ATLS Initial Assessment and Management 2 — Questions and Answers
Question 1: During the primary survey, a trauma patient has absent breath sounds on the left, distended neck veins, and tracheal deviation to the right. What action should be taken BEFORE chest X-ray?
- Start a second large-bore IV
- Perform needle decompression of the left chest (Correct answer)
- Intubate the patient
- Administer a fluid bolus
Correct answer: Perform needle decompression of the left chest
Tension pneumothorax is a clinical diagnosis requiring immediate needle decompression without waiting for radiographic confirmation.
Tension pneumothorax is identified and treated during the Breathing phase of the primary survey. After decompression, a tube thoracostomy is placed for definitive management.
Question 2: In the ATLS primary survey, what is the correct sequence of assessment?
- Circulation, Airway, Breathing, Disability, Exposure
- Airway, Breathing, Circulation, Disability, Exposure (Correct answer)
- Breathing, Airway, Circulation, Exposure, Disability
- Airway, Circulation, Breathing, Disability, Exposure
Correct answer: Airway, Breathing, Circulation, Disability, Exposure
The ATLS primary survey follows ABCDE: Airway, Breathing, Circulation, Disability, Exposure.
The ABCDE approach prioritizes by lethality. Life-threatening conditions are treated as identified. You do not move to B if A problems remain unresolved.
Question 3: Which injury must be identified and treated during the primary survey?
- Simple rib fracture
- Massive hemothorax (Correct answer)
- Stable pelvic fracture
- Small pneumothorax
Correct answer: Massive hemothorax
Massive hemothorax (>1500 mL) is an immediately life-threatening condition that must be treated during the primary survey.
The lethal six treatable during the primary survey are: airway obstruction, tension pneumothorax, open pneumothorax, massive hemothorax, flail chest with pulmonary contusion, and cardiac tamponade.
Question 4: A trauma patient has HR 130, BP 70/50, RR 30, and altered mental status. What class of hemorrhagic shock?
- Class I
- Class II
- Class III
- Class IV (Correct answer)
Correct answer: Class IV
Tachycardia >120, hypotension, tachypnea >30, and altered mental status indicate Class IV shock (>40% blood volume loss).
Class IV: >40% blood loss, >2000 mL. Management requires massive transfusion protocol (1:1:1 ratio) and emergent hemorrhage control.
Question 5: When should the secondary survey be initiated?
- Immediately upon arrival
- After primary survey is complete and resuscitation initiated (Correct answer)
- After all imaging is completed
- Only after hemodynamic stability
Correct answer: After primary survey is complete and resuscitation initiated
The secondary survey begins after the primary survey is complete and initial resuscitation efforts are underway.
The secondary survey is a comprehensive head-to-toe examination with AMPLE history. If the patient deteriorates during the secondary survey, return to the primary survey.
Question 6: What is the recommended initial fluid resuscitation for an adult trauma patient with hemorrhagic shock?
- 500 mL normal saline
- 1 liter of warmed isotonic crystalloid (Correct answer)
- 2 liters of warmed lactated Ringer's
- Immediate packed red blood cells only
Correct answer: 1 liter of warmed isotonic crystalloid
ATLS 10th edition recommends a 1-liter bolus of warmed isotonic crystalloid, then assessing the response.
The 10th edition moved from 2L to 1L initial crystalloid. The emphasis has shifted to damage control resuscitation: permissive hypotension, minimal crystalloid, and early blood products.
ATLS Initial Assessment and Management 2
During the primary survey, a trauma patient has absent breath sounds on the left, distended neck veins, and tracheal deviation to the right.
What action should be taken BEFORE chest X-ray?