ACTUAL EXAM WITH CORRECT

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ATLS POST TEST

ACTUAL EXAM WITH CORRECT

SOLUTIONS.

A 22 year old male is brought by ambulance to a small community hospital after falling from the top of an 8 foot ladder.Initially, he was found to have a large right pneumothorax. A chest tube was inserted and connected to an underwater seal drainage collection system with negative pressure. A repeat CXR demonstrates a residual, large right pneumothorax. After transferring the patient to a verified trauma center, a third chest x-ray reveals a persistent right pneumothorax. The chest tube appears to be functioning and in good position. He remains hemodynamically normal with no signs of respiratory distress.

The most likely cause for the persistent right pneumothorax is:

• Flail chest
• Diaphragmatic injury
• Pulmonary contusion
• Esophageal perforation
• Tracheobronchial injury - correct answer- E.

Tracheobronchial injury

Which of the following is LEAST reliable for diagnosing ESOPHAGEAL intubation?

• symmetrical chest wall movement
• end-tidal CO2
• bilateral breath sounds 1 / 4

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• oxygen saturation >92%
• ETT above carina on chest x-ray - correct answer- D.

oxygen saturation >92% -> if it says ESOPHAGEAL, go with this answer

Which of the following signs necessitates the need for a definitive airway in severe trauma patient?

• facial lacerations
• repeated vomiting
• severe maxillofacial trauma
• sternal fracture
• GCS 12 - correct answer- C. Severe maxillofacial trauma

Twenty seven people are severely injured in an aircraft crash at

a local airport. The principles of triage include:

• establish a triage site within the internal perimeter of the

crash site

• treat only the most severely injured patients first
• immediately transport all patients to the nearest hospital
• treat the greatest number of patients in the shortest period of

time

• produce the greatest number of survivors based on available

resources - correct answer- E. Produce the greatest number of survivors based on available resources

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Which of the following statements are correct?

• Cerebral contusions may coalesce to form an intracerebral

hematoma

• Epidural hematomas are usually seen in the frontal region
• Subdural hematomas are caused by injury to the middle

meningeal artery

• Subdural hematomas typically have a lenticular shape on CT
• The associated brain damage is more severe in epidural

hematomas - correct answer- A. Cerebral contusions may coalesce to form an intracerebral hematoma

EM: Epidural, middle meningeal

SuB: Subdural, Bridging veins

An 18 year old male is brought to the ED after being shot. He has one bullet wound just below the right clavicle and another just below the costal margin in the right posterior axillary line.His blood pressure is 110/60, heart rate of 90, and respiratory rate of 34. After ensuring a patent airway and inserting 2 large

caliber IV lines, the next most appropriate step is to:

• Obtain a portable chest x-ray
• Administer a bolus of additional IV fluid
• Perform a laparatomy
• Obtain an abdominal CT scan
• Perform diagnostic peritoneal lavage - correct answer- A.

Obtain a portable chest x-ray need more info on chest, not abdomen 3 / 4

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Which of the following should be performed FIRST in any patient whose injuries may include multiple closed extremity fractures?

• A thorough assessment of four limb perfusion
• Manuevers to prevent necrosis of the skin
• Extremity compartment syndrome release
• Ensuring adequate oxygenation and ventilation
• Evaluation for occult crush syndrome - correct answer- D.

Ensuring adequate oxygenation and ventilation (ABC's)

A 22 year old male sustains a shotgun wound to the shoulder and chest at close range. His BP is 80/40 and HR 130. After 2 L of crystalloid solution are rapidly infused, his BP increases to 122/84 and HR decreases to 100. He is tachypneic with RR of

• On PE, his breath sounds are decreased at the left upper

chest with dullness on percussion. A large caliber tube thoracostomy is inserted into the fifth intercostal space with the return of 200 mL of blood and no air leak. The most appropriate

next step is:

• Insert a foley catheter
• Begin to transfuse O negative blood
• Perform thoracotomy
• Obtain a CT Chest/Abd
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