ATLS - ACS (American College Of Surgeons) Exam Question With Complete Solutions | Graded A+ | Latest Update 2026

ATLS - ACS (American College Of Surgeons) Exam Question With Complete Solutions | Graded A+ | Latest Update 2026 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 BP increases to 122/84 mm Hg. His HR is now 100 bpm and his RR is 28 breaths/min. A tube thoracotomy 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, what is the most appropriate next step? a. Re-examine the chest b. Perform an aortogram c. Obtain a CT scan of the chest d. Obtain arterial blood gas analysis e. Perform transesophageal echocardiography - answer-a. Re-examine 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. Which of the following is most likely to confirm the suspected diagnosis? a. Angiography b. Compartment pressures c. Retrograde urethrogram d. Doppler ultrasound studies e. Complete spine x-ray series - answer-e. Complete spine x-rays series Which of the following is TRUE regarding the initial resuscitation of a trauma patient?a. A patient with a torso gunshot wound and hypotension 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 units of packed RBC and plasma within 24 hours. d. When tranexamic acid us 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, what is the most important initial step? a. Secure the airway b. Obtain a c-spine film c. Support the circulation d. Control scalp hemorrhage e. Determine the GCS score - answer-a. Secure the airway A previously healthy, 70 kg (154 lbs) man suffers an estimated acute blood loss of 2 Liters. Which one of the following statements applies 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 his systolic BP d. An ABG would demonstrate a base deficit between -6 and -10 mEq/L e. His systolic BP will be maintained with an elevated diastolic pressure - answer-d. An ABG would demonstrate a base deficit between -6 and -10 mEq/L How does the physiological hypervolemia of pregnancy have clinical significance in the management of the severely injured, gravid woman?a. It reduces the need for blood transfusion b. It results in an elevated hematocrit c. It complicates the management of closed head injury d. It reduces the volume of crystalloid required for resuscitation e. It increases the volume of blood loss to produce maternal hypotension - answer-e. It increases the volume of blood loss to produce maternal hypotension. What is the best assessment of fluid resuscitation in the adult burn patient? a. Urinary output of 0.5 mL/kg/hr b. Normalization of BP c. Normalization of the HR d. Measuring a normal central venous pressure e. Providing 4 mL/kg/percent body burn/24 hours of crystalloid fluid - answer-a. Urinary output of 0.5 mL/kg/hr What must the diagnosis of shock include? 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 ED by his parents several minutes after he fell through a window. He is bleeding profusely from a 6 cm wound of his medical right thigh. What should immediate management of the wound consist of? a. Application of a tourniquet b. Direct pressure on the woundc. 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, avoiding profound hypocarbia will prevent what from happening? 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. What is the next step? 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 What is the first maneuver to improve oxygenation after chest injury? a. Intubate the patient b. Assess arterial blood gases c. Administer supplemental oxygen d. Ascertain the need for a chest tube e. Obtain a chest x-ray - answer-c. Administer supplemental oxygenA 25-year-old man, injured in a MVC, is admitted to the ED. His pupils react sluggishly and his eyes open to pressure. He does not follow commands, but he does moan periodically. His right arm is deformed and does not respond to pressure; however, his left hand reaches purposefully toward the stimulus. Both legs are stiffly extended. What is his GCS score? a. 4 b. 6 c. 9 d. 12 e. 2 - answer-c. 9