spine are. + \yasuccessful'due to bleeding and distorted anatomy. /The paticat becomes agpcic, BEST procedure for temporary airway management 4a this simation is f \ a ‘jnasotracheal innubation. emergency tracheostomy Placemeat of an oropharyngeal airway. as see e883 8 '& 6. Placement of 2 nasopharyngeal airway. oi Tanscricothyroid needle jet insufflation. 2 a Neo. Limb-threatening extremity injuries = <—— 2 2 require immediate anceriograms. >. are rarely present without an open wound. : 2 <. should be suibilized by the pneumatic antishock garment, Sy " are characterized by the presence.of ischemic or crushed tissue. ..\ */oq indicate 2 different-order of priorities for the initial assessment and : resuscitation, ; 43. Aviddle-aged man sustains multiple injuries in a single car crash and is take n ies in a single car c is taken © 2 it , He is hemodynamically stable, but has Tonle aca ceraions = and : Sounds arc'slighlly decreased over the Agi hemithoraiGybut he is a id ao respiratory distress.~His abdomen is soft with active bowel He has a wt thigh from a femur fracnke with decreased pedal pulses. His Glasgow Goma Scale Score is nipe. ‘A chest roerfgenogram demonstrates @ small pneumovherss on dhe right and the question of 2 wid Surgice] specialty capabilities Base nox available at thes hospital and nearest trauma center is 64 Jan (40 miles) away ; rt, all of the following i formed < — x / : ee : a “Looe % | : 8 a 2 J ATL9® 1995 Tes 04 3 a3 4-4. The purpose of the primary survey is to identify \se a. occult bead injury. al. b. the catse of sick, ¢. _ cervical spine injury. |” life-threatening conditions. fo the patient who requires wansfer to another facility. a -4-5. Which one of the following statements concerning hypovolemic shock is TRUE? <— up to 15% (Class D. Pulse and blood pressure are reliable signs of restoration of an adequate circulating blood volume. ¢. Children manifest clinical signs of bypovolemia earlier than adults with the ‘same relative volume loss. a. Tachycardia is a common finding in wel!-conditioned auhletes with a blood ¢ loss of less than 15%. ©. Aggressive shock management should not be initiated in the hypotensive ppatient with a concomitant head injury until the etiology of the blood loss hhas been confirmed. fo ” Clinical signs of inadequate organ perfusion may be absent with hemorrhage b. of bo 46, A 35-year-old man, involved in ap automobile collision ong hour ago, is brought <— to the emergency deparment. During the ensuing one-half hour he is examined and ‘for evident injuries is initiated. Among other injuries, he has obvious evidence ight pneumothorax and a right «ube thoracostomy is performed. The chest tube is ot to an underwater seal aod continues to bubble. A chest roentgenogram shows collapse of the 3 lyng_sith 2 persistent pneumothorax. These findings oes fae concern that the patient has 2 flail chest. rupaured bronchus. 2 rupnired esophagus 2 mupnired right hemidiaphragm. ‘mucous plug in the right bronchus. (&) 8 we °/\o°' iW 4-7. Major operation for 2 multiply injured patient during the frst houf after injury ea a is contraindicated in the presence of shock. b. cam be justified only if brain death has been excluded. mx c. should be undertaken only if sufficient blood is available. gis usually underuaken to control > 40% blood volume loss a e. _cantbe life-saving in 50% of the victims of blunt injury who sustain cardiac 4-8. A g]-year-old painter is brought to the bospital after falling Smneters (20. feet) from ~~ ~ fa ladder, landing straddled on a fence. Examination of bis perineum reveals extensive ‘ecchymosis. There is blood in the external urethral meatus. The initial diagnostic study for evaluation of the urinary tract in this patient should be 2 cystoscopy. og or b. _cystography. #2 rexograte ureihrography _-— 4. ___ intravenous pyelography. (G ao e. computerized tomography. see g @ \Unconsciousness.can result from injury to the falx cerebri, b cerebral conices bilaterally. frontal Jobe cerebral corcex Not sore temporal lobe eerebral cancer. farsa of the brain supplied by the middle cerebral artery. 440. A 29-year-old man is admined to the emergency department after sustaining 2 a gunshot wound to the right dc oC his chest. The patient's blood pressure is 70/40, polse rate is Mate is 24, and respirations are shallow. He is combative and . (Nd) breath sounds are beard on the right side of his chest. Based on these: optimal initial management should include the initiation of Ringer's lactate ‘solution and a. _ pericardiocentesis. : b. endotracheal innubation, : right tube thoracostomy. a ‘d. administration of 'O" negativ- blood. ae oO ¢ application of the pneumatic antishock garment. © So “ACS ATLS® 1998 Te 16 5