ATLS EXAM QUESTIONS AND ANSWERS 2022/2023 ALL ANSWERS CORRECT.BEST GRADED A+ FOR NURING, Exams of Nursing

Download ATLS EXAM QUESTIONS AND ANSWERS 2022/2023 ALL ANSWERS CORRECT.BEST GRADED A+ FOR NURING and more Exams Nursing in PDF only on Docsity! ATLS EXAM QUESTIONS AND ANSWERS 2022/2023 ALL ANSWERS CORRECT.BEST GRADED A+ FOR NURING 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 initial fluid resuscitation 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. A tube thoracostomy is performed for decreased left chest 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: - CORRECT ANSWERS re-examine the chest 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: - CORRECT ANSWERS complete spine x-ray series What is true regarding the initial resuscitation of a trauma patient? - CORRECT ANSWERS Evidence of improved perfusion after fluid resuscitation could include improvement in Glasgow Coma Scale score on reevaluation In managing a patient with a severe traumatic brain injury, the most important initial step is to: - CORRECT ANSWERS secure the airway A previously healthy, 70-kg (154-pound) man suffers an estimated acute blood loss of 2 liters. What applies to this patient? - CORRECT ANSWERS An ABG would demonstrate a base deficit between -6 and -10 mEq/L. The physiological hypervolemia of pregnancy has clinical significance in the management of the severely injured, gravid woman by: - CORRECT ANSWERS increasing the volume of blood loss to produce maternal hypotension. The best assessment of fluid resuscitation of the adult burn patient is: - CORRECT ANSWERS urinary output of 0.5 mL/kg/hr ATLS EXAM QUESTIONS AND ANSWERS 2022/2023 ALL ANSWERS CORRECT.BEST GRADED A+ FOR NURING The diagnosis of shock must include: - CORRECT ANSWERS evidence of inadequate organ perfusion A 7-year-old boy is brought to the emergency department by his parents several minutes after he fell through a window. He is bleeding profusely from a 6-cm wound of his medial right thigh. Immediate management of the wound should consist of: - CORRECT ANSWERS direct pressure on the wound For the patient with severe traumatic brain injury, profound hypocarbia should be avoided to prevent: - CORRECT ANSWERS cerebral vasoconstriction with diminished perfusion 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: - CORRECT ANSWERS perform an exploratory laparotomy What statements regarding abdominal trauma in the pregnant patient is TRUE? - CORRECT ANSWERS Leakage of amniotic fluid is an indication for hospital admission. The first maneuver to improve oxygenation after chest injury is: - CORRECT ANSWERS administer supplemental oxygen A 25-year-old man, injured in a motor vehicular crash, is admitted to the emergency department. His pupils react sluggishly and his eyes open to pressure. He does not follow commands, but he does moan periodically. His right arm is deformed and does not respond to pressure; however, his left hand reaches purposefully toward the stimulus. Both legs are stiffly extended. His GCS score is: - CORRECT ANSWERS 9 ATLS EXAM QUESTIONS AND ANSWERS 2022/2023 ALL ANSWERS CORRECT.BEST GRADED A+ FOR NURING 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: - CORRECT ANSWERS suction the oropharynx A 22-year-old man sustains a gunshot wound to the left chest and is transported to a small community hospital no surgical capabilities are 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 heart rate increases to 136 beats per minute. The next step should be to: - CORRECT ANSWERS repeat the primary survey and proceed with transfer A 64-year-old man involved in a high-speed car crash, is resuscitated initially in a small hospital without surgical capabilities. He has a closed head injury with a GCS score of 13. He has a widened mediastinum on chest x-ray with fractures of left ribs 2 through 4, but no pneumothorax. After initiating fluid resuscitation, his blood pressure is 110/74 mm Hg, heart rate is 100 beats per minute, 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: - CORRECT ANSWERS call the receiving hospital and speak to the surgeon on call Hemorrhage of 20% of the patient's blood volume is associated usually with - CORRECT ANSWERS tachycardia What statement concerning intraosseous infusion is TRUE? - CORRECT ANSWERS Aspiration of bone marrow confirms appropriate positioning of the needle. 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 ATLS EXAM QUESTIONS AND ANSWERS 2022/2023 ALL ANSWERS CORRECT.BEST GRADED A+ FOR NURING 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 - CORRECT ANSWERS avoid hypotension A 33-year-old woman is involved in a head-on motor vehicle crash. It took 30 minutes to extricate her from the car. Upon arrival in the emergency department, her heart rate is 120 beats per minute, BP is 90/70 mm Hg, respiratory rate is 16 breaths per minute, and her GCS score is 15. Examination reveals bilaterally equal breath sounds, anterior chest wall ecchymosis, and distended neck veins. Her abdomen is flat, soft, and not tender. Her pelvis is stable. Palpable distal pulses are found in all 4 extremities. Of the following, the most likely diagnosis is: - CORRECT ANSWERS cardiac tamponade 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). What mandates prompt celiotomy (laparotomy)? - CORRECT ANSWERS development of peritonitis on physical exam A 40-year-old woman who was a restrained driver in a motor vehicle crash is evaluated in the emergency department. She is hemodynamically normal and found to be paraplegic at the level of T10. What precaution should be taken during evaluation and management? - CORRECT ANSWERS Log rolling using 4 people is a safe approach to restrict spinal motion when moving her. 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: - CORRECT ANSWERS restrict cervical motion and establish a definitive airway When applying the Rule of Nines to infants - CORRECT ANSWERS The head is proportionally larger in infants than in adults ATLS EXAM QUESTIONS AND ANSWERS 2022/2023 ALL ANSWERS CORRECT.BEST GRADED A+ FOR NURING A healthy young male is brought to the emergency department following a motor vehicle crash. His vital signs are a blood pressure of 84/60, pulse 123, GCS 10. The patient moans when his pelvis is palpated. After initiating fluid resuscitation, the next step in management is: - CORRECT ANSWERS placement of a pelvic binder What situations requires Rh immunoglobulin administration to an injured woman? - CORRECT ANSWERS positive pregnancy test, Rh negative, and has torso trauma A 22-year-old female athlete is stabbed in her left chest at the third interspace in the anterior axillary line. On admission to the emergency department and 15 minutes after the incident, she is awake and alert. Her heart rate is 100 beats per minute, blood pressure 80/60 mm Hg, and respiratory rate 20 breaths per minute. A chest x-ray reveals a large left hemothorax. A left chest tube is placed with an immediate return of 1600 mL of blood. The next management step for this patient is: - CORRECT ANSWERS prepare for an exploratory thoracotomy 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). What's true about this patient? - CORRECT ANSWERS A pulmonary contusion may be present in the absence of rib fractures. Adjuncts used during the primary survey - CORRECT ANSWERS ECG Pulse ox CO2 monitoringV Ventilatory rate ABGs Foleys (UOP) Gastric catheter ATLS EXAM QUESTIONS AND ANSWERS 2022/2023 ALL ANSWERS CORRECT.BEST GRADED A+ FOR NURING Hospital preparation for trauma - CORRECT ANSWERS Resuscitation area Airway équipement Warmed IV crystalloid solution Monitoring devices Protocol for requesting additional assistance Transfer agreements Primary survey - CORRECT ANSWERS Airway maintenance with restriction of cervical spine motion Breathing Circulation Disability Exposure/Environmental control Patients with maxillofacial or head trauma should be presumed to have - CORRECT ANSWERS A cervical pine injury and cervical spine motion must be restricted PITFALL: equipment failure - CORRECT ANSWERS Test regularly Ensure spare equipment and batteries are readily available PITFALL: unsuccessful intubation - CORRECT ANSWERS Identify patients with difficult anatomy Identify the most experienced/skilled airway manager on team Ensure appropriate equipment is available Be prepared to prefer a surgical airway ATLS EXAM QUESTIONS AND ANSWERS 2022/2023 ALL ANSWERS CORRECT.BEST GRADED A+ FOR NURING PITFALL: progressive airway loss - CORRECT ANSWERS Recognize the dynamic status of the airway Recognize the injuries that can result in progressive airway loss Frequently reassess the patient for signs of deterioration of the airway In a trauma patient with hypotension, what are the two most important causes to consider in order of importance? - CORRECT ANSWERS Tension pneumothorax Hemorrhage What is the best way to manage rapid external blood loss? - CORRECT ANSWERS Direct manual pressure on the wound What are the major areas of internal hemorrhage? - CORRECT ANSWERS Chest Abdomen Retroperitoneum Pelvis Long bones How should fluids be administered in trauma patients with shock? - CORRECT ANSWERS Warm IVFs If unresponsive to initial IVF, give blood transfusion immediately What are the uses for ETCO2? - CORRECT ANSWERS Detect ROSC Confirm ET intubation Help avoid hypoventilation and hyperventilation ATLS EXAM QUESTIONS AND ANSWERS 2022/2023 ALL ANSWERS CORRECT.BEST GRADED A+ FOR NURING You'd like to insert a foley catheter for a trauma patient but you notice urethras injury. What test should be performed prior to the insertion of a urinary catheter? - CORRECT ANSWERS Retrograde urethrogram DDX for blood in gastric aspirate in a trauma patient - CORRECT ANSWERS Swallowed blood Traumatic gastric tube placement UGI injury What's a C/I to NGT insertion? - CORRECT ANSWERS Fracture of the cribriform/midface fracture (insert OG instead) What injuries are at high risk of compartment syndrome in trauma patients? - CORRECT ANSWERS Long bones Crush injuries Circumferential thermal burns Prolonged ischemia to the limb What's normal UOP? - CORRECT ANSWERS Adult: 0.5 ml/kg/hr Child: 1-2 ml/kg/hr MIST for obtaining info from EMS - CORRECT ANSWERS Mechanism and time of injury Injuries found and suspected Symptoms and signs Treatment initiated Retroperitoneal organs - CORRECT ANSWERS Abdominal aorta ATLS EXAM QUESTIONS AND ANSWERS 2022/2023 ALL ANSWERS CORRECT.BEST GRADED A+ FOR NURING Side impact MVC - CORRECT ANSWERS Contralateral neck sprain Head injury Cervical spine fracture Flail chest Pneumothorax Traumatic aortic disrution Diaphragmatic rupture Fractured spleen/liver/kidney Fractured pelvis or acetabulum Rear impact MVC - CORRECT ANSWERS Cervical spine injury Head injury Soft tissue injury to neck MVC vs pedestrian - CORRECT ANSWERS Head injury Traumatic aortic disruption Abdominal visceral injuries Fractured lower extremities/ pelvis Fall from heigh - CORRECT ANSWERS Head injury Axial spine injury Abdominal visceral injuries Fractured pelvis or acetabulum Bilateral LE fractures Anterior stab wound - CORRECT ANSWERS Cardiac tamponade ATLS EXAM QUESTIONS AND ANSWERS 2022/2023 ALL ANSWERS CORRECT.BEST GRADED A+ FOR NURING Hemothorax Pneumothorax Hemopneumothorax Left stab wound - CORRECT ANSWERS Left diaphragm injury Spleen injury Hemopneumothoax Abdomen stab wound - CORRECT ANSWERS Visceral injury Extremity GSW - CORRECT ANSWERS Neurovascular injury Fractures Compartment syndrome Thermal burns - CORRECT ANSWERS Eschar on extremities or chest Electrical burns - CORRECT ANSWERS Cardiac arrhythmias Myonecrosis Compartment syndrome Inhalation burns - CORRECT ANSWERS CO poisoning Upper airway swelling Pulmonary edema What is your first step when a patient condition changes? - CORRECT ANSWERS ABCDEs ATLS EXAM QUESTIONS AND ANSWERS 2022/2023 ALL ANSWERS CORRECT.BEST GRADED A+ FOR NURING What's the importance of meticulous record keeping? - CORRECT ANSWERS Crucial during patient assessment and management because often more than one clinician cares for an individual patient and allows those to evaluate the patient's needs and clinical status What info should be provided to the receiving facility for a transferring patient? - CORRECT ANSWERS As much info as possible! Event of injury, patient exam, treatments done, responses of treatments, tests and results, and possible injuries What key information should prehospital providers obtain and report to the receiving hospital? - CORRECT ANSWERS Events associated with injury What patient sign can be quickly observed to assess a patient's hemodynamic status? - CORRECT ANSWERS Skin perfusion Definitive airway - CORRECT ANSWERS A tube placed in the trachea with the cuff inflated below the vocal cords, the tube connected to a form of oxygen- enriched assisted ventilation and the airway secured in place with an appropriate stabilizing method What's critical management for trauma patients, especially those with sustained head injuries? - CORRECT ANSWERS Maintaining oxygenation and printing hypercarbia Triad of largyneal fracture - CORRECT ANSWERS Hoarseness Subcutaneous emphysema Palpable fracture ATLS EXAM QUESTIONS AND ANSWERS 2022/2023 ALL ANSWERS CORRECT.BEST GRADED A+ FOR NURING On exam, an unrestrained driver is hoards and has minimal subcutaneous neck emphysema. This patient likely has a/an - CORRECT ANSWERS Obstructed airway In an agitated trauma patient who refuses to lay down - CORRECT ANSWERS Assessment of airway adequacy may include suctioning What's an indication for rapid sequence intubation? - CORRECT ANSWERS Patients who need airway control, have intact gag reflex, especially those who have sustained head injury A surgical airway is indicated in the presence of - CORRECT ANSWERS Edema of the glottis Fracture of larynx Severe oropharyngeal hemorrhage that obstructs airway Inability to place an endotracheal tube Possible causes of confusion after traumatic event? - CORRECT ANSWERS Hemorrhage Brain injury Stroke Intoxication What's the most common cause of shock after an injury? - CORRECT ANSWERS Hemorrhage What're the early clinical manifestations of shock? - CORRECT ANSWERS Tachycardia and cutaneous vasoconstriction ATLS EXAM QUESTIONS AND ANSWERS 2022/2023 ALL ANSWERS CORRECT.BEST GRADED A+ FOR NURING What's the preferred method of vascular access for a patient involved in a MVC? - CORRECT ANSWERS 2 large bore PIVs in the antecubital veins What's the most appropriate means to restore cardiac output and end organ perfusion in hemorrhagic shock? - CORRECT ANSWERS Stopping the source of bleeding and ensuring appropriate volume repletion A 24-year-old male arrives in ED already intubated. He has significant crepitus of the right chest wall and diminished breath sounds. You place a chest tube and note a large amount of bubbling in the water seal chamber. His O2 saturation remains at 85% and he has goodCO2 return on capnography. The most likely cause of his low oxygen saturation is - CORRECT ANSWERS Tracheobronchial tree injury Most injuries to the tracheobronchial tree occur where? - CORRECT ANSWERS Within 2.5 cm from the carina Do the vast majority of thoracic injuries (blunt and penetrating) require operative intervention? - CORRECT ANSWERS No, most are treated with technical procedures Airway thoracic injuries - CORRECT ANSWERS Airway obstruction (laryngeal injury, posterior dislocation of clavicular head, or penetrating trauma) Tracheobronchial tree injury Breathing thoracic injuries - CORRECT ANSWERS Tension pneumothorax Open pneumothorax Massive hemothorax ATLS EXAM QUESTIONS AND ANSWERS 2022/2023 ALL ANSWERS CORRECT.BEST GRADED A+ FOR NURING Circulation thoracic injuries - CORRECT ANSWERS Massive hemothorax Cardiac tamponade Traumatic circulatory arrest What's the most common cause of a tension pneumothorax? - CORRECT ANSWERS Mechanical positive-pressure ventilation in patients with a visceral pleural inury Where is the ideal location for needle decompression of a tension pneumothorax? - CORRECT ANSWERS 5th intercostal space, slightly anterior to midaxillary line What do you need to remember when treating an open pneumothorax? - CORRECT ANSWERS Place a dressing on the site and only secure is on 3 sides so air can escape, then place a chest tube Massive hemothorax - CORRECT ANSWERS Accumulation of >1500 ml of blood in one side of chest Causes of PEA? - CORRECT ANSWERS Hypovolemia Hypoxia Hydrogen acidosis Hypo/hyperkalemia Hypoglycemia Hypothermia Toxins Tamponade Tension pneumo Thrombosis ATLS EXAM QUESTIONS AND ANSWERS 2022/2023 ALL ANSWERS CORRECT.BEST GRADED A+ FOR NURING Why are rib fractures in older adults a more significant concern than in young patients? - CORRECT ANSWERS The incidence of PNA and mortality is doubled in older patients Pulmonary contusion/flail chest is best treated by? - CORRECT ANSWERS Supplemental oxygen, pain control, and recognition if the patient is unable to ventilate properly The cause of hypoxia associated with flail chest is - CORRECT ANSWERS Pulmonary contusion A patient arrives in your hospital after a fall from 20 ft landing on his right side. He has been intubated and two large-bore IVs have been started. His o2 sat is 82%, he has a good capnography waveform, and significant deformity to right chest wall. He has no breath sounds on the right. His BP is 75/30. Your next step should be to - CORRECT ANSWERS Perform a needle decompression or finger throacostomy on the right side You have completed a secondary survey on a patient who feel from a standing height. You note exquisite tenderness posterolaterally on the left chest wall at 9-11 ribs. This should raise suspicion for what other injury? - CORRECT ANSWERS Splenic injury A patient's CXR reveals left pneumothorax. Additionally, the left diaphragm is obscured and there is an air fluid level in the left hemithorax. You decide to place a chest tube. The patient is at increased risk for damage to - CORRECT ANSWERS Abdominal contents that have become displaced into the chest cavity Stab wounds most commonly injury? - CORRECT ANSWERS Liver (40%) Small bowel (30%) Diaphragm (20%) ATLS EXAM QUESTIONS AND ANSWERS 2022/2023 ALL ANSWERS CORRECT.BEST GRADED A+ FOR NURING Colon (15%) Gunshot wounds most commonly injury? - CORRECT ANSWERS Small bowel (50%) Colon (40%) Liver (30%) Abd vascular structures (25%) When is a retrograde urethrogram mandatory? - CORRECT ANSWERS Patient is unable to void, requires pelvic binder, or has blood at the meatus, scrotal hematoma, or perineal ecchymosis A 28-year-old male, helmeted motorcyclist was in a high speed MVC, striking head-on into the side of a vehicle. He arrives on a backboard and with a cervical collar in place via pre-hospital BLS transport. Vitals are: BP 100/75, HR 115, RR 20, GCS 15. The patient reports a brief loss of consciousness and is complaining of pain in the chest, abdomen, and pelvis. What're the priorities for management? - CORRECT ANSWERS Rapidly assess ABCs Auscultate the lungs, provide supplemental oxygen, and apply pulse ox A 28-year-old male, helmeted motorcyclist was in a high speed MVC, striking head-on into the side of a vehicle. He arrives on a backboard and with a cervical collar in place via pre-hospital BLS transport. Vitals are: BP 100/75, HR 115, RR 20, GCS 15. The patient reports a brief loss of consciousness and is complaining of pain in the chest, abdomen, and pelvis. What's the interpretation of the VS and the initial therapy? - CORRECT ANSWERS VS are consistent with hemorrhagic shock from intraabdominal or pelvic sound Maintain IV/IO access and initiate volume resuscitation, including blood transfusion if indicated Pelvic binder application may be appropriate ATLS EXAM QUESTIONS AND ANSWERS 2022/2023 ALL ANSWERS CORRECT.BEST GRADED A+ FOR NURING Will retroperitoneal injuries prevent with obvious signs of peritoneal irritation? - CORRECT ANSWERS No, retroperitoneal structures are separated from anterior peritoneum by the intraperitoneal viscera, therefore no peritonitis may be present A patient was found 10' from his motorcycle, laying on his right side. He was wearing a helmet. He was going ~45 mph. He had brief LOC. He states he has no allergies, medications that he takes, no current illness. Last meal was 6 hours ago. Based on mechanism, what intra-abdominal and/or pelvic injuries is he likely to have sustained? - CORRECT ANSWERS Visceral lacerations (liver/spleen) Bowel visceral/vascular injuries Retroperitoneal visceral/vascular injuries (kidneys/adrenal) Pelvic fractures A patient was found 10' from his motorcycle, laying on his right side. He was wearing a helmet. He was going ~45 mph. He had brief LOC. He states he has no allergies, medications that he takes, no current illness. Last meal was 6 hours ago. How would the risk of intra-abdominal injury change if the patient described stroking the handlebar into the epigastrium? - CORRECT ANSWERS A direct blow to the epigastrium would raise the risk of a pancreas, duodenal, or small bowel injury A 30-year-old male presents with a 2 cm stab wound to the mid-abdomen, 3 cm to the right of the umbilicus. VS are BP 85/60, HR 130, RR 25, GCS 14. Neck veins are flat. Chest exam is CTAB. The abdomen is tender. What's the ONE BEST therapy to treat this patient's injury? - CORRECT ANSWERS Airway appears intact. Breathing has increased rate. Circulation demonstrated hemorrhagic shock. Penetrating abdominal injury with shock is one of the indications for emergent laparotomy. In a patient with a possible pelvic fracture, how frequently should the pelvis be tested for mechanical stability? - CORRECT ANSWERS The pelvis should not be ATLS EXAM QUESTIONS AND ANSWERS 2022/2023 ALL ANSWERS CORRECT.BEST GRADED A+ FOR NURING What are the signs that the patient's injury is progressing? - CORRECT ANSWERS Decreased GCS indicates worsening intracranial pathology with possible intracranial HTN and impending herniation A 78-year-old ale is found down in the bathroom with a large left scalp laceration from striking the corner of the sink. He arrives in the ED with a BP 180/90, HR 60, dilated, non-responsive right pupil. The most likely finding on the patient's CT scan will be - CORRECT ANSWERS Illustrtive of impending uncle hernia associated with Cushing response (high BP + bradycardia)-- associated with a large subdural hematoma with midline shift Intracranial mass effect is defined by the - CORRECT ANSWERS Monro-Kellie Doctrine A trauma patient opens her eyes, moans, and withdraws from pain. What is her GCS score? - CORRECT ANSWERS Eye opening: 2 Verbal response: 2 Best motor response: 4 Total = 8 A 48-year-old female falls from a balcony. She was witnessed striking her head on the steps after an ~8' fall. The patient briefly lost consciousness and is found confused, lying at the bottom of the steps. Her eyes are open, and she is rubbing her forehead. The most important finding related to this patient's long- term outcome is - CORRECT ANSWERS GCS score A 56-year-old male repeats questions, his eyes are open, and he moves to command - CORRECT ANSWERS GCS 14 A 17-year-old female was struck by a vehicle while crossing the road. Upon arrival she is moaning, her eyes open, and she withdraws to painful stimuli - CORRECT ANSWERS GCS 8 ATLS EXAM QUESTIONS AND ANSWERS 2022/2023 ALL ANSWERS CORRECT.BEST GRADED A+ FOR NURING A 82-year-old female was found home by family. Her eyes are closed, she extends to pain, and is not speaking - CORRECT ANSWERS GCS 4 A 63-year-old male fell off a ladder. Witnesses report loss of consciousness. His eyes open to voice, he localizes to pain, and has garbled speech - CORRECT ANSWERS GCS 11 What types of intracranial hemorrhage can be identified on CT scan? - CORRECT ANSWERS Epidural Sudural Intra-ventricular Subarachnoid Intra-parenchymal What CT scan findings are indicative of severe head injury that may require intervention? - CORRECT ANSWERS Midline shift (> 5mm), loss of definition of the basil cisterns, and severe skull fractures with intrusion into the brain matter A 70-year-old female falls at home and strikes her head on the bathtub. She is found down by her granddaughter ~6 hours later. GCS is 8: eye opening 2, verbal 2, motor 4. She is intubated for airway protection upon arrival in the trauma bay. What preexisting patient characteristics should you consider that may affect this patient's outcome? - CORRECT ANSWERS Current anti platelet therapy, beta blockade, and anticoagulation What is the purpose of intubation in a comatose patient? - CORRECT ANSWERS Prevent hypoxia and secondary brain injury occurs with a protection of the airway ATLS EXAM QUESTIONS AND ANSWERS 2022/2023 ALL ANSWERS CORRECT.BEST GRADED A+ FOR NURING Ancillary studies to confirm brain death? - CORRECT ANSWERS EEG: no activity at high gain CBF studies Cerebral angiography Diagnosing brain death - CORRECT ANSWERS GCS = 3 Nonreactive pupils Absent brainstem reflexes (oculocephalic corneal, doll's eyes, and no gag reflex) No spontaneous ventilatory effect on formal apnea testing Absence of confounding factors such as alcohol or drug intoxication or hypothermia What are the initial management options for mild brain injury? - CORRECT ANSWERS Monitoring isnt' required but know long-term effects can manifest over time What are the initial management options for moderate brain injury? - CORRECT ANSWERS Monitoring for decompensation is important and requires hospital admission, ongoing neurologic exam, possible further CT imaging What are the initial management options for severe brain injury? - CORRECT ANSWERS Requires a center with neurosurgical support and associated aggressively treat intracranial swelling, osmotic intravascular fluid management, and rapid surgical intervention A CT scan reveals intracranial hemorrhage and swelling with collapse of the 3rd and 4th cventricles and impending uncle herniation. What treatment measures are appropriate? - CORRECT ANSWERS Mannitol, hypertonic saline, and phenytoin are initial management of intracranial HTN ATLS EXAM QUESTIONS AND ANSWERS 2022/2023 ALL ANSWERS CORRECT.BEST GRADED A+ FOR NURING elbow. He is able to feel his fingers and thumbs bilaterally, but not feel anything above his elbow. Where is the suspected spine lesion? - CORRECT ANSWERS C6 or C7 The patient is unable to move his legs. He can move his fingers and wrists bilaterally. He has weal triceps extension on the left. He is unable to move right elbow. He is able to feel his fingers and thumbs bilaterally, but not feel anything above his elbow. Why is there a difference b/t the PW findings for the UE on PE? - CORRECT ANSWERS The difference between the PE findings for the UE is likely due to initial inflammatory response, edema, and/or the presence of an incomplete spinal cord injury. Spinal cord injuries can be defined by neurologic level and severity in addition to associated syndromes and morphology. Describe Brown-Sequard syndrome lesion at T5. - CORRECT ANSWERS T5, penetrating injury to one side (partial) Which type of thoracic spinal fracture is associated with MVC with restrained passengers using lap belt, a forward flexion mechanism, likely visceral organ injury, and frequent need for internal fixation? - CORRECT ANSWERS Chance fracture What's the appropriate treatment for a C6 vertebral body fracture - CORRECT ANSWERS Spinal immobilization and IVFs, followed by vasopressors if patient remains bradycardic after fluids A patient with a known cervical spine fracture who is being transferred from a rural hospital to definitive care should be transported in which way? - CORRECT ANSWERS Semi-regid collar and head restraint Patients with cerviacl fractures above C6 require special consideration prior to transportation due to? - CORRECT ANSWERS Potential progression to respiratory failure ATLS EXAM QUESTIONS AND ANSWERS 2022/2023 ALL ANSWERS CORRECT.BEST GRADED A+ FOR NURING A 35-year-oldman was ejected from a MV. On arrival, his VS are BP 80/40, HR 110,RR 24, GCS 15. Airway and breathing are intact. He complains of severe back pain, has no sensation below umbilicus, has lower thoracic tenderness, and is unable to move LE. Chest and pelvic X-rays are normal. Along with IVFs, what is most appropriate treatment for this patient's hypotension? - CORRECT ANSWERS Although this patient likely has a spinal cord injury, perform a FAST exam or DPL to r/o other etiology. An elderly female falls and sustains a hyperextension injury to her neck. Her exam demonstrated decreased strength in UE compared to LE. What is the cause of her unusual neurologic findings? - CORRECT ANSWERS Central cord syndrome What's the most common location of all spinal injuries? - CORRECT ANSWERS C5 A 40-year-old M involved in a MVC is evaluated in a rural hospital without spine surgical capacity. The patient has a clear C-spine fracture at C4 on plain film and the inability to move any extremities and sensation limited to supraclavicular region. He is having difficulty breathing with a RR 30. BP 80/40 and HR 50. What should be performed prior to transfer? - CORRECT ANSWERS Crystalloid bolus, initiate pressers, intubate, and then transfer patient once he is hemodynamically stable Potentially life threatening extremity injuries - CORRECT ANSWERS Marjor arterial hemorrhage Bilateral femoral fractures Crush syndrome Rhabdomyolysis can lead to - CORRECT ANSWERS Metabolic acidosis Hyperkalemia Hypocalcemia ATLS EXAM QUESTIONS AND ANSWERS 2022/2023 ALL ANSWERS CORRECT.BEST GRADED A+ FOR NURING Disseminated intravascular coagulation (DIC) A 38-year-old female restrained driver is involved in a high-speed, head-on collision with a truck. Following a prolonged extrication, she noted to have deformity of her right thigh. On arrival, her VS are HR 120, BP 90/50, RR 22, GC 15. 2 large bore IVs are inserted in UE. VS are now HR 13- BP 80/40, RR 24, GCS 14. CXR, pelvis X-ray, and FAST are negative. You suspect the source of hypotension is a femur fracture and bilateral tibial shaft fractures. How much blood loss would you expect from this patient's extremity injuries and what's the best way to control it? - CORRECT ANSWERS A femur fracture can result in blood loss up to 2 L and each tibial fracture can cause up to 1.5 L of blood loss. Fracture immobilization is the best control. How should femur and tibial shaft fractures be stabilized? - CORRECT ANSWERS A traction splint should NOT be used. Tibial fracture should be placed in a long leg splint. A femur and tibial fracture should be placed in a long leg posterior splint. Open fractures should be covered with moist saline gauze before placed in splint. Neurovascular exams should be performed before and after splint placement Extremity bleeding control order - CORRECT ANSWERS 1) Manual pressure to the wound 2) Pressure dressing 3) Compression of the artery proximal to the injury 4) Tourniquet application Cold, pale, pulseless extremity - CORRECT ANSWERS Interrupted arterial blood supply Rapidly expanding hematoma - CORRECT ANSWERS Significant vascular injury ATLS EXAM QUESTIONS AND ANSWERS 2022/2023 ALL ANSWERS CORRECT.BEST GRADED A+ FOR NURING When should IV antibiotics be given to patients with open fractures? - CORRECT ANSWERS All patients with an open fracture should receive IV antibiotics A 22-year-old female presents after jumping from the 3rd story of a building in a suicide attempt. She's stable, but GCS is 13. Both ankles are swollen. Her pulses intact. Initial chest and pelvis films are normal. Ankle films reveal bilateral calcanea fracture. What additional work-ip is important to undertake in this patient? - CORRECT ANSWERS Radiographic work-up of the spine to rule out occult injury What's true about tourniquets? - CORRECT ANSWERS It must occlude arterial inflow Musculoskeletal adjuncts to the primary survey may include? - CORRECT ANSWERS Proper application of a splint can help control blood loss, reduce pain, and prevent further neurovasculr compromise ABLS indications for early intubation - CORRECT ANSWERS Signs of airway obstruction TBSA > 40-50% Extensive and deep facial burns Burns inside the mouth Significant edema or risk for edema Difficulty swallowing Signs of respiratory compromise Decreased LOC Anticipated patient transfer of large burn with airway issue without qualified personnel to intake en route ATLS EXAM QUESTIONS AND ANSWERS 2022/2023 ALL ANSWERS CORRECT.BEST GRADED A+ FOR NURING Parkland formula - CORRECT ANSWERS 2-4 ml of LR x patient's weight (kg) x % TBSA for 2nd and 3rd degree burns with 1/2 administered in the 1st 8h and the 2nd 1/2 administered during the subsequent 16h Simplest way to remove tar from trauma patient? - CORRECT ANSWERS Mineral oil Reperfusion syndrome - CORRECT ANSWERS Indicated by acidosis, hyperkalemia, and local swelling; therefore monitor the patient's cardiac status and peripheral perfusion during rewarming Immediate lifesaving measures for patients with burn injuries - CORRECT ANSWERS Stopping the burn process Recognize inhalation injury Assuring an adequate airway Oxygenation and ventilation Rapidly initiating IVF What's the most significant difference between burns and other injuries? - CORRECT ANSWERS The consequence of a burn injury are directly linked to the extent of the inflammatory response to the injury A 29-year-old M jumps from the 1st story of a burning house. His clothes are on fire. Bystanders extinguished the flames. He is conscious, agitated, and complaining of abdominal and leg pain. The patient's head and upper body appear to be extensively burned. What are the unique considerations that a burn injury adds to the initial management of this patient? - CORRECT ANSWERS Some interventions to be considered are early intubation and initiation of burn resuscitation. ATLS EXAM QUESTIONS AND ANSWERS 2022/2023 ALL ANSWERS CORRECT.BEST GRADED A+ FOR NURING What is the primary difference b/t the presentation of airway injury in patients with burns compared to other forms of trauma? - CORRECT ANSWERS Airway injury can develop over time due to edema from burn injury How does hypovolemia from burn injury differ from hypovolemia from other forms of trauma? - CORRECT ANSWERS Other trauma usually result in hemorrhagic volume loss, however burn hypovolemia is due to inflammatory changes and capillary leak When do you provide burn resuscitation? - CORRECT ANSWERS Deep partial and full thickness burns larger than 20% TBSA A 29-year-old M jumps from the 1st story of a burning house. His clothes are on fire. Bystanders extinguished the flames. He is conscious, agitated, and complaining of abdominal and leg pain. The patient's head and upper body appear to be extensively burned. The patient is now intubated with IV access. A foley is placed with minimal dark urine output. The estimate of burn size is 45% TBSA. How should the patient's burn wound be managed in the initial stages? - CORRECT ANSWERS ABC management in addition to stopping the burning process, cleansing the wound, protecting it from infection, and preventing hypothermia What is the goal of burn resuscitation? - CORRECT ANSWERS To maintain end- organ perfusion in the context of ongoing intravascular fluid loss What info should be recorded on the trauma flow sheet? - CORRECT ANSWERS Depth and extent of burn Fluids given UOP Any significant interventions, including escharotomies ATLS EXAM QUESTIONS AND ANSWERS 2022/2023 ALL ANSWERS CORRECT.BEST GRADED A+ FOR NURING Burn shock is a result of? - CORRECT ANSWERS Interstitial loss due to inflammation The immediate treatment of electrical injury consists of? - CORRECT ANSWERS Maintaining UOP of 100 ml/hr What're the leading causes of unsuccessful resuscitation in pediatric patients with severe trauma? - CORRECT ANSWERS Failure to secure a compromised airway Failure to support breathing Failure to recognize and respond to intra-abdominal and intracranial hemorrhage A 3-year-old falls 10 meters out of an apartment window onto pavement. He does not open his eyes, moans incomprehensibly, and extending abnormally when stimulated. The patient is unresponsive on arrival to the ED, and pupils are unequal. He has blood coming from his right ear, is breathing rapidly, and is pale, with mottled extremities. VS are BP 74/57,HR 156, RR 49. What steps and maneuvers would you use to manage this patient's airway? - CORRECT ANSWERS Maintain airway with chin-lift and jaw-thrust with assisted ventilation using bag mask with placement of laryngeal mask or ETT A 3-year-old falls 10 meters out of an apartment window onto pavement. He does not open his eyes, moans incomprehensibly, and extending abnormally when stimulated. The patient is unresponsive on arrival to the ED, and pupils are unequal. He has blood coming from his right ear, is breathing rapidly, and is pale, with mottled extremities. VS are BP 74/57,HR 156, RR 49. Is this child in shock? - CORRECT ANSWERS Yes (tachycardia, mottled extremities, and hypotension) indicates significant compromise, likely due to bleeding but other etiology must be ruled out. Trauma triad of death - CORRECT ANSWERS Hypothermia Acidosis ATLS EXAM QUESTIONS AND ANSWERS 2022/2023 ALL ANSWERS CORRECT.BEST GRADED A+ FOR NURING Coagulopathies A 5-year-old boy is struck by a car and brought to the ED. He is lethargic but withdraws from painful stimuli. VS are BP 90, HR 160, RR 40, and oxygen sat 85%. The best option for establishing vascular access after experienced nurses have failed to obtain PIV on two attempts is? - CORRECT ANSWERS Placement of intraosseous device into proximal tibia When treating a severely injured child, it is very important to rapidly establish the patient's weight in order to determine equipment size, drug doses, and resuscitation volumes. What are options for estimating weight quickly or determining appropriate equipment size? - CORRECT ANSWERS Asking parent or caregiver Using a length-based pediatric resuscitation tape Using the formula (2 x age in years + 10) Common causes of deterioration in intubated patients - CORRECT ANSWERS Dislodgement Obstruction Pneumothorax Equipment failures Classifications of responses of children to fluid resuscitation - CORRECT ANSWERS Responders: stabilized by crystalloid fluid OR crystalloid and blood resuscitation Transient responders: install response to crystalloid and blood, but then deteriorates Nonresponders: doesn't respond to crystalloid or blood infusion A 3-year-old falls 10 meters out of an apartment window onto pavement. He does not open his eyes, moans incomprehensibly, and extending abnormally ATLS EXAM QUESTIONS AND ANSWERS 2022/2023 ALL ANSWERS CORRECT.BEST GRADED A+ FOR NURING when stimulated. The patient is unresponsive on arrival to the ED, and pupils are unequal. He has blood coming from his right ear, is breathing rapidly, and is pale, with mottled extremities. The patient is intubated and IV access is obtained. He's given crystalloid and blood with good response. HR 110 and BP 90/60. CXR shows pulmonary contusions. What are the priorities in evaluating a small child with multi system trauma? - CORRECT ANSWERS ABCDE Why do children commonly develop pulmonary contusions following trauma, even in absence of rib fractures? - CORRECT ANSWERS Ribs of children are primarily cartilaginous therefore bend and allows transmission of kinetic energy to underlying lung rather than absorbing and dissipating energy by fracturing ribs What's the most common immediately lift-threatening injury in children? - CORRECT ANSWERS Tension pneumothorax What visceral injuries are more common in children? - CORRECT ANSWERS Blunt pancreatic injuries Small bowel perforations near ligament of Treitz Mesenteric and small bowel avulsions Bladder rupture Enteric disruption Penetrating injuries to perineum Rupture of hollow viscus A 10-year-old M arrives to ED after bike accident. He's complaining of upper abdominal pain. VS HR 115 BP 100/65. CT shows large splenic laceration with contrast extravasation. He returns to ED from radiology, his HR increased to 150 BP drops to 70/45. What's the appropriate next step? - CORRECT ANSWERS Administer 20 ml/kg isotonic IVF bolus and 10 ml/kg pRBCs. The patient should undergo an emergent laparotomy/splenectomy. ATLS EXAM QUESTIONS AND ANSWERS 2022/2023 ALL ANSWERS CORRECT.BEST GRADED A+ FOR NURING Preexisting conditions that impact morbidity and mortality of trauma patients? - CORRECT ANSWERS Cirrhosis Coagulopathy COPD Ischemic heart disease DM What pitfalls may you face when intubating an elderly patient? - CORRECT ANSWERS Decreased chest wall and pulmonary compliance Decreased mucus clearance Diminished functional residual capacity Increased work of breathing A geriatric trauma patient falls from her wheelchair at a nursing home. She presents with a GCS score of 13, The patient is likely suffering from a? - CORRECT ANSWERS TBI An important immediate treatment of intracranial hemorrhage in elderly patients is? - CORRECT ANSWERS Correct all sources of coagulopathy Likely causes of elderly patient's decline in mental status? - CORRECT ANSWERS Delirium Dementia Pain medication Sedatives Increase ICP Decreased cerebral perfusion pressure ATLS EXAM QUESTIONS AND ANSWERS 2022/2023 ALL ANSWERS CORRECT.BEST GRADED A+ FOR NURING Geriatric trauma patients are at greater risk of mortality from rib fractures than younger individuals because they? - CORRECT ANSWERS Are at a greater risk of developing pneumonia An elderly patient is transferred from a long-term care facility after being found down. In addition to a hip fracture, you find the patient is wearing soiled clothes and a soiled diaper, has dry mucus membranes, and tenting skin. You should evaluate the patient for? - CORRECT ANSWERS Elder maltreatment Compared to a younger patient, a geriatric trauma patient with a pelvic fracture is more likely to? - CORRECT ANSWERS Require blood transfusions The removal of spine boards early is particularly important in geriatric patients because? - CORRECT ANSWERS Patients are at increased risk of pressure ulcers The best initial treatment for pregnant trauma patients is? - CORRECT ANSWERS Resuscitate the mother and consult surgeon and obstetrician A 35-year-old woman who appears to be in the second trimester of pregnancy is brought to the ED following a MVC. She is unconscious and immobilized on a long spine board. How might the patient's pregnant affect the performance of the primary survey? - CORRECT ANSWERS The priorities are the same: ABCDE. Care must be taken to interpret VS. In addition to VS and GCS score, what information would be helpful to obtain in order to evaluate pregnant trauma patients? - CORRECT ANSWERS Additional scene information: whether/how the patient was restrained and MOI A 22-year-old female in the 3rd trimester of her pregnancy presents after MVC. Her VS are BP 100/70, HR 120,RR 22. FHR found to be 90. What statement ATLS EXAM QUESTIONS AND ANSWERS 2022/2023 ALL ANSWERS CORRECT.BEST GRADED A+ FOR NURING about FHR is correct? - CORRECT ANSWERS This is abnormally low FHR likely presents impair oxygen flow to the fetus from the placental vasculature (sensitive to catecholamine surge during trauma causing increased uterine vascular resistance and decreased fetal oxygenation) What's true about hypervolemia associated with pregnancy? - CORRECT ANSWERS Cardiac output increased by 1-1.5 L/min after the 10th week of pregnancy due to the increase in plasma volume and decrease in vascular resistance Healthy pregnant patients can lose _____ ml of blood before exhibiting signs and symptoms of hypovolemia - CORRECT ANSWERS 1200-1500 ml of blood Lab values changed during pregnany - CORRECT ANSWERS Elevated WBC (12000-25000) Mildly elevated fibrinogen and other clotting factors Shortened PT and PTT (bleeding and clotting times unchanged) Decreased Hct (32-42%) While supine, vena cava compression can cause? - CORRECT ANSWERS Decrease cardiac output by 30% because of decreased venous return from the lower extremities A 35-year-old woman who appears to be in the second trimester of pregnancy is brought to the ED following a MVC. VS are RR 28, HR 130, BP 110/50, GCS 7. What are the first steps in primary survey in this patient? - CORRECT ANSWERS Establish definitive airway and stabilize cervical spine Placing a orogastric tube may be advised as it's likely to reflux gastric contents If the patient becomes hypotensive, elevate the patient's right side to displace uterus off IVC ATLS EXAM QUESTIONS AND ANSWERS 2022/2023 ALL ANSWERS CORRECT.BEST GRADED A+ FOR NURING What's true regarding serum fibrinogen levels in pregnant patients? - CORRECT ANSWERS A normal serum fibrinogen level late in pregnancy may indicated early disseminated intravascular coagulation A 19-year-old female stepped off a curb, tripped, and fell. Her VS are normal. She had LOC and brain CT is negative. Her only prior ED visit was for a broken arm sustained in a bike accident 5 years ago. She sees a PCP and Gyn regularly. What's true regarding intimate partner violence for this patient? - CORRECT ANSWERS Screening for intimate partner violence should be performed on all patients who present to ED Rapid triage and transport issues during primary survey - CORRECT ANSWERS Airway compromise, high risk for loss of airway Tension pneumothorax, hemothorax, open pneumothorax, hypoxia Hypotension, pelvic fracture, vascular injury, open fracture, abdominal distention/peritonitis GCS < 13, intoxicated, evidence of paralysis Rapid triage and transport issues during secondary survey - CORRECT ANSWERS Depressed skull fracture or penetrating injury Eye injury, open fractures, ongoing nasopharyngeal bleeding Neck hematoma, crepitus Multiple rib fractures, flail chest, pulmonary contusion, widened mediastinum Rebound or guarding of abdomen Laceration of perineum Neurologic deficit Complex or multiple fractures, bony spine injuries Multiple comorbities, pregnancy, burns ATLS EXAM QUESTIONS AND ANSWERS 2022/2023 ALL ANSWERS CORRECT.BEST GRADED A+ FOR NURING A 17-year-old male is brought to a 20 bed hospital following a snowmobile crash. Hospital has CT and ultrasound capabilities. VS are SBP 85, HR 120, GCS 15. Patient is breathing shallow. Unstable pelvis and deformity of left thigh. What's priorities of management? - CORRECT ANSWERS Perform primary survey: establish airway, obtain IV access, apply pelvic binder, and begin IVF resuscitation A 54-year-old male arrives to ED at small hospital without surgical capabilities. He was involved in MVC in which he was the driver of a car that Tboned a delivery truck at 55 mph. He has GCS of 8, decreased breath sounds on the left, abdominal tenderness. BP 95/65, HR 110. What are the priorities of management? - CORRECT ANSWERS Establish airway and insert chest tube. Resuscitate and stabilize prior to transporting patient to adequate hospital Identify the responsibilities of a referring physician in a patient transfer situation? - CORRECT ANSWERS Initiating transfer during resuscitation Consult with receiving physician Maintain familiarity with transporting agencies Select appropriate transportation Determine level of care required during transfer Stabilize the patient's confiriotn Provide patient summary Ensure adequate trained personnel accompanying patient Ensure pediatric patients are transferred to facilities with special expertise when available Airway treatments that must be established before transfer - CORRECT ANSWERS Insert airway or ETT with low GCS or the potential to deteriorate Provide suction Place gastric tube in all intubated patients and those with gastric distention ATLS EXAM QUESTIONS AND ANSWERS 2022/2023 ALL ANSWERS CORRECT.BEST GRADED A+ FOR NURING Breathing treatments that must be established before transfer - CORRECT ANSWERS Determine rate and administer supplementary oxygen Provide mechanical ventilation when needed Insert chest tube Circulation treatments that must be established before transfer - CORRECT ANSWERS Control external bleeding Establish 2 large bore IVs and begin IVF Restore blood volume using crystalloid fluids and blood Insert indwelling catheter to monitor UOP Monitor cardiac rate and rhythm Transport patients late in pregnancy (tilted to the left side) Restrict spinal motion Disability treatments that must be established before transfer - CORRECT ANSWERS Assist respiration in unconscious patients Administer mannitol or hypertonic saline if needed Restrict spinal motion in spine injuries What should be done about wounds/fractures before transfers? - CORRECT ANSWERS Clean and dress wounds after external control Administer tetanus Administer antibiotics if needed Splint and tract fractures What diagnostic studies should be conducted prior to transfer? - CORRECT ANSWERS X-rays of chest, pelvis, and extremities Blood work