ATLS Exam Practice Questions and Answers Latest Updates 2024, Exams of Nursing

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ATLS Exam Practice Questions and

Answers Latest Updates 2024

7 - year-old girl is found at the bottom of a swimming pool. Initially she was in full arrest but after 5 minutes she showed sinus tachycardia but no respiratory effort. Intubation was done in the field and cervical collar placed. After transport to the emergency department she was unresponsive with a blood pressure of 100/ mmHg, pulse 105, temperature 34.3C, and oxygen saturation 100%. The pupils were 3 mm and sluggishly responsive to light. There is no response to pain. The lungs show wheezing on the left and coarse breath sounds bilaterally. The monitor shows sinus tachycardia. There is no rectal tone. Which of the following should be the next step in management? A. Cervical spine films and CT of the head B. Portable chest radiograph C. Arterial blood gas D. Right and left decubitus chest radiographs - A. Cervical spine films and CT of the head 37 - year-old man is struck on the side of the head but is conscious and talkative after the injury. No evidence of skull fracture. Several days later, he becomes increasingly lethargic, somewhat confused, and unable to move his right side. Which type of event has most likely occurred? A. Subdural hematoma B. Epidural hematoma C. Carotid dissection D. Brain contusion - A. Subdural hematoma A 13 year old boy fell while riding his bicycle and hit his head. He was unconscious for 4 or 5 minutes. He vomited twice. He has no memory of the event or a headache. His exam is entirely normal. Glasgow coma score is 15. Select the next step in management. A. Discharge home with concussion instructions B. CT of the head C. Skull films D. Admit for observation - B. CT of the head

A 17-year-old male is hit on the head with a baseball bat. He withdraws and opens his eyes in response to deep painful stimuli. He also mumbles incomprehensibly. What is his Glasgow coma scale score? - 8 A 18-year-old male sustains a right femur fracture and a cerebral concussion in a motor vehicle accident. His initial blood pressure is 75/50 mmHg with a pulse of 90 beats per minute. After giving him 2 liters of Ringer lactate he stabilizes, but the blood pressure falls when he is seen in the ER. Which of the following would be the cause of suspected hypotension in this patient? A. Subdural hematoma B. Undiagnosed facial fracture C. Ruptured spleen D. 10% pneumothorax - C. Ruptured spleen A 22-year-old man sustains a gunshot wound to the abdomen and presents with shock. He requires multiple units of packed red blood cells during resuscitation. Later he complains of numbness around his mouth. Physical exam reveals carpopedal spasm and a positive Chvostek sign. An electrocardiogram demonstrates a prolonged QT interval. Which of the following is the most appropriate treatment? A. IV bicarbonate B. IV furosemide C. IV calcium D. IV insulin - C. IV calcium A 26-year-old male is resuscitated with blood transfusion after a motor vehicle collision that was complicated by a fractured pelvis. A few hours later, the patient becomes febrile, hypotensive with a normal CVP, and oliguric. Upon examination, the patient is found to be bleeding from the NG tube and IV sites. Which of the following is the most likely diagnosis? A. Hemorrhagic shock B. Acute adrenal insufficiency C. Fat embolism syndrome D. Transfusion reaction - D. Transfusion reaction

A 28 - year-old male was involved in a motor vehicle accident. He is stable. When he is asked to sit up, the umbilicus moves up toward the neck area. What type of injury can this indicate? A. Rectus hematoma B. Diastasis recti C. T6-T10 spinal cord injury D. Muscle spasms - C. T6-T10 spinal cord injury A 34-year-old with severe head trauma and elevated intracranial pressures is intubated. Which of the following should be the target for mechanical ventilation?

• Set PaCO2 between 30 - 35 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 E. jugular venous pressure - C. breath sounds A female is transported to the emergency department after a motor vehicle accident with trauma to the left leg and back. Vital signs show temperature=37.1ºC, BP= 125/75 mm Hg, HR= 94, R=20. GCS is 15. There is paraplegia, T12 sensory level, and decreased rectal tone. Hemoglobin is normal and stable at 1 hour. Which of the following should be done to assess for intraperitoneal bleeding? A. Diagnostic peritoneal lavage B. CT of the abdomen C. Abdominal ultrasound D. Flat plate of the abdomen - C. Abdominal ultrasound A healthy 24-year-old is involved in a motor vehicle accident. He loses consciousness but regains it within a few hours and appears normal to friends. He

later presents to the emergency room very lethargic, weak, and with a dilated pupil on the left side. The patient most likely has which of the following conditions? A. Acute subdural hematoma B. Subarachnoid hemorrhage C. Acute epidural hematoma D. Intra-cerebral hemorrhage - C. Acute epidural hematoma A hemodynamically normal 10 - year-old girl is hospitalized for observation after a Grade III (moderately severe) splenic injury has been confirmed by computed tomography (CT). Which of the following mandates prompt celiotomy (laparotomy)? A. a serum amylase of 200 B. a leukocyte count of 14, C. evidence of retroperitoneal hematoma on CT scan D. development of peritonitis on physical exam E. a fall in the hemoglobin level from 12 g/dL to 8 g/dL over 24 hours - D. development of peritonitis on physical exam A laceration of the neck superficial to the deep cervical fascia along the sternocleidomastoid muscle at its midpoint would cause bleeding from which structure? - External jugular vein A patient admitted with mild hypothermia is at risk to develop: A. Atrial fibrillation B. Ventricular tachycardia C. Heart failure D. Loss of their extremity - A. Atrial fibrillation A patient has been in a major MVA and is comatose. He has a high level of alcohol and is hypothermic. Which of the following test can stand alone in certifying the patient as brain dead? A. Apnea test B. Absence of oculocephalic and oculovestibular reflexes C. Absence of blood flow on cerebral angiogram after warming D. EEG - C. Absence of blood flow on cerebral angiogram after warming

A patient injures his left arm and is found to have a transected nerve. Which is true about this injury? A. Nerves tend to recover and grow at a rate of 1 mm/day B. The growing ends of the nerve can be located by EMG studies C. All cut nerves should be immediately resutured D. The neuromuscular junction end plates start to degenerate 2-3 weeks after the nerve is transected - A. Nerves tend to recover and grow at a rate of 1 mm/day A patient involved in a road accident is brought to the emergency department in an unconscious state. On arrival, her vitals show a temperature of 96.4 degrees Fahrenheit, a respiration rate of 24 breaths per minute, a heart rate of 140 beats per minute, and a blood pressure of 80/40 mm Hg. She is cold, shivering, and perspiring profusely. She has bilateral reactive pupils but she does not respond to pain. On physical examination, she has no obvious sign of external bleeding. Which of the following cannot be the cause of hypotension in this patient? A. Pelvic fracture B. Fracture of femur C. Intracranial hemorrhage D. Hemothorax - C. Intracranial hemorrhage A patient is found unconscious after a fire in his bedroom. He is found to have severe burns around his face. What is the first aspect of treatment? A. Tetanus toxoid B. Cover the wound C. Airway D. Obtain blood work - C. Airway A patient is hit by a car and has severe injuries to his extremities. He is immediately brought to the emergency room by EMS. Evaluation reveals that he has multiple organ injuries. He has an open, gaping wound which measures 2 x 2 centimeters, just below the right knee. The leg appears dislocated and ecchymotic. However, pulses are present in the distal extremity. He does not complain of any paresthesias. X-ray reveals that there is a fracture of the tibia. The trauma team is called. As their arrival is awaited, which of the following should NOT be done to help manage this patient? A. Obtain culture and close wound using a sterile technique

B. Don't reduce the dislocation C. Give tetanus toxoid/booster shot D. Give antibiotics - A. Obtain culture and close wound using a sterile technique A patient is involved in a motor vehicle accident. He is brought into the ER and found to have a broken femur. His blood work reveals an hemoglobin of eight and an Hct of 28. It is decided to transfuse him with three units of blood. Soon after the blood is started, he develops a fever and becomes hypotensive. In a patient suspected of having a hemolytic transfusion reaction, one should do which of the following?A A. Inserting a foley catheter B. Fluid restriction C. 0.1N HCL to reverse the alkalosis D. Fluids and mannitol - D. Fluids and mannitol A patient is involved in a MVA and suffers multiorgan trauma. He is brought to the ER by EMS and found to be hypotensive with bradycardia and his abdomen is not distended. He is disoriented and confused. He has a GCS of 9; his legs are warm and the pulses thready. His CVP is 9, his HR is 42, and his BP is 80/40. What is the most likely cause of his shock state? A. Closed head injury B. Ongoing intra-abdominal hemorrhage C. Pneumothorax D. Neurogenic shock - D. Neurogenic shock A patient is involved in a MVA. He suffers a left femur fracture with head trauma. He is resuscitated at the scene and stabilized. Upon transfer to the ER, his blood pressure gradually decreases and then suddenly drops to 60/40. He has a splint on the left leg. What is the most likely cause of his decreased blood pressure? A. Head trauma B. Abdominal organ rupture C. Rib fracture D. Cardiac contusion - B. Abdominal organ rupture A patient is on mechanical ventilator and his arterial blood gas reveals a PCO2 of 38 and a pH of 7.41. What is the appropriate next step?

A. Increase oxygen B. Observe C. Increase rate D. Increase tidal volume - B. Observe A patient is placed on a heating blanket for hypothermia. It is most important to monitor which of the following? A. Vital signs B. Neurologic status C. Sensory deficits D. Oxygenation - A. Vital signs A patient is thrown out of a car. He is hemodynamically stable, asymptomatic, and the only finding is a right sided pneumothorax. What is the best treatment for this man? A. Aspiration of pneumothorax B. Monitor pneumothorax C. CT scan D. Placement of chest tube - D. Placement of chest tube A patient on a mechanical ventilator is fighting the machine, and has elevated peak airway pressures. What medication should be used? A. Benzodiazepines B. Vecuronium C. Barbiturates D. Baclofen - B. Vecuronium A patient presents to the emergency room after a motor vehicle accident with hypotension, tachycardia, and abdominal distension. What is the most likely diagnosis? A. Closed head injury B. Splenic injury C. Pneumothorax D. Neurogenic shock - B. Splenic injury

A patient suffered a slash to his right neck. The wound is over the mid-portion of the sternocleidomastoid. There is a large hematoma and brisk bleeding when uncovered. He is stable. What is the next step in management? A. Get an angiogram B. Close the wound in the ER C. Take him to the operating room D. CT scan to evaluate neck structure - C. Take him to the OR A patient suffers a gunshot wound to the abdomen. She is stable and only complains of mild pain at the site. On examination, she has mild rebound tenderness. Her WBC count is 10, hematocrit is 31, and hemoglobin is 13.2. What is the next step in the management of this patient? A. Surgery B. Abdominal CT C. Abdominal Ultrasound D. Rectal exam - B. Abdominal CT A patient suffers a stab wound to the chest. In the emergency room, he is found to have an 80 percent pneumothorax with a midline shift of the trachea to the contralateral chest. There is evidence of circulatory and respiratory dysfunction. What is the next step in the management of this patient? A. Endotracheal tube B. Fluid bolus C. Epinephrine D. 20 gauge needle - D. 20 gauge needle A patient sustains blunt trauma to the back and left leg. Vital signs in the emergency department show temperature 36 degrees C, BP 120/80 mm Hg, heart rate 92, respirations 19, GCS 15. There is bilateral lower extremity paraplegia, T sensory level, and decreased rectal tone. Hemoglobin is 14.2 and the same in one hour. Which of the following tests is best for diagnosing an intraperitoneal bleed? A. Abdominal ultrasound B. Laparotomy C. KUB D. Diagnostic peritoneal lavage - A. Abdominal ultrasound

A patient with their neck flexed would have which vertebrae as most prominent? A. C B. C C. C D. T A patient with von Willebrand disease is bleeding after sustaining a knife wound. Which of the following is most appropriate for the treatment of this patient? A. Vitamin K B. Cryoprecipitate C. Protamine D. DDAVP - A patient with which condition should be triaged to receive medical attention first? A. Choking B. Dizziness C. Leg cramp D. Vomiting - A. Choking A provider is examining a patient who sustained a severe traumatic head injury. He documents no Doll's eyes. What does this signify? - Brainstem injury A stab wound at the left 5th intercostal space, 8 cm from the midline would most likely damage which of the following? A. Spleen B. Apex of the heart C. Left lung D. Left kidney - B. Apex of heart A trauma patient is rapidly intubated and capnograph is hooked up to the outflow line. After five breaths the capnography tracings falls off. What is the next step in the management? A. Increased FIO B. Hyperventilate patient C. Immediately remove the endotracheal tube and reintubate

D. DDAVP

- C. C

D. Add CO2 to the system - C. Immediately remove the endotracheal tube and reintubate A trauma patient is receiving fluids at 150 cc/hr. He received two units of blood because his initial hemoglobin was 7.3 g. After 4 hours, his urine output is 7 cc/hr and his central venous pressure is 3 cm of water. What is the next step in his management? A. Start furosemide drip B. Start dopamine at renal dose C. Administer 500 cc of NS bolus over 1 hour D. Decrease the rate of fluid administration - C. Administer 500 cc of NS bolus over 1 hour A young motorcycle driver is thrown against a concrete bridge and sustains severe trauma about the face, with marked deformity and bleeding. Which of the following statements regarding this scenario is TRUE? A. Cervical spine evaluation takes precedence over facial injuries B. LeFort fractures rarely cause severe hemorrhage C. Nasotracheal intubation must be done urgently to prevent airway obstruction D. Plain radiographs are preferred to CT in emergencies - A. Cervical spine evaluation takes precedence over facial injuries 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/ 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 E. distinguish between intracranial hematoma and cerebral edema - A. avoid hypotension After a femur fracture, which of the following is LEAST likely?

A. Severe pain B. Expanding hematoma C. Severe nerve injury D. Absent distal pulses - C. Severe nerve injury After abdominal injury, which of the following urinalysis findings would be an indication for further testing? A. 0 - 5 casts/HPF B. 5 - 10 WBC/HPF C. 10 - 20 RBC/HPF D. Gross hematuria - D. Gross hematuria After being involved in a motor vehicle crash, a 25-year-old man is brought to a hospital that has surgery capabilities available.. Computed tomography of the chest and abdomen shows an aortic injury and splenic laceration with free abdominal fluid. His blood pressure falls to 70 mm Hg after CT. The next step is: - perform an exploratory laparotomy After placement of a chest tube for a traumatic pneumothorax, subcutaneous emphysema is observed. After checking the drainage and chest tube site, what else should be done? - - Increase level of suction

• Insert second chest tube
• Adjust chest tube Do NOT flush tube with saline Air embolism - PE: murmur, petechiae, desaturation Tx: turn patient on left side in Trendelenburg position An 8-year old child is brought to the ER after being struck by a car while crossing the street. He is not alert and required immediate intubation at the scene by EMS. His GCS is 8 T. He appears to have a significant laceration of his scalp on the left side but there are no skeletal fractures. The initial chest x-ray revealed a right sided pneumothorax and a chest tube was inserted. His hematocrit is 23.5 and hemoglobin is 7.6. The next thing you would do is:

A. CT head B. CT abdomen C. Repeat blood work D. Observe patient - B. CT abdomen An 18 - year-old is thrown off his motorbike on a slippery road. At the scene, what is the first priority in the management of this patient? A. Assess vital signs B. Stabilize cervical spine C. Assess airway D. Start IV fluids - C. Assess airway An adult with a widened mediastinum might have which of the following? - Aortic dissection An investigational drug is being tried on health volunteers for its safety and pharmacokinetic properties. Which of the following stages in the drug development process does this scenario most closely describe? A. Phase I B. Phase II C. Phase III D. Phase IV - A. Phase I An unrestrained driver involved in a high speed MVA is transported by paramedics with c-spine precautions. GCS score is 7, but there is no obvious trauma. Respirations are shallow, and BVM is not providing adequate ventilation. Extremities are cool, and the pulses are thready. Prior to rapid sequence intubation, what should be done? A. Brief neurologic examination B. Immediate chin lift and jaw thrust maneuver C. Assess all vital signs D. Administer 4 - 5 quick tidal volume breaths with an FIO2 of 100% using a bag mask ventilatory device - D. Administer 4-5 quick tidal volume breaths with an FIO2 of 100% using a bag mask ventilatory device

Appropriate site for insertion of a subclavian line - - One centimeter inferior to the junctions of the middle and medial third of the clavicle

• One fingerbreadth lateral to the angle of the clavicle
• Inferior to the clavicle @ deltopectoral groove, lateral to the midclavicular line As a result of burn trauma, fluid shifts can cause hematocrit levels to A. Rise B. Fall C. Remain unchanged while hemoglobin levels drop D. Rise initially then fall dramatically - A. Rise Assessed first in trauma patient - Airway Associated with hypovolemic shock - - Inadequate tissue perfusion with resultant tissue hypoxia
• Blood shunting to vital organs
• Decreased circulating blood volume and decreased venous return
• Low cardiac output
• Loss of less than 20% of the blood volume is usually without symptom except for mild tachycardia
• Patients become orthostatic with losses between 20 and 40%
• Shock is evidenced by tachycardia, hypotension, oliguria, flat neck veins At what point should hyper oxygenation be administered when performing tracheal suctioning on a mechanically ventilated patient? A. Before the procedure B. After the procedure C. Before and after the procedure D. During the procedure - C. Before and after the procedure At which temperature would a hypothermic patient stop shivering? - 88 degrees F Basilar skull fracture - PE: raccoon eyes, battle sign, CSF ottorrhea (rhinorrhea), loculated pneumoencephalocele Bone MC involved = Temporal

Battle sign - (Mastoid ecchymosis) Etiology: fracture of middle cranial fossa of skull Posterior auricular = artery that causes the bruising Best assessment of fluid resuscitation of adult burn patient A. Urine output of 0.5 mL/kg/hr B. Normalization of BP C. Normalization of HR D. Measuring a normal central venous pressure E. Providing 4mL/kg/% body burned/24 hours crystalloid fluid - A. urine output of 0.5 mL/kg/hr Blood containing HIV that is spilled on the floor can be disinfected with which of the following? A. Benzene B. Sodium hypochlorite C. Iodine D. Penicillin - B. Sodium hypochlorite Blood group that is considered a universal donor - O Blood groups facts - - ABO compatibility is a must for renal transplant

• Febrile reactions may be due to bacterial contamination
• Citrate toxicity can cause hypocalcemia Blunt trauma to abdomen - - Result in rupture of hollow viscus
• Can cause hematoma in the duodenum
• May cause stress ulcers Bronchial intubation of the right or left mainstem bronchus can easily occur during infant endotracheal intubation because: A. The trachea is relatively short. B. The distance from the lips to the larynx is relatively short.

C. The use of cuffed endotracehal tubes eliminates this issue. D. The mainstem bronchi are less angulated in their relation to the trachea. E. So little friction exists between the endotracheal tube and the wall of the trachea. - A. The trachea is relatively short. Can be added to lidocaine to reduce the burning sensation when administered - Sodium bicarbonate Can occur during massive blood transfusions - - Dilutional thrombocytopenia

• Hypocalcemia
• Coagulation abnormalities NOT hypokalemia Carbon monoxide poisoning - PE: cherry red skin Cauda equina syndrome - - Bilateral sciatica
• Bowel dysfunction
• Saddle sensory changes Causes of heme-positive urine - Ingestion of blackberries, beets or phenolphthalein Central venous pressure is reflective of: - Pressure of blood returning to the heart Cerebral contusions - May happen opposite to the point of impact Cerebral edema treatment - Mannitol Head up position Hyperventilation Characteristics of early hemorrhagic shock - Cold skin Slow capillary refill Confusion NOT bradycardia

Class I hemorrhage indicates what percentage of blood loss? - 10% Class III hemorrhage indicates what % of blood loss - 35% Class IV hemorrhage indicates what % blood loss - 55% Clinical features associated with tension pneumothorax - Unilateral decrease in breath sounds Hyperresonance Respiratory distress Tachycardia Tracheal shift Desatruation Decreased breath sounds Decreased compliance Asymmetric chest movement NOT hypertension, audible bronchial sounds Clinical presentation of cardiogenic shock - - Hypotension

• Clammy skin
• Tachycardia
• Confusion Complications of head trauma - Intracerebral hematoma Extradural hematoma Brain abscess Concurrent injuries occur in which percentage of thoracic spine injuries? A. 6% B. 10% C. 21% D. 30% - B. 10% Confirmatory test that is a reliable indicator of brain death

A. Apnea test with a pCO2 less than 40 B. Electromyography C. 4 - vessel cerebral angiography D. CT scan of the brain - C. 4 - vessel cerebral angiography Considered a mechanically stable cervical spine injury - - Clay shoveler's fracture

• Simple wedge fracture not involving posterior elements
• Unilateral facet dislocation NOT flexion teardrop fracture Contributes to a low score on the Glasgow coma scale - Paralysis Low blood sugar Use of narcotics Crystalloid solutions - Ringer's lactate Dextrose 5% D5W plus 1/2 NS NOT albumin Dermatome level for nipple sensation Dermatome level for umbilicus - T T During an MVA, what is most likely injury to occur after knees strike the dashboard A. Fractured femur B. Fractured humerus C. Lacerated spleen D. None of the above - A. Fractured femur During CPR, the highest amount of blood flow is observed with which technique?
• High impulse CPR at 100 - 120 compressions per min

During neck trauma, which cervical disc is most likely to herniate?Mark one answer: A. C 1 - C B. C3-C C. C5-C D. C6-C7 - D. C6-C During resuscitation, your intubated patient's intravenous fluid infiltrates. You know that you may deliver the following drugs via the endotracheal tube: - Lidocaine Atropine Naloxone Epinephrine Earliest symptom of local anesthetic toxicity - Tongue and circumoral numbness Emergency decompression of the brain with a subdural hematoma should be evacuated if there is a midline shift of what amount? A. 1 mm B. 2 mm C. 5 mm D. 10 mm - C. 5 mm Epidural hematoma - MC due to injury of Middle meningeal artery Temporoparietal = area that has most epidural hematomas from trauma

• Can be intracranial or intraspinal (may follow LP)
• Often associated with skull fractures Facts concerning spine trauma - - 5% patients with brain injury have a spine injury
• 25% patients with spine injury have a brain injury
• 33% of patients with upper c-spine injuries die at the scene Fat embolism - MCC = bone fx

Clinical presentation

• Fever
• Petechial hemorrhage
• Desaturation
• Hypotension
• Altered mental status First parameter to change in patient's with hypovolemic shock? A. Systolic blood pressure B. Pulse rate C. Respiratory rate D. Skin vasoconstriction - B. Pulse rate First priority in the treatment of an unconscious patient - Checking the pulse First step taken to minimize thermal burn injury - Remove source of heat Flail chest - Mediastinum is pulled toward affected side during expiration Following a minor motor vehicle accident, a patient is experiencing pain and stiffness in her neck. Upon physical exam, she is able to rotate her neck greater than 55 degrees and denies paresthesias in the extremities. Which of the following is the next best step for this patient? A. Exercise therapy B. NSAIDs and rest C. Neck x-rays D. Narcotics - B. NSAIDs and rest Foot drop is caused by which of the following? A. Common peroneal nerve lesion B. Superficial peroneal nerve lesion C. Sciatic nerve D. Femoral nerve - A. Common peroneal nerve lesion For flail chest to occur... - 3 or more anterior and posterior rib fractures need to be present

For pediatric patients, what volume of fluid resuscitation should be given initially in the setting of shock? A. 750 mL of saline uniformly B. 1 liter of saline C. 20 mL/kg of 0.45% NaCl with 5% glucose D. 10 to 20 mL/kg of Ringers lactate - D. 10 to 20 mL/kg of Ringers lactate For the patient with severe traumatic brain injury, profound hypocarbia should be avoided to prevent: - cerebral vasoconstriction with diminished perfusion Head trauma in children - - Brain doubles in size in first 6 months of life and achieves 80% of adult size at 2 years of age

• Subarachnoid space is smaller and offers less protection to the brain because there is less buoyancy and momentum is more likely to cause parenchymal structural damage
• Cerebral blood flow increases to nearly twice adult levels by age 5, then decreases, placing children at greater risk of cerebral hypoxia and edema
• Children have a better outcome than adults who suffer brain injuries Hemothorax facts - - Must have at least 500 cc of blood to make a diagnosis on chest x-rayin an adult
• Incomplete evacuation of hemothorax can lead to empyema
• Initial treatment of hemothorax is always a chest tube How deep should the provider depress the patient's sternum during CPR in adults?
• 2 to 3 inches How does shivering affect body temperature - Increases body temperature How should epinephrine should be injected for treatment of anaphylaxis? - Intramuscularly (IM) into vastus lateralis How would a patient with a change in mental status would be triaged using the simple triage and rapid treatment (START)? A. Delayed B. Immediate

C. Minor D. Critical - B. Immediate Hypersensitivity is most commonly reported after use of which type of suture? A. Nylon B. Stainless steel wire C. Chromic catgut D. Silk - C. Chromic catgut Hypoxia - PE: cyanosis Can be rapidly measured with pulse ox If a trauma patient has clear fluid draining from the nose the provider should do which of the following? A. Tilt the head back B. Apply pressure C. Collect the fluid D. Insert nasal tampons - C. Collect the fluid Important landmark for location of second rib - Sternal angle In a 66 year old intubated, comatose patient, what is one of the most important information that one needs to obtain? A. Organ donation status B. Power of attorney C. Lawyer D. Driver's license - B. Power of attorney In a patient with a pneumothorax following a stab wound, the chest tube is best inserted at which level? - Between the 4th and 5th intercostal spaces, just anterior to the mid axillary line In a patient with head trauma, what indicates rising intracranial pressure (ICP)? - Pupillary dilation Wide pulse pressure

Rising BP In adults, an aspirated foreign body is most likely to get stuck in the: A. Left main bronchus B. Carina C. Right main bronchus D. Esophagus - C. Right main bronchus In comparison to the vocal cords, where is the laryngeal mask airway usually placed? A. Superior B. Inferior C. Adjacent D. Flush - A. Superior In head trauma, the majority of patients with post-traumatic CSF otorrhea: A. Need surgery B. Should be started on antibiotics C. Heal spontaneously D. Develop meningitis - C. Heal spontaneously In most adults, the spinal cord terminates at what vertebrae? - L1 In which of the following clinical contexts is an urgent, post-traumatic head CT NOT necessary? A. Individual with seizures B. Individual with a progressive headache C. Individual with an unreliable history D. Individual with a Glasgow coma scale score of 15 - D. Individual with a Glasgow coma scale score of 15 In which patients can an oropharyngeal airway be used? - Non-gag reflex In which situation should a femoral traction splint NOT be used? A. Hip dislocation B. Femur fracture

C. Ankle fracture D. Tibia fracture - A. Hip dislocation Increases ICP after head trauma - Meningitis Intracerebral bleed Cerebral edema Indication for emergency thoracotomy A. Pulmonary contusion B. Flail chest C. Hemothorax with initial blood loss of 700 cc D. Lung collapse with an air leak - D. Lung collapse with an air leak Indications for a CT scan of the head in trauma patients - - Glasgow coma scale score of less than 14

• Evidence of basilar skull fracture
• Amnesia lasting more than 30 minutes Intervention that can help prevent development of acute renal failure - Infusion of normal saline Laryngeal mask is usually seated over the which structure? A. Tonsils B. Esophagus C. Vallecula D. Pyriform fossa - D. Pyriform fossa Management of a stable patient with kidney contusion - Observation MC spine problem seen in patient's with Down syndrome - Atlanto-axial instability Minimal score on the Glasgow coma scale - 3 Most common cause of kidney injuries - Motor vehicle accidents Most common cause of laryngotracheal stenosis - Trauma

Most common Emergency Medical Services pediatric calls - - Seizures

• Respiratory problems
• Trauma Nerve + sensory relationships - C6 - Thumb C7 - Middle finger C8 - Little finger Nerve to muscle relationship - C5 - Deltoid C6 - Wrist extension C7 - Elbow extension Neurogenic pulmonary edema - Treatment
• Oxygenation
• Reduce ICP
• High PO2 Neuromuscular blocking agent works by depolarization - Succinylcholine Normal adult respiratory rate - 12 - 20 breaths per minute Normal capillary refill time - 2 seconds Not recommended as a mode of ventilation for a patient with a diaphragmatic hernia A. Bag and mask B. LMA C. Endotracheal intubation D. Jet ventilation - A. Bag and mask Patterns of injury seen in spinal cord trauma - - Central cord syndrome
• Anterior cord syndrome
• Brown-Sequard syndrome Pericardial tamponade - Muffled heart sounds

JVD

Equalization of cardiac chamber pressure NOT hypertension Pericardiocentesis is done by needle insertion through which of the intercostal spaces? - Fifth intercostal space Pharmacologic effects of Morphine - Behavioral changes Analgesia Respiratory depression NOT diarrhea Position patient should be transported in when patient complains of neck pain and is 32 weeks pregnant - Supine on a backboard with her right hip elevated Principle that most closely aligns with the oath, "Do no harm." - Nonmaleficence Prior to tracheobronchial suctioning, the patient should receive: A. 5cc normal saline lavage B. Be placed on NPO status C. 100% oxygen prior to suctioning D. Versed 1 mg/mL - C. 100% oxygen prior to suctioning Reason epinephrine is added to local anesthetics - Prolongs its action Scapular fracture - - Usually requires a tremendous force to fracture

• May be uneasily visible on plain xray
• Treatment requires prolonged immobilization
• Usually associated with other chest injuries Sellick maneuver - Minimizes the chances of regurgitation during intubation Should be avoided in patient with suspected nasal fracture - Nasal intubation