ADVANCED TRAUMA LIFE SUPPORT
EXAM AND PRACTICE EXAM NEWEST
2024 ACTUAL EXAM 400 QUESTIONS AND
CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) |ALREADY
GRADED A+
How should you position the patient before placing a
subclavian or IJ line? - ....ANSWER....Supine, head down
15 degrees to distend neck neck veins and prevent
embolism, only turn head away is C-spine has been cleared
first.
How long can you keep and IO line in -
....ANSWER....Intraosseous infusions should be limited to
emergency resuscitation and should be discontinued as soon
as other venous access is obtained
Where do you want to make an incision for a saphenous
vein cutdown and how long should your incisions be? -
....ANSWER....1 cm superior, 1 cm anterior to medial
malleolus. 2.5 cm transverse incusion through the skin and
SQ, careful to not to inure the vessel.
A patient arrives to the trauma bay intubated and there are
absent breath sounds over the left hemithorax, where should
you place your decompression needle? - ....ANSWER....This
,may NOT be a pneumothorax, for intubated patients always
suspect a right main-stem before attempting needle
decompression.
Where would you insert a large caliber needle to
decompress a tension pneumo - ....ANSWER....2nd IC space
in the midclavicular line of affected hemithorax
For an open pneumothorax, (sucking chest wound) air
passes preferentially through the chest wall defect (least
resistance) if the diameter of the defect is at least ___ the
diameter of the trachea. - ....ANSWER....2/3
Flail chest results from multiple rib fractures - by definition
this would be ___ or more ribs, fractured in ___ or more
places. - ....ANSWER....2 or more ribs fractured in 2 or
more places
Both tension pneumothorax and massive hemothorax are
associated with decreased breath sounds on auscultation, so
you can tell which it is by _______. -
....ANSWER....Percussion - hyperresonant with pnuemo,
dull with hemothorax.
If a patient doesn't have JVD, does this mean they don't have
a tension pneumo or tamponade? - ....ANSWER....No, they
might have a massive internal hemorrhage and be
hypovolemic.
By definition, how much blood is in the chest cavity to call
it a "massive hemothorax"? - ....ANSWER....1500 mL or 1/3
or more of the patient's total blood volume. (Some also
,define it as continued blood loss of 200 mL/hr for 2-4 hours-
but ATLS does NOT use this rate for any mandatory
treatment decisions).
What size chest tube might you use to evacuate a massive
hemothorax? - ....ANSWER....#38 French - inserted at the
4th or 5th intercostal space, just anterior to the midaxillary
line.
What is Kussmaul's sign? - ....ANSWER....A rise in venous
pressure with inspiration while breathing spontaneously, and
is a true paradoxical venous pressure abnormality associated
with cardiac tamponade.
How well do CPR compressions work on someone with a
penetrating chest injury and hypovolemia? -
....ANSWER...."Closed heart massage for cardiac arrest or
PEA is INEFFECTIVE in patients with hypovolemia."
Patients with PENETRATING thoracic injuries who arrive
pulseless, but with myocardial electrial activity, may be
candidates for an ED thoacotomy.
Are patients with PEA who have sustained blunt thoracic
injuries candidates for an ED thoracotomy? -
....ANSWER....NO - Only PEA with PENETRATING
thoracic injuries should get an ED thoracotomy.
An ED thoracotomy can allow you to do what? -
....ANSWER....Evacuate pericardial blood, directly control
hemorrhage, cardiac massage, cross-clamp the descending
aorta to slow blood loss below the diaphragm and increase
perfusion to the heart and brain.
, For a patient with a traumatic simple pneumothorax, what
should you do BEFORE you start positive pressure
ventilation or take them to surgery for a GA? -
....ANSWER....Chest tube - positive pressure ventilation can
turn a sumple pneumo into a tension pneumo, so put in a
chest tube first.
Should you evacuate a simple hemothorax if it is not causing
any respiratory problems? - ....ANSWER....YES - A simple
hemothorax, if not fully evacuated, may result in a retained,
clotted hemothroax with lung entrapment or, if infected,
develop into an empyema.
A pneumothorax associated with a persistent large air leak
after tube thoracostomy suggests a _______ injury. -
....ANSWER....tracheobronchial - Use bronchoscopy to
confirm, you may need more than one chest tube before
definitive operative management.
What radiographic findings are suggestive of traumatic
aortic disruption? - ....ANSWER....Widened mediastinum,
obliteration of aortic knob, deviation of trachea to the right,
depression of left mainstem bronchus, deviation of
esophagus (NG tube) to right, widened paratracheal stripe,
fx'd 1st/2nd ribs or scapula.
A deceleration injury victim with a left pnuemothorax or
hemothorax without rib fractures, is in pain or shock out of
proportion to the apparent injury, and has particulate matter
in their chest tube may have _________. - ....ANSWER....an
ESOPHAGEAL RUPTURE - a forceful blow causes
EXAM AND PRACTICE EXAM NEWEST
2024 ACTUAL EXAM 400 QUESTIONS AND
CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) |ALREADY
GRADED A+
How should you position the patient before placing a
subclavian or IJ line? - ....ANSWER....Supine, head down
15 degrees to distend neck neck veins and prevent
embolism, only turn head away is C-spine has been cleared
first.
How long can you keep and IO line in -
....ANSWER....Intraosseous infusions should be limited to
emergency resuscitation and should be discontinued as soon
as other venous access is obtained
Where do you want to make an incision for a saphenous
vein cutdown and how long should your incisions be? -
....ANSWER....1 cm superior, 1 cm anterior to medial
malleolus. 2.5 cm transverse incusion through the skin and
SQ, careful to not to inure the vessel.
A patient arrives to the trauma bay intubated and there are
absent breath sounds over the left hemithorax, where should
you place your decompression needle? - ....ANSWER....This
,may NOT be a pneumothorax, for intubated patients always
suspect a right main-stem before attempting needle
decompression.
Where would you insert a large caliber needle to
decompress a tension pneumo - ....ANSWER....2nd IC space
in the midclavicular line of affected hemithorax
For an open pneumothorax, (sucking chest wound) air
passes preferentially through the chest wall defect (least
resistance) if the diameter of the defect is at least ___ the
diameter of the trachea. - ....ANSWER....2/3
Flail chest results from multiple rib fractures - by definition
this would be ___ or more ribs, fractured in ___ or more
places. - ....ANSWER....2 or more ribs fractured in 2 or
more places
Both tension pneumothorax and massive hemothorax are
associated with decreased breath sounds on auscultation, so
you can tell which it is by _______. -
....ANSWER....Percussion - hyperresonant with pnuemo,
dull with hemothorax.
If a patient doesn't have JVD, does this mean they don't have
a tension pneumo or tamponade? - ....ANSWER....No, they
might have a massive internal hemorrhage and be
hypovolemic.
By definition, how much blood is in the chest cavity to call
it a "massive hemothorax"? - ....ANSWER....1500 mL or 1/3
or more of the patient's total blood volume. (Some also
,define it as continued blood loss of 200 mL/hr for 2-4 hours-
but ATLS does NOT use this rate for any mandatory
treatment decisions).
What size chest tube might you use to evacuate a massive
hemothorax? - ....ANSWER....#38 French - inserted at the
4th or 5th intercostal space, just anterior to the midaxillary
line.
What is Kussmaul's sign? - ....ANSWER....A rise in venous
pressure with inspiration while breathing spontaneously, and
is a true paradoxical venous pressure abnormality associated
with cardiac tamponade.
How well do CPR compressions work on someone with a
penetrating chest injury and hypovolemia? -
....ANSWER...."Closed heart massage for cardiac arrest or
PEA is INEFFECTIVE in patients with hypovolemia."
Patients with PENETRATING thoracic injuries who arrive
pulseless, but with myocardial electrial activity, may be
candidates for an ED thoacotomy.
Are patients with PEA who have sustained blunt thoracic
injuries candidates for an ED thoracotomy? -
....ANSWER....NO - Only PEA with PENETRATING
thoracic injuries should get an ED thoracotomy.
An ED thoracotomy can allow you to do what? -
....ANSWER....Evacuate pericardial blood, directly control
hemorrhage, cardiac massage, cross-clamp the descending
aorta to slow blood loss below the diaphragm and increase
perfusion to the heart and brain.
, For a patient with a traumatic simple pneumothorax, what
should you do BEFORE you start positive pressure
ventilation or take them to surgery for a GA? -
....ANSWER....Chest tube - positive pressure ventilation can
turn a sumple pneumo into a tension pneumo, so put in a
chest tube first.
Should you evacuate a simple hemothorax if it is not causing
any respiratory problems? - ....ANSWER....YES - A simple
hemothorax, if not fully evacuated, may result in a retained,
clotted hemothroax with lung entrapment or, if infected,
develop into an empyema.
A pneumothorax associated with a persistent large air leak
after tube thoracostomy suggests a _______ injury. -
....ANSWER....tracheobronchial - Use bronchoscopy to
confirm, you may need more than one chest tube before
definitive operative management.
What radiographic findings are suggestive of traumatic
aortic disruption? - ....ANSWER....Widened mediastinum,
obliteration of aortic knob, deviation of trachea to the right,
depression of left mainstem bronchus, deviation of
esophagus (NG tube) to right, widened paratracheal stripe,
fx'd 1st/2nd ribs or scapula.
A deceleration injury victim with a left pnuemothorax or
hemothorax without rib fractures, is in pain or shock out of
proportion to the apparent injury, and has particulate matter
in their chest tube may have _________. - ....ANSWER....an
ESOPHAGEAL RUPTURE - a forceful blow causes
