ITLS — International Trauma Life Support — is one of the world's leading trauma care certifications for prehospital providers, emergency nurses, and physicians. Built around a rapid, systematic patient assessment model, ITLS trains providers to identify and manage life-threatening injuries within the critical first minutes of trauma care. Our free ITLS practice test PDF gives you a printable study resource covering every major exam domain so you can review offline and arrive fully prepared for your ITLS course skills station and written assessment.
Download the PDF below and work through the practice questions at your own pace. The questions are written to reflect the scenario-based, decision-making format used in the actual ITLS assessment — helping you build both knowledge and the rapid clinical thinking the course demands.
The ITLS written and practical assessments evaluate your mastery of a rapid, systematic trauma assessment approach and your ability to manage life-threatening injuries in the prehospital environment. The topics below are the highest-yield domains across both the written exam and the skills stations.
The ITLS primary survey follows a fixed sequence: scene size-up (mechanism of injury, number of patients, hazards, resources needed); initial assessment (level of consciousness via AVPU or GCS, mechanism/chief complaint, ABCDE — Airway, Breathing, Circulation, Disability, Expose/Environment); rapid trauma assessment for unstable patients or significant MOI (head-to-toe sweep to find all life threats quickly); focused exam for stable patients with minor or isolated injuries; baseline vital signs; and the ITLS history (SAMPLE: Signs/symptoms, Allergies, Medications, Past history, Last intake, Events). Knowing when to perform a rapid versus focused exam is one of the most commonly tested primary survey decisions.
Kinematics is the science of how energy transfer causes injury. ITLS tests blunt versus penetrating mechanisms: frontal impact vehicle collisions predict head, neck, thorax, and lower extremity injuries through the down-and-under and up-and-over pathways; lateral impacts predict clavicle, shoulder, and lateral chest injuries on the struck side; rear impacts predict hyperextension cervical injuries. Seat belt syndrome describes the constellation of abdominal wall bruising, hollow organ perforation, and lumbar fracture caused by lap-only belt use in a frontal crash. Penetrating trauma injury severity depends on the velocity and mass of the projectile and the tissue density of the structures in its path.
Airway management in trauma patients differs from medical patients because of cervical spine precautions. The jaw thrust maneuver (not head-tilt chin-lift) is used first. Supraglottic airways (King LT, LMA, iGel) are appropriate rescue devices when intubation is not immediately available or fails. Rapid sequence intubation (RSI) indications include GCS 8 or below, inability to protect the airway, and anticipated deterioration. Surgical airway — cricothyrotomy — is indicated when intubation and supraglottic airways have both failed in a "can't intubate, can't oxygenate" scenario.
Thoracic emergencies are the single most heavily tested area on the ITLS written exam. Tension pneumothorax presents with respiratory distress, absent breath sounds on the affected side, tracheal deviation away from the injury (late sign), and hemodynamic instability — treatment is immediate needle decompression at the second intercostal space, midclavicular line. Open pneumothorax (sucking chest wound) is treated with an occlusive dressing sealed on three sides (or a commercial flutter valve device) to allow air to escape without allowing it to re-enter. Hemothorax is treated with fluid resuscitation and rapid transport. Flail chest — two or more adjacent ribs fractured in two or more places — produces paradoxical chest wall motion and is managed with positive pressure ventilation.
Hemorrhage classification on the ITLS exam uses four classes based on estimated blood volume loss. Class I (up to 15%) causes minimal signs. Class II (15–30%) produces tachycardia and anxiety. Class III (30–40%) causes significant tachycardia, hypotension, and altered mental status. Class IV (over 40%) is immediately life-threatening with profound shock. Hemorrhage control priorities: direct pressure for external bleeding; wound packing with hemostatic gauze for junctional wounds; tourniquet application for extremity hemorrhage (tighten until bleeding stops, note time). Permissive hypotension — targeting a systolic BP of 80–90 mmHg in penetrating trauma without head injury — is an evidence-based strategy to limit coagulopathy until definitive surgical control is achieved.
Disability assessment uses the Glasgow Coma Scale (eye opening + verbal response + motor response, maximum 15) and bilateral pupil assessment (size, equality, reactivity). Spinal immobilization is now selective, not universal — the ITLS selective immobilization criteria allow providers to withhold spinal precautions in alert, sober patients with no midline tenderness, no neurological deficits, and no distracting injuries. When indicated, full spinal precautions remain the standard for unconscious trauma patients, penetrating spine injuries, and patients with neurological deficits.
ITLS tests pediatric anatomy and physiology differences (larger head relative to body — higher cervical injury risk in axial loading; more pliable chest wall — internal thoracic injuries without rib fractures; smaller blood volume — 80 mL/kg). Obstetric trauma management includes left lateral displacement of the uterus after 20 weeks gestation to relieve aortocaval compression, and awareness of physiologic changes (increased blood volume masks hemorrhagic shock signs). Geriatric trauma considerations include osteoporosis increasing fracture risk, anticoagulant and antiplatelet medications worsening hemorrhage, and reduced physiologic reserve narrowing the window for intervention. Burns are assessed using the Rule of Nines (head/neck 9%, each arm 9%, each leg 18%, anterior trunk 18%, posterior trunk 18%, perineum 1%), with airway injury being the top priority over burn surface area in inhalation burns.
Our printable PDF is the ideal complement to hands-on skills practice, but adding timed online questions takes your preparation to the next level. Our ITLS practice test delivers scenario-based questions with instant feedback and detailed answer rationales — helping you understand not just what the right answer is, but why it is correct in the clinical context of each trauma scenario. Use the PDF for in-depth topic review and the online practice tests to simulate the pace and format of the actual ITLS written assessment before your course date.