ATLS PRACTICE 2 REVISION HANDBOOK 2026
AIRWAY BREATHING CIRCULATION AND
TRAUMA MANAGEMENT
◉ A 26-year-old male is resuscitated with blood transfusion after a
motor vehicle collision that was complicated by a fractured pelvis. A
few hours later, the patient becomes febrile, hypotensive with a
normal CVP, and oliguric. Upon examination, the patient is found to
be bleeding from the NG tube and IV sites. Which of the following is
the most likely diagnosis?
A. Hemorrhagic shock
B. Acute adrenal insufficiency
C. Fat embolism syndrome
D. Transfusion reaction
Answer: D. Transfusion reaction
◉ Skin antiseptic
Answer: -Ethanol 70% is an effective skin antiseptic
-Acetic acid can be used to treat Gram- skin infections
-Salicylic acid is used to treat certain skin yeast infections
◉ Class IV hemorrhage indicates what % blood loss
,Answer: 55%
◉ How does shivering affect body temperature
Answer: Increases body temperature
◉ Class III hemorrhage indicates what % of blood loss
Answer: 35%
◉ Management of a stable patient with kidney contusion
Answer: Observation
◉ Associated with hypovolemic shock
Answer: -Inadequate tissue perfusion with resultant tissue hypoxia
-Blood shunting to vital organs
-Decreased circulating blood volume and decreased venous return
-Low cardiac output
-Loss of less than 20% of the blood volume is usually without
symptom except for mild tachycardia
-Patients become orthostatic with losses between 20 and 40%
-Shock is evidenced by tachycardia, hypotension, oliguria, flat neck
veins
,◉ The most effective method of monitoring the success of
resuscitation during CPR?
Answer: Reactivity of pupils to light
◉ Used to ensure correct placement of endotracheal tube
Answer: -Ultrasound
-Bilateral breath sounds
-Sustained end-tidal CO2
◉ Total body surface area involved in a burn in an adult to the
anterior chest and abdomen
Answer: 18%
◉ What is often caused by carotid massage?
Answer: Bradycardia
◉ Step in a patient diagnosed with tension pneumothorax
Answer: 1. Needle decompression/ thoracotomy
2. Chest tube
◉ True statements regarding diaphragmatic injuries
, Answer: -Blunt diaphragmatic injuries are usually associated with
skeletal trauma
-Penetrating diaphragmatic injuries may be missed
-Repair of traumatic diaphragmatic injuries usually does not require
prosthetic material
◉ First priority in the treatment of an unconscious patient
Answer: Checking the pulse
◉ A patient involved in a road accident is brought to the emergency
department in an unconscious state. On arrival, her vitals show a
temperature of 96.4 degrees Fahrenheit, a respiration rate of 24
breaths per minute, a heart rate of 140 beats per minute, and a
blood pressure of 80/40 mm Hg. She is cold, shivering, and
perspiring profusely. She has bilateral reactive pupils but she does
not respond to pain. On physical examination, she has no obvious
sign of external bleeding. Which of the following cannot be the cause
of hypotension in this patient?
A. Pelvic fracture
B. Fracture of femur
C. Intracranial hemorrhage
D. Hemothorax
Answer: C. Intracranial hemorrhage
AIRWAY BREATHING CIRCULATION AND
TRAUMA MANAGEMENT
◉ A 26-year-old male is resuscitated with blood transfusion after a
motor vehicle collision that was complicated by a fractured pelvis. A
few hours later, the patient becomes febrile, hypotensive with a
normal CVP, and oliguric. Upon examination, the patient is found to
be bleeding from the NG tube and IV sites. Which of the following is
the most likely diagnosis?
A. Hemorrhagic shock
B. Acute adrenal insufficiency
C. Fat embolism syndrome
D. Transfusion reaction
Answer: D. Transfusion reaction
◉ Skin antiseptic
Answer: -Ethanol 70% is an effective skin antiseptic
-Acetic acid can be used to treat Gram- skin infections
-Salicylic acid is used to treat certain skin yeast infections
◉ Class IV hemorrhage indicates what % blood loss
,Answer: 55%
◉ How does shivering affect body temperature
Answer: Increases body temperature
◉ Class III hemorrhage indicates what % of blood loss
Answer: 35%
◉ Management of a stable patient with kidney contusion
Answer: Observation
◉ Associated with hypovolemic shock
Answer: -Inadequate tissue perfusion with resultant tissue hypoxia
-Blood shunting to vital organs
-Decreased circulating blood volume and decreased venous return
-Low cardiac output
-Loss of less than 20% of the blood volume is usually without
symptom except for mild tachycardia
-Patients become orthostatic with losses between 20 and 40%
-Shock is evidenced by tachycardia, hypotension, oliguria, flat neck
veins
,◉ The most effective method of monitoring the success of
resuscitation during CPR?
Answer: Reactivity of pupils to light
◉ Used to ensure correct placement of endotracheal tube
Answer: -Ultrasound
-Bilateral breath sounds
-Sustained end-tidal CO2
◉ Total body surface area involved in a burn in an adult to the
anterior chest and abdomen
Answer: 18%
◉ What is often caused by carotid massage?
Answer: Bradycardia
◉ Step in a patient diagnosed with tension pneumothorax
Answer: 1. Needle decompression/ thoracotomy
2. Chest tube
◉ True statements regarding diaphragmatic injuries
, Answer: -Blunt diaphragmatic injuries are usually associated with
skeletal trauma
-Penetrating diaphragmatic injuries may be missed
-Repair of traumatic diaphragmatic injuries usually does not require
prosthetic material
◉ First priority in the treatment of an unconscious patient
Answer: Checking the pulse
◉ A patient involved in a road accident is brought to the emergency
department in an unconscious state. On arrival, her vitals show a
temperature of 96.4 degrees Fahrenheit, a respiration rate of 24
breaths per minute, a heart rate of 140 beats per minute, and a
blood pressure of 80/40 mm Hg. She is cold, shivering, and
perspiring profusely. She has bilateral reactive pupils but she does
not respond to pain. On physical examination, she has no obvious
sign of external bleeding. Which of the following cannot be the cause
of hypotension in this patient?
A. Pelvic fracture
B. Fracture of femur
C. Intracranial hemorrhage
D. Hemothorax
Answer: C. Intracranial hemorrhage
