ATLS Practice Test 10th Edition

Question 1

1. A base deficit of -4 in a patient with hemorrhagic shock indicates which type of shock?

Accepted Answer

Class 2

Answer

According to ATLS guidelines, base deficit is a crucial physiological parameter for classifying hemorrhagic shock. A base deficit of -4 mEq/L falls within the range of -2 to -6 mEq/L, which is characteristic of Class 2 hemorrhagic shock. This indicates a moderate level of metabolic acidosis due to hypoperfusion.

Question 2

2. Mildly hypotensive patient, tachycardic, BP returns to normal after 1L fluid bolus but then drops again. What are you going to do?

Accepted Answer

Begin transfusing blood.

Answer

The patient's initial response to a 1L fluid bolus followed by a recurrent drop in blood pressure indicates ongoing blood loss or inadequate volume replacement with crystalloids alone. This suggests that crystalloids are insufficient to maintain hemodynamic stability. Therefore, the next appropriate step in managing suspected hemorrhagic shock is to begin transfusing blood to replace lost red blood cells and improve oxygen-carrying capacity.

Question 3

3. A 20-year-old man fell 20 feet through a rotten plank on an old wooden bridge to the rocky stream below. He was taken to the emergency room within 30 minutes, complaining of chest pain. On arrival at the ED, he is hypotensive. What are you going to do?

Accepted Answer

1L bolus crystalloid

Answer

In a trauma patient presenting with hypotension, the immediate priority is to address potential hemorrhagic shock. According to ATLS guidelines, the initial management involves rapid administration of an intravenous crystalloid fluid bolus. For adults, the standard initial bolus is 1 liter, which helps to restore circulating volume and improve hemodynamic stability.

Question 4

4. A 30-year-old woman was walking across a busy intersection when she was hit by a van. She has a clearly  broken right femur as well as three broken ribs on the right side. She is in need of a blood transfusion. Which of the following statements is correct?

Accepted Answer

A massive transfusion is defined as >4u pRBC in 1 hour.

Answer

A massive transfusion is generally defined by the volume of blood products administered over a specific timeframe, indicating significant hemorrhage. One widely accepted definition, particularly relevant in acute trauma, is the transfusion of more than 4 units of packed red blood cells (pRBC) within one hour. This threshold often triggers institutional massive transfusion protocols to optimize patient outcomes.

Question 5

5. A 29-year-old man is diagnosed with scrotum ecchymosis after landing hard on his bike while jumping across rugged terrain in the national forest.

Accepted Answer

A retrograde urethrogram is advised.

Answer

Scrotum ecchymosis following perineal trauma, such as landing hard on a bike, is a strong indicator of potential urethral injury. In such cases, inserting a Foley catheter is contraindicated until urethral integrity is confirmed. Therefore, a retrograde urethrogram (RUG) is the advised diagnostic procedure to evaluate for urethral disruption before any instrumentation of the urethra.

ATLS - Advanced Trauma Life Support Practice Test

ATLS - Advanced Trauma Life Support Practice Test

ATLS Practice Test 10th Edition