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ATLS 7 Edition - answers
2 initial assessment 44 answers
1. d
Explanation: When possible trauma patients should be transported to a trauma center, especially if significant injury is
suspected or confirmed. A GCS < 14, respiratory rate < 10 breaths/min or greater than 29 breaths/min and a systolic blood
pressure < 90 mmm Hg all suggest potentially life-threatening injury and should prompt transport to a trauma center.
2. a
Explanation: The decision to transport a patient to a trauma center will depend upon many factors. Some situations that should
prompt transport to a trauma center include: ejection from auto, death in the same passenger compartment, pedestrian run over
or thrown, unrestrained passenger in a high speed MVA (speed > 40 mph, major deformity to vehicle such as > 20 inches,
intrusion into the passenger compartment > 12 inches, extrication time > 20 minutes, falls > 20 ft, rollover, pedestrian hit at > 5
mph or motorcycle crash traveling at greater than 20 mph or with separation from the bike.
3. d
Explanation: Some situations that should prompt transport to a trauma center include: flail chest, 2 or more proximal long bone
fractures (humerus, femur), amputation proximal (above) the wrist or ankle, penetrating trauma to the head, neck, chest and to
the extremities proximal to the knee and elbow, suspected open or depressed skull fracture, paralysis, suspected pelvic fracture,
combination trauma with burns and isolated major burns.
4. b
Explanation: Whether managing a medical or trauma patient the ABCs take priority. As soon as the airway has been evaluated
(and in practice simultaneously) protect the cervical spine.
5. d
Explanation: Definitive airway management is commonly indicated for trauma patients with tracheal/laryngeal fractures that
cause airway obstruction, GCS < 8 and nonpurposeful motor responses. Patients with mandible fractures who are protecting
their airway usually do not require emergent intubation. A respiratory rate > 29 breaths/min is concerning but does not
necessarily require intubation, especially if it is from a tension pneumothorax, massive hemothorax or pulmonary contusion.
6. e
Explanation: Airway management of trauma patients can be extremely difficult. If a trauma patient deteriorates following
intubation the most common reason would be improper endotracheal tube placement. Tube placement should be reconfirmed
by auscultating bilateral breath sounds and watching the chest rise and fall, using an end tidal CO2 detector, visualizing the
endotracheal tube through the cords and checking a chest X-ray. Other less common but potentially life-threatening causes of
deterioration following intubation include unrecognized laryngeal fracture, incomplete upper airway transection that becomes
complete following intubation, worsening pneumothorax or the development of a tension pneumothorax.
7. c
Explanation: Hemorrhage is the most common cause of preventable post-traumatic death.
8. d
Explanation: When a trauma patient is hypotensive suspect hemorrhage. If there is no visible evidence of external hemorrhage
suspect occult blood loss. Major sources of occult blood loss include hemorrhage into the thoracic or abdominal cavities,
hemorrhage surrounding long bone fractures (femur more commonly than humerous) or a pelvic fracture with retroperitoneal
hemorrhage. Neurogenic shock secondary to spinal cord injury is an uncommon cause of hypotension.
9. d
Explanation: Elderly patients, especially those on medications that may attenuate tachycardia such as beta blockers and
calcium channel blockers, children and athletes may not respond to hemorrhage in a normal manner, obscuring one of the
earliest signs of volume depletion.
10. a
Explanation: Rapid external hemorrhage is best controlled during the primary survey using direct manual compression.
Tourniquets can cause tissue injury and distal ischemia and hemostats can cause damage to veins and nerves.
11. e
Explanation: The GCS can help to determine a patients level of consciousness. The GCS measures eye opening, verbal and
motor responses.
12.
13. e
Explanation: The maximum rate of fluid administration is determined by the internal diameter of the intravenous catheter and
inversely by the length of the intravenous catheter. The size of the vein has less to do with the rate of fluid resuscitation than
these mechanical factors.
14. c
Explanation: Warmed crystalloid solution such as normal saline or Lactated Ringers, is the preferred initial intravenous fluid for
the resuscitation of trauma patients with hypotension. The ATLS textbook states that Ringer's Lactate solution is the preferred
initial crystalloid solution. The ATLS textbook states that normal saline the second choice because it has the potential to cause
hyperchloremic acidosis especially if renal function is impaired. Normal saline is, however, commonly used as the initial
intravenous fluid of choice at many trauma centers.
ATLS 7 Edition - answers
2 initial assessment 44 answers
1. d
Explanation: When possible trauma patients should be transported to a trauma center, especially if significant injury is
suspected or confirmed. A GCS < 14, respiratory rate < 10 breaths/min or greater than 29 breaths/min and a systolic blood
pressure < 90 mmm Hg all suggest potentially life-threatening injury and should prompt transport to a trauma center.
2. a
Explanation: The decision to transport a patient to a trauma center will depend upon many factors. Some situations that should
prompt transport to a trauma center include: ejection from auto, death in the same passenger compartment, pedestrian run over
or thrown, unrestrained passenger in a high speed MVA (speed > 40 mph, major deformity to vehicle such as > 20 inches,
intrusion into the passenger compartment > 12 inches, extrication time > 20 minutes, falls > 20 ft, rollover, pedestrian hit at > 5
mph or motorcycle crash traveling at greater than 20 mph or with separation from the bike.
3. d
Explanation: Some situations that should prompt transport to a trauma center include: flail chest, 2 or more proximal long bone
fractures (humerus, femur), amputation proximal (above) the wrist or ankle, penetrating trauma to the head, neck, chest and to
the extremities proximal to the knee and elbow, suspected open or depressed skull fracture, paralysis, suspected pelvic fracture,
combination trauma with burns and isolated major burns.
4. b
Explanation: Whether managing a medical or trauma patient the ABCs take priority. As soon as the airway has been evaluated
(and in practice simultaneously) protect the cervical spine.
5. d
Explanation: Definitive airway management is commonly indicated for trauma patients with tracheal/laryngeal fractures that
cause airway obstruction, GCS < 8 and nonpurposeful motor responses. Patients with mandible fractures who are protecting
their airway usually do not require emergent intubation. A respiratory rate > 29 breaths/min is concerning but does not
necessarily require intubation, especially if it is from a tension pneumothorax, massive hemothorax or pulmonary contusion.
6. e
Explanation: Airway management of trauma patients can be extremely difficult. If a trauma patient deteriorates following
intubation the most common reason would be improper endotracheal tube placement. Tube placement should be reconfirmed
by auscultating bilateral breath sounds and watching the chest rise and fall, using an end tidal CO2 detector, visualizing the
endotracheal tube through the cords and checking a chest X-ray. Other less common but potentially life-threatening causes of
deterioration following intubation include unrecognized laryngeal fracture, incomplete upper airway transection that becomes
complete following intubation, worsening pneumothorax or the development of a tension pneumothorax.
7. c
Explanation: Hemorrhage is the most common cause of preventable post-traumatic death.
8. d
Explanation: When a trauma patient is hypotensive suspect hemorrhage. If there is no visible evidence of external hemorrhage
suspect occult blood loss. Major sources of occult blood loss include hemorrhage into the thoracic or abdominal cavities,
hemorrhage surrounding long bone fractures (femur more commonly than humerous) or a pelvic fracture with retroperitoneal
hemorrhage. Neurogenic shock secondary to spinal cord injury is an uncommon cause of hypotension.
9. d
Explanation: Elderly patients, especially those on medications that may attenuate tachycardia such as beta blockers and
calcium channel blockers, children and athletes may not respond to hemorrhage in a normal manner, obscuring one of the
earliest signs of volume depletion.
10. a
Explanation: Rapid external hemorrhage is best controlled during the primary survey using direct manual compression.
Tourniquets can cause tissue injury and distal ischemia and hemostats can cause damage to veins and nerves.
11. e
Explanation: The GCS can help to determine a patients level of consciousness. The GCS measures eye opening, verbal and
motor responses.
12.
13. e
Explanation: The maximum rate of fluid administration is determined by the internal diameter of the intravenous catheter and
inversely by the length of the intravenous catheter. The size of the vein has less to do with the rate of fluid resuscitation than
these mechanical factors.
14. c
Explanation: Warmed crystalloid solution such as normal saline or Lactated Ringers, is the preferred initial intravenous fluid for
the resuscitation of trauma patients with hypotension. The ATLS textbook states that Ringer's Lactate solution is the preferred
initial crystalloid solution. The ATLS textbook states that normal saline the second choice because it has the potential to cause
hyperchloremic acidosis especially if renal function is impaired. Normal saline is, however, commonly used as the initial
intravenous fluid of choice at many trauma centers.
