ATLS Practice Test 8
Answers & Explanations
1. A resuscitation team fails to recognize worsening shock because each member is focused only on
their specific task. What best describes this failure?
a. Task fixation due to cognitive overload
b. Poor leadership delegation
c. Inadequate resource allocation
d. Lack of structured briefing
e. Failure of situational awareness
e.
This is situational awareness failure. ATLS emphasizes continuous reassessment and global
awareness beyond one’s own task. The team leader is primarily responsible for situational
awareness and, ideally, should not have any other tasks in addition to leading the team.
2. A 17-year-old male with severe TBI (GCS 5, fixed left pupil) arrives at a rural emergency
department. Intubation is successful, and vital signs are stable on ventilator support. CT scan
confirms a large subdural hematoma. The nearest neurosurgical facility is 4 hours away. Which of
the following is the priority during transfer preparation?
a. Hyperventilate to PaCO₂ <25 mmHg before transfer
b. Ensure sedation and paralysis for transport
c. Insert an ICP monitor to guide resuscitation
d. Administer mannitol or hypertonic saline as indicated
e. Delay transfer to place arterial and central venous lines
d.
Mannitol or hypertonic saline reduces ICP temporarily and is a recommended temporizing
measure during prolonged transfer to definitive neurosurgical care. Prolonged hyperventilation is
harmful since it may cause ischemic CNS events; only brief rescue hyperventilation is
recommended for impending herniation. Sedation and paralysis prevents proper neurological
examination and doesn’t address ICP; not the priority compared to osmotic therapy. Insertion of
an ICP monitor requires neurosurgical expertise and equipment not available here. Delaying
transfer for insertion of invasive lines is against ATLS principles – Lines are not worth delaying
transfer; IV/IO access is adequate.
1
, 3. A 35-year-old construction worker falls 6 meters. He has bilateral calcaneal fractures. What
additional injury should be suspected?
a. Cervical spine fracture
b. Thoracic aortic injury
c. Lumbar spine fracture
d. Pelvic fracture
e. Liver rupture
c.
Bilateral calcaneal fractures are strongly associated with axial load injuries, like lumbar spine
fracture (“lover’s fracture pattern”). Always evaluate the entire spine in this context. Cervical
spine injuries occur with head/neck trauma, and are not classically linked to calcaneal fractures.
Thoracic aortic injury is associated with high-speed deceleration, not axial loading through the
feet. Pelvic fracture is also less common in this context. Liver rupture is more related to blunt
abdominal trauma.
4. A 37-year-old man after blunt trauma has a GCS of 7. Which statement is most accurate?
a. Definitive airway control is indicated
b. Intubation should be delayed until CT scan is complete
c. Only supplemental O₂ is required
d. Observation with serial neurological checks is appropriate
e. Hyperventilation is the first-line of therapy
a.
For GCS ≤ 8, airway protection is needed. Never delay airway for imaging. Only oxygen
administration and observation is entirely insufficient. Hyperventilation is a temporizing measure
for impending herniation, not first-line.
5. A 29-year-old man presents after a stab wound to the left chest. He is tachycardic and
hypotensive. Chest tube is placed, draining 1,600 mL of blood immediately. What is the most
appropriate next step?
a. Continue tube thoracostomy and observe output
b. Autotransfuse the blood and continue resuscitation
c. Urgent thoracotomy
d. CT scan of the chest
e. eFAST examination of the chest and abdomen
c.
>1,500 mL immediately or >200 mL/hr x 2–4 hrs → urgent thoracotomy. He is too unstable to
undergo a CT scan. e.FAST would only further delay surgery. Autotransfusion is adjunctive only.
2
Answers & Explanations
1. A resuscitation team fails to recognize worsening shock because each member is focused only on
their specific task. What best describes this failure?
a. Task fixation due to cognitive overload
b. Poor leadership delegation
c. Inadequate resource allocation
d. Lack of structured briefing
e. Failure of situational awareness
e.
This is situational awareness failure. ATLS emphasizes continuous reassessment and global
awareness beyond one’s own task. The team leader is primarily responsible for situational
awareness and, ideally, should not have any other tasks in addition to leading the team.
2. A 17-year-old male with severe TBI (GCS 5, fixed left pupil) arrives at a rural emergency
department. Intubation is successful, and vital signs are stable on ventilator support. CT scan
confirms a large subdural hematoma. The nearest neurosurgical facility is 4 hours away. Which of
the following is the priority during transfer preparation?
a. Hyperventilate to PaCO₂ <25 mmHg before transfer
b. Ensure sedation and paralysis for transport
c. Insert an ICP monitor to guide resuscitation
d. Administer mannitol or hypertonic saline as indicated
e. Delay transfer to place arterial and central venous lines
d.
Mannitol or hypertonic saline reduces ICP temporarily and is a recommended temporizing
measure during prolonged transfer to definitive neurosurgical care. Prolonged hyperventilation is
harmful since it may cause ischemic CNS events; only brief rescue hyperventilation is
recommended for impending herniation. Sedation and paralysis prevents proper neurological
examination and doesn’t address ICP; not the priority compared to osmotic therapy. Insertion of
an ICP monitor requires neurosurgical expertise and equipment not available here. Delaying
transfer for insertion of invasive lines is against ATLS principles – Lines are not worth delaying
transfer; IV/IO access is adequate.
1
, 3. A 35-year-old construction worker falls 6 meters. He has bilateral calcaneal fractures. What
additional injury should be suspected?
a. Cervical spine fracture
b. Thoracic aortic injury
c. Lumbar spine fracture
d. Pelvic fracture
e. Liver rupture
c.
Bilateral calcaneal fractures are strongly associated with axial load injuries, like lumbar spine
fracture (“lover’s fracture pattern”). Always evaluate the entire spine in this context. Cervical
spine injuries occur with head/neck trauma, and are not classically linked to calcaneal fractures.
Thoracic aortic injury is associated with high-speed deceleration, not axial loading through the
feet. Pelvic fracture is also less common in this context. Liver rupture is more related to blunt
abdominal trauma.
4. A 37-year-old man after blunt trauma has a GCS of 7. Which statement is most accurate?
a. Definitive airway control is indicated
b. Intubation should be delayed until CT scan is complete
c. Only supplemental O₂ is required
d. Observation with serial neurological checks is appropriate
e. Hyperventilation is the first-line of therapy
a.
For GCS ≤ 8, airway protection is needed. Never delay airway for imaging. Only oxygen
administration and observation is entirely insufficient. Hyperventilation is a temporizing measure
for impending herniation, not first-line.
5. A 29-year-old man presents after a stab wound to the left chest. He is tachycardic and
hypotensive. Chest tube is placed, draining 1,600 mL of blood immediately. What is the most
appropriate next step?
a. Continue tube thoracostomy and observe output
b. Autotransfuse the blood and continue resuscitation
c. Urgent thoracotomy
d. CT scan of the chest
e. eFAST examination of the chest and abdomen
c.
>1,500 mL immediately or >200 mL/hr x 2–4 hrs → urgent thoracotomy. He is too unstable to
undergo a CT scan. e.FAST would only further delay surgery. Autotransfusion is adjunctive only.
2
