ATLS Practice Test 6
Answers & Explanations
1. A 25-year-old male is brought in after a motorcycle crash. He is unconscious, has gurgling
respirations, and blood in his oropharynx. What is the first priority in his airway management?
a. rapid sequence intubation
b. suctioning the oropharynx
c. cricothyroidotomy
d. bag-mask ventilation
e. insertion of an oral airway
b.
The first step is to clear the airway of secretions, blood, or vomitus using suction. Only after the
airway is cleared can definitive airway maneuvers (intubation or surgical airway) be attempted.
Immediate intubation without suction risks aspiration and failed airway control.
2. Which of the following is the most immediate life-threatening chest injury that requires needle
decompression?
a. flail chest
b. massive hemothorax
c. tension pneumothorax
d. cardiac tamponade
e. open pneumothorax
c.
Tension pneumothorax causes rapid cardiovascular collapse due to impaired venous return. It
must be treated immediately with needle decompression, followed by chest tube insertion. Other
chest injuries are serious but not treated initially with needle decompression.
3. A 17-year-old helmeted motorcyclist is struck broadside by an automobile at an intersection. He
is unconscious at the scene with a blood pressure of 140/90 mm Hg, heart rate of 90 beats per
minute, and respiratory rate of 22 breaths per minute. His respirations are sonorous and deep. His
GCS score is 8. Immobilization of the entire patient may include the use of all the following
EXCEPT
1
, a. air splints
b. bolstering devices
c. a long spine board
d. a scoop-style stretcher
e. a semirigid cervical collar
c.
ATLS emphasizes that the long spine board should be used primarily as an extrication device, not
for prolonged immobilization, due to potential complications like pain, pressure ulcers, and
respiratory compromise. Instead, spinal motion restriction is preferred and is achieved
by application of a semirigid cervical collar and securing the patient firmly to the EMS stretcher
in a supine position with the head elevated at approximately 20º to 30º.
4. A 35-year-old male with blunt trauma has a GCS of 6. Pupils are unequal. What is the next best
step?
a. mannitol IV and observe
b. RSI and hyperventilate; urgent neurosurgical consultation
c. place in Trendelenburg position, cricothyrotomy; urgent neurosurgical consultation
d. Dexamethtasone IV
e. noncontrast head CT
b.
Unequal pupils + low GCS = space-occupying lesion → possible herniation. First priority: airway
protection and oxygenation, while arranging emergent neurosurgical care. Hyperventilation is
temporary. Steroids are not indicated in TBI. CT would delay resuscitation with potentially
catastrophic results.
5. A 54-year-old male presents to the emergency department after a motorcycle accident. He is
complaining of severe right hip pain and is unable to bear weight on the affected leg. On physical
examination, you note shortening and marked external rotation of the right lower extremity.
Which of the following is the most likely diagnosis?
a. pubic symphysis diastasis
b. hip fracture
c. pelvic fracture
d. femur fracture
e. hip dislocation
2
Answers & Explanations
1. A 25-year-old male is brought in after a motorcycle crash. He is unconscious, has gurgling
respirations, and blood in his oropharynx. What is the first priority in his airway management?
a. rapid sequence intubation
b. suctioning the oropharynx
c. cricothyroidotomy
d. bag-mask ventilation
e. insertion of an oral airway
b.
The first step is to clear the airway of secretions, blood, or vomitus using suction. Only after the
airway is cleared can definitive airway maneuvers (intubation or surgical airway) be attempted.
Immediate intubation without suction risks aspiration and failed airway control.
2. Which of the following is the most immediate life-threatening chest injury that requires needle
decompression?
a. flail chest
b. massive hemothorax
c. tension pneumothorax
d. cardiac tamponade
e. open pneumothorax
c.
Tension pneumothorax causes rapid cardiovascular collapse due to impaired venous return. It
must be treated immediately with needle decompression, followed by chest tube insertion. Other
chest injuries are serious but not treated initially with needle decompression.
3. A 17-year-old helmeted motorcyclist is struck broadside by an automobile at an intersection. He
is unconscious at the scene with a blood pressure of 140/90 mm Hg, heart rate of 90 beats per
minute, and respiratory rate of 22 breaths per minute. His respirations are sonorous and deep. His
GCS score is 8. Immobilization of the entire patient may include the use of all the following
EXCEPT
1
, a. air splints
b. bolstering devices
c. a long spine board
d. a scoop-style stretcher
e. a semirigid cervical collar
c.
ATLS emphasizes that the long spine board should be used primarily as an extrication device, not
for prolonged immobilization, due to potential complications like pain, pressure ulcers, and
respiratory compromise. Instead, spinal motion restriction is preferred and is achieved
by application of a semirigid cervical collar and securing the patient firmly to the EMS stretcher
in a supine position with the head elevated at approximately 20º to 30º.
4. A 35-year-old male with blunt trauma has a GCS of 6. Pupils are unequal. What is the next best
step?
a. mannitol IV and observe
b. RSI and hyperventilate; urgent neurosurgical consultation
c. place in Trendelenburg position, cricothyrotomy; urgent neurosurgical consultation
d. Dexamethtasone IV
e. noncontrast head CT
b.
Unequal pupils + low GCS = space-occupying lesion → possible herniation. First priority: airway
protection and oxygenation, while arranging emergent neurosurgical care. Hyperventilation is
temporary. Steroids are not indicated in TBI. CT would delay resuscitation with potentially
catastrophic results.
5. A 54-year-old male presents to the emergency department after a motorcycle accident. He is
complaining of severe right hip pain and is unable to bear weight on the affected leg. On physical
examination, you note shortening and marked external rotation of the right lower extremity.
Which of the following is the most likely diagnosis?
a. pubic symphysis diastasis
b. hip fracture
c. pelvic fracture
d. femur fracture
e. hip dislocation
2
