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ATLS – Advanced Trauma Life Support Review |
Exam Prep 2025/2026 | EXACT Questions with
Answers & Complete Study Notes
True or false? Although the mechanism of injury may be similar to those for the younger
population, data shows increased mortality with similar severity of injury in older adults.
True
In the elderly population, what is decreased physiological reserve?
aging is characterized by impaired adaptive and homeostatic mechanisms that caused an
increased susceptibility to the stress of injury. Insults tolerated by the younger population can
lead to devastating results in elderly patients.
Pre-existing conditions that affect morbidity and mortality include:
cirrhosis, coagulopathy, COPD, ischemic heart disease, DM
What is the most common mechanism of injury in the elderly?
Fall. Nonfatal falls are common in women and fractures are common in women who fall. Falls
are the most common cause of TBI.
In the elderly population, what are risk factors for falls?
advanced age, physical impairment, history of previous fall, medication use, dementia, unsteady
gait, and visual, cognitive impairment
Most of elderly traffic fatalities occur in the daytime and on weekends and typically involve
other vehicles. Why?
Older people drive on more familiar roads and at lower speeds and tend to drive during the day.
Older people have slower reaction time, a larger blind spot, limited cervical mobility, decreased
hearing, and cognitive impairment.
,2|Page
True or False? Mortality associated with small to moderate sized burns in older adults
remains high
True
Spilled hot liquids on the leg, which in younger patients may re-epithelialize due to an
adequate number of hair follicles, will result in a full thickness burn in older patients.
this is true
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?
bag mask ventilation, as it improves mask fitting.
When preforming rapid sequence intubation, the dose of benzos, barbiturates, and other
sedatives should be reduced to what percentage to minimize the risk of cardiovascular
depression?
20-40%
Functional changes in cardiac system include declining function, decreased sensitivity to
catecholamines, atherosclerosis of coronary vessels, increased afterload, fixed heart rate
(beta blockers)
this results in lack of classic response to hypovolemia, risk for cardiac ischemia, elevated BP at
baseline, and increased risk of dysrythmias.
Functional changes in pulmonary system include decreased elastic recoil, reduced residual
capacity, decreased gas exchange and decreased cough reflex
thus they are at increased risk for respiratory failure, increased risk for pneumonia, and poor
tolerance to rib fractures
Functional changes in renal system include loss of renal mass, decreased GFR, and
decreased sensitivity to ADH and aldosterone
resulting in drug dosing for renal insufficiency, decreased ability to concentrate urine, increased
risk for AKI and urine flow may be normal with hypovolemia
,3|Page
Functional changes to MSK include loss of lean body mass, osteoporosis, changes in joints
and cartilage, c spine degenerative changes and loss of skin elastin and subcutaneous fat
resulting in increased risk for fractures, decreased mobility, difficulty for oral intubation, risk of
skin injury, increased risk for hypothermia, challenges in rehabiliation
Functional changes in Endocrine system include decreased production and response to
thyroxin and decreased dehydroepiandrosterone (DHEA)
resulting in occult hypothyroidism, relative hypercortisone states and increased risk of infection
True or false: Arthritis can complicate the airway and cervical spine. Patients can have
multilevel degenerative changes affecting disk spaces and posterior elements associated
with severe central canal stenosis, cord compression, and myelomalacia
true
In elderly population, due to their changes in pulmonary system, placing a gauze between
gums and cheek to achieve seal when using bag valve mask ventilation is okay. In addition,
because aging causes a suppressed heart rate response to hypoxia......
respiratory failure may present insidiously in older adults.
Age related changes in the cardiovascular system place the elderly trauma patient at
significant risk for being inaccurately categorized as hemodynamically stable.
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.
Do no equate blood pressure with shock in older patients
BP in older patients may look normal due to the medications they are on. Use lactate and base
deficit to evaluate for evidence of shock
what 2 factors place elderly patients at risk for intracranial hemorrhage?
, 4|Page
aging causes dura to become more adherent to the skull increasing risk of injury and older
patients are on anticoagulant and antiplatelet medications.
Loss of subcutaneous fat, nutritional deficiencies, chronic medical conditions place elderly
patients as risk for hypothermia and complications for immobility.
Rapid evaluation and when possible early liberation from spine boards and cervical collars will
minimize complications.
True or False: Fall prevention is the mainstay of reducing the mortality associated with
pelvic fractures.
true
poor hygiene, dehydration, oral injury, contusions affecting the inner arms, inner thighs,
palms, soles, scalp, ear, nasal bridge and temple injury from being struck while wearing
glasses, contact burns and scalds. These are all signs of.......?
Elder maltreatment. The presence of physical findings of maltreatment should prompt a detailed
history. if history conflicts with findings, immediately report findings to authorities.
True of false: early activation of the trauma team may be required for elderly patients who
do not meet traditional criteria for activation
True. A simple injury such as an open tibia fracture in a frail elderly patient may become life
threatening.
Common mechanisms of injury include falls, MVC, burns, and penetrating injuries
common injuries in the elderly include rib fractures, TBI, pelvic fractures
The best initial treatment for the fetus is to provide optimal resuscitation of the mother.
True or False?
True. Also if xray examination is indicated during the pregnant patient's treatment, it should not
be withheld because of the pregnancy.
What happens as the uterus enlarged and the bowel is pushed cephalad.
ATLS – Advanced Trauma Life Support Review |
Exam Prep 2025/2026 | EXACT Questions with
Answers & Complete Study Notes
True or false? Although the mechanism of injury may be similar to those for the younger
population, data shows increased mortality with similar severity of injury in older adults.
True
In the elderly population, what is decreased physiological reserve?
aging is characterized by impaired adaptive and homeostatic mechanisms that caused an
increased susceptibility to the stress of injury. Insults tolerated by the younger population can
lead to devastating results in elderly patients.
Pre-existing conditions that affect morbidity and mortality include:
cirrhosis, coagulopathy, COPD, ischemic heart disease, DM
What is the most common mechanism of injury in the elderly?
Fall. Nonfatal falls are common in women and fractures are common in women who fall. Falls
are the most common cause of TBI.
In the elderly population, what are risk factors for falls?
advanced age, physical impairment, history of previous fall, medication use, dementia, unsteady
gait, and visual, cognitive impairment
Most of elderly traffic fatalities occur in the daytime and on weekends and typically involve
other vehicles. Why?
Older people drive on more familiar roads and at lower speeds and tend to drive during the day.
Older people have slower reaction time, a larger blind spot, limited cervical mobility, decreased
hearing, and cognitive impairment.
,2|Page
True or False? Mortality associated with small to moderate sized burns in older adults
remains high
True
Spilled hot liquids on the leg, which in younger patients may re-epithelialize due to an
adequate number of hair follicles, will result in a full thickness burn in older patients.
this is true
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?
bag mask ventilation, as it improves mask fitting.
When preforming rapid sequence intubation, the dose of benzos, barbiturates, and other
sedatives should be reduced to what percentage to minimize the risk of cardiovascular
depression?
20-40%
Functional changes in cardiac system include declining function, decreased sensitivity to
catecholamines, atherosclerosis of coronary vessels, increased afterload, fixed heart rate
(beta blockers)
this results in lack of classic response to hypovolemia, risk for cardiac ischemia, elevated BP at
baseline, and increased risk of dysrythmias.
Functional changes in pulmonary system include decreased elastic recoil, reduced residual
capacity, decreased gas exchange and decreased cough reflex
thus they are at increased risk for respiratory failure, increased risk for pneumonia, and poor
tolerance to rib fractures
Functional changes in renal system include loss of renal mass, decreased GFR, and
decreased sensitivity to ADH and aldosterone
resulting in drug dosing for renal insufficiency, decreased ability to concentrate urine, increased
risk for AKI and urine flow may be normal with hypovolemia
,3|Page
Functional changes to MSK include loss of lean body mass, osteoporosis, changes in joints
and cartilage, c spine degenerative changes and loss of skin elastin and subcutaneous fat
resulting in increased risk for fractures, decreased mobility, difficulty for oral intubation, risk of
skin injury, increased risk for hypothermia, challenges in rehabiliation
Functional changes in Endocrine system include decreased production and response to
thyroxin and decreased dehydroepiandrosterone (DHEA)
resulting in occult hypothyroidism, relative hypercortisone states and increased risk of infection
True or false: Arthritis can complicate the airway and cervical spine. Patients can have
multilevel degenerative changes affecting disk spaces and posterior elements associated
with severe central canal stenosis, cord compression, and myelomalacia
true
In elderly population, due to their changes in pulmonary system, placing a gauze between
gums and cheek to achieve seal when using bag valve mask ventilation is okay. In addition,
because aging causes a suppressed heart rate response to hypoxia......
respiratory failure may present insidiously in older adults.
Age related changes in the cardiovascular system place the elderly trauma patient at
significant risk for being inaccurately categorized as hemodynamically stable.
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.
Do no equate blood pressure with shock in older patients
BP in older patients may look normal due to the medications they are on. Use lactate and base
deficit to evaluate for evidence of shock
what 2 factors place elderly patients at risk for intracranial hemorrhage?
, 4|Page
aging causes dura to become more adherent to the skull increasing risk of injury and older
patients are on anticoagulant and antiplatelet medications.
Loss of subcutaneous fat, nutritional deficiencies, chronic medical conditions place elderly
patients as risk for hypothermia and complications for immobility.
Rapid evaluation and when possible early liberation from spine boards and cervical collars will
minimize complications.
True or False: Fall prevention is the mainstay of reducing the mortality associated with
pelvic fractures.
true
poor hygiene, dehydration, oral injury, contusions affecting the inner arms, inner thighs,
palms, soles, scalp, ear, nasal bridge and temple injury from being struck while wearing
glasses, contact burns and scalds. These are all signs of.......?
Elder maltreatment. The presence of physical findings of maltreatment should prompt a detailed
history. if history conflicts with findings, immediately report findings to authorities.
True of false: early activation of the trauma team may be required for elderly patients who
do not meet traditional criteria for activation
True. A simple injury such as an open tibia fracture in a frail elderly patient may become life
threatening.
Common mechanisms of injury include falls, MVC, burns, and penetrating injuries
common injuries in the elderly include rib fractures, TBI, pelvic fractures
The best initial treatment for the fetus is to provide optimal resuscitation of the mother.
True or False?
True. Also if xray examination is indicated during the pregnant patient's treatment, it should not
be withheld because of the pregnancy.
What happens as the uterus enlarged and the bowel is pushed cephalad.
