ATLS Final Exam 2024 Version New with All Questions
ATLS Final Exam 2024 Version New with All
Questions from Actual Past Exam and 100%
Correct Answers
What is the difference between burns and other injuries? ——— Correct Answer ———
The biggest difference is that the consequences of burn injury are directly linked to the
extent of the inflammatory response to the injury. The larger and deeper the burn, the
worse the inflammation.
Direct thermal injury to the lower airway is very rare and essentially occurs only after
exposure to superheated steam or ignition of inhaled inflammable gases. Breathing
concerns arise from what 3 general causes: ——— Correct Answer ——— hypoxia,
carbon monoxide poisoning, and smoke inhalation injury.
Always assume CO exposure in patients who were burned in enclosed areas. Patients
with CO levels less than 20% may not show any symptoms ——— Correct Answer ——
— HA and nausea (20-30%), confusion (30-40%), coma (40-60%) and death (>60%).
Cherry red skin color in patients may only be seen in moribund patients.
Flame injury is more evident than most chemical injuries. ——— Correct Answer ———
Monitor IV lines closely to ensure they do not become dislodged as the patient becomes
more edematous. Regularly check ties securing ET or NG to ensure they are not too
tight.
Factors that increase the risk of upper airway obstruction are: ——— Correct Answer —
—— increasing burn size and depth, burns to the head and face, inhalation injury,
associated trauma, and burns inside the mouth. Airway can become obstructed form
direct injury such as inhalation injury, but also from massive edema resulting from burn
injury.
How do you decontaminate burn areas? ——— Correct Answer ——— Completely
remove the patient’s clothing to stop burning process, but do not peel off adherent
clothing. Synthetic fabrics can ignite, burn rapidly at high temps and melt into hot
residue that continues to burn the patient. brush any dry chemical powder from wound.
rinse with copious amounts of warm saline irrigation or rinsing in a warm shower. once
the burning process has been stopped, cover the patient with warm, clean, dry linens to
prevent hypothermia.
hoarseness, stridor, accessory respiratory muscle use, sternal retraction are signs of
what? ——— Correct Answer ——— airway obstruction. Clinical manifestations of
inhalation injury may be subtle and may not show up within the first 24 hours. do not
wait for the xray to show evidence of pulmonary injury or changes in blood gas because
airway edema can preclude intubation and a surgical airway will be required.
A carboxyhemoglobin level greater than what percentage indicates a patient was
involved in a fire and has inhalation injury? ——— Correct Answer ——— 10%
Indications for early intubation in burn patients: ——— Correct Answer ——— full
thickness circumferential neck burns, signs of airway obstruction, extent of the burn >
40%, burns inside the mouth, difficulty clearing secretions or swallowing, decreased
level of consciousness,
Patient with inhalation injury are at risk for bronchial obstruction from secretions and
debris and they may require bronchoscopy. ——— Correct Answer ——— Make sure to
place an adequately sized airway tube
Measurements of arterial PaO2 do not reliably predict CO poisoning b/c a partial
pressure of only 1 mm Hg results in an HbCO level of 40% or greater. Pulse ox cannot
be relied on to rule out carbon monoxide poisoning b/c we cant distinguish
oxyhemoglobin from carboxyhemoglobin. A discrepancy between pulse ox and arterial
blood gas may be explained by presence of carboxyhemoglobin.
Cyanide inhalation poisoning can occur in confined spaces and sign of potential toxicity
is persistent profound unexplained metabolic acidosis. ——— Correct Answer ———
THERE IS NO ROLE for hyperbaric oxygen therapy in the primary resuscitation of a
patient with critical burn injury.
American Burn Association states 2 requirements for diagnosis of smoke inhalation
injury: ——— Correct Answer ——— 1. exposure to combustible agent
- signs of exposure to smoke in the lower airway, below the vocal cords, seen on
bronchoscopy.
A chest Xray and arterial blood gases should be ordered to evaluate the pulmonary
status of a patient with smoke inhalation injury, but normal values on admission DO
NOT exclude an inhalation injury.
The treatment of smoke inhalation injury is supportive. ——— Correct Answer ———
Any patient with smoke inhalation injury and significant burns greater than 20% TBSA
should be intubated. IF the patient’s hemodynamic condition permits and spinal injury
has been excluded, elevate the patient’s head and chest 30 degrees to help reduce
neck and chest wall edema.
True or false: Clinicians should provide burn resuscitation fluids for deep partial and full
thickness burns larger than 20% TBSA ——— Correct Answer ——— True. urine
output monitoring is 0.5mL/kg/hr in adults and should be maintained at 30-50cc/hr to
minimize over resuscitation
in a burn patient, cardiac dysrhytmias may be the first sign of hypoxia and electrolyte or
acid base abnormalities. ——— Correct Answer ——— therefore an ECG should be
performed for cardiac rhythm disturbances. Persistent acidemia in patients with burn
injuries may be due to under resuscitation or infusion of large volumes of saline.
Tachycardia is a poor indication for resuscitation in the burn patient. ——— Correct
Answer ——— Adjust the fluid rate up or down based on the urine output and recognize
that factors such as inhalation injury, age of patient, renal failure, diuretics, and alcohol
can affect the volume of resuscitation and urine output.
True of false: Burn patients should get tetanus. ——— Correct Answer ——— true
Partial thickness burns ——— Correct Answer ——— are characterized as either
superficial partial thickness (moist, painfully hypersensitive, , potentially blistered,
homogenously pink, and blanch to touch) or deep partial thickness ( drier, less painful,
potentially blistered, red or mottled in appearance, and do not blanch to touch)
Full thickness burns ——— Correct Answer ——— appear leathery and skin may be
white or translucent or waxy white. surface area is painless to light touch or pinprick and
generally dry
Compartment syndrome in burn patients: ——— Correct Answer ——— Compartment
syndrome can result from an increase in pressure inside the compartment that
interferes with perfusion to the structures within that compartment. In burns, this
condition results from a combination of decreased skin elasticity and increased edema
in the soft tissue. A pressure > 30 mm Hg within the compartment can lead to muscle
necrosis and once the pulse is gone it may be TOO LATE to save the muscle. so
recognize the signs early:
pain greater than expected and out of proportion to the injury
pain on passive stretch of the affected muscle
tense swelling of the affected compartment
paresthesias or altered sensation distal to the affected compartment
compartment syndrome may be present with circumferential chest and abdominal burns
——— Correct Answer ——— chest and abdominal escharotomies performed along the
anterior axillary lines with cross incision at the clavicular line and the junction of the
thorax and abdomen usually relieve this problem. relieve circulatory compromise in a
circumferentially burned limb by eschartomy and these escharotimies are not needed
within the first 6 hours.
True or false? Although the mechanism of injury may be similar to those for the younger
population, data shows increased mortality with similar severity of injury in older adults.
——— Correct Answer ——— True
In the elderly population, what is decreased physiological reserve? ——— Correct
Answer ——— aging is characterized by impaired adaptive and homeostatic
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