ATLS EXAM QUESTIONS FINAL STUDY
GUIDE 2026 TESTED ANSWERS GRADED A+
⩥ Failure to displace the uterus to the left side in a hypotensive pregnant
patient
Answer: logroll all patients appearing clinically pregnant (second and
third trimester) to the left 15-30 degrees and elevate the right side 4-6
inches and support with a bolstering device to maintain spinal motion
restriction and decompression of the vena cava.
⩥ Due to increases intravascular volume, pregnant patients can lose a
significant amount of blood before tachycardia, hypotension, and other
signs of hypovolemia occur. Thus, what do stable vital signs in a
pregnant patient indicate about the fetus?
Answer: The fetus may be in distress and the placenta deprived of vital
perfusion while the mother's condition and vital signs appear stable.
Administer crystalloid fluid resuscitation and blood to support the
physiological hypervolemia of pregnancy. vasopressers should be an
absolute last resort in restoring maternal blood pressure as they further
reduce uterine blood flow, resulting in fetal hypoxia.
⩥ What does a normal fibrinogen level indicate in a pregnant patient?
Answer: Fibrinogen level may double in late pregnancy and a normal
level may indicate early disseminated intravascular coagulation
,⩥ Most common cause of fetal death?
Answer: maternal shock and maternal death. Placental abruption is
second. Placental abruption is suggested by vaginal bleeding, uterine
tenderness, frequent uterine contractions, uterine tetany, and uterine
irritability (uterus contracts when touched). In 30% of cases of
abruption, bleeding may not occur. Uterine ultrasound may be helpful in
diagnosis, but is NOT definitive.
⩥ Signs of uterine rupture
Answer: abdominal tenderness, guarding, rigidity, or rebound
tenderness. Signs of peritonitis are hard to tell due to expansion and
attenuation of the abdominal wall musculature. Other findings include
abdominal fetal lie (oblique or transverse lie), easy palpation of the fetal
parts because of their extrauterine location and inability to readily
palpate the uterine fundus when there is fundal rupture. Xray evidence
of rupture include extended fetal extremities, abnormal fetal position,
and free intraperitoneal air.
⩥ Perform continuous fetal monitoring with a tocodynamometer beyond
20-24 weeks of gestation.
Answer: Patients with no risk factors for fetal loss should have
continuous monitoring for 6 hours, whereas, patients with risk factors
for fetal loss or placental abruption should be monitored for 24 hours.
RISK FACTORS ARE: heart rate > 110, an injury severity score >9,
evidence of placental abruption, fetal heart rate >160 or less than 120,
ejection during MV, and motorcycle or pedestrian collisions
,⩥ REMEMBER: maternal bicarbonate is low during pregnancy to
compensate for respiratory alkalosis.
Answer: 17-22 in pregnant patient. (non pregnant patient is 22-28)
⩥ Fetal heart rate is a sensitive indicator of maternal blood volume
status and fetal well being.
Answer: normal range for fetus is 120-160. abnormal heart rate,
repetitive decelerations, absence of accelerations or beat to beat
variability and frequent uterine activity can be signs of impending
maternal and or fetal decompensation (hypoxia or acidosis) and should
prompt immediate obstetrical consultation.
⩥ If a DPL is to be placed in a pregnant trauma patient, place the
catheter above the umbilicus using the open technique. Be alert to
uterine contractions which suggest early labor and tetanic contractions
which suggest placental abruption.
Answer: evidence of ruptured chorioamniotic membranes include
amniotic fluid in vagina evidenced by a pH of 4.5
⩥ Bleeding in 3rd trimester may indicate placental abruption and
impending death of the fetus, a vaginal exam is vital
Answer: however, avoid repeating vaginal examination, CT abdominal
imaging can be done and radiation doses less than 50mGy are not
associated with fetal anomalies or higher risk of fetal loss.
, ⩥ Admission to hospital for pregnant patients:
Answer: vaginal bleeding, uterine irritability, abdominal tenderness, pain
or cramping, evidence of hypovolemia, changes in or absence of fetal
heart tones and or leakage of amniotic fluid
⩥ With extensive placental separation or amniotic fluid embolization,
widespread consumptive coagulopathy can emerge rapidly causing
depletion of fibrinogen, other clotting factors, and platelets.
Answer: immediately perform uterine evacuation and replace platelets,
fibrinogen, and other clotting factors.
⩥ As little as 0.01mL of RH+ blood will sensitize 70% of Rh- women.
Answer: All pregnany RH negative trauma patients should receive RH
immunoglobulin therapy unless injury is remote from the uterus
(isolated distal extremity injury)
⩥ Intimate partner violence in pregnant patient:
Answer: injuries inconsistent with history, diminished self image,
depression or suicide attempts, self abuse, frequent ED visits, symptoms
suggestive of substance abuse, isolated injuries to the gravid abdomen,
parter insists on being present for the interview and exam and
monopolizes discussion
⩥ What is the difference between burns and other injuries?
GUIDE 2026 TESTED ANSWERS GRADED A+
⩥ Failure to displace the uterus to the left side in a hypotensive pregnant
patient
Answer: logroll all patients appearing clinically pregnant (second and
third trimester) to the left 15-30 degrees and elevate the right side 4-6
inches and support with a bolstering device to maintain spinal motion
restriction and decompression of the vena cava.
⩥ Due to increases intravascular volume, pregnant patients can lose a
significant amount of blood before tachycardia, hypotension, and other
signs of hypovolemia occur. Thus, what do stable vital signs in a
pregnant patient indicate about the fetus?
Answer: The fetus may be in distress and the placenta deprived of vital
perfusion while the mother's condition and vital signs appear stable.
Administer crystalloid fluid resuscitation and blood to support the
physiological hypervolemia of pregnancy. vasopressers should be an
absolute last resort in restoring maternal blood pressure as they further
reduce uterine blood flow, resulting in fetal hypoxia.
⩥ What does a normal fibrinogen level indicate in a pregnant patient?
Answer: Fibrinogen level may double in late pregnancy and a normal
level may indicate early disseminated intravascular coagulation
,⩥ Most common cause of fetal death?
Answer: maternal shock and maternal death. Placental abruption is
second. Placental abruption is suggested by vaginal bleeding, uterine
tenderness, frequent uterine contractions, uterine tetany, and uterine
irritability (uterus contracts when touched). In 30% of cases of
abruption, bleeding may not occur. Uterine ultrasound may be helpful in
diagnosis, but is NOT definitive.
⩥ Signs of uterine rupture
Answer: abdominal tenderness, guarding, rigidity, or rebound
tenderness. Signs of peritonitis are hard to tell due to expansion and
attenuation of the abdominal wall musculature. Other findings include
abdominal fetal lie (oblique or transverse lie), easy palpation of the fetal
parts because of their extrauterine location and inability to readily
palpate the uterine fundus when there is fundal rupture. Xray evidence
of rupture include extended fetal extremities, abnormal fetal position,
and free intraperitoneal air.
⩥ Perform continuous fetal monitoring with a tocodynamometer beyond
20-24 weeks of gestation.
Answer: Patients with no risk factors for fetal loss should have
continuous monitoring for 6 hours, whereas, patients with risk factors
for fetal loss or placental abruption should be monitored for 24 hours.
RISK FACTORS ARE: heart rate > 110, an injury severity score >9,
evidence of placental abruption, fetal heart rate >160 or less than 120,
ejection during MV, and motorcycle or pedestrian collisions
,⩥ REMEMBER: maternal bicarbonate is low during pregnancy to
compensate for respiratory alkalosis.
Answer: 17-22 in pregnant patient. (non pregnant patient is 22-28)
⩥ Fetal heart rate is a sensitive indicator of maternal blood volume
status and fetal well being.
Answer: normal range for fetus is 120-160. abnormal heart rate,
repetitive decelerations, absence of accelerations or beat to beat
variability and frequent uterine activity can be signs of impending
maternal and or fetal decompensation (hypoxia or acidosis) and should
prompt immediate obstetrical consultation.
⩥ If a DPL is to be placed in a pregnant trauma patient, place the
catheter above the umbilicus using the open technique. Be alert to
uterine contractions which suggest early labor and tetanic contractions
which suggest placental abruption.
Answer: evidence of ruptured chorioamniotic membranes include
amniotic fluid in vagina evidenced by a pH of 4.5
⩥ Bleeding in 3rd trimester may indicate placental abruption and
impending death of the fetus, a vaginal exam is vital
Answer: however, avoid repeating vaginal examination, CT abdominal
imaging can be done and radiation doses less than 50mGy are not
associated with fetal anomalies or higher risk of fetal loss.
, ⩥ Admission to hospital for pregnant patients:
Answer: vaginal bleeding, uterine irritability, abdominal tenderness, pain
or cramping, evidence of hypovolemia, changes in or absence of fetal
heart tones and or leakage of amniotic fluid
⩥ With extensive placental separation or amniotic fluid embolization,
widespread consumptive coagulopathy can emerge rapidly causing
depletion of fibrinogen, other clotting factors, and platelets.
Answer: immediately perform uterine evacuation and replace platelets,
fibrinogen, and other clotting factors.
⩥ As little as 0.01mL of RH+ blood will sensitize 70% of Rh- women.
Answer: All pregnany RH negative trauma patients should receive RH
immunoglobulin therapy unless injury is remote from the uterus
(isolated distal extremity injury)
⩥ Intimate partner violence in pregnant patient:
Answer: injuries inconsistent with history, diminished self image,
depression or suicide attempts, self abuse, frequent ED visits, symptoms
suggestive of substance abuse, isolated injuries to the gravid abdomen,
parter insists on being present for the interview and exam and
monopolizes discussion
⩥ What is the difference between burns and other injuries?
