ATLS Test Study Guide Test 4 Latest Versions Real Exam Questions and Answers 2025, Exams of Nursing

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ATLS Test Study Guide Test 4 Latest Versions Real Exam

Questions and Answers 2025

Order of Initial Assessment

1. Preparation - prehospital and hospital
2. Triage
3. Primary Survey- ABCDEs
4. Adjuncts to primary
5. Consider transfer
6. Secondary Survey- head to toe exam and pt history
7. Continue post-resuscitation and re-evalution
8. Definitive care Why should primary and secondary surveys be repeated frequently? Identify any change in the patient's status and need for additional intervention Prehospital Phase Preparation

• notify receiving hospital to allow for mobilization of trauma team to be there when pt arrives
• provide airway maintenance, control of bleeding, assess shock, immobilize c- spine/other injuries
• transport to the closest facility, preferred trauma center
• minimize scene time
• obtain report needed for triage at the hospital Hospital Phase Preparation
• resuscitation area available for patients
• proper airway equipment
• warmed IV crystalloid solutions
• a protocol to summon additional medical equipment
• transfers agreements w/ verified trauma centers are established **Consider wearing protection (face mask, gloves, eye care) due to concern for hepatitis and AIDs in patients Triage sorting patients based on resources required for treatment and the resources that are actually available
• order of patient is based on ABC priorities Multiple Casualties vs Mass Casualties multiple: incidents are those in which the number of patients and the severity of their injures DO NOT exceed the capability of the facility mass: the number of patients and severity of their injuries DO exceed the capability of the facility

Primary Survey Vitals must be assessed quickly and efficiently using the ABCDE method Airway maintenance w/ restriction of c-spine Breathing and Ventilation Circulation w/ hemorrhage control Disability - neurologic status Exposure/Environmental control How can you assess ABCD in a patient in under 10 seconds? Identify yourself Ask the patient their name Ask the patient what happened If the patient is able to give an appropriate response during the primary survey what does that mean about their ABCD status the patient likely doesn't have an extreme airway or breathing compromise and not a markedly decreased level of consciousness A trauma patient with a known head injury has a compromised airway, do you assess the head trauma or airway Airway - clear, suction, administer oxygen, open and secure airway What is important with airway maintenance? Restrict the cervical spine, ALWAYS assume a cervical spinal injury exists

Airway Maintenance assess airway's patency, inspect any form of obstruction including foreign bodies or fractures, suction blood and secretions *if the patient is able to communicate verbally, the airway is likely not compromised -

• UNLESS GCS less than 8, then will still likely have to intubate Trauma patient is able to speak so you are not worried about airway compromise, what is a scenario in which you should still be concerned even with verbal communication? Head injuries with altered level of consciousness, GCS less than 8 usually required definitive airway Trauma patient with non- purposeful motor responses would strongly suggest the need for what? a definitive airway *non-purposeful would include decorticate or decerebrate positions A c-collar is placed on a trauma patient in the field but once the patient arrives to the hospital it is determined that the patient needs to be intubated, however there have not been any imaging on the c- spine. What should you do? Open the cervical collar and have a team member manually restrict motion of the c- spine Breathing and Ventilation Required adequate gas exchanged to maximize oxygen and eliminate carbon dioxide

• requires lungs, chest wall, and diaphragm Important aspects of assessing breathing and ventilation
• look for JVD
• listen to the lungs
• visual inspection of the chest wall
• palpate chest wall What are some major injuries that can impair ventilation? tension pneumothorax, massive hemothorax, open pneumothorax, tracheal or bronchial injuries What can a simple A tension pneumothorax due to positive pressure if the

pneumothorax turn into after the patient is intubated? patient isn't decompressed before intubated Does a normal neurologic exam exclude a cervical spine injury? No, the cervical spine needs to be protected until imaging is done Blood Volume and Cardiac Output Identifying, quickly controlling hemorrhage, and initiating resuscitation

• once tension pneumo has been excluded as a cause of shock, it is blood loss until proven otherwise What is the predominant cause of preventable deaths after injury? Hemorrhage What elements of clinical observation yield important information within seconds when assessing blood volume and cardiac output? Level of Consciousness - if cerebral perfusion is impaired, may alter consciousness Skin Perfusion- a patient with pink skin, especially in the face and extremities rarely have hypovolemia Pulse- rapid pulse is a sign of hypovolemia What pulses should be assessed? Carotid or femoral What is the mainstay treatment for external blood loss but what can this result in? Direct manual pressure, possible tourniquets are effective but has risk for ischemic injury - only tourniquet if direct pressure is not working
• blind clamping can result in damage to nerves and veins What are major areas of internal hemorrhage? chest, abdomen, retroperitoneum, pelvis, long bones

What is essential with a patient actively bleeding? Definitive control - may need chest decompression, pelvic stabilizing device, surgery, etc. AND replacing intravascular volume What labs should be done on a bleeding trauma patient? Place two large-bore peripheral venous catheters to administer fluid, blood, plasma

• Obtain pregnancy if female, blood type and cross matching, blood gases, lactate Is aggressive and continued volume resuscitation a substitute for definitive control of hemorrhage? No, give 1L of NS and if that does not improve then give blood transfusion What does the neurologic evaluation (D, disability) do? Shows level of consciousness, pupillary size, identifies the presence of lateralizing signs, spinal cord injury level (if present) What does an altered level of consciousness mean it could be? Need to immediate reevaluate the patient's oxygenation, ventilation, and perfusion status **hypoglycemia, alcohol, narcotics, and other drugs can alter the patient's consciousness **Until proven otherwise, presume CNS injury When resources for patients with a brain injury are not available, what is the next step? Transfer and consult neurosurgery Exposure and Environmental Control Carefully and completely undress the patient. Inspect for uncontrolled bleeding and note any obvious injuries. Prevent heat loss. Hypothermia combined with hypotension and acidosis is a potentially lethal combination in the injured patient. Consider: warm blankets, keep ambient temperature warm, warm IVF, forced air warmers, radiant warming lights. Adjuncts to Primary Survery
• continuous electrocardiology
• pulse ox
• CO2 monitoring
• assessing ventilation rate
• ABG measurement

- I&O

• lactate
• imaging: x-ray, FAST, etc. Ventilatory Rate, Capnography, and ABG - part of adjuncts to primary survey Measures the adequacy of the patient's respirations
• ventilation can be monitored using end tidal CO2 levels - colorimetry, capnometry, or capnography. Endotracheal tubes can be dislodged whenever a patient is moved, capnography can be used to confirm intubation of the airway vs esophagus. However, it does not confirm proper position of the tube within the trachea, end tidal CO2 can be used to avoid hypo or hyperventilation - this reflects cardiac output, it predicts return of spontaneous circulation (ROSC) during CPR In trauma what does a low pH or base excess indicate? shock, therefore can use these levels to trend a patient's improvements When are urinary and gastric catheters placed? during or following primary survey What is the first step before inserting a catheter during a trauma? Examine the perineum and genitalia If there is a urethral injury suspected, what should be done before inserting the catheter? perform a retrograde urethrogram (an x-ray with dye, this shows the urethral integrity) What are physical signs that indicate a urethral injury? Blood at the meatus or perineal ecchymosis

What is contraindicated if there is blood at the urethral meatus or perineal ecchymosis? Transurethral bladder catheterization What are the advantages of gastric catheters during trauma? decompresses stomach distension, decreases risk of aspiration, and looks for upper GI hemorrhage What does blood in gastric catheter indicate? swallowed blood, traumatic insertion, or injury to upper GI tract If a cribriform plate injury is suspected (broken nose) but a gastric catheter is warranted what should you do? insert the tube orally to prevent intracranial passage Who are special populations in trauma patients they may warrant special consideration? children, pregnant women, older adults, obese patients, and athletes Why are women, older adults, obese patients, and athletes apart of the special population? They may have physiologic responses that do not follow expected patterns What is a special consideration for a child with hypovolemia? Children have abundant reserve and often show few signs of hypovolemia even after severe depletion. When deterioration does occur - it is precipitous and catastrophic Consider Need for Transfer: what should be done vs not Do not delay transfer to perform an in-depth dx evaluation, ONLY undertake testing that enhances the ability to resuscitate, stabilize, and ensure the patient's safe transfer Other than difficulties with airway, what else is an important factor with an obese patient in terms of resuscitation? Many obese patients have cardiopulmonary disease, limiting their ability to compensate and rapid fluid resuscitation can exacerbate their underlying comorbidities

Why would an athlete cause a need for more concern in a trauma? Due to their excellent conditioning, they may not manifest early signs of shock like tachypnea, tachycardia

• they also normally have low BP When does the Secondary Survey occur? ABCDE of primary survey HAS to be completed first, resuscitative efforts are underway and patient's vital functions are demonstrated What does the Secondary Survey consist of? Head to toe evaluation, a complete history and physical exam including reassessment of all vital signs.
• each region of the body is examined, seeing potential for any missing injury Secondary survey - what does the history portion include?
• mechanism of injury, may have to speak to family "AMPLE"
• Allergies
• Medications
• Past illness/pregnancy
• Last meal
• Events/Environments related to injury What can the mechanism of injury tell you? Enhance the physiologic state and provide clues to anticipated injuries, some can be predicted based on the direction and amount of energy of the MOI
• Category 1: blunt trauma
• Category 2: penetrating trauma Blunt Trauma An impact on the body by objects that cause injury without penetrating soft tissues or internal organs and cavities.
• important things to note: seat-belt use, steering wheel deformation, direction of impact, what damage occurred to the vehicle, ejection from the vehicle

Penetrating Trauma Injury caused by objects, such as knives and bullets, that pierce the surface of the body and damage internal tissues and organs.

• important things to note: body region, organs in the path, distance from the weapon What complicates a thermal injury? Carbon monoxide poisoning What can cause significant heat loss even at moderate temperatures? wet clothes, decreased activity, vasodilation caused by alcohol or drugs that compromise the patient's ability to conserve heat Why is it important to ask about any exposure of chemicals, toxins, or radiation in trauma?

1. The affect on cardiac, pulmonary, and internal organ dysfunction
2. Danger to healthcare workers **Get in contact with regional poison control Secondary Survey: Physical Exam Order
3. Head
4. Maxillofacial structures
5. C-spine
6. Chest
7. Abdomen
8. Pelvis
9. Perineum/rectum/vagina
10. Musculoskeletal system
11. Neurologic system Physical Exam, Head Inspect entire scalp for laceration, contusions, evidence of fractures

• visual acuity, pupil size, hemorrhage of conjunctiva or TM, ocular entrapment **Snellen chart and ocular mobility to check for entrapment Physical Exam, Maxillofacial Palpate all bony structures, intraoral
• if injuries to not affect breathing/airway then treat once pt is stabilized If a patient has a midface fracture that fractured the cribriform plate what is a special indication? Gastric tube will need to be placed orally When questioning cardiac tamponade what are physical Auscultate: distant heart sounds (muffled) and decreased pulse pressure
• also JVD "distended neck veins" --> this is also a sign of tension

exam findings? pneumo If you are highly suspcious of cardiac tamponade or tension pneumo but there is no JVD what is likely the reason for that? Hypovolemia What is important when re- evaluating abdominal trauma? Have the same provider do it so they know of any change --

early involvement of a surgeon is crucial What are physical exam findings that clue you to pelvic fractures? ecchymosis over the iliac wings, pubis, labia, or scrotum

• palpation over the pelvic ring
• assess peripheral pulses When should a vaginal exam occur? In patients who are risk of vaginal injury to assess presence of blood in the vaginal vault and vaginal laceration, pregnancy tests should be performed on ALL women of child bearing age Pelvic Fracture downfalls produce a large amount of blood loss, place a pelvic binder to limit blood loss but do not repeatedly adjust because this can cause blood clots to get dislodged What is the best way to go about assessing a patient with head or spinal cord injuries who may not be able to give you a good history? Frequent reassessments, look for worsening ecchymosis/swelling, understand that any change in movement or less response to stimulus may indicate injury What kind of injury do you need to be hyperaware of compartment syndrome? long bone fractures, crush injuries, prolonged ischemia, circumferential thermal injury

What part of the musculoskeletal exam can be missed but is essential? Examination of the back If a patient with a known head injury starts to deteriorate, what should be the first thing to reassess? Oxygenation, adequacy of ventilation Who do you consult if there are s/s that lead you to believe there is a spinal injury? Early consultation with a neurosurgeon or orthopedic surgeon Reevaluation of trauma patients must occur constantly to ensure that new findings are not overlooked and to discover any deterioration in previously noted findings What is adequate urinary output for an adult patient and a pediatric patient? Adult: 0.5mgL/kg/h Pediatric: 1mL/kg/h Definitive Care - when do you know when a transfer is necessary? Whenever a patient's treatment needs exceed the capability of the receiving institution - looking at equipment, resources, and personnel How to keep records during a trauma Assign a team member the primary responsibility to accurately record and collate all patient care information What are components of team members during a trauma? team leader, airway manager, trauma nurse, and trauma technician

• can also include: assessing airway, undressing and exposing the patient, applying monitoring equipment, obtaining IV access, serving as a scribe/recorder What does the role of a team member entail? supervises, checks, and directs the assessment
• should be trained in ATLS
• assigns roles, gets the hospital ready for arrival What is the acronym used for handing over a patient from EMS to hospital trauma team?

"MIST"

• Mechanism of injury
• Injuries found and suspected
• Symptoms and signs
• Treatment initiated

What should be done once the patient leaves the ED? After Action session, the team addresses technical and emotional aspects of the resuscitation and identifies opportunities What is the quickest killer of injured patients? inadequate delivery of oxygenated blood to the brain and other vital organs

• supplemental oxygen must be administered o all severely injured trauma patients What can be a subtle but early sign of airway/ventilation compromise? tachypnea What is the number one key thing to do for a patient with sustained head injury that need a definitive airway? Maintaining oxygenation and preventing hypercarbia Inhalation and facial burn patients are at increased risk for what? Respiratory compromise, consider preemptive intubation What do you do if you have a trauma patient who started to vomit during intubation? Immediately suction then rotate patient to the lateral position all while keeping the cervical spine stable
• vomiting could cause aspiration pneumonia Laryngeal Trauma clinical triad? Hoarseness, subcutaneous emphysema, and palpable fracture - can cause acute airway obstruction There is a patient with airway trauma, you try to do an intubation with a flexible endoscope but are unsuccessful. What is the next step? Tracheostomy - difficult to perform under emergency conditions and can be associated with profuse bleeding. Therefore, a cricothyroidotomy might be the next best thing.

What is noisy breathing a sign of? Partial airway obstruction (tracheobronchial injury) that can suddenly become complete

• when a patient's level of consciousness is depressed, this detection might be more subtle and the only way to tell is from labored breathing **snoring, gurgling, stridor, dysphonia You observe a trauma patient and they are agitated? Other than the patient being in pain - what do you need to think The patient is hypoxic You observe a trauma patient and they are obtunded, what do you need to think of? The patient may be hypercarbia (holding onto CO2) What are signs of hypoxia? Hypoxia is inadequte oxygenation - you can identify this by nail beds and circumoral skin, however these are LATE findings.
• look for retractions and use of accessory muscles
• use pulse ox If a patient is belligerent and abusive what should you not assume? Intoxication, this could actually mean the patient is hypoxic What patient population is especially sensitive to direct trauma to the chest leading to ventilatory failure? Elderly patients and patients with pre-existing pulmonary dysfunction A trauma patient has abnormal ventilation but you see no obvious thoracic or tracheobronchial injury, what are your next thoughts? Intracranial injury can cause abnormal breathing and compromise ventilation Cervical spine cord injury can result in respiratory muscle paralysis or paresis

Below what cervical spinal injury will maintain diaphragmatic function but lose intercostal and abdominal muscle contribution to respiration?

C

If you have a patient who is diaphragmatic breathing/seesaw pattern, what do you suspect? A cervical spinal injury below C3, but damage to spinal cord to the intercostal and abdominal muscles but maintains diaphragm breathing

• this leads to inefficient respiration -- mismatch and result in respiratory failure 3 Important steps when assessing ventilation

1. LOOK for symmetrical chest rise and fall
2. LISTEN for air movement on both sides, tachypnea
3. Use capnography in spontaneously breathing and intubated patients to assess whether ventilation is adequate. In intubated patients it can confirm the tube is positioned within the airway How do you to take off a helmet off a trauma patient? This is a two-person procedure: one person restricts cervical spine motion from below while the other person expands the sides of the helmet and removes it