ATLS - Advanced Trauma Life Support Musculoskeletal Trauma Questions and Answers

Question 1

A 40-year-old motorcyclist involved in a high-speed collision presents with a clinically unstable pelvis and a blood pressure of 85/50 mmHg.
According to ATLS principles, what is the most appropriate and immediate intervention to help control the pelvic hemorrhage?

Accepted Answer

Application of a pelvic binder or circumferential sheet.

Answer

Immediate transfer to the operating room for external fixation.

Answer

Angiographic embolization.

Answer

Massive transfusion protocol activation.

Question 2

Which of the following is considered the earliest and most reliable clinical finding in a conscious patient with acute compartment syndrome of the lower leg?

Accepted Answer

Pain that is out of proportion to the apparent injury

Answer

Pallor of the foot

Answer

Loss of the dorsalis pedis pulse

Answer

Inability to dorsiflex the ankle (foot drop)

Question 3

A 22-year-old rugby player sustains a knee dislocation on the field. The deformity is immediately reduced by the team physician, and upon arrival to the emergency department, the patient has warm feet and palpable distal pulses. Which potential injury remains a primary concern that requires urgent further evaluation?

Accepted Answer

Popliteal artery injury

Answer

Anterior cruciate ligament (ACL) tear

Answer

Common peroneal nerve palsy

Answer

A meniscal tear

Question 4

In the initial management of a patient with an open tibial fracture, which of the following is the most appropriate sequence of actions in the emergency department according to ATLS guidelines?

Accepted Answer

Remove gross contaminants, cover with a sterile saline-moistened dressing, realign the limb, splint, and administer IV antibiotics.

Answer

Aggressively scrub the wound with povidone-iodine, apply a tourniquet, and await surgical consultation.

Answer

Perform a bedside fracture reduction, apply a cast, and administer oral antibiotics.

Answer

Take multiple x-rays from various angles before touching the wound, then apply a compressive dressing.

Question 5

A 70-year-old woman falls and presents with a shortened, externally rotated, and severely swollen right thigh. Her vital signs are HR 120 bpm, BP 90/60 mmHg. This presentation is highly suggestive of a femur fracture with associated hemorrhage. In addition to initiating fluid resuscitation, which intervention is most critical for controlling the ongoing blood loss?

Accepted Answer

Applying a traction splint.

Answer

Placing the patient in the Trendelenburg position.

Answer

Administering a bolus of tranexamic acid (TXA).

Answer

Obtaining an urgent CT angiogram of the leg.

Question 6

A patient is extricated after being trapped under a collapsed structure for several hours. They are diagnosed with crush syndrome and rhabdomyolysis. What is the primary goal of initial fluid management to prevent acute kidney injury?

Accepted Answer

Aggressive intravenous fluid resuscitation to induce a high-volume diuresis.

Answer

Administration of loop diuretics like furosemide to force urination.

Answer

Fluid restriction to avoid volume overload in a potentially anuric patient.

Answer

Prioritizing colloid solutions over crystalloids to maintain oncotic pressure.