Download ATLS TEST 1 LATEST EXAM 2022-2024 /ADVANCED TRAUMA LIFE SUPPORT TEST 1 LATEST 2022-2024 and more Exams Nursing in PDF only on Docsity! ATLS TEST 1 LATEST EXAM 2022-2024 /ADVANCED TRAUMA LIFE SUPPORT TEST 1 LATEST 2022-2024 QUESTIONS AND ANSWERS What is the Golden hour --ANSWER- refers to the first hour after an injury until definitive care at the Trauma Center 50% of mortality immediately after injury, within the first hour. Most trauma deaths occur immediately at scene and within the GOLDEN HOUR How much time, in reality, do you have of the golden hour once a pt hits the ED door --ANSWER- about 30 minutes, called platinum half hour When someone has trauma, but they die later from it (within days to weeks) what is it typically due to? --ANSWER- hemorrhagic shock- most common Hypovolemic shock What is the mneumonic for Hand-off to trauma team? --ANSWER- MIST Mechanism of injury- need high index of suspicion for dx after getting MOI Injuries found and suspected Symptoms and signs Treatment: Usually treat before definitive dx via tests! Objectives of the Advanced Trauma Life Support (ATLS) --ANSWER- 1. initial evaluation of the trauma pt 2. Identify life threatening injuries and initiate tx 3. Stabilize the trauma pt What is the mnemonic for history taking – ANSWER- "SAMPLE" Signs/Sx Allergies Medication Past medical illness Last meal Event/Environment related to injury Test that you give to all female pts of childbearing age? --ANSWER- BHCG What are the complications of initial trauma? --ANSWER- hemorrhage, acidosis, hypothermia, coagulopathy, hypoxia Primary survey in a trauma situation --ANSWER- ABCDE Airway maintenance with *c-spine restriction of spinal motion* Breathing and ventilation Circulation Disability: Neurological status Exposure/Environmental control Gold Standard to get definitive airway --ANSWER- endotracheal intubation What do you use if someone is presenting with tracheal injury, flail chest, or sucking chest wound with decreased breath sounds? --ANSWER- insert a chest tube (28-32 Fr) Pneumonic for circulation and hemorrhage control –ANSWER - Direct pressure Elevation Pressure point Tourniquet aka DEPT Hypovolemia tx in emergency situations --ANSWER- Start with two large bore IVs (14-gauge catheter), one below and one above the site of injury Infuse 1 liter of lactate ringers 3:1 ratio Select one: a. A patient that presents with a torso gunshot wound and is hypotensive should receive crystalloid fluid resuscitation until the blood pressure is normal b. Evidence of improved perfusion after fluid resuscitation could include improvement in Glasgow coma scale score on reevaluation c. Massive transfusion is defined as transfusion of more than >10 of packed red blood cells and plasma in 24 hours d. When tranexamic acid is administered by pre-hospital providers a second dose is required within 24 hours e. Fluid resuscitation is far more important than bleeding control in trauma patients -- ANSWER- b. 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: Select one: a. Secure the airway b. obtain a c-spine film c. support the circulation d. control scalp hemorrhage e. determine the GCS score Feedback Your answer is corr --ANSWER- a. 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? Select one: 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. An ABG would demonstrate a base deficit between -6 and -10 mEq/L e. His systolic blood pressure will be maintained with an elevated diastolic pressure. - -ANSWER- d. An ABG would demonstrate a base deficit between -6 and -10 mEq/L The physiologic hypervolemia of pregnancy has clinical significance in the management of the severely injured, gravid woman by: Select one: a. reducing the need for blood transfusion b. resulting in an elevated hematocrit c. complicating the management of closed head injury d. reducing the volume of crystalloid required for resuscitation e. increasing the volume of blood loss to produce maternal hypotension --ANSWER- e. increasing the volume of blood loss to produce maternal hypotension The best assessment of fluid resuscitation of the adult burn patient is: Select one: a. Urine output of 0.5 mL/kg/hr b. normalization of blood pressure c. normalization of the heart rate d. measuring a normal central venous pressure e. providing 4 mL/kg/percent body burn/24 hours of crystalloid fluid --ANSWER- a. Urine output of 0.5 mL/kg/hr The diagnosis of shock must include: Select one: a. hypoxemia b. acidosis c. hypotension d. increased vascular resistance e. evidence of inadequate organ perfusion --ANSWER- e. 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: Select one: a. application of a tourniquet b. direct pressure on the wound c. packing the wound with gauze d. direct pressure on the femoral artery at the groin e. debridement of devitalized tissue --ANSWER- b. direct pressure on the wound For the patient with severe traumatic brain injury, profound hypocarbia should be avoided to prevent: Select one: a. respiratory acidosis b. deformity of the right thigh e. respiratory rate of 40 breaths per minute --ANSWER- e. respiratory rate of 40 breaths per minute A 20-year-old woman that is 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: Select one: a. perform tracheal intubation b. insert an oropharyngeal airway c. perform needle or finger decompression of the right chest d. manually displace the gravid uterus to the left side of the abdomen e. initiate 2, large-caliber peripheral IV lines and crystalloid infusion --ANSWER- c. perform needle or finger decompression of the right chest An important, immediate step in the management of an open pneumothorax is: Select one: 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 secured on three sides e. initiation of 2, large-caliber IVs and infusing crystalloid solution --ANSWER- d. placement of an occlusive dressing over the wound secured on three sides Which of the following is a contraindication for tetanus toxoid administration? Select one: a. history of neurological reaction or severe hypersensitivity to the product b. Local side effects c. muscular spasms d. pregnancy e. all of the above --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 to 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? Select one: a. tachycardia b. pulse volume c. breath sounds d. pulse pressure e. jugular venous pressure --ANSWER- c. breath sounds Bronchial intubation of the right or left mainstem bronchus can easily occur during infant endotracheal intubation because: Select one: a. The trachea is relatively short. b. The distance from the lips to the larynx is relatively short. c. The use of cuffed endotracheal 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. -- ANSWER- a. The trachea is relatively short. A 23-year-old man sustains 4 stab wounds to the upper right chest during an altercation and is brought by ambulance to a hospital that has full surgical capabilities. His wounds are all above the nipple. He is endotracheally intubated, closed tube thoracostomy is performed, fluid resuscitation is initiated through 2 large-caliber IVs. FAST exam does not reveal intraabdominal injuries. 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% O2). 1500 mL of blood has drained from the right chest. The most appropriate next step in managing this patient is to Select one: a. perform diagnostic peritoneal lavage b. obtain a CT of the chest c. perform an angiography d. urgently transfer the patient to the operating room e. immediately transfer the patient to a trauma center --ANSWER- d. urgently transfer the patient to the operating room A 39-year-old man is admitted to the emergency department after an automobile collision. He is cyanotic, has insufficient respiratory effort, and has a GCS score of 6. His full beard makes it difficult to fit the oxygen facemask to his face. The most appropriate next step is to Select one: a. perform a surgical cricothyroidotomy b. attempt nasotracheal intubation c. ventilate him with a bag-mask device until c-spine injury can be excluded d. restrict cervical motion and attempt orotracheal intubation using 2 people d. obtain a lateral cervical spine x-ray e. ventilate the patient with a bag-mask --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; 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: Select one: a. clamp the chest tube b. cancel the patient's transfer c. perform an emergency department thoracotomy d. repeat the primary survey and proceed with transfer e. delay the transfer until the referring doctor can contact a thoracic surgeon -- ANSWER- d. 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: Select one: a. intubate the patient b. perform diagnostic peritoneal lavage or FAST c. insert a left chest tube d. call the receiving hospital and speak to the surgeon on call e. discuss the advisability of transfer with the patient's family --ANSWER- d. call the receiving hospital and speak to the surgeon on call Hemorrhage of 20% of the patient's blood volume is associated usually with: Select one: a. oliguria b. confusion c. hypotension d. tachycardia e. blood transfusion requirement --ANSWER- d. tachycardia Which one of the following statements concerning intraosseous infusion is TRUE? Select one: a. Only crystalloid solutions may be safely infused through the needle. b. Aspiration of bone marrow confirms appropriate positioning of the needle. c. Intraosseous infusion is the preferred route for volume resuscitation in small children. d. Intraosseous infusion may be utilized indefinitely. e. Swelling in the soft tissues around the intraosseous site is not a reason to discontinue infusion. --ANSWER- b. Aspiration of bone marrow confirms appropriate positioning of the needle. A young female sustains a severe head injury as the result of a motor vehicle crash. In the emergency department, her GCS is 6, 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: Select one: 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 --ANSWER- a. avoid hypotension A 33-year-old female 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: Select one: a. hemorrhagic shock b. cardiac tamponade c. massive hemothorax d. tension pneumothorax e. diaphragmatic rupture --ANSWER- b. 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 placement of a pelvic binder Which situation requires Rh immunoglobulin administration to an injured female? Select one: a. negative pregnancy test, Rh negative, and has torso trauma b. positive pregnancy test, Rh positive, and has torso trauma c. positive pregnancy test, Rh negative, and has torso trauma d. positive pregnancy test, Rh positive, and has an isolated wrist fracture e. positive pregnancy test, Rh negative, and has an isolated wrist fracture -- ANSWER- c. 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 ED and 15 minutes after the incident, she is awake and alert. Her heart rate is 100 beats per minute, blood pressure is 80/60 mm Hg, and respiratory rate is 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 to: Select one: a. perform a thoracoscopy b. perform an arch aortogram c. insert a second left chest tube d. prepare for an exploratory thoracotomy e. perform a chest CT --ANSWER- d. 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). Which one of the following statements is TRUE about this patient? Select one: a. A flail chest is probable. b. A symptomatic blunt cardiac injury is expected. c. A pulmonary contusion may be present in the absence of rib fractures. d. Transection of the thoracic aorta is more likely than in an adult patient. e. Rib fractures are commonly found in children with this mechanism of injury. -- ANSWER- c. A pulmonary contusion may be present in the absence of rib fractures