2024/2025 POST TEST ATLS EXAM/CURRENT TESTING QUESTIONS ANSWERS /GRADED A+, Exams of Nursing

Download 2024/2025 POST TEST ATLS EXAM/CURRENT TESTING QUESTIONS ANSWERS /GRADED A+ and more Exams Nursing in PDF only on Docsity! 2024/2025 POST TEST ATLS EXAM/CURRENT TESTING QUESTIONS ANSWERS /GRADED A+ A 22-year-old man is hypotensive and tachycardic after a shotgun wound to the left shoulder. His blood pressure is initially 80/40 mm Hg. After 2 liters of crystalloid solution his blood pressure increases to 122/84 mm Hg. His heart rate is now 100 beats per minute and his respiratory rate 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: a) reexamine the chest. b) perform an aortogram. c) obtain a CT scan of the chest. d) obtain arterial blood gas analyses - ANSWER>>a) reexamine the chest Which one of the following physical findings suggests a cause of hypotension other than spinal cord injury? a) priapism. b) bradycardia. c) diaphragmatic breathing. d) presence of deep tendon reflexes. - ANSWER>>d) presence of deep tendon reflexes. 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: a) compartment pressures b) retrograde urethrogram c) Doppler-ultrasound studies d) complete spine x-ray series - ANSWER>>d) complete spine x-ray series In managing the head-injured patient, the most important initial step is to: a) obtain c-spine film. b) secure the airway. c) support the circulation. d) control scalp hemorrhage. - ANSWER>>b) secure the airway. A previously healthy, 70-kg (154-pound) man suffers an estimated acute blood loss of 2 liters. Which one of the following statements applies to this patient? a) His pulse pressure will be widened. b) His urinary output will be at the lower limits of normal. c) He will have tachycardia, but no change in his systolic blood pressure. d) His systolic blood pressure will be decreased with a narrowed pulse pressure. - ANSWER>>d) His systolic blood pressure will be decreased with a narrowed pulse pressure. The physiologic hypervolemia of pregnancy has clinical significance in the management of the severely injured, gravid woman by: a) reducing the need for blood transfusion. b) increasing the risk of pulmonary edema. c) increasing the volume of blood loss to produce maternal hypotension. d) complicating the mangement of closed head injury. - ANSWER>>c) increasing the volume of blood loss to produce maternal hypotension. The best assessment of fluid resuscitation of the burn patient is: a) adequate urinary output. 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: a) 2 b) 4 c) 6 d) 9 - ANSWER>>d) 9 A 20-year-old woman, at 32 weeks gestation, is stabbed in the upper right chest. In the emergency department, her blood pressure is 80/60 mm Hg. She is gasping for breath, extremely anxious, and yelling for help. Breath sounds are diminished in the right chest. The most appropriate first step is to: a) perform tracheal intubation. b) perform needle decompression of the right chest. c) manually displace the gravid uterus to the left side of the abdomen. d) insert an oropharyngeal airway. - ANSWER>>b) perform needle decompression of the right chest. Which one of the following findings in an adult is most likely to require immediate management during the primary survey? a) Distended abdomen. b) Glasgow Coma Scale Score of 11. c) Temperature of 36.5°C (97.8°F). d) Respiratory rate of 40 breaths per minute. - ANSWER>>d) Respiratory rate of 40 breaths per minute. The most important, immediate step in the management of an open pneumothorax is: a) endotracheal intubation. b) operation to close the wound. c) placing a chest tube through the chest wound. d) placement of an occlusive dressing over the wound. - ANSWER>>d) placement of an occlusive dressing over the wound. The following are contraindications for tetanus toxoid administration: a) History of neurological reaction or severe hypersensitivity to the product. b) Local side effects. c) Muscular spasms. d) Pregnancy. - ANSWER>>a) History of neurological reaction or severe hypersensitivity to the product. 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 blood pressure is 60/40 mm Hg and his respiratory rate is 40 breaths per minute. Which of the following best differentiates cardiac tamponade from tension pneumothorax as the cause of his hypotension? a) Tachycardia. b) Pulse volume. c) Breath sounds. d) Pulse pressure. - ANSWER>>c) Breath sounds. and his heart rate is 70 beats per minute. His skin is warm. Which one of the following statements is TRUE? a) Flaccidity of the lower extremities and loss of deep tendon reflexes are expected. b) Vasoactive medications have no role in this patient's management. c) The hypotension should be managed with volume resuscitation alone. d) Flexion and extension views of the c-spine should be performed early. - ANSWER>>a) Flaccidity of the lower extremities and loss of deep tendon reflexes are expected. Which one of the following is the most effective method for initially treating frostbite? a) Moist heat. b) Early amputation. c) Padding and elevation. d) Vasodilators and heparin. - ANSWER>>a) Moist heat. A 32-year-old man's right leg is trapped beneath his overturned car for nearly 2 hours before he is extricated. On arrival in the emergency department, his right lower extremity is cool, mottled, insensate, and motionless. Despite normal vital signs, pulses cannot be palpated below the femoral vessel and the muscles of the lower extremity are firm and hard. During the management of this patient, which of the following is most likely to improve the chances for limb salvage? a) Applying skeletal traction. b) Administering anticoagulant drugs. c) Administering thrombolytic therapy. d) Perform right lower extremity fasciotomy. - ANSWER>>d) Perform right lower extremity fasciotomy. 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: a) request a CT scan. b) insert a gastric tube. c) suction the oropharynx. d) obtain a lateral cervical spine x-ray. - ANSWER>>c) suction the oropharynx. 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 department, a chest tube is inserted and 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 blood pressure decreases to 80/68 mm Hg and his and respiratory rate is 18 breaths per minute. He has gross hematuria and a pelvic fracture. You decide to transfer this patient to a facility capable of providing a higher level of care. The facility is 128 km (80 miles) away. Before transfer, you should first: a) intubate the patient. b) call the receiving hospital and speak to the surgeon on call. c) perform diagnostic peritoneal lavage or FAST. d) discuss the advisability of transfer with the patient's family. - ANSWER>>b) call the receiving hospital and speak to the surgeon on call. Hemorrhage of 20% of the patient's blood volume is associated usually with: a) oliguria. b) confusion. c) hypotension. d) tachycardia. - ANSWER>>d) tachycardia. What blood volumes must be lost to meet criteria for the four stages of shock? - ANSWER>>Stage 1: <20% Stage 2: 20-30% Stage 3: 30-40% Stage 4: >40% 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 mm Hg and her heart rate is 80 beats per minute. She is intubated and mechanically ventilated. Her 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: a) avoid hypotension. b) administer an osmotic diuretic. c) aggressively treat systemic hypertension. d) reduce metabolic requirements of the brain. - ANSWER>>a) avoid hypotension. A 6 year old boy walking across the street is struck by the front bumper of a sports utility vehicle traveling at 32 kph (20 mph). Which one of the following statements is TRUE? a) A flail chest is probable. b) A symptomatic cardiac contusion is expected. c) Transection of the thoracic aorta is more likely than in an adult patient. d) A pulmonary contusion may be present in the absence of rib fractures. - ANSWER>>d) A pulmonary contusion may be present in the absence of rib fractures. heart rate is 182 beats per minute, and his respiratory rate is 48 breaths per minute with no breath sounds heard in the left chest. A tension pneumothorax is relieved by immediate needle decompression and tube thoracostomy. Subsequently, his heart rate decreases to 144 beats per minute, his respiratory rate decreases to 36 breaths per minute, and his blood pressure is 81/53 mm Hg. Warmed Ringer's lactate is administered intravenously. The next priority should be to: a) perform external fixation of the pelvis. b) obtain abdominal and pelvic CT scans. c) perform arterial embolization of the pelvic vessels. d) perform diagnostic peritoneal lavage or FAST. - ANSWER>>d) perform diagnostic peritoneal lavage or FAST. A 42yearold man, injured in a motor vehicle crash, suffers a closed head injury, multiple palpable left rib fractures, and bilateral femur fractures. He is intubated orotracheally without difficulty. Initially, his ventilations are easily assisted with a bagmask device. It becomes more difficult to ventilate the patient over the next 5 minutes, and his hemoglobin oxygen saturation level decreases from 98% to 89% with decreased breath sounds over the left chest. The most appropriate next step is to: a) obtain a chest xray. b) decrease the tidal volume. c) increase the rate of assisted ventilations. d) perform needle decompression of the left chest. - ANSWER>>d) perform needle decompression of the left chest. A young man sustains a rifle wound to the midabdomen. He is brought promptly to the emergency department by prehospital personnel. His skin is cool and diaphoretic, and his systolic blood pressure is 58 mm Hg. Warmed crystalloid fluids are initiated without improvement in his vital signs. The next, most appropriate, step is to perform: a) a laparotomy. b) diagnostic laparoscopy. c) abdominal ultrasonography. d) a diagnostic peritoneal lavage. - ANSWER>>a) a laparotomy. The primary indication for transferring a patient to a higher level trauma center is: a) unavailability of a surgeon or operating room staff. b) multiple system injuries, including severe head injury. c) resource limitations as determined by the transferring doctor. d) resource limitations as determined by the hospital administration. - ANSWER>>c) resource limitations as determined by the transferring doctor. A 42yearold man is trapped from the waist down beneath his overturned tractor for several hours before medical assistance arrives. He is awake and alert until just before He is endotracheally intubated, closed tube thoracostomy is performed, and 2 liters of Ringer's lactate solution are infused via 2 largecaliber IVs. His blood pressure now is 60/0 mm Hg, heart rate is 160 beats per minute, and respiratory rate is 14 breaths per minute (ventilated with 100% 02). The most appropriate next step in managing this patient is: a) laparotomy. b) diagnostic peritoneal lavage. c) arterial blood gas determination. d) administer packed red blood cells. - ANSWER>>d) administer packed red blood cells. A 23 year old man is brought immediately to the emergency department from the hospital's parking lot where he was shot in the lower abdomen. Examination reveals a single bullet wound. He is breathing and has a thready pulse. However, he is unconscious and has no detectable blood pressure. Optimal immediate management is to: a) perform diagnostic peritoneal lavage. b) initiate infusion of packed red blood cells. c) insert a nasogastric tube and urinary catheter. d) transfer the patient to the operating room, while initiating fluid therapy. - ANSWER>>d) transfer the patient to the operating room, while initiating fluid therapy. A teenaged bicycle rider is hit by a truck traveling at high speed. In the emergency department, she is actively bleeding from open fractures of her legs, and has abrasions on her chest and abdominal wall. Her blood pressure is 80/50 mm Hg, heart rate is 140 beats per minute, respiratory rate is 8 breaths per minute, and GCS score is 6. The first step in managing this patient is to: a) obtain a lateral cervical spine xray. b) administer 2 liters of crystalloid solution. c) insert a central venous pressure line. d) perform endotracheal intubation and ventilation. - ANSWER>>d) perform endotracheal intubation and ventilation. An 8yearold boy falls 4.5 meters (15 feet) from a tree and is brought to the emergency department by his family. His vital signs are normal, but he complains of left upper quadrant pain. An abdominal CT scan reveals a moderately severe laceration of the spleen. The receiving institution does not have 24houraday operating room capabilities. The most appropriate management of this patient would be to: a) type and crossmatch for blood. b) request consultation of a pediatrician. c) transfer the patient to a trauma center. d) admit the patient to the intensive care unit. - ANSWER>>c) transfer the a) treat the most severely injured patients first. b) establish a field triage area directed by a doctor. c) produce the greatest number of survivors based on available resources. d) treat the greatest number of patients in the shortest period of time. - ANSWER>>c) produce the greatest number of survivors based on available resources. An electrician is electrocuted by a downed power line after a thunderstorm. He apparently made contact with the wire at the level of the right mid thigh. In the emergency department, his vital signs are normal and no dysrhythmia is noted on ECG. On examination, there is an exit wound on the bottom of the right foot. His urine is positive for blood by dipstick but no RBCs are seen microscopically. Initial management should include: a) immediate angiography. b) aggressive fluid infusion. c) intravenous pyelography. d) debridement of necrotic muscle. - ANSWER>>b) aggressive fluid infusion. A young woman sustains a severe head injury as the result of a motor vehicular crash. In the emergency department, her GCS score is 6. Her blood pressure is 140/90 mm Hg and her heart rate is 80 beats per minute. She is intubated and is being mechanically ventilated. Her 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: a) administer an osmotic diuretic. b) prevent secondary brain injury. c) aggressively treat systemic hypertension. d) distinguish between intracranial hematoma and cerebral edema. - ANSWER>>d) distinguish between intracranial hematoma and cerebral edema. To establish a diagnosis of shock: a) systolic blood pressure must be below 90 mm Hg. b) the presence of a closed head injury should be excluded. c) acidosis should be present by arterial blood gas analysis. d) clinical evidence of inadequate organ perfusion must be present. - ANSWER>>d) clinical evidence of inadequate organ perfusion must be present. A 32 year old man is brought to the hospital unconscious with severe facial injuries and noisy respirations after an automobile collision. In the emergency department, he has no apparent injury to the anterior aspect of his neck. He suddenly becomes apneic, and attempted ventilation with a face mask is minute, and respiratory rate is 16 breaths per minute. Her GCS score is 14. She complains that her legs feel "funny and won't move right." However, her spine xrays do not show a fracture or dislocation. A spinal cord injury in this child: a) is most likely a central cord syndrome. b) must be diagnosed by magnetic resonance imaging. c) can be excluded by obtaining a CT of the entire spine. d) may exist in the absence of objective findings on xray studies. - ANSWER>>d) may exist in the absence of objective findings on xray studies. Immediate chest tube insertion is indicated for which of the following conditions? a) Pneumothorax b) Pneumomediastinu m c) Massive hemothorax d) Diaphragmatic rupture - ANSWER>>c) Massive hemothorax Cardiac tamponade after trauma: a) is seldom lifethreatening. b) can be excluded by an upright, AP chest xray. c) can be confused with a tension pneumothorax. d) causes a fall in systolic pressure of >15 mm Hg with expiration. - ANSWER>>c) can be confused with a tension pneumothorax. What are the three aspects of Beck's Triad for cardiac tamponade? - ANSWER>>Elevated JVD Hypotension Distant heart sounds What is the most rapid way to diagnose cardiac tamponade? - ANSWER>>eFAST ultrasound exam A 22 year old man is brought to the hospital after crashing his motorcycle into a telephone pole. He is unconscious and in profound shock. He has no open wounds or obvious fractures. The cause of his shock is MOST LIKELY caused by: a) hemorrhage into the chest or abdomen. b) an epidural hematoma. c) a transected lumbar spinal cord. d) a basilar skull fracture. - ANSWER>>a) hemorrhage into the chest or abdomen. What is the most likely cause of shock in the trauma patient? - ANSWER>>Hemorrhage WHAT IS THE MOST LIKELY CAUSE OF SHOCK IN THE TRAUMA PATIENT? - ANSWER>>HEMORRHAGE a) decrease in PaCO2. b) decrease in leukocyte count. c) reduced gastric emptying rate. d) diminished residual lung volume. - ANSWER>>b) decrease in leukocyte count. In managing the headinjured patient, the most important initial step is to: a) secure the airway. b) obtain cspine film. c) support the circulation. d) control scalp hemorrhage. - ANSWER>>a) secure the airway. A trauma patient presents to your emergency department with inspiratory stridor and a suspected cspine injury. Oxygen saturation is 88% on highflow oxygen via a nonrebreathing mask. The most appropriate next step is to: a) apply cervical traction. b) perform immediate tracheostomy. c) insert bilateral thoracostomy tubes. d) maintain inline immobilization and establish a definitive airway. - ANSWER>>d) maintain inline immobilization and establish a definitive airway. When applying the Rule of Nines to infants: a) it is not reliable. b) the body is proportionally larger in infants than in adults. c) the head is proportionally larger in infants than in adults. d) the legs are proportionally larger in infants than in adults. - ANSWER>>c) the head is proportionally larger in infants than in adults. A 60 year old man sustains a stab wound to the right posterior flank. Witnesses state the weapon was a small knife. His heart rate is 90 beats per minute, blood pressure is 128/72 mm Hg, and respiratory rate is 24 breaths per minute. The most appropriate action to take at this time is to: a) perform a colonoscopy. b) perform a barium enema. c) perform an intravenous pyelogram. d) perform serial physical examinations. - ANSWER>>d) perform serial physical examinations. The following are criteria for transfer to a burn center, EXCEPT for: a) Partialthickness and fullthickness burns on greater than 10% of the BSA b) Any fullthickness burn c) Partialthickness and fullthickness burns involving the face, hands, feet, b) cardiac tamponade. c) massive hemothorax. d) tension pneumothorax. - ANSWER>>b) cardiac tamponade. A hemodynamically normal 10yearold girl is admitted to the Pediatric Intensive Care Unit (PICU) for observation after a Grade III (moderately severe) splenic injury has been confirmed by computed tomography (CT). Which of the following mandates prompt laparotomy? a) A serum amylase of 200. b) A leukocyte count of 14,000. c) Extraperitoneal bladder rupture. d) Free intraperitoneal air demonstrated on followup CT. - ANSWER>>d) Free intraperitoneal air demonstrated on followup CT. A 40-year-old woman restrained driver is transported to the emergency department in full spinal immobilization. She is hemodynamically normal and found to be paraplegic at the level of T10. Neurologic examination also determines that there is loss of pain and temperature sensation with preservation of proprioception and vibration. These findings are consistent with the diagnosis of: a) central cord syndrome. b) anterior cord syndrome. c) complete cord syndrome. d) Brown-Sequard's syndrome. - ANSWER>>b) anterior cord syndrome. A 38 year old woman is stabbed in the back by a 4-inch knife. Her blood pressure is 120/78. She has motor weakness in her left leg and loss of sensation to pain and temperature in her right side below the navel. What spinal cord syndrome is she suffering? a) central cord syndrome. b) anterior cord syndrome. c) complete cord syndrome. d) Brown-Sequard's syndrome. - ANSWER>>d) Brown-Sequard's syndrome. A trauma patient presents to your emergency department with inspiratory stridor and a suspected c-spine injury. Oxygen saturation is 88% on high-flow oxygen via a nonrebreathing mask. The most appropriate next step is to: a) apply cervical traction. b) perform immediate tracheostomy. c) maintain 100% oxygen and obtain immediate c-spine x-rays. d) maintain inline immobilization and establish a definitive airway. - ANSWER>>d) maintain inline immobilization and establish a definitive airway. b) patient with an inhalation injury. c) 6 year old child with a pelvic fracture. d) patient with a severe cardiac contusion. - ANSWER>>d) patient with a severe cardiac contusion. A 24 year old man sustains multiple fractured ribs bilaterally as a result of being crushed in a press at a plywood factory. Examination in the emergency department reveals a flail segment of the patient's thorax. Primary resuscitation includes highflow oxygen administration via a nonrebreathing mask, and initiation of Ringer's lactate solution. The patient exhibits progressive confusion, pain, and tachypnea. Management at this time should consist of: a) intravenous sedation. b) external stabilization of the chest wall. c) increasing the FIO2 in the inspired gas. d) intercostal nerve blocks for pain relief. - ANSWER>>d) intercostal nerve blocks for pain relief. Which one of the following statements regarding patients with thoracic spine injuries is TRUE? a) Logrolling may be destabilizing to fractures from T12 to L1. b) Adequate immobilization can be accomplished with the scoop stretcher. c) Spinal cord injury below T10 usually spares bowel and bladder function. d) Hyperflexion fractures in the upper thoracic spine are inherently unstable. - ANSWER>>d) Hyperflexion fractures in the upper thoracic spine are inherently unstable. The driver of a single car crash is orotracheally intubated in the field by prehospital personnel after they identify a closed head injury and determine that the patient is unable to protect his airway. In the emergency department, the patient demonstrates decorticate posturing bilaterally. He is being ventilated with a bagvalve device, but his breath sounds are absent in the left hemithorax. His blood pressure is 160/88 mm Hg, heart rate is 70 beats per minute, and the pulse oximeter displays a hemoglobin oxygen saturation of 96%. The next step in assessing and managing this patient should be to: a) determine the arterial blood gases. b) obtain a lateral cervical spine xray. c) assess placement of the endotracheal tube. d) perform needle decompression of the left chest. - ANSWER>>c) assess placement of the endotracheal tube. The response to catecholamines in an injured, hypovolemic pregnant woman can be expected to result in: a) placental abruption. (ventilated with 100% O2). 1500 mL of blood has drained from the right chest. The most appropriate next step in managing this patient is to: a) perform FAST. b) obtain a CT of the chest. c) perform an angiography. d) urgently transfer the patient to the operating room. - ANSWER>>d) urgently transfer the patient to the operating room. All of the following are true of the Mallampati classification, EXCEPT: a) Class IV is the easiest intubation, while Class I is the most difficult. b) It helps assess for difficult intubations. c) It is part of the LEMON assessment. d) It comprises a visual assessment of the distance from the tongue base to the roof of the mouth, and therefore the amount of space in which there is to work. - ANSWER>>a) Class IV is the easiest intubation, while Class I is the most difficult. A 29yearold female arrives in the emergency department after being involved in a motor vehicle crash. She is 30 weeks pregnant. She was restrained with a lap and shoulder belt, and an airbag deployed. Which one of the following statements best describes the risk of injury? a) The deployment of the airbag increases the risk of fetal loss. b) The use of seatbelts is associated with increased risk of maternal death c) The mechanism of injury suggests the need for emergency caesarean section due to the risk of impending abruptio placentae. d) The risk of premature fetal delivery and death is reduced by the use of restraints. - ANSWER>>d) The risk of premature fetal delivery and death is reduced by the use of restraints. Cardiac tamponade: a) is definitively managed by needle pericardiocentesis b) is most common with blunt thoracic trauma and anterior rib fractures c) is easily diagnosed by discovery of Beck's triad in the emergency department d) requires surgical intervention and drainage - ANSWER>>d) requires surgical intervention and drainage A 14yearold female is brought to the emergency department after falling from a horse. She is immobilized on a long spine board with a hard collar and blocks. Cervical spine xrays: a) will show cervical spine injury in more than 20% of these patients. b) will exclude cervical spine injury if no abnormalities are found on the xrays. c) are not needed if she is awake, alert, neurologically normal, and has no neck pain or midline tenderness. d) should be performed before addressing potential breathing or circulatory a) Fetal assessment should take priority. b) Logrolling the patient to the right will decompress the vena cava. c) Rhimmunoglobulin therapy should be immediately administered. d) The patient likely has impending cardiorespiratory failure. - ANSWER>>d) The patient likely has impending cardiorespiratory failure. The most important consequence of inadequate organ perfusion is: a) multiple organ failure b) decreased base deficit c) acute glomerulonephritis d) increased cellular adenosine triphosphate (ATP) production - ANSWER>>a) multiple organ failure Hypertension following a head injury: a) should be treated to reduce intracranial pressure b) may indicate imminent herniation from critically high intracranial pressure c) indicates preexisting hypertension d) mandates prompt administration of mannitol - ANSWER>>b) may indicate imminent herniation from critically high intracranial pressure Initial treatment of frostbite injuries involves: a) application of dry heat. b) rapid rewarming of the body part in circulating warm water. c) debridement of hemorrhagic blisters. d) early amputation to prevent septic complications. - ANSWER>>b) rapid rewarming of the body part in circulating warm water. Which of the following signs is least reliable for diagnosing esophageal intubation? a) symmetrical chest wall movement b) endtidal CO2 c) bilateral breath sounds d) oxygen saturation - ANSWER>>d) oxygen saturation A 6monthold infant, being held in her mother's arms, is ejected on impact from a vehicle that is struck headon by an oncoming car traveling at 64 kph (40 mph). The infant arrives in the emergency department with multiple facial injuries, is lethargic, and is in severe respiratory distress. Respiratory support is not effective using a bagmask device, and her oxygen saturation is falling. Repeated attempts at orotracheal intubation are unsuccessful. The most appropriate procedure to perform next is: a) administer heliox and racemic epinephrine b) perform needle cricothyroidotomy with jet c) patients with circumferential truncal burns need prompt fasciotomies. d) electrical burns are associated with extensive skin necrosis. - ANSWER>>a) chemical burns require the immediate removal of clothing. Which one of the following statements is true? a) Elevated intracranial pressure will not affect cerebral perfusion. b) Cerebrospinal fluid cannot be displaced from the cranial vault. c) Cerebral blood flow is increased when the PacO2 is below 30 mm Hg. d) Autoregulation of cerebral blood flow normally occurs between mean arterial pressures of 50 to 150 mm Hg. - ANSWER>>d) Autoregulation of cerebral blood flow normally occurs between mean arterial pressures of 50 to 150 mm Hg. Initial resuscitation in adult trauma patients should: a) be with 2 liters of crystalloid, monitoring the patient's response. b) use crystalloid to normalize blood pressure. c) use permissive hypotension in patients with head injury. d) be with a nonblood colloid solution. - ANSWER>>a) be with 2 liters of crystalloid, monitoring the patient's response. A 25yearold male is brought to the emergency department following a bar fight. He has an altered level of consciousness, opens his eyes on command, moans without forming discernible words, and localizes to painful stimuli. Which one of the following statements concerning this patient is true? a) Mandatory intubation to protect his airway is required. b) His Glasgow Coma Scale suggests a severe head injury. c) His level of consciousness can be solely attributed to elevated blood alcohol. d) CT Scanning is an important part of neurological assessment. - ANSWER>>d) CT Scanning is an important part of neurological assessment. Which one of the following statements is true regarding access in pediatric resuscitation? a) Intraosseous access should only be considered after five percutaneous attempts. b) Cutdown at the ankle is the preferred initial access technique. c) Internal jugular cannulation is the next preferred option when percutaneous venous access fails. d) Blood transfusion can be effectively delivered through intraosseous access. - ANSWER>>d) Blood transfusion can be effectively delivered through intraosseous access. A 35 year old female sustains multiple injuries in a motor vehicle crash and is transported to a small hospital in full spinal protection. She has a GCS score of 4 and is being mechanically ventilated. Intravenous access is established and warmed reveals normal vital signs. There is a large bruise over his epigastrium that extends to the left flank. He has no other apparent injuries. A CT scan of the abdomen demonstrates a ruptured spleen surrounded by a large hematoma and fluid in the pelvis. The next step in this patient's management is: a) splenic artery embolization. b) surgical consultation. c) transfer to a pediatrician. d) urgent laparotomy. - ANSWER>>b) surgical consultation. A 30yearold female is brought to the emergency department after being injured in a motor vehicle crash. Her initial blood pressure is 90/60 mm Hg, and her heart rate is 122 beats per minute. She responds to the rapid infusion of 1 liter of crystalloid Solution with a rise in her blood pressure to 118/88 mm Hg and a decrease in her heart rate to 90 beats per minute. Her pressure then suddenly decreases to 96/66 mm Hg. The least likely cause of her hemodynamic change is: a) traumatic brain injury. b) ongoing blood loss. c) blunt cardiac injury. d) inadequate resuscitation. - ANSWER>>b) ongoing blood loss. Limbthreatening extremity injuries: a) require a tourniquet. b) are characterized by the presence of ischemic or crushed tissue. c) should be definitively managed by application of a traction splint. d) are rarely present without an open wound. - ANSWER>>b) are characterized by the presence of ischemic or crushed tissue. The first priority in the management of a long bone fracture is: a) reduction of pain. b) prevention of infection in case of an open fracture. c) prevention of further soft tissue injury. d) control of hemorrhage. - ANSWER>>d) control of hemorrhage. Which one of the following statements regarding genitourinary injuries is true? a) Urethral injuries are associated with pelvic fractures. b) All patients with microscopic hematuria require evaluation of the genitourinary tract. c) Patients presenting with gross hematuria and shock will have a major renal injury as the source of hemorrhage. d) Intraperitoneal bladder injuries are usually managed definitively with a urinary catheter. - ANSWER>>a) Urethral injuries are associated with pelvic fractures. a) priapism b) bradycardia c) distended neck veins d) diaphragmatic breathing - ANSWER>>c) distended neck veins Lateral cervical spine films: a) must be performed in the primary survey. b) can exclude any significant spinal injury. c) should be combined with clinical exam, AP and odontoid, or CT. d) are indicated in all trauma patients. - ANSWER>>c) should be combined with clinical exam, AP and odontoid, or CT. A 30 year old male is brought to the hospital after falling 6 meters (20 feet). Inspection reveals an obvious flail chest on the right. The patient is tachypneic. Breath sounds are present and symmetrical. There is no significant hyperresonance or dullness. Arterial blood gases obtained while the patient receives oxygen by face mask are: Pao2 of 45 mm Hg (6 kPa), PaCO2 of 28 mm Hg (3.7 kPa), and pH of 7.47. The component of injury that is most likely responsible for the abnormalities in the patient's blood gases is: a) hypoventilation. b) hypovolemia c) small pneumothorax. d) pulmonary contusion. - ANSWER>>d) pulmonary contusion. Which one of the following statements concerning massive hemothorax is TRUE? a) It is usually caused by blunt thoracic trauma. b) It is commonly confused with a pneumothorax. c) The diagnosis should be confirmed by upright, plain chest roentgenograms prior to treatment. d) The condition should be suspected in situations associated with shock and unilateral absent breath sounds. - ANSWER>>d) The condition should be suspected in situations associated with shock and unilateral absent breath sounds. A 25-year-old man is brought to the hospital after being involved in a motor vehicular crash when his car struck a bridge abutment. He is intoxicated, has a Glasgow Coma Scale score of 13, and complains of abdominal pain. His blood pressure was 80 mm Hg systolic by palpation on admission to the hospital, but it rapidly increased to 110/70 with the administration of intravenous fluids. His heart rate is now 120 beats per minute. The chest roentgenogram shows loss of the aortic knob, widening of the mediastinum, no rib fractures, and no hemopneumothorax. Contrast CT angiography: a) is not indicated. c) copious, tenacious oral secretions. d) posterior displacement of tongue. - ANSWER>>d) posterior displacement of tongue. Cervical spine injury: a) is excluded by a normal neurologic examination. b) may be first manifested by neurologic deficit after movement of the neck. c) can be detected safely by careful flexion and extension of the neck. d) can be excluded by a crosstable lateral roentgenogram of the c-spine. - ANSWER>>b) may be first manifested by neurologic deficit after movement of the neck. Typical pelvic fracture patterns and injuries following major mechanisms of injury include: a) lateral compression forces, resulting in open book pelvic fractures. b) anterior-posterior compression, resulting in shifting of the iliac bones vertically. c) vertical displacement of the hemipelvis, typically resulting in disruption of the sacrospinous ligaments. d) direct blows to the iliac crest of the pelvis, resulting in sacral fractures. - ANSWER>>c) vertical displacement of the hemipelvis, typically resulting in disruption of the sacrospinous ligaments. A 26-year-old seat-belted driver is brought to the hospital after a car crash. Primary survey reveals no evidence of serious injury except for diffuse, mild abdominal tenderness. Bowel sounds are hypoactive and liver dullness is questionable. Abdominal films reveal free air. The patient should: a) undergo peritoneal lavage. b) undergo prompt laparotomy. c) be carefully observed for further evidence of intra-abdominal injury. d) have a contrast roentgenographic study of the gastrointestinal tract. - ANSWER>>b) undergo prompt laparotomy. A four-year-old girl, weighing approximately 20 kg (44 pounds), is admitted in shock after an automobile crash. How much crystalloid should be given as an initial fluid bolus? a) 200 mL. b) 400 mL. c) 440 mL. d) 600 mL - ANSWER>>b) 400 mL. Which of the following injuries is most likely to be missed by FAST or DPL? a) Mesenteric laceration b) Splenic capsular laceration a) Airway b) Breathing c) Circulation d) Neurologic - ANSWER>>b) Breathing In addition to an endotrachel tube, which other "tubes" are important to consider inserting in the trauma patient? - ANSWER>>OG tube and Foley catheter What is an important drug to administer following successful intubation of a trauma patient? - ANSWER>>Continuous sedation - consider fentanyl When finished performing an intervention to correct an abnormality in one of the ABCs, what is your next step? - ANSWER>>Restart ABCs and reassess In which patients is the FAST exam appropriate? - ANSWER>>Patient with hypotension who have undergone blunt abdominal trauma