ATLS test exam Study Guide with Complete Solutions When something crashes in secondary survey, you... - Answer-GO BACK TO PRIAMRY SURVEY If the question says you do not have capabilities, you will most likely - Answer-PREPARE FOR AND DO NOT DELAY TRANSPOR

ATLSPOST TEST 4 LATEST VERSIONS REAL EXAM 260 QUESTIONS AND CORRECT ANSWERS |AGRADE re-examine the chest - Answer-A 22-year-old man is hypotensive and tachycardic after a shotgun wound to the left shoulder. His BP is initially 80/40 mm Hg. After 2 liters of crystalloid solution his BP increases to 122/84. His heart rate is now 100 BPM and his RR is 28 breaths per minute. His breath sounds are decreased in the left hemithorax, and after initial IV fluid resuscitation, a closed tube thoracostomy is performed for decreased left breath sounds with the return of a small amount of blood and no air leak. After chest tube insertion, the most appropriate next step is __________. complete spine x-rays - Answer-A construction worker falls two stories from a building and sustains bilateral calcaneal fractures. In the emergency department, he is alert, vital signs are normal, and he is complaining of severe pain in both heels and HIS LOWER BACK. Lower extremity pulses are strong and there is no other deformity. The suspected diagnosis is most likely to be confirmed by _________. secure the airway - Answer-In managing the head-injured patient, the most important initial step is to ________. GRACEAMELIA 2024/2025 ACADEMIC YEAR ©2024. ALL RIGHTS RESERVED. FIRST PUBLISH OCTOBER, 2024 Page 2/34 his systolic pressure will be decreased with a narrowed pulse pressure - Answer-A previously healthy, 70 kg man suffers an estimated acute blood loss of 2 liters. How will this affect his blood pressure? increasing the volume of blood loss to produce maternal hypotension - Answer-The physiologic hypervolemia of pregnancy has clinical significance in the management of the severely injured, gravid woman by ____________. adequate urinary output - Answer-The best assessment of fluid resuscitation of the adult burn patient is __________. evidence of inadequate organ perfusion - Answer-The diagnosis of shock must include _________. direct pressure on the wound - Answer-A 7-year old boy is brought to the emergency department by his parents several minutes after he fell through a window. He is bleeding profusely from a 6-cm wound of his medial right thigh. Immediate management of the wound should consist of ________ (application of a tourniquet vs. direct pressure on the wound). cerebral vasoconstriction with diminished perfusion - Answer-For the patient with severe TBI, profound hypocarbia should be avoided to prevent __________. GRACEAMELIA 2024/2025 ACADEMIC YEAR ©2024. ALL RIGHTS RESERVED. FIRST PUBLISH OCTOBER, 2024 Page 3/34 exploratory laparotomy - Answer-A 25-year-old man is brought to a hospital after being involved in a MVA. CT shows an aortic injury and splenic laceration with free abdominal fluid. His BP falls to 70 mm Hg after CT. The next step is _______. leakage of amniotic fluid - Answer-Abdominal trauma in a pregnant patient -- _________ is an indication for hospital admission. administer supplemental oxygen - Answer-What is the first maneuver to improve oxygenation after chest injury? 9 (eyes = 2, verbal = 2, motor = 5) - Answer-A 25-year old man, injured in a MVA, is admitted to the emergency department. His pupils react sluggishly and his eyes open to painful stimuli. He does not follow commands, but he does moan periodically. His right arm is deformed and does not respond to painful stimulus; however, his left hand reaches purposefully toward the painful stimulus. Both legs are stiffly extended. His GCS score is ________. RR of 40 BPM - Answer-Which one of the following findings in an adult is most likely to require immediate management during the primary survey: distended abdomen, GCS score of 11, deforming of the right thigh, RR of 40 BPM. placement of an occlusive dressing over the wound - Answer-The most important, immediate step in the management of an open pneumothorax is _________. GRACEAMELIA 2024/2025 ACADEMIC YEAR ©2024. ALL RIGHTS RESERVED. FIRST PUBLISH OCTOBER, 2024 Page 4/34 history of neurological reaction or severe hypersensitivity to the product - Answer-The following are contraindications for tetanus toxoid administration: history of neurological reaction or severe hypersensitivity to the product, local side effects, muscular spasms, pregnancy, or all of the above. breath sounds - Answer-A 56-year-old man is thrown violently against the steering wheel of his truck during a motor vehicle crash. On arrival in the emergency department, he is diaphoretic and complaining of chest pain. His BP is 60/40 mm Hg and his RR is 40 breaths per minute. Which of the following best differentiates cardiac tamponade from tension pneumothorax as the cause of his hypotension? the trachea is relatively short - Answer-Bronchial intubation of the right or left mainstem bronchus can easily occur during infant ET intubation because _______. urgently transfer the patient to the operating room - Answer-A 23-year-old man sustains 4 stab wounds to the upper right chest during an altercation and is brought by ambulance to a hospital that has full surgical capabilities. His wounds are all above the nipple. He is endotracheally intubated, closed tube thoracostomy is performed, and 2 liters of crystalloid solution are infused through 2 large-caliber IVs. His blood pressure is now 60/0 mm Hg. Heart rate is 160 bpm, and RR is 14 breaths per minute (ventilated with 100% O2). 1500 cc of blood has drained from the right chest. The most appropriate next step in managing this patient is to ______. GRACEAMELIA 2024/2025 ACADEMIC YEAR ©2024. ALL RIGHTS RESERVED. FIRST PUBLISH OCTOBER, 2024 Page 5/34 attempt orotracheal intubation using 2 people and inline stabilization of the cervical spine - Answer-A 39-year-old man is admitted to the emergency department after an automobile collision. He is cyanotic, has insufficient respiratory effort, and has a GCS Score of 6. His full beard makes it difficult to fit the oxygen facemask to his face. The most appropriate next step is to _______. flaccidity of the lower extremities and loss of deep tendon reflexes are expected - Answer-A patient is brought to the emergency department after a motor vehicle crash. He is conscious and there is no obvious external trauma. He arrives at the hospital completely immobilized on a long spine board. His BP is 60/40 mm Hg and his heart rate is 70 beats per minute. His skin is warm. Which one of the following statements is TRUE? moist heat - Answer-What is the most effective method for initially treating frostbite? suction the oropharynx - Answer-A patient arrives in the emergency department after being beaten about the head and face with a wooden club. He is comatose and has a palpable depressed skull fracture. His face is swollen and ecchymotic. He has gurgling respirations and vomitus on his face and clothing. The most appropriate step after providing supplemental oxygen and elevating his jaw is to _______. repeat the primary survey and proceed with the transfer - Answer-A 22-year-old man sustains a gunshot wound to the left chest and is transported to a small community hospital at which surgical capabilities are not available. In the emergency dept, a chest tube is inserted and GRACEAMELIA 2024/2025 ACADEMIC YEAR ©2024. ALL RIGHTS RESERVED. FIRST PUBLISH OCTOBER, 2024 Page 6/34 700 mL of blood is evacuated. The trauma center accepts the patient in transfer. Just before the patient is placed in the ambulance for transfer, his BP decreases to 80/68 and his HR increases to 136 beats per minute. The next step should be to ______. call the receiving hospital and speak to the surgeon on call - Answer-A 64-year-old man involved in a high-speed car crash is resuscitated initially in a small hospital without surgical capabilities. He has a closed head injury with a GCS score of 13. He has a widened mediastinum on CXR with fractures of left ribs 2-4, but no pneumothorax. After infusing 2 liters of crystalloid solution, bis BP is 110/74, his heart rate is 100 bpm, and his RR is 18 breaths per minute. He has gross hematuria and a pelvic fracture. You decided to transfer this patient to a facility capable of providing a higher level of care. The facility is 80 miles away. Before transfer, you should first _______. tachycardia - Answer-Hemorrhage of 20% of the patient's blood volume is usually a/w _______. aspiration of bone marrow confirms appropriate positioning of the needle - Answer-Which one of the following statements concerning intraosseous infusion is TRUE? avoid hypotension - Answer-A young woman sustains a severe head injury as the result of a motor vehicle crash. In the emergency department, her GCS is 6. Her blood pressure is 140/90 and her heart rate is 80 beats per minute. She is intubated and mechanically ventilated. Her GRACEAMELIA 2024/2025 ACADEMIC YEAR ©2024. ALL RIGHTS RESERVED. FIRST PUBLISH OCTOBER, 2024 Page 7/34 pupils are 3 mm in size and equally reactive to light. There is no other apparent injury. The most important principle to follow in the early management of her head injury is to ________. maintaining a SBP around 90 mm Hg during the early stages of treatment, prior to surgical control (crystalloid use is limited or nonexistent as blood products are transfused in fixed ratios - - this strategy should NOT be used in patients with CNS injury, in which hypotension is a/w adverse outcomes) - Answer-What is permissive hypotension? cardiac tamponade - Answer-A 33-year-old woman is involved in a head-on motor vehicle crash. It took 30 minutes to extricate her from the car. Upon arrival in the emergency department, her heart rate is 120 bpm BP is 90/70, RR is 16 breaths per minute, and her GCS score is 15. Examination reveals bilaterally equal breath sounds, ANTERIOR CHEST WALL ECCHYMOSIS, and DISTENDED NECK VEINS. Her abdomen is flat, soft, and non-tender. Her pelvis is stable. Palpable distal pulses are found in all 4 extremities. Of the following, the most likely diagnosis is: free intraperitoneal air demonstrated on follow-up CT - Answer-A hemodynamically normal 10-year-old girl is admitted to the PICU for observation after a Grade III (moderately severe) splenic injury has been confirmed by CT. Which of the followi