ATLS EXAM Guide Questions and Answers -Updated
2023
> 40% blood loss. heart rate increase, RR increase, BP decrease, pulse pressure decrease, urine
output and GCS decrease - Answer MTP and base deficit is -10 or less
15-30% blood loss. increase in heart rate. decrease in pulse pressure. BP, RR, urine output do not
change - Answer class II hemorrhagic shock. possible need for blood products, but mostly
crystalloid fluid and base deficit of -2 to -6. anxiety, fear
31-40% blood loss. heart rate increase, respiratory rate increase, blood pressure decrease, pulse
pressure decrease, urine output and GCS decrease - Answer class III and this is the least amount
of blood loss that consistently causes a drop in systolic blood pressure. blood products needed
and base deficit is -6 to -10
A carboxyhemoglobin level greater than what percentage indicates a patient was involved in a
fire and has inhalation injury? - Answer 10%
A chest xray must be obtained after attempts at inserting a subclavian or IJ to document position
of line and evaluate for pneumo or hemothorax. - Answer do not use sodium bicarb to treat
metabolic acidosis from hypovolemic shock
A clenched hand with a small electrical entrance wound should alert the clinician that a deep soft
tissue injury is likely much more extensive than is visable to the naked eye - Answer true.
patients with severe electrical injuries require fasciotomies. Electricity can cause forced
contraction of muscles, doctors need to examine patient for skeletal and muscular damage,
especially for fractures of the spine and rhabdomyolysis
A tube placed in the trachea with the cuff inflated below the vocal cords and the tube connected
to oxygen enriched assisted ventilation and airway secured in place. - Answer definitive airway
Abuse and burns - Answer circular burns and burns with clear edges and unique patterns may
reflect cigarette burns or iron. Burns on the sole of the feet usually suggest child was placed in
hot water. A burn on the posterior aspect of the LE and buttocks
Acute respiratory distress, subcutaneous emphysema, absent unilateral breath sounds,
hyperresonance to percussion, and tracheal shift supports the diagnosis of???? - Answer tension
pneumothorax. needle or finger decompression temporarily relieves this life threatening
condition and follow this with a chest tube
Admission to hospital for pregnant patients: - Answer vaginal bleeding, uterine irritability,
abdominal tenderness, pain or cramping, evidence of hypovolemia, changes in or absence of fetal
heart tones and or leakage of amniotic fluid
,After the 10th week of pregnancy, cardiac output can increase 1.0-1.5 L/min because of the
increase in plasma volume and decrease in vascular resistance of the uterus and placenta. -
Answer The placenta receives 20% of the patient's cardiac output during the 3rd trimester. In
supine position, vena cava compression can decrease cardiac output by 30% because of
decreased venous return from lower extremities.
Age related changes in the cardiovascular system place the elderly trauma patient at significant
risk for being inaccurately categorized as hemodynamically stable. - Answer 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.
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? - Answer bag mask ventilation, as it
improves mask fitting.
Always assume CO exposure in patients who were burned in enclosed areas. Patients with CO
levels less than 20% may not show any symptoms - Answer HA and nausea (20-30%),
confusion (30-40%), coma (40-60%) and death (>60%). Cherry red skin color in patients may
only be seen in moribund patients.
Measurements of arterial PaO2 do not reliably predict CO poisoning b/c a partial pressure of
only 1 mm Hg results in an HbCO level of 40% or greater. Pulse ox cannot be relied on to rule
out carbon monoxide poisoning b/c we cant distinguish oxyhemoglobin from
carboxyhemoglobin. A discrepancy between pulse ox and arterial blood gas may be explained by
presence of carboxyhemoglobin.
American Burn Association states 2 requirements for diagnosis of smoke inhalation injury: -
Answer 1. exposure to combustible agent
2. signs of exposure to smoke in the lower airway, below the vocal cords, seen on bronchoscopy.
A chest Xray and arterial blood gases should be ordered to evaluate the pulmonary status of a
patient with smoke inhalation injury, but normal values on admission DO NOT exclude an
inhalation injury.
Amniotic fluid can cause amniotic fluid embolism and disseminated intravascular coagulation
following trauma if fluid enters maternal intravascular space. True or False - Answer True
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. -
Answer this is true
An injured patient who is cool to the touch and is tachycardic should be considered to be in
shock until proven otherwise. Massive blood loss may only produce a slight decrease in
HCT/Hgb. - Answer relying solely on BP as an indicator of shock can delay recognition of the
, condition b/c compensatory mechanisms can prevent measurable fall in systolic pressure until up
to 30% of the patient's blood volume is loss. A narrowed pulse pressure suggests significant
blood loss and involvement in compensatory mechanisms.
tachycardia is diagnosed as > 100 in adults
> 160 in infants
>140 in preschool aged children
>120 in children from school age to puberty.
Anatomical alterations in the thoracic cavity seem to account for the decreased residual volume
associated with diphragmatic elevation and chest x ray reveals increased lung marking and
prominence of the pulmonary vessels. - Answer oxygen consumption increases during
pregnancy and its important when resuscitating injured pregnant patients to maintain adequate
oxygenation above 95%
Anterior Cord Syndrome - Answer injury to the motor and sensory pathways in the anterior part
of cord. paraplegia and bilateral loss of pain and temp. However, position, vibration, and deep
pressure sense are preserved (sensations from dorsal columns). commonly due to cord ischemia
Any early normal serum amylase level or an elevated amylase level does not conclude pancreas
injury - Answer
As little as 0.01mL of RH+ blood will sensitize 70% of Rh- women. - Answer All pregnany RH
negative trauma patients should receive RH immunoglobulin therapy unless injury is remote
from the uterus (isolated distal extremity injury)
Atlanto Occipital Dislocation - Answer this is commonly seen in shaken baby syndrome due to
severe traumatic flexion and distraction. Most patients with this injury die of brainstem
destruction and apnea or have profound neurological impairments.
Blanched skin associated with fractures and dislocations can lead to soft tissue necrosis. The
purpose of promptly reducing this injury is to prevent pressure necrosis of the lateral left ankle
soft tissue - Answer the only reason to forgo an xray exam before treating a dislocation or
fracture is the presence of vascular compromise or impending skin breakdown, often seen with
fracture dislocations of the ankle
Bleeding in 3rd trimester may indicate placental abruption and impending death of the fetus, a
vaginal exam is vital - Answer however, avoid repeating vaginal examination, CT abdominal
imaging can be done and radiation doses less than 50mGy are not associated with fetal anomalies
or higher risk of fetal loss.
Blood pressure falls 5-15 mm Hg in systolic and diastolic pressures during second trimester,
although it returns to near normal levels at term. - Answer some women experience hypotension
when placed in the supine position due to the compression of teh inferior vena cava.
2023
> 40% blood loss. heart rate increase, RR increase, BP decrease, pulse pressure decrease, urine
output and GCS decrease - Answer MTP and base deficit is -10 or less
15-30% blood loss. increase in heart rate. decrease in pulse pressure. BP, RR, urine output do not
change - Answer class II hemorrhagic shock. possible need for blood products, but mostly
crystalloid fluid and base deficit of -2 to -6. anxiety, fear
31-40% blood loss. heart rate increase, respiratory rate increase, blood pressure decrease, pulse
pressure decrease, urine output and GCS decrease - Answer class III and this is the least amount
of blood loss that consistently causes a drop in systolic blood pressure. blood products needed
and base deficit is -6 to -10
A carboxyhemoglobin level greater than what percentage indicates a patient was involved in a
fire and has inhalation injury? - Answer 10%
A chest xray must be obtained after attempts at inserting a subclavian or IJ to document position
of line and evaluate for pneumo or hemothorax. - Answer do not use sodium bicarb to treat
metabolic acidosis from hypovolemic shock
A clenched hand with a small electrical entrance wound should alert the clinician that a deep soft
tissue injury is likely much more extensive than is visable to the naked eye - Answer true.
patients with severe electrical injuries require fasciotomies. Electricity can cause forced
contraction of muscles, doctors need to examine patient for skeletal and muscular damage,
especially for fractures of the spine and rhabdomyolysis
A tube placed in the trachea with the cuff inflated below the vocal cords and the tube connected
to oxygen enriched assisted ventilation and airway secured in place. - Answer definitive airway
Abuse and burns - Answer circular burns and burns with clear edges and unique patterns may
reflect cigarette burns or iron. Burns on the sole of the feet usually suggest child was placed in
hot water. A burn on the posterior aspect of the LE and buttocks
Acute respiratory distress, subcutaneous emphysema, absent unilateral breath sounds,
hyperresonance to percussion, and tracheal shift supports the diagnosis of???? - Answer tension
pneumothorax. needle or finger decompression temporarily relieves this life threatening
condition and follow this with a chest tube
Admission to hospital for pregnant patients: - Answer vaginal bleeding, uterine irritability,
abdominal tenderness, pain or cramping, evidence of hypovolemia, changes in or absence of fetal
heart tones and or leakage of amniotic fluid
,After the 10th week of pregnancy, cardiac output can increase 1.0-1.5 L/min because of the
increase in plasma volume and decrease in vascular resistance of the uterus and placenta. -
Answer The placenta receives 20% of the patient's cardiac output during the 3rd trimester. In
supine position, vena cava compression can decrease cardiac output by 30% because of
decreased venous return from lower extremities.
Age related changes in the cardiovascular system place the elderly trauma patient at significant
risk for being inaccurately categorized as hemodynamically stable. - Answer 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.
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? - Answer bag mask ventilation, as it
improves mask fitting.
Always assume CO exposure in patients who were burned in enclosed areas. Patients with CO
levels less than 20% may not show any symptoms - Answer HA and nausea (20-30%),
confusion (30-40%), coma (40-60%) and death (>60%). Cherry red skin color in patients may
only be seen in moribund patients.
Measurements of arterial PaO2 do not reliably predict CO poisoning b/c a partial pressure of
only 1 mm Hg results in an HbCO level of 40% or greater. Pulse ox cannot be relied on to rule
out carbon monoxide poisoning b/c we cant distinguish oxyhemoglobin from
carboxyhemoglobin. A discrepancy between pulse ox and arterial blood gas may be explained by
presence of carboxyhemoglobin.
American Burn Association states 2 requirements for diagnosis of smoke inhalation injury: -
Answer 1. exposure to combustible agent
2. signs of exposure to smoke in the lower airway, below the vocal cords, seen on bronchoscopy.
A chest Xray and arterial blood gases should be ordered to evaluate the pulmonary status of a
patient with smoke inhalation injury, but normal values on admission DO NOT exclude an
inhalation injury.
Amniotic fluid can cause amniotic fluid embolism and disseminated intravascular coagulation
following trauma if fluid enters maternal intravascular space. True or False - Answer True
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. -
Answer this is true
An injured patient who is cool to the touch and is tachycardic should be considered to be in
shock until proven otherwise. Massive blood loss may only produce a slight decrease in
HCT/Hgb. - Answer relying solely on BP as an indicator of shock can delay recognition of the
, condition b/c compensatory mechanisms can prevent measurable fall in systolic pressure until up
to 30% of the patient's blood volume is loss. A narrowed pulse pressure suggests significant
blood loss and involvement in compensatory mechanisms.
tachycardia is diagnosed as > 100 in adults
> 160 in infants
>140 in preschool aged children
>120 in children from school age to puberty.
Anatomical alterations in the thoracic cavity seem to account for the decreased residual volume
associated with diphragmatic elevation and chest x ray reveals increased lung marking and
prominence of the pulmonary vessels. - Answer oxygen consumption increases during
pregnancy and its important when resuscitating injured pregnant patients to maintain adequate
oxygenation above 95%
Anterior Cord Syndrome - Answer injury to the motor and sensory pathways in the anterior part
of cord. paraplegia and bilateral loss of pain and temp. However, position, vibration, and deep
pressure sense are preserved (sensations from dorsal columns). commonly due to cord ischemia
Any early normal serum amylase level or an elevated amylase level does not conclude pancreas
injury - Answer
As little as 0.01mL of RH+ blood will sensitize 70% of Rh- women. - Answer All pregnany RH
negative trauma patients should receive RH immunoglobulin therapy unless injury is remote
from the uterus (isolated distal extremity injury)
Atlanto Occipital Dislocation - Answer this is commonly seen in shaken baby syndrome due to
severe traumatic flexion and distraction. Most patients with this injury die of brainstem
destruction and apnea or have profound neurological impairments.
Blanched skin associated with fractures and dislocations can lead to soft tissue necrosis. The
purpose of promptly reducing this injury is to prevent pressure necrosis of the lateral left ankle
soft tissue - Answer the only reason to forgo an xray exam before treating a dislocation or
fracture is the presence of vascular compromise or impending skin breakdown, often seen with
fracture dislocations of the ankle
Bleeding in 3rd trimester may indicate placental abruption and impending death of the fetus, a
vaginal exam is vital - Answer however, avoid repeating vaginal examination, CT abdominal
imaging can be done and radiation doses less than 50mGy are not associated with fetal anomalies
or higher risk of fetal loss.
Blood pressure falls 5-15 mm Hg in systolic and diastolic pressures during second trimester,
although it returns to near normal levels at term. - Answer some women experience hypotension
when placed in the supine position due to the compression of teh inferior vena cava.
