ATLS WRITTEN REVIEW A
COMPREHENSIVE STUDY GUIDE 2026 FULL
QUESTIONS AND SOLUTIONS GRADED A+
◍ 39yo M is crushed by a glass plate wishing 450kg. Following extrication, he
shows signs of subcutaneous emphysema, is dyspneic, and complains of
abdominal pain. In the ED, bilateral chest rubes are inserted and decompress
the pneumothoraces; however, he remains tachycardia and hypotensive. The
most likely etiology is:.
Answer: intraabdominal hemorrhage
◍ A previously healthy 70kg man suffered ~2L of acute blood loss. Which
appropriately applies to this patient?.
Answer: His systolic BP will be decreased with a narrowed pulse
pressureNOT his pulse pressure will be widened, urinary output at lower
level of normal, tachy but no BP change, or maintained systolic BP with
elevated diastolic BP
◍ Middle meningeal artery.
Answer: MC artery lacerated in epidural hematoma
◍ A 56-year-old male archer was riding a horse when it bucked and the saddle
struck him in the chest wall. You note paradoxical chest wall movement on
the left anterior chest. CXR is negative..
Answer: Flail chest due to costochondral disruption
◍ Blood Alcohol Concentration.
Answer: Level indicating potential impairment or injury risk.
◍ Increase fluids to target urine output of 100 cc/hr (theoretically washing out
myoglobin before it can settle in), Mannitol (acts a free radical scavenger,
and osmo diuretic to increase urine output and wash out myoglobin).
, Answer: 2 Interventions for treating rhabomyolysis:
◍ The most important, immediate step in the management of open PTX is?.
Answer: placement of an occlusive dressing on the wound
◍ The best assessment of fluid resuscitation of the adult burn patient is:.
Answer: urine output of >0.5
◍ Patients with cerviacl fractures above C6 require special consideration prior
to transportation due to?.
Answer: Potential progression to respiratory failure
◍ A 22-year-old female presents after jumping from the 3rd story of a building
in a suicide attempt. She's stable, but GCS is 13. Both ankles are swollen.
Her pulses intact. Initial chest and pelvis films are normal. Ankle films
reveal bilateral calcanea fracture. What additional work-ip is important to
undertake in this patient?.
Answer: Radiographic work-up of the spine to rule out occult injury
◍ Crepitus.
Answer: Grating sound or sensation from fractured bones.
◍ Hemorrhage of 20% of the patient's blood volume is associated usually with.
Answer: tachycardia
◍ The extent of hypoxemia resulting from a flail chest is primarily due to:.
Answer: underlying lung contusion
◍ 14yo M is injured with a propane tank explosion and he is thrown 5m (16ft)
against a tree. He arrives in the ED with a BP of 80/45, HR 100, RR of 32.
He has reddened skin on his face and exposed extremities, but his clothes
are not burned. He is gasping and says that he cannot breathe. His neck
veins are distended. Most likely cause of hypotension is?.
Answer: tension pneumothorax
◍ Ventilation, Hypercarbia.
Answer: For peds patients, a needle cricothyroidotomy is an appropriate
temporizing technique for oxygen, but does NOT provide adequate _______
, resulting in progressive ______
◍ Open pneumothorax (next step is placement of chest tube in an area remote
from the injury).
Answer: A 26YOM sustained a posterior stab wound. Blood and bubbling
are coming from the wound. What are the associated
injuries:-Pneumothorax-Massive hemothorax-Open
pneumothorax-Diaphragm injury
◍ Signs of hemothorax.
Answer: Absence of breath sounds and dullness to percussion.
◍ Packed red blood cells.
Answer: Concentrated red blood cells for transfusion.
◍ In addition to VS and GCS score, what information would be helpful to
obtain in order to evaluate pregnant trauma patients?.
Answer: Additional scene information: whether/how the patient was
restrained and MOI
◍ Which of the following tests is the most specific in the hemodynamically
normal patient with suspected blunt abdominal injury?.
Answer: CT
◍ Surgical Intervention.
Answer: Required for severe internal injuries.
◍ Hemorrhage of 20% of the patient's blood volume is associated usually
with:.
Answer: tachycardia
◍ Secondary Survey.
Answer: Detailed examination after primary survey.
◍ Anterior cord syndrome.
Answer: - caused by flexion injuries- occurs when 2/3 of the anterior cord is
lost- motor function, pain, and temperature sensation lost bilaterally below
the lesion (flaccidity below the lesion)
, ◍ ARF (Acute renal failure from circulating myoglobin).
Answer: Risk of Crush syndrome
◍ What findings in an adult is most likely to require immediate management
during the primary survey?.
Answer: respiratory rate of 40 breaths per minute
◍ Indication for chest tube insertion.
Answer: Conditions like pneumothorax or massive hemothorax.
◍ Types of definitive airways.
Answer: Orotracheal tubeNasotracheal tubeSurgical airways
(cricothyroidotomy and tracheostomy)
◍ Diagnostic peritoneal lavage.
Answer: Procedure to assess intra-abdominal bleeding.
◍ Which one of the following findings in an adult is most likely to require
immediate management during the primary survey?.
Answer: respiratory rate of 40 breaths per minute
◍ Left stab wound.
Answer: Left diaphragm injurySpleen injuryHemopneumothoax
◍ Backward, Upward, Rightward pressure of larynx (BURP from Knill paper
1993).
Answer: The BURP maneuver for orotracheal intubation/Manual laryngeal
manipulation technique:
◍ Why are the elderly at a higher risk for TBIs?.
Answer: The dura is more adherent to the skullMore commonly on
anticoagulant/antiplatelet medication
◍ High mortality.
Answer: Hypotension + Pelvic fracture =
◍ 15yo F wall 6.5m (20ft) while rock climbing. She sustains a right closed
midshaft femur fracture with obvious angulation. She did not lose
COMPREHENSIVE STUDY GUIDE 2026 FULL
QUESTIONS AND SOLUTIONS GRADED A+
◍ 39yo M is crushed by a glass plate wishing 450kg. Following extrication, he
shows signs of subcutaneous emphysema, is dyspneic, and complains of
abdominal pain. In the ED, bilateral chest rubes are inserted and decompress
the pneumothoraces; however, he remains tachycardia and hypotensive. The
most likely etiology is:.
Answer: intraabdominal hemorrhage
◍ A previously healthy 70kg man suffered ~2L of acute blood loss. Which
appropriately applies to this patient?.
Answer: His systolic BP will be decreased with a narrowed pulse
pressureNOT his pulse pressure will be widened, urinary output at lower
level of normal, tachy but no BP change, or maintained systolic BP with
elevated diastolic BP
◍ Middle meningeal artery.
Answer: MC artery lacerated in epidural hematoma
◍ A 56-year-old male archer was riding a horse when it bucked and the saddle
struck him in the chest wall. You note paradoxical chest wall movement on
the left anterior chest. CXR is negative..
Answer: Flail chest due to costochondral disruption
◍ Blood Alcohol Concentration.
Answer: Level indicating potential impairment or injury risk.
◍ Increase fluids to target urine output of 100 cc/hr (theoretically washing out
myoglobin before it can settle in), Mannitol (acts a free radical scavenger,
and osmo diuretic to increase urine output and wash out myoglobin).
, Answer: 2 Interventions for treating rhabomyolysis:
◍ The most important, immediate step in the management of open PTX is?.
Answer: placement of an occlusive dressing on the wound
◍ The best assessment of fluid resuscitation of the adult burn patient is:.
Answer: urine output of >0.5
◍ Patients with cerviacl fractures above C6 require special consideration prior
to transportation due to?.
Answer: Potential progression to respiratory failure
◍ A 22-year-old female presents after jumping from the 3rd story of a building
in a suicide attempt. She's stable, but GCS is 13. Both ankles are swollen.
Her pulses intact. Initial chest and pelvis films are normal. Ankle films
reveal bilateral calcanea fracture. What additional work-ip is important to
undertake in this patient?.
Answer: Radiographic work-up of the spine to rule out occult injury
◍ Crepitus.
Answer: Grating sound or sensation from fractured bones.
◍ Hemorrhage of 20% of the patient's blood volume is associated usually with.
Answer: tachycardia
◍ The extent of hypoxemia resulting from a flail chest is primarily due to:.
Answer: underlying lung contusion
◍ 14yo M is injured with a propane tank explosion and he is thrown 5m (16ft)
against a tree. He arrives in the ED with a BP of 80/45, HR 100, RR of 32.
He has reddened skin on his face and exposed extremities, but his clothes
are not burned. He is gasping and says that he cannot breathe. His neck
veins are distended. Most likely cause of hypotension is?.
Answer: tension pneumothorax
◍ Ventilation, Hypercarbia.
Answer: For peds patients, a needle cricothyroidotomy is an appropriate
temporizing technique for oxygen, but does NOT provide adequate _______
, resulting in progressive ______
◍ Open pneumothorax (next step is placement of chest tube in an area remote
from the injury).
Answer: A 26YOM sustained a posterior stab wound. Blood and bubbling
are coming from the wound. What are the associated
injuries:-Pneumothorax-Massive hemothorax-Open
pneumothorax-Diaphragm injury
◍ Signs of hemothorax.
Answer: Absence of breath sounds and dullness to percussion.
◍ Packed red blood cells.
Answer: Concentrated red blood cells for transfusion.
◍ In addition to VS and GCS score, what information would be helpful to
obtain in order to evaluate pregnant trauma patients?.
Answer: Additional scene information: whether/how the patient was
restrained and MOI
◍ Which of the following tests is the most specific in the hemodynamically
normal patient with suspected blunt abdominal injury?.
Answer: CT
◍ Surgical Intervention.
Answer: Required for severe internal injuries.
◍ Hemorrhage of 20% of the patient's blood volume is associated usually
with:.
Answer: tachycardia
◍ Secondary Survey.
Answer: Detailed examination after primary survey.
◍ Anterior cord syndrome.
Answer: - caused by flexion injuries- occurs when 2/3 of the anterior cord is
lost- motor function, pain, and temperature sensation lost bilaterally below
the lesion (flaccidity below the lesion)
, ◍ ARF (Acute renal failure from circulating myoglobin).
Answer: Risk of Crush syndrome
◍ What findings in an adult is most likely to require immediate management
during the primary survey?.
Answer: respiratory rate of 40 breaths per minute
◍ Indication for chest tube insertion.
Answer: Conditions like pneumothorax or massive hemothorax.
◍ Types of definitive airways.
Answer: Orotracheal tubeNasotracheal tubeSurgical airways
(cricothyroidotomy and tracheostomy)
◍ Diagnostic peritoneal lavage.
Answer: Procedure to assess intra-abdominal bleeding.
◍ Which one of the following findings in an adult is most likely to require
immediate management during the primary survey?.
Answer: respiratory rate of 40 breaths per minute
◍ Left stab wound.
Answer: Left diaphragm injurySpleen injuryHemopneumothoax
◍ Backward, Upward, Rightward pressure of larynx (BURP from Knill paper
1993).
Answer: The BURP maneuver for orotracheal intubation/Manual laryngeal
manipulation technique:
◍ Why are the elderly at a higher risk for TBIs?.
Answer: The dura is more adherent to the skullMore commonly on
anticoagulant/antiplatelet medication
◍ High mortality.
Answer: Hypotension + Pelvic fracture =
◍ 15yo F wall 6.5m (20ft) while rock climbing. She sustains a right closed
midshaft femur fracture with obvious angulation. She did not lose
