ATLS - Advanced Trauma Life Support Thoracic Trauma Questions and Answers

Question 1

A 34-year-old patient presents with a deep penetrating wound to the right chest following an assault.
On inspiration, a distinct 'sucking' sound is heard from the wound.
The patient is tachypneic and anxious.
What is the most appropriate immediate field management for this injury?

Accepted Answer

Applying an occlusive dressing taped on three sides.

Answer

Packing the wound with sterile gauze.

Answer

Immediately inserting a chest tube through the wound.

Answer

Performing endotracheal intubation and positive pressure ventilation.

Question 2

A 55-year-old driver involved in a high-speed motor vehicle collision presents with severe chest pain and paradoxical movement of the right chest wall. The patient is hypoxic despite receiving high-flow oxygen. What is the primary cause of hypoxemia in a patient with a flail chest?

Accepted Answer

Underlying pulmonary contusion.

Answer

Mechanical inefficiency of breathing due to the flail segment.

Answer

Pain from multiple rib fractures causing splinting.

Answer

Hypovolemia from intercostal vessel lacerations.

Question 3

Following the insertion of a large-bore chest tube for a hemothorax in a trauma patient, the initial drainage is 1,600 mL of blood. According to ATLS guidelines, what is the most appropriate next step in management?

Accepted Answer

Preparing for an urgent thoracotomy.

Answer

Clamping the chest tube to prevent further blood loss.

Answer

Administering a second 2-liter bolus of crystalloid.

Answer

Monitoring chest tube output for the next hour.

Question 4

A 28-year-old male is brought in after a stab wound to the left parasternal area. He is hypotensive (BP 80/50 mmHg), has distended neck veins, and muffled heart sounds on auscultation. A FAST exam reveals a significant pericardial effusion. What is the most appropriate immediate life-saving intervention?

Accepted Answer

Pericardiocentesis.

Answer

Needle decompression of the left chest.

Answer

Immediate transport to the operating room for sternotomy.

Answer

Aggressive fluid resuscitation with blood products.

Question 5

A trauma patient arrives after a severe deceleration injury. An initial supine AP chest x-ray is performed. Which of the following radiographic findings is most suggestive of a traumatic aortic disruption?

Accepted Answer

A widened mediastinum (>8 cm).

Answer

Multiple left-sided rib fractures.

Answer

Presence of a large hemothorax.

Answer

Fracture of the first or second rib.

Question 6

A patient with blunt chest trauma has a chest tube placed for a large pneumothorax. Despite the chest tube being on suction, there is a persistent, large air leak, and the lung fails to re-expand on chest x-ray. Extensive subcutaneous emphysema is noted on the neck and chest. Which injury should be strongly suspected?

Accepted Answer

Tracheobronchial injury.

Answer

Esophageal rupture.

Answer

Diaphragmatic tear.

Answer

Myocardial rupture.