ATLS Post Test Questions with Correct Answers Latest
Updated 2024 (Advanced trauma life support)
Complete absence of breathing sounds
___________ sounds are associated with partial obstruction of the pharynx or larynx. __________ implies
functional laryngeal obstruction.
Snoring, gurgling, crowding sounds (stridor)
Hoarseness
Decreased or absent breath sounds over one or both hemithoraces should alert the examiner to the presence
of ______________________
Pneumothorax, hemothorax, contusion or flail chest
We have an expert-written solution to this problem!
Direct chest trauma causes what kind of signs of ventilation problems?
Painful breathing
Rapid, shallow breathing
Hypoxemia
Intracranial injury causes what kind of signs of ventilation problems?
Abnormal breathing patterns and compromised ventilation
C-spine injuries causes what kind of signs of ventilation problems?
More proximal = worse the respiratory impairment
Before C3 = diaphragm impaired
After C3 = "diaphragmatic breathing:" since intercostal muscles and abdominal muscle contribution is lost but
diaphragm is intact so get belly out on inspo and belly in on expo
What are the two best parameters to quickly assess airway patency and adequacy of ventilation?
1. Pulse oximetry
2. ETCO2 (also shows CO)
3 factors that indicate potentially difficult airways?
1. C-spine injury
2. Severe cervical arthritis
3. Significant maxillofacial or mandibular trauma
LEMON Assessment for Difficult Intubation
L: Look externally: is there a small mouth or jaw, large overbite, facial trauma?
E: Evaluate 3-3-2 rule
M: Mallampati classification
O: Obstruction in the airway anywhere?
Neck mobility (many trauma pts will require c-spine restriction)
1/4
,What is 3-3-2 Rule for intubation?
-Distance b/w incisor teeth should be 3 fingers
-Distance b/w hyoid bone and chin should be 3 fingers
-Distance b/w thyroid notch and floor of mouth should be 2 fingers
What are the Mallampati Classifications?
I: soft palate, uvula, fauces and pillars entirely visible
II: partially visible
III: base of uvula visible only
IV: not visible, only hard palate visible
How is chin-lift maneuver performed?
Place fingers under the mandible and then gently lift upward to bring the chin anterior
-Use thumbs to lightly depress the lower lip and open the mouth
How is jaw thrust performed?
Grab the angles of the mandible and displace the mandible forward
How should Oropharyngeal airway be inserted?
Insert OPA upside down until it touches the soft palate, then rotate it 180 degrees and slip it into place over the
tongue
**For adults only (children use tongue depressor and go the right way in)
What are the ABCD criteria for establishing a definitive airway?
A- inability to maintain a patent airway by other means
B- inability to Breathe (maintain adequate oxygenation, or presence of apnea)
C- cerebral hypoperfusion causing obtundation or combativeness
D- Disabled: obtundation indicating the presence of a head injury, GCS <8, sustained seizure activity, need to
protect airway from aspiration of blood or vomit
What are relative contraindications to nasotracheal intubation?
-Facial, frontal sinus, basilar skull and cribiform plate fractures
Orotracheal intubation is a ________person (#) technique with restriction of ___________
3 person; restriction of cervical movement
___________ during intubation can reduce the risk of aspiration, although it might also reduce the view of the
larynx.
Cricoid pressure
What is BURP maneuver for intubation?
Backward, Upward, and Rightward Pressure on thyroid cartilage to help visualize the vocal cords
What can be used when personnel have a difficult airway?
Gum elastic bougie-- using laryngoscope, slide the bougie blindly past the epiglottis with the tip angled
anteriorly
-Feel the clicks/notches of the trachea cartilage as it passes through
-Pass the ETT on top of it
What are induction and paralytic doses for RSI?
-Etomidate 0.3-0.4mg/kg
-Ketamine 1.5-2mg/kg
-Propofol 1.5mg/kg
2/4
,-Succinylcholine 1-2mg/kg
-Rocuronium 0.6-1.2mg/kg
What is onset and duration of succinylcholine?
Onset <1minute
DOA: 5 mins or less
Multiple casualties versus Mass casualties?
Multiple casualties: number of pts and the severity of their injuries DO NOT exceed the capability of the facility
to render care
-Priority given to life-threatening injuries or those with multiple systems injured
Mass casualties: number of pts and severity DOES overwhelm the facility
-Priority given to those with greatest chance of survival, least expenditure of time and equipment, supplies and
personnel
What is easiest way to quickly perform ABCD assessment?
Ask patient to identify themselves, their name and ask them what happened
Previous
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Next
Rewind 10 seconds
Move forward 10 seconds
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0:00
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0:15
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What are main indications for a definitive airway?
-GCS <8
-Finding of non purposeful motor responses
-Inability to protect airway
Once tension PTX has been excluded as a cause of shock, consider that hypotension following injury is due to
____________until proven otherwise
blood loss!
What are the 3 elements from clinical observation that show patient's hemodynamic status?
1. Level of consciousness
2. Skin perfusion
3. Pulse
-Rapid and thready = hypovolemia
When should tourniquets be used for bleeding?
ONLY for massive exsanguination when patient's life is threatened
What are the main areas of massive hemorrhage?
-Chest
-Abdomen
-Pelvis
-External bleeding
-Long bones
All IV solutions should be warmed to _____
37-40C (98.6-104F)
When/how should TXA be used for severely injured patients?
3/4
, -Should be given within 3 hours of injury
-Should be given follow up infusion over 8 hours in the hospital when it is given in the field
The _______ score of the GCS correlates with outcome.
Motor
What are the physiologic parameters that show adequacy of resuscitation?
-Pulse rate
-BP
-Pulse Pressure
-Ventilatory rate
-ABG levels
-Body temp
-Urinary output
What are adjuncts to primary survey?
-Continuous ECG
-Pulse ox
-CO2 monitoring
-Ventilatory rate assessment
-ABG
-urinary catheters to monitor UO
-Gastric catheters to reduce distention and detect possible blood
-Blood lactate
-XRs
-eFAST, DPL
PEA can indicate ___________what 3 things?
-Cardiac tamponade
-Tension PTX
-Profound hypovolemia
Suspect a urethral injury in the presence of _________ or _________
blood at urethral meatus or perineal ecchymosis
Indications for gastric tube in trauma?
-Decompress stomach distention
-Decrease risk of aspiration
-Check for upper GI hemorrhage from trauma
What are the trauma special populations?
-Pregnant women
-Children
-Elderly
-Athletes
-Obese
What is included in the secondary survey?
-Complete head to toe physical exam
-Complete history
-Reassessment of vital signs
AMPLE history mnemonic?
Allergies?
Medications?
PMH?
Last meal?
Events leading up to trauma?
Electrical burns typically cause what injury patterns?
4/4
Updated 2024 (Advanced trauma life support)
Complete absence of breathing sounds
___________ sounds are associated with partial obstruction of the pharynx or larynx. __________ implies
functional laryngeal obstruction.
Snoring, gurgling, crowding sounds (stridor)
Hoarseness
Decreased or absent breath sounds over one or both hemithoraces should alert the examiner to the presence
of ______________________
Pneumothorax, hemothorax, contusion or flail chest
We have an expert-written solution to this problem!
Direct chest trauma causes what kind of signs of ventilation problems?
Painful breathing
Rapid, shallow breathing
Hypoxemia
Intracranial injury causes what kind of signs of ventilation problems?
Abnormal breathing patterns and compromised ventilation
C-spine injuries causes what kind of signs of ventilation problems?
More proximal = worse the respiratory impairment
Before C3 = diaphragm impaired
After C3 = "diaphragmatic breathing:" since intercostal muscles and abdominal muscle contribution is lost but
diaphragm is intact so get belly out on inspo and belly in on expo
What are the two best parameters to quickly assess airway patency and adequacy of ventilation?
1. Pulse oximetry
2. ETCO2 (also shows CO)
3 factors that indicate potentially difficult airways?
1. C-spine injury
2. Severe cervical arthritis
3. Significant maxillofacial or mandibular trauma
LEMON Assessment for Difficult Intubation
L: Look externally: is there a small mouth or jaw, large overbite, facial trauma?
E: Evaluate 3-3-2 rule
M: Mallampati classification
O: Obstruction in the airway anywhere?
Neck mobility (many trauma pts will require c-spine restriction)
1/4
,What is 3-3-2 Rule for intubation?
-Distance b/w incisor teeth should be 3 fingers
-Distance b/w hyoid bone and chin should be 3 fingers
-Distance b/w thyroid notch and floor of mouth should be 2 fingers
What are the Mallampati Classifications?
I: soft palate, uvula, fauces and pillars entirely visible
II: partially visible
III: base of uvula visible only
IV: not visible, only hard palate visible
How is chin-lift maneuver performed?
Place fingers under the mandible and then gently lift upward to bring the chin anterior
-Use thumbs to lightly depress the lower lip and open the mouth
How is jaw thrust performed?
Grab the angles of the mandible and displace the mandible forward
How should Oropharyngeal airway be inserted?
Insert OPA upside down until it touches the soft palate, then rotate it 180 degrees and slip it into place over the
tongue
**For adults only (children use tongue depressor and go the right way in)
What are the ABCD criteria for establishing a definitive airway?
A- inability to maintain a patent airway by other means
B- inability to Breathe (maintain adequate oxygenation, or presence of apnea)
C- cerebral hypoperfusion causing obtundation or combativeness
D- Disabled: obtundation indicating the presence of a head injury, GCS <8, sustained seizure activity, need to
protect airway from aspiration of blood or vomit
What are relative contraindications to nasotracheal intubation?
-Facial, frontal sinus, basilar skull and cribiform plate fractures
Orotracheal intubation is a ________person (#) technique with restriction of ___________
3 person; restriction of cervical movement
___________ during intubation can reduce the risk of aspiration, although it might also reduce the view of the
larynx.
Cricoid pressure
What is BURP maneuver for intubation?
Backward, Upward, and Rightward Pressure on thyroid cartilage to help visualize the vocal cords
What can be used when personnel have a difficult airway?
Gum elastic bougie-- using laryngoscope, slide the bougie blindly past the epiglottis with the tip angled
anteriorly
-Feel the clicks/notches of the trachea cartilage as it passes through
-Pass the ETT on top of it
What are induction and paralytic doses for RSI?
-Etomidate 0.3-0.4mg/kg
-Ketamine 1.5-2mg/kg
-Propofol 1.5mg/kg
2/4
,-Succinylcholine 1-2mg/kg
-Rocuronium 0.6-1.2mg/kg
What is onset and duration of succinylcholine?
Onset <1minute
DOA: 5 mins or less
Multiple casualties versus Mass casualties?
Multiple casualties: number of pts and the severity of their injuries DO NOT exceed the capability of the facility
to render care
-Priority given to life-threatening injuries or those with multiple systems injured
Mass casualties: number of pts and severity DOES overwhelm the facility
-Priority given to those with greatest chance of survival, least expenditure of time and equipment, supplies and
personnel
What is easiest way to quickly perform ABCD assessment?
Ask patient to identify themselves, their name and ask them what happened
Previous
Play
Next
Rewind 10 seconds
Move forward 10 seconds
Unmute
0:00
/
0:15
Full screen
Brainpower
Read More
What are main indications for a definitive airway?
-GCS <8
-Finding of non purposeful motor responses
-Inability to protect airway
Once tension PTX has been excluded as a cause of shock, consider that hypotension following injury is due to
____________until proven otherwise
blood loss!
What are the 3 elements from clinical observation that show patient's hemodynamic status?
1. Level of consciousness
2. Skin perfusion
3. Pulse
-Rapid and thready = hypovolemia
When should tourniquets be used for bleeding?
ONLY for massive exsanguination when patient's life is threatened
What are the main areas of massive hemorrhage?
-Chest
-Abdomen
-Pelvis
-External bleeding
-Long bones
All IV solutions should be warmed to _____
37-40C (98.6-104F)
When/how should TXA be used for severely injured patients?
3/4
, -Should be given within 3 hours of injury
-Should be given follow up infusion over 8 hours in the hospital when it is given in the field
The _______ score of the GCS correlates with outcome.
Motor
What are the physiologic parameters that show adequacy of resuscitation?
-Pulse rate
-BP
-Pulse Pressure
-Ventilatory rate
-ABG levels
-Body temp
-Urinary output
What are adjuncts to primary survey?
-Continuous ECG
-Pulse ox
-CO2 monitoring
-Ventilatory rate assessment
-ABG
-urinary catheters to monitor UO
-Gastric catheters to reduce distention and detect possible blood
-Blood lactate
-XRs
-eFAST, DPL
PEA can indicate ___________what 3 things?
-Cardiac tamponade
-Tension PTX
-Profound hypovolemia
Suspect a urethral injury in the presence of _________ or _________
blood at urethral meatus or perineal ecchymosis
Indications for gastric tube in trauma?
-Decompress stomach distention
-Decrease risk of aspiration
-Check for upper GI hemorrhage from trauma
What are the trauma special populations?
-Pregnant women
-Children
-Elderly
-Athletes
-Obese
What is included in the secondary survey?
-Complete head to toe physical exam
-Complete history
-Reassessment of vital signs
AMPLE history mnemonic?
Allergies?
Medications?
PMH?
Last meal?
Events leading up to trauma?
Electrical burns typically cause what injury patterns?
4/4
