ATLS EXAM WITH COMPLETE SOLUTIONS
QUESTIONS AND ANSWERS GRADED A
True or false? Although the mechanism of injury may be similar to those for the younger population,
data shows increased mortality with similar severity of injury in older adults.
ANS: True
In the elderly population, what is decreased physiological reserve?
ANS: 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:
ANS: cirrhosis, coagulopathy, COPD, ischemic heart disease, DM
What is the most common mechanism of injury in the elderly?
ANS: 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?
ANS: 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?
ANS: 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
ANS: 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.
ANS: 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?
ANS: 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?
ANS: 20-40%
Functional changes in cardiac system include declining function, decreased sensitivity to catechol
amines, atherosclerosis of coronary vessels, increased afterload, fixed heart rate (beta blockers)
,ANS: this results in lack of classic response to hypovolemia, risk for cardiac ischemia, elevated BP at
baseline, and increased risk of dysrhythmias.
Functional changes in pulmonary system include decreased elastic recoil, reduced residual capacity,
decreased gas exchange and decreased cough reflex
ANS: 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
ANS: 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
ANS: resulting in increased risk for fractures, decreased mobility, difficulty for oral intubation, risk of
skin injury, increased risk for hypothermia, challenges in rehabilitation
Functional changes in Endocrine system include decreased production and response to thyroxin and
decreased dehydroepiandrosterone (DHEA)
ANS: resulting in occult hypothyroidism, relative hyper cortisone 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
ANS: 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......
ANS: 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.
ANS: 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
ANS: 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
what 2 factors place elderly patients at risk for intracranial hemorrhage?
ANS: aging causes dura to become more adherent to the skull increasing risk of injury and older
patients are on anticoagulant and antiplatelet medications.
Loss of subcutaneous fat, nutritional deficiencies, chronic medical conditions place elderly patients as
risk for hypothermia and complications for immobility.
, ANS: Rapid evaluation and when possible early liberation from spine boards and cervical collars will
minimize complications.
True or False: Fall prevention is the mainstay of reducing the mortality associated with pelvic
fractures.
ANS: true
poor hygiene, dehydration, oral injury, contusions affecting the inner arms, inner thighs, palms, soles,
scalp, ear, nasal bridge and temple injury from being struck while wearing glasses, contact burns and
scalds. These are all signs of.......?
ANS: Elder maltreatment. The presence of physical findings of maltreatment should prompt a detailed
history. if history conflicts with findings, immediately report findings to authorities.
True of false: early activation of the trauma team may be required for elderly patients who do not
meet traditional criteria for activation
ANS: True. A simple injury such as an open tibia fracture in a frail elderly patient may become life
threatening.
Common mechanisms of injury include falls, MVC, burns, and penetrating injuries
ANS: common injuries in the elderly include rib fractures, TBI, pelvic fractures
The best initial treatment for the fetus is to provide optimal resuscitation of the mother. True or False?
ANS: True. Also if xray examination is indicated during the pregnant patient's treatment, it should not
be withheld because of the pregnancy.
What happens as the uterus enlarged and the bowel is pushed cephalad.
ANS: When the uterus enlarges it pushes the bowel cephalad and the uterus lies in the upper
abdomen. As a result, the bowel is somewhat protected from blunt abdominal trauma, whereas the
uterus and its contents (fetus and placenta) become more vulnerable. Uterus remains intrapelvic until
12 weeks and then at 20 weeks it is at the umbilicus, and at 34-36 weeks it reaches the costal
margin.
Amniotic fluid can cause amniotic fluid embolism and disseminated intravascular coagulation
following trauma if fluid enters maternal intravascular space. True or False
ANS: True
By the third trimester, what is the complication of trauma to the pelvis of the mother?
ANS: by the third trimester, the uterus is large and thin walled. In vertex presentation, fetal head is
usually in the pelvis and the remainder of the fetus is exposed above the pelvic brim. Pelvic fractures
in late gestation can result in skull fracture or intracranial injury to the fetus. Also we can have a
placental abruption due to its little elasticity and vulnerability to sheer forces.
An abrupt decrease in maternal intravascular volume can result in a profound increase in uterine
vascular resistance reducing fetal oxygenation despite reasonably normal maternal vital signs.
ANS: this is true
Physiological anemia of pregnancy
ANS: A smaller increase in red blood cell volume can occur resulting in a decreased hematocrit level.
Thus, in late pregnancy a hematocrit of 31-33% is normal.
QUESTIONS AND ANSWERS GRADED A
True or false? Although the mechanism of injury may be similar to those for the younger population,
data shows increased mortality with similar severity of injury in older adults.
ANS: True
In the elderly population, what is decreased physiological reserve?
ANS: 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:
ANS: cirrhosis, coagulopathy, COPD, ischemic heart disease, DM
What is the most common mechanism of injury in the elderly?
ANS: 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?
ANS: 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?
ANS: 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
ANS: 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.
ANS: 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?
ANS: 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?
ANS: 20-40%
Functional changes in cardiac system include declining function, decreased sensitivity to catechol
amines, atherosclerosis of coronary vessels, increased afterload, fixed heart rate (beta blockers)
,ANS: this results in lack of classic response to hypovolemia, risk for cardiac ischemia, elevated BP at
baseline, and increased risk of dysrhythmias.
Functional changes in pulmonary system include decreased elastic recoil, reduced residual capacity,
decreased gas exchange and decreased cough reflex
ANS: 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
ANS: 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
ANS: resulting in increased risk for fractures, decreased mobility, difficulty for oral intubation, risk of
skin injury, increased risk for hypothermia, challenges in rehabilitation
Functional changes in Endocrine system include decreased production and response to thyroxin and
decreased dehydroepiandrosterone (DHEA)
ANS: resulting in occult hypothyroidism, relative hyper cortisone 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
ANS: 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......
ANS: 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.
ANS: 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
ANS: 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
what 2 factors place elderly patients at risk for intracranial hemorrhage?
ANS: aging causes dura to become more adherent to the skull increasing risk of injury and older
patients are on anticoagulant and antiplatelet medications.
Loss of subcutaneous fat, nutritional deficiencies, chronic medical conditions place elderly patients as
risk for hypothermia and complications for immobility.
, ANS: Rapid evaluation and when possible early liberation from spine boards and cervical collars will
minimize complications.
True or False: Fall prevention is the mainstay of reducing the mortality associated with pelvic
fractures.
ANS: true
poor hygiene, dehydration, oral injury, contusions affecting the inner arms, inner thighs, palms, soles,
scalp, ear, nasal bridge and temple injury from being struck while wearing glasses, contact burns and
scalds. These are all signs of.......?
ANS: Elder maltreatment. The presence of physical findings of maltreatment should prompt a detailed
history. if history conflicts with findings, immediately report findings to authorities.
True of false: early activation of the trauma team may be required for elderly patients who do not
meet traditional criteria for activation
ANS: True. A simple injury such as an open tibia fracture in a frail elderly patient may become life
threatening.
Common mechanisms of injury include falls, MVC, burns, and penetrating injuries
ANS: common injuries in the elderly include rib fractures, TBI, pelvic fractures
The best initial treatment for the fetus is to provide optimal resuscitation of the mother. True or False?
ANS: True. Also if xray examination is indicated during the pregnant patient's treatment, it should not
be withheld because of the pregnancy.
What happens as the uterus enlarged and the bowel is pushed cephalad.
ANS: When the uterus enlarges it pushes the bowel cephalad and the uterus lies in the upper
abdomen. As a result, the bowel is somewhat protected from blunt abdominal trauma, whereas the
uterus and its contents (fetus and placenta) become more vulnerable. Uterus remains intrapelvic until
12 weeks and then at 20 weeks it is at the umbilicus, and at 34-36 weeks it reaches the costal
margin.
Amniotic fluid can cause amniotic fluid embolism and disseminated intravascular coagulation
following trauma if fluid enters maternal intravascular space. True or False
ANS: True
By the third trimester, what is the complication of trauma to the pelvis of the mother?
ANS: by the third trimester, the uterus is large and thin walled. In vertex presentation, fetal head is
usually in the pelvis and the remainder of the fetus is exposed above the pelvic brim. Pelvic fractures
in late gestation can result in skull fracture or intracranial injury to the fetus. Also we can have a
placental abruption due to its little elasticity and vulnerability to sheer forces.
An abrupt decrease in maternal intravascular volume can result in a profound increase in uterine
vascular resistance reducing fetal oxygenation despite reasonably normal maternal vital signs.
ANS: this is true
Physiological anemia of pregnancy
ANS: A smaller increase in red blood cell volume can occur resulting in a decreased hematocrit level.
Thus, in late pregnancy a hematocrit of 31-33% is normal.
