ATLS EXAM EXAM PREP 2026 PRACTICE
SOLUTION STUDY GUIDE
◉ In the elderly population, what is decreased physiological
reserve? Answer: aging is characterized by impaired adaptive and
homeostatic mechanisms that caused an increased susceptibility to
the stress of injury. Insults tolerated by the younger population can
lead to devastating results in elderly patients.
◉ Pre-existing conditions that affect morbidity and mortality
include: Answer: cirrhosis, coagulopathy, COPD, ischemic heart
disease, DM
◉ What is the most common mechanism of injury in the elderly?
Answer: Fall. Nonfatal falls are common in women and fractures are
common in women who fall. Falls are the most common cause of
TBI.
◉ In the elderly population, what are risk factors for falls? Answer:
advanced age, physical impairment, history of previous fall,
medication use, dementia, unsteady gait, and visual, cognitive
impairment
◉ Most of elderly traffic fatalities occur in the daytime and on
weekends and typically involve other vehicles. Why? Answer: Older
,people drive on more familiar roads and at lower speeds and tend to
drive during the day. Older people have slower reaction time, a
larger blind spot, limited cervical mobility, decreased hearing, and
cognitive impairment.
◉ True or False? Mortality associated with small to moderate sized
burns in older adults remains high Answer: True
◉ Spilled hot liquids on the leg, which in younger patients may re-
epithelialize due to an adequate number of hair follicles, will result
in a full thickness burn in older patients. Answer: this is true
◉ Airway-patients may have dentures that may loosen or obstruct
the airway. If dentures are not obstructing the airway, leave them in
place for what? Answer: bag mask ventilation, as it improves mask
fitting.
◉ When preforming rapid sequence intubation, the dose of benzos,
barbiturates, and other sedatives should be reduced to what
percentage to minimize the risk of cardiovascular depression?
Answer: 20-40%
◉ Functional changes in cardiac system include declining function,
decreased sensitivity to catecholamines, atherosclerosis of coronary
vessels, increased afterload, fixed heart rate (beta blockers) Answer:
this results in lack of classic response to hypovolemia, risk for
,cardiac ischemia, elevated BP at baseline, and increased risk of
dysrythmias.
◉ Functional changes in pulmonary system include decreased
elastic recoil, reduced residual capacity, decreased gas exchange and
decreased cough reflex Answer: thus they are at increased risk for
respiratory failure, increased risk for pneumonia, and poor tolerance
to rib fractures
◉ Functional changes in renal system include loss of renal mass,
decreased GFR, and decreased sensitivity to ADH and aldosterone
Answer: resulting in drug dosing for renal insufficiency, decreased
ability to concentrate urine, increased risk for AKI and urine flow
may be normal with hypovolemia
◉ Functional changes to MSK include loss of lean body mass,
osteoporosis, changes in joints and cartilage, c spine degenerative
changes and loss of skin elastin and subcutaneous fat Answer:
resulting in increased risk for fractures, decreased mobility,
difficulty for oral intubation, risk of skin injury, increased risk for
hypothermia, challenges in rehabiliation
◉ Functional changes in Endocrine system include decreased
production and response to thyroxin and decreased
dehydroepiandrosterone (DHEA) Answer: resulting in occult
hypothyroidism, relative hypercortisone states and increased risk of
infection
, ◉ True or false: Arthritis can complicate the airway and cervical
spine. Patients can have multilevel degenerative changes affecting
disk spaces and posterior elements associated with severe central
canal stenosis, cord compression, and myelomalacia Answer: true
◉ In elderly population, due to their changes in pulmonary system,
placing a gauze between gums and cheek to achieve seal when using
bag valve mask ventilation is okay. In addition, because aging causes
a suppressed heart rate response to hypoxia...... Answer: respiratory
failure may present insidiously in older adults.
◉ Age related changes in the cardiovascular system place the elderly
trauma patient at significant risk for being inaccurately categorized
as hemodynamically stable. Answer: Elderly patients have a fixed
heart rate and fixed cardiac output, thus, their response to
hypovolemia will involve increasing their systemic vascular
resistance. Furthermore, since older patients have HTN, an
acceptable BP may truly reflect a hypotensive state. A systolic BP of
110 is to be utilized as the threshold for identifying hypotension in
patients 65 and older.
◉ Do no equate blood pressure with shock in older patients Answer:
BP in older patients may look normal due to the medications they
are on. Use lactate and base deficit to evaluate for evidence of shock
SOLUTION STUDY GUIDE
◉ In the elderly population, what is decreased physiological
reserve? Answer: aging is characterized by impaired adaptive and
homeostatic mechanisms that caused an increased susceptibility to
the stress of injury. Insults tolerated by the younger population can
lead to devastating results in elderly patients.
◉ Pre-existing conditions that affect morbidity and mortality
include: Answer: cirrhosis, coagulopathy, COPD, ischemic heart
disease, DM
◉ What is the most common mechanism of injury in the elderly?
Answer: Fall. Nonfatal falls are common in women and fractures are
common in women who fall. Falls are the most common cause of
TBI.
◉ In the elderly population, what are risk factors for falls? Answer:
advanced age, physical impairment, history of previous fall,
medication use, dementia, unsteady gait, and visual, cognitive
impairment
◉ Most of elderly traffic fatalities occur in the daytime and on
weekends and typically involve other vehicles. Why? Answer: Older
,people drive on more familiar roads and at lower speeds and tend to
drive during the day. Older people have slower reaction time, a
larger blind spot, limited cervical mobility, decreased hearing, and
cognitive impairment.
◉ True or False? Mortality associated with small to moderate sized
burns in older adults remains high Answer: True
◉ Spilled hot liquids on the leg, which in younger patients may re-
epithelialize due to an adequate number of hair follicles, will result
in a full thickness burn in older patients. Answer: this is true
◉ Airway-patients may have dentures that may loosen or obstruct
the airway. If dentures are not obstructing the airway, leave them in
place for what? Answer: bag mask ventilation, as it improves mask
fitting.
◉ When preforming rapid sequence intubation, the dose of benzos,
barbiturates, and other sedatives should be reduced to what
percentage to minimize the risk of cardiovascular depression?
Answer: 20-40%
◉ Functional changes in cardiac system include declining function,
decreased sensitivity to catecholamines, atherosclerosis of coronary
vessels, increased afterload, fixed heart rate (beta blockers) Answer:
this results in lack of classic response to hypovolemia, risk for
,cardiac ischemia, elevated BP at baseline, and increased risk of
dysrythmias.
◉ Functional changes in pulmonary system include decreased
elastic recoil, reduced residual capacity, decreased gas exchange and
decreased cough reflex Answer: thus they are at increased risk for
respiratory failure, increased risk for pneumonia, and poor tolerance
to rib fractures
◉ Functional changes in renal system include loss of renal mass,
decreased GFR, and decreased sensitivity to ADH and aldosterone
Answer: resulting in drug dosing for renal insufficiency, decreased
ability to concentrate urine, increased risk for AKI and urine flow
may be normal with hypovolemia
◉ Functional changes to MSK include loss of lean body mass,
osteoporosis, changes in joints and cartilage, c spine degenerative
changes and loss of skin elastin and subcutaneous fat Answer:
resulting in increased risk for fractures, decreased mobility,
difficulty for oral intubation, risk of skin injury, increased risk for
hypothermia, challenges in rehabiliation
◉ Functional changes in Endocrine system include decreased
production and response to thyroxin and decreased
dehydroepiandrosterone (DHEA) Answer: resulting in occult
hypothyroidism, relative hypercortisone states and increased risk of
infection
, ◉ True or false: Arthritis can complicate the airway and cervical
spine. Patients can have multilevel degenerative changes affecting
disk spaces and posterior elements associated with severe central
canal stenosis, cord compression, and myelomalacia Answer: true
◉ In elderly population, due to their changes in pulmonary system,
placing a gauze between gums and cheek to achieve seal when using
bag valve mask ventilation is okay. In addition, because aging causes
a suppressed heart rate response to hypoxia...... Answer: respiratory
failure may present insidiously in older adults.
◉ Age related changes in the cardiovascular system place the elderly
trauma patient at significant risk for being inaccurately categorized
as hemodynamically stable. Answer: Elderly patients have a fixed
heart rate and fixed cardiac output, thus, their response to
hypovolemia will involve increasing their systemic vascular
resistance. Furthermore, since older patients have HTN, an
acceptable BP may truly reflect a hypotensive state. A systolic BP of
110 is to be utilized as the threshold for identifying hypotension in
patients 65 and older.
◉ Do no equate blood pressure with shock in older patients Answer:
BP in older patients may look normal due to the medications they
are on. Use lactate and base deficit to evaluate for evidence of shock
