Chapter Review Questions
for the
ATLS
Student Course Manual
Dr. Ken Evans, MD
, atls.yolasite.com
Chapter 1 Initial Assessment and Management
A cast-cutter should be used to remove a trauma victim's helmet if there is evidence
of a C-spine injury or if .
the patient experiences pain or paresthesias during an initial attempt to remove the
helmet.
The "A" in ABCDE stands for .
Airway; however, always be cautious about and protect the cervical spine.
Any patient who is cool and tachycardic is considered to be until proven
otherwise.
in shock
The definition of tachycardia depends on the patient's age. What heart rate is
considered tachycardic for infants, toddlers/preschoolers, school age/prebuscent,
and adults?
Infants > 160,
toddlers/preschoolers > 140,
school age/prepubescent > 120, and
adults > 100
Compensatory mechanisms may preclude a measurable fall in systolic
blood pressure until up to % of the patient's blood volume is lost.
30%
What is the trauma triad of death?
The trauma triad of death is the combination of hypothermia, coagulopathy, and
acidosis. Severe hemorrhage in trauma diminishes oxygen delivery, and may lead
to hypothermia. Hypothermia, in turn, can halt the coagulation cascade, which
exacerbates the hemorrhage. Since tissues are hypoperfused, anaerobic metabolism
increases, causing the release of lactic acid and other acidic compounds. Such an
increase in acidity can reduce myocardial performance, further exacerbating tissue
hypoperfusion. And so, the viscious cycle continues, ultimately ending in death ...
unless someone trained in ATLS intervenes.
A patient may be abusive and belligerent because of , so don't just assume it's
due to drugs, alcohol, or that he is a jerk.
hypoxia
1
, atls.yolasite.com
Describe the Glasgow Coma Scale (GCS).
A patient opens her eyes only to painful stimuli, utters inappropriate words, and
localizes pain. What is her GCS score?
E=2
V=3
M=5
Therefore, GCS = 2+3+5 = 10
Patients with a GSC of less than usually require intubation.
9
2
, atls.yolasite.com
What information is in an “AMPLE” patient history?
A = Allergies
M = Medications
P=
PMH/Pregnancy L
= Last meal
E = Events/Environment of injury
When is this done?
During the secondary survey.
You should assume that any patient with multisystem trauma and altered level of
consciousness, or blunt injury above the clavicle, has what type of injury?
Cervical spine injury.
How can you clear the C-spine without imaging?
The C-spine can be cleared clinically if the patient:
is awake, alert, and sober;
has no distracting injuries;
has no neurological deficits referable to the cervical spine;
has no midline neck pain or tenderness on palpation; and
can flex, extend, and laterally rotate his head to both sides without pain.
Otherwise, when would C-spine films be obtained?
During the secondary survey.
When should most images be obtained?
During the secondary survey. There are a small number of exceptions (see next
question).
What imaging is done during the primary survey?
CXR and pelvis films (both AP views), and FAST scan.
What should you do for every female patient of childbearing age?
Pregnancy test.
3
for the
ATLS
Student Course Manual
Dr. Ken Evans, MD
, atls.yolasite.com
Chapter 1 Initial Assessment and Management
A cast-cutter should be used to remove a trauma victim's helmet if there is evidence
of a C-spine injury or if .
the patient experiences pain or paresthesias during an initial attempt to remove the
helmet.
The "A" in ABCDE stands for .
Airway; however, always be cautious about and protect the cervical spine.
Any patient who is cool and tachycardic is considered to be until proven
otherwise.
in shock
The definition of tachycardia depends on the patient's age. What heart rate is
considered tachycardic for infants, toddlers/preschoolers, school age/prebuscent,
and adults?
Infants > 160,
toddlers/preschoolers > 140,
school age/prepubescent > 120, and
adults > 100
Compensatory mechanisms may preclude a measurable fall in systolic
blood pressure until up to % of the patient's blood volume is lost.
30%
What is the trauma triad of death?
The trauma triad of death is the combination of hypothermia, coagulopathy, and
acidosis. Severe hemorrhage in trauma diminishes oxygen delivery, and may lead
to hypothermia. Hypothermia, in turn, can halt the coagulation cascade, which
exacerbates the hemorrhage. Since tissues are hypoperfused, anaerobic metabolism
increases, causing the release of lactic acid and other acidic compounds. Such an
increase in acidity can reduce myocardial performance, further exacerbating tissue
hypoperfusion. And so, the viscious cycle continues, ultimately ending in death ...
unless someone trained in ATLS intervenes.
A patient may be abusive and belligerent because of , so don't just assume it's
due to drugs, alcohol, or that he is a jerk.
hypoxia
1
, atls.yolasite.com
Describe the Glasgow Coma Scale (GCS).
A patient opens her eyes only to painful stimuli, utters inappropriate words, and
localizes pain. What is her GCS score?
E=2
V=3
M=5
Therefore, GCS = 2+3+5 = 10
Patients with a GSC of less than usually require intubation.
9
2
, atls.yolasite.com
What information is in an “AMPLE” patient history?
A = Allergies
M = Medications
P=
PMH/Pregnancy L
= Last meal
E = Events/Environment of injury
When is this done?
During the secondary survey.
You should assume that any patient with multisystem trauma and altered level of
consciousness, or blunt injury above the clavicle, has what type of injury?
Cervical spine injury.
How can you clear the C-spine without imaging?
The C-spine can be cleared clinically if the patient:
is awake, alert, and sober;
has no distracting injuries;
has no neurological deficits referable to the cervical spine;
has no midline neck pain or tenderness on palpation; and
can flex, extend, and laterally rotate his head to both sides without pain.
Otherwise, when would C-spine films be obtained?
During the secondary survey.
When should most images be obtained?
During the secondary survey. There are a small number of exceptions (see next
question).
What imaging is done during the primary survey?
CXR and pelvis films (both AP views), and FAST scan.
What should you do for every female patient of childbearing age?
Pregnancy test.
3
