Anda di halaman 1dari 17

ATLS 9 d1tlon

. sophageal
' . . . . . bl for diagnosing c
I '!' h11:h ol the roJioy,mg s1gns 1S LEAST re 13 e

n. S)mmclrical chest \\all mo,ement

h. end-tidal C02 presence b' colorimetl')
c. bilateral breath sounds '
d . oxygen -.aturation >92/o
c. L I I abo' e carina on chest x -ra\ e
WI h in sc'-erc trauma
2. 1!c one of the folio'' ing signs necessitates a ddimU'-e mrwa)
a facial lacerations
h. repeated vomiting c
c. sc\crc maxillofacial fractures
u. ~tcrnal fracture
c. <ilm.gow Coma Scale score of 12

~. 'I ~cnty ~even patients are seriously injured in an aircraft crash at a local airport. The
pnnc1plc\ nf triage include:
<1.e-.tablish a triage site within the internal perimeter of the crash site
b. ~rcat o~ly the most severely injured patients first e
c. mmcdmtcly transport all patients to the nearest hospital
u. treat the greatest number of patients in the shortest period of time
c. produce the greatest number of suniYors based on available resources

L Which one of the follo.... ing statements is correct?

a. Cerebral contusions rna) coalesce to form an intracerebral hematoma.
h. Epidural hematomas are usuall} seen in the frontal region.
contusions may coalesce to c. Subdural hematomas are caused b} injul) to the middle meningeal artery.
form an intracerebral d. Suh<.lural hematomas t)picall) ha"e a lenticular shape on CT scan.
hematoma. c. I he a:.~ociated brain damage is more se,ere in epidural hematomas.
An 18-ycar-old male is brought to the emergenc} department afte r having been shot.
s. J tc has one bullet wound just belo'' the right cia" icle and another just below the
costal margin in the right posterior axilla~ line. IIi~ ~lood pressure is II ?' 60 mm Hg.
hcurt rate is 90 beats per minute, and resptratory ~te 1s 34.breaths per mmute. After
atnt airway and inserting 2\arge-cahber IV hnel., the next appropriate
cnsunng a P c
a step is to:
obtain a portable chest x-ray .
h. administer n bolus of additional IV flUid
c. perform a laparotomYCT
d. obtain an abdominal . sceanllavaoc
c. perform diagnostic penton a o

II ~ )l! I.I>HIJ)\

p I\ *'H' till}
~ tlll\olh'lhlll'- 1') "'''~'-lf'h\
II l I 'I Ill
~. , .. , ..,,~hldl llh'lhh~ll\J'll\

11 h)t''*"'"'" A narrowed pulse pressure is not seen in

h \ ,.,,,,ltl!llhl\1 neurogenic shock.
~ . hr.ul\,,
e II 11~'\lfllhiNi "''"'" life-support/shock.html
\' ,,,,no'"''II'HlM' 1'"'~"111 ,.

\\ ht\ h 111\l' I lith "''"'"In~ 'hMilWilh" r~alw ~'1,11\l't:lllin~ ~h \),WliU\\W\izntll.\{1 '"

pr-.~111111 t ""'"''' l'llll'tll.."

[I h ,,, 'ur-. in hlunt 11r Jlc.' tll'h tltin.:. utxl,mnl.lltttt\llllll.

c h II h,d h) nHt\llr d.~l"\.'1.'' ''' 1\:t,lm.u.mul h~mNchus.: .
,~. Rh imnHIIllli:llhulin themp) '>h~'uld ~ admini,tcr.J l\' pr..:nal\l femal.
h.-, .,ll,hllnd 11 i:lllhlllll wound ll ttw lc
,, I hh ,, not d f'l\lbl~m
In tnlllnlt\tilt'd. RhJXISiti\~ prvgoant p;\ticnt:-...
1-'. lniiUIIiPn 111' l~h lmnllmu.:l,,bulin th~nlp) \1,)('-. nN r.:quir.: pr\)(11 of fet.'lln ~~ ~~ \
h"llllll I hllgt\

v \ 11 I~-) ~~ar-1 'llltnllh\1"\.'~ '-'11-.1 ' ll'ttlin-. tn~'\sh ~ fad I injurk~ in u h :W-on.,...... ~
ptl ._. up tru1._ It, j, hn1u~ht "' the- cmcrgcnc) lkpartmem c~..'lnplet~\~ unn~\t\.1
'''"S 'f'II\C ~\3rJ 11nd "~'1\rin n l'Cr\ ical C{'llar tlis ~lood prc~),IJI~;; 1:. 1:\()1~\lli:U
t lg. h!!~rl rat~ j, MH Jxut' 1)\'r minute and regular. and n~'pinuv1 nuc h
mimllo t lh r"''pinui,\th ure- luhond ttnJ 'l)ll\)r\'U'. H1s I..J\a...g,.\\\ l \'Ina S\:'<iru'.:;"
"' \ uemph atM\llm-.:hcallntubalil'll "ith manual inline- ,labili.LAUI..'ll ~f \l\.~8~\\i~
"f" UtbUCct>s..,l\tl due to bleeding and distl'r\C\1 anat~o\ln). \be ~ticnt
1h~ ~t pn\Cedun. for airwil) rmmagcmcnt in thi' situativu \s:

a., nast,tr~ch"al intubation c

b, emerJlc.'lllC) tracheostom)
\ sura:ical cric,lthynlidolllffi)
d. pla"~mont of an orophal') ngeal a~rn-a~
~. pl~emont of a nasophar) ngeal aarn-ay

Escharotomy is the surgical division of the nonviable eschar, which allows the cutaneous
envelope to become more compliantFull-thickness circumferential and near-
circumferential skin burns result in the formation of a tough, inelastic mass of burnt tissue
(eschar). The eschar, by virtue of this inelasticity, results in the burn-induced compartment
ro~. "'"'"" syndrome. This is caused by the accumulation of extracellular and extravascular fluid
I i~ urit)
11 11
~ , hnnhiiTI\
c within confined anatomic spaces of the extremities or digits. The excessive fluid causes the
intracompartmental pressures to increase, resulting in collapse of the contained vascular
and lymphatic structures and, hence, loss of tissue viability. The capillary closure pressure
tf h, f'lrlll il'Uiitlll of 30 mm Hg, also measured as the compartment pressure, is accepted as that which
" . Htngcnl iul C'-\:"i'm requires intervention to prevent tissue deat .

II \II ''' th~ 1111111\\ n1; ~~~~~., ''"the ehe' t '- ra) ,,, a ra1~ "11-' ~~~~ "'....,
'" '' ' " t~tc 'l unc ruruurc t'scept \\hrch ,,nc'

n m.:Jra,unal .:mph) scma

h f''"' 'cn.:, ,,fu plcurol cup
,,f:llrt~rall,m llfthc u,1nic knob a
tl, ' '"'' rdl itm ,1f1he Lmchea to the right
' dept'\!"""' of the left mainstem bronchu!\
1 '. \ ~0-) cdr-old \\oman tell down four stairs landing on c,,n..~rt'tl~. ~..itt~""'
\\<1" unl.'ltlSCious for five minutes beginning immedta~~ -~iN' ~1\ 'SI!Il'
lhlllnn~iousness during the ten minute transport''' tM ~
l'nt~rv,cnc) department. she is awake. alen. and responsiv~ ~ a ~ ~
SI.'alc SC\li'C of I5. Her only complaint is a slight ~tit . 1'ttil't\ fh~
t'ICC~'mcs unresponsive with a Glasgo" Coma Scale ~'ft! ,, , ~ - )fl
pupil is large and nonreactive. The right pupil i ~1 . Tht ,"'nt NN
in.iul) most consistent with this patient' entire clinkI rou

a. a subdural hematoma
b. an epidural hematoma
~ . an occipital lobe hemorrhage
d. tbcal subarachnoid hemorrhage
c. a cerebellar hemorrhage
1.: , ~"-''
.1 \).4 ('1. wr:'
~,,t1, "- ''"~"' ~, ;\1\ "'ll\',,,lbilt'.~ admi~K"d ..
v .-ft r '1\1111'\ l h, 'bk...~ f'C'C''urt' '' 0 ~ mm Hg. heart , _ 11
.st~ . :-.. , \ .tc. ~ 1'\'l>J'\ 1"\ t:\t 1, \('ll'\rt'ath' r mtnult' , He 15 k!lhlrlte:
'~ ~ h, ~ "~ t: ma"'-. anJ ''"' lar&c "*hhcr ,, ., arr anitaaaod A"tW'"'rl
""'-''" ~...~~ ,~3u~....t His f\30, i .. 11. mm 111!1 t 1" 7 t..ral. rat<\~ H> 1\0 mm Hs
{~.I,) f\)\ ~~ rH ll> ...)l I ht tre.llnM\1 t"l hi' 11\' IIJh.:l ~IS\11\k'r lli .....

a.. h~ "' ntilsll ~~

t-_ nost, r.\ll\'n ,,f"''"";tl rerfu,j,,n
initi..lti..'n N ' k'"
-J,,:;, J('l'>lmino: b
J . .tmma:-tr:ltiNl ,,f Mxlium btctl""'"ntc

~- lntll. "''" ''" rh n~ lcphrino: inl'u j,,ll
1-4. ~\ hio;-h ''fth: ~~'Ill)\\ ins should ~ J)\!tli.,rmcd tit I ln Ull) J"Uticnl \\ h()C;(' injiJrl~ may
mduJ..- multark d\)~ocJ c'\tremil) fnt turc~)

a. \ th,,~ ugh n,-so::~mcnt l)f ti.1ur limb ('k!rfu l(.'n

b. }.l.mcUH'I'S h) ('fC\-C11l11CCI"ll_,iS Of lhC <.l,in.
r,~rem it~ ' ')lliJXIrtmcnt S) ndrome rclcu..,c: d
d. ensuring mkquotc ox gcnntiM und , cnttlutmn
~ . E\ aluatit)n l{)r occult crush:.) ndrome.

I5 . \ J()..)c:lr-nld mule su tains a gun hot \\Ound to the n~ht lo"'~r ,N:...t , m'd"'11.
~l\\ ~n the nipple nnd the co tul mar~in. lie is hrousht hy amhulnncc ''' 11 hot;pita1
that hn full surgicul copabi litics. In the emergency def'lllrtmcm he ~ndotra:tu:a.U)
imubutcd. _ liter:- of crystulloid solution arc infuS<!d roptdly through two tar" -~fi'"-cr
I lines. and n closed tube thorocostomy ill performed with the n:tum of 20U m n
blood. A chest x-rn) rcvcnl:, correct pluccment of the chest tube and a mall re~d
hcrnothorn\.. II is blood prclisure ill now 7010 mm I Jg. and h heart rau: l 40.b:.a~
per minute. r hc mo:.t approprioLc nc\t slep in managing thts pal~nt it. t(l;

a. insert u second chest tube

b. obtain o CT scan of the abdomen
c. perfonn a thoracotom)' in the emergency department d
d. perfonn a laparotomy in the operating room
e. pcrtonn a FA T exam
a patient with gunshot , BP 70/0 , Chest tube drained
120 ml , chest sounds normal. next step?
- Laparatomy
I t;

h a

A 7'> )'Cnr-ultJ I' 1, i
emu ( ' trt\lulvnl ltt 11 lttnlut vchu.. h; 1.111\ h und pr~;sents to the
c." ' ~r~~~~t:y d1. pnn men1 . "ih~ 1.. uu ( !illlllllt lln 1111tl 11 bctu hlnckcr . Whrch of the
1 ll 1 1 ll\.\l tnou '<tti!Ctll

~I '

Ill I ru t t,;UIICCII\IIIjlftCI IIIHIIUJ(Cmcnt'/

he 1 i:-.1-. ul '< llhdur nllwmu"h'I" C: '"' di'I. ICII~td.

~: Ab-.cncc tlt'IUI.hyl'llrd ut rndtiiiiC\ thutthc rattcnt '"hemodynamically normal.
~on-upcrntlvc lllllllO~I.'HlCIII ol ulxlumltuti H1jurle~ ~~ more likely to be successful
"'.older udull\ t hnn in )'lllltlf,!cr pulk t 11P~.
d. ~~~orou-; flu id rc,u\CIIUliuu IIIII)' he u<~.,lll.tlllcd with ctmliCJrc'!piratory failure.
c. L prncphrtllc ~ ho ul d h1. i nlu~ocd lmlllt'llluh.: ly lbr hypotension.

18. A 22-ycnr-old mule i'i brought hy umhuln11cc tu 11 <tntllll cumrnunity hospital alter
Hill ing from the top tl l o 2.'1-mctcr ( ~ lout} !udder . tnitl(tlly, he wa!> found to have a
lurgc right pncumo1horu x 1\ chc,t lllhc was lrhcrtcd und connected to an underwater
sent dm inngc collcctiM 'Y'IIclll with "'* utivc pressure. 1\ rcpcut A I' portable chest x-
rll) dcmonstrutcs o rc-.rdunl, lur~;;c 1 i~ht pneumothorax. After transferring the patient
10 a veri lied 1rouma center, u th ird chc'>l x-r::y reveals u persistent right
pneumothorax. '1 he chc!>ttuhc appcurs til be fu nctioning nnd in good position. He
remains hcmody nomicnlly normal with no 'i~tn ~ of rc.,piratory distress. The most
likely cause fo r his pcrsi... t~nt 1 i~ht pncumothurux is:

n. nail chest
b. diaphmgmnric injury

c. pulmonary conlw;ron e
d. esophageal pcrforo1ion
c. tracheobronchial injur

19. A 22-year-old female who is 6 m~mths prc~nant presents following a motor vehicle
crash. Paramedics reJXrt vaginal hlccdlng. What is the initial step in her treatment?

a. assess fetal heart sounds

b. check for fetal movement
c. pcrfonn inspection of the cerv~x d
d. ask the patient what her name 1s . .
e. insert a wedge under the patient's r1ght h1p
ATt.s 9 "' ldltlon

20. A constru
dcparune~uon_ worker falls from a .
o f lo\.\er a~~~s.hean rate is 124 an~~~ and~ ~sfe:1ed to the coeT:>tXXY
spine and . . ~mal pa in. After a . pressure b g, 60 mm H:. He ax:-;..azc.
Initiating nud . .s~smg the air\.\ a) and chest. ~r _.,.__
I re susc Jtauon the . IZm:c '"""" c -
n. FAS-... next step tS to perform:
' I e)(am
b. dctai led n . a
c. rectal euro loglcal exam
d . cervical spine x-ray
e . urethral catheterization
range. His blood press 1 ~ 5 ; :.~otgun " ound to the left shoulder and ;nc\cse
A 2 2 -year-old male s usta'
After 2 liters ofcrysta~:~s ~ ~0 mm Hg. and his heart rate is 130 beazs ~c~'2
to 122/84 mm Hg and h I so uudo n are rapidly infused. his blood pres-w;e U::..eases.
h a respLratory
\.\It . rate o eartrate
f 28 b ec 100 beats per mm\Jl.C.
. He i5 uC::.: ,x-e,c
sounds are decreas d h reaths per mmute. On pb)sical exam.in3tic"L .:S bee!::'
caliber (36 F h}e at l e left upper chest ,, jth d ullness on percussion. ,\ 1.:!---
- rene tube tho racosto
the retu rn of200 mL o f bl oo d and no ~s
mya1r leak.
mse Themmostthe fifth intercosul

appropriate oe:n step~

a. msert a Foley catheter
b. begin to transfuse 0-negative blood e
c. perform thoracotomy
d. obtain aCT scan of the chest and abdomen
e. repeat the physical examination of the chest

Which one of the following statements concerning spine and spina'. cord {I'a'Ol'tl3 \5

\nj~ -
a. A normal lateral c-spine film excludes injut') .
b. A vertebral injury is unlikely in the absence ofph)sica\ fmdingsofarord
c. A patient with a suspected spine injW') requires immob\\iz.:nion on a -hort sp\ne
d. Diaphragmatic breathing in an unconscious patient" ho has fulkn is a sign ot .:-

e. spine injury. of whether a spinal cord lesion is complete or incomplete must be

made in the primar) sur. e}.

The laryngeal mask airway (LMA) is a

supraglottic airway device


' ''"' I "'"'q II n "" 1 llo "'"''''"'Y d P'"'"'.""l"'' flolllro
Ill Loll Phl111<ll'" Ill Oilllll!hl ICI\h '
II : I"
h'"~~~rw~y h, c;.lt!Br r .ptMury rate'' 21S orld ,.,.

~ ~ ,~n~u~tI ~~~~' ~~;~yn:~~e~!lmplains

'lhnl pt ... '""'" ito \HI mm II I yi>\.QJIC

' "" 'I "'"hi 1 o " , 1"" ""
\II hidl tnt.:rl/1.!111 iun Is
"I' I """"' '"'
quo 1.-looidc> uttl c
Ill pain ''" pelp;t.lllln of

!1 ~~~ ~ l i!J ch.1tllll1('1rl!ti~ion of tlw chc..l

h 11' 1 '~ ur~ltrw~ c
I jM HI llllllllll:!l' lll< fll
d 1 \ lllllll'l\liiOI~
~ lltl" tlutrun,tomy
ud~ bu...: dbturhancc encountered in injured nrdt lrk n \~~
I h
""'" J h>
Ullllol l' UIIIIllilH
~ ,. - '

,, ' '' 1, IUt i hup~ b

h l hclll~l~ Ill 11\'llllhlt lllfl

.I ''""'"''
hlll., ht.:nrbonatl.! uJmOI'\nUion
' lu.. ulll'"'"' .. u.Juun hl\lridc: sJministl't\tion
I ! I ,.,., " '" ""'"" " brou~ht to
o the emcraeney depanmcnt l<oll>wi"'l ?...m<:ter
hll I II " "'" ""'"'" \ he ;, unre,pan i.e nd found to h.-e
hlo" oJ ""'" "" ,,r>)()160 mm Itg. and h..n r" of M. I h<: ft r>t p o .. j" . .

,,dmtnl~h:ring vn.,oprc..sors
It "'"tuhll.,hin~ IV u~cc's for druga~.,i~tcd intuh:ttiOO
h 'll' "'~ In~ th~ ~a use of her dccrea'\Cd \eve\ of con~iou~nes~
uppl}in~ U\) ~en and maintaining uirway
'-' '~hading
hcn1nrrhugc ns u cau'\C of <;hock d
\\ hkh 11"C l1fthc lllhm intt ~lutctncttl'~- j, true rcgntd'"l! tlittlln Itt ptrtt'" I llf'llll

ho' nv utilit in the diu!lno~i~ l'fdinphta!!rnati< rupture


h. I>PI ~honld he p;lrlimm:d whcnuvcr 1111 httltcolitn hr hp trot mV fot PI' fit
c IWI ha!. u hii!h 'JlCcilicit\ . e
~: I )I' I ctm he U\ed 1\tr dln~lll~ing rc!rttt>eriltlflcnl iniuru:~
I> PI ha:. n hi~o~h M.:n,ith ih .

~ htch
(. on~:
11f the fo 1111w111!! stgtt~
ts n~soctntcd
. with dos~ II hc:mhrrh 1 6 M It
c:-tunatcd bluod lo~s \lf7S0- 1500 ml )'!

u. role nbovc 140 beats per minute

b. urtn~ output lc~~ thnn 15 tnl per hout
~:. rc~pii'I.HOI) rotc shove 35 hrcuth, r er tttlmttc e
d . dccrcu~d diu,tolic blood pre~surc
c. normul~o) sto llc blood prcssur t.:

:!9. Ncul'\)gcnic :.hod. k

n. diagnosed by the pre cnce ol nat:cid paroly~i~

h. cuuscd b) bruin injul)
C. d ue lO llCUlC hC111llrrhagc
d. due to ' nsculur resistance
c. initially munugcd with VUS\1prcssor the111py

JO. A 23)Car-old male is admitted to the emergency d t (lillhttl'nt t.ltr t tlv fler t ~t,unm
full-thickness bums 10 his head, 11rms. and up~r tnt"o. totnhn~ot ~(~ .. f>f ht!l h\ I bOO)'
surface nn:a.lle weighs 80 kg ( 185 poumh) Jl j<; hh'tld rn:~~ureo '' lh~fl~ mrn Jl
and hean rate is 135 beats per minute. A uri nury cnthctcr I~ ut~c:rtc:d Wtth th r~htfl\ (>(
20 rnl of dark amber urine. He has received I000 ml ,,r R tngd~ In 1 tc ,fu tttt
since the time of his injury. Using the Parkland lbrmulaoc; lll!lllll( , ht e um ue<:l
cry stalloid fluid resuscitation volume per hour tbr the nc't It h(lnf' hhuh1

a. 667mL
b. 87Sml
c. IOOO mL b
d. 1800mL
c. 2000mL
.... 110n

A 34-,car I
dcP3rim -o d female in'IOolvea
bnlising e::!~~llcang. Cu1 :ra~=IS=~
and antericr r.eclc ar>d
a d' oatJS .ene

b. OX\ " OSCopy to CXelude h~,
. gen b) non-rebreath ....,T,;;-...a:. trlmr.a
c. protect the spine b
d. palpation of the
e. attach a pulse o .
mg mask
her fie down
Xtmeter to her i

32. Compa~d h adults ch"ldr
... "'It pseudosubluxation" at C2/C3 - a posterior step may be
en !-.ave:
a . a longer. wider. funnei-'Shapel . Neurogenic shock can result from severe central nervous
system damage
h. a less pliable:. calcified sketC:U:..r i3Y
c c. lo"'er incidence of borl -
d. relath el) smaller h~ ~rr.._ ;itt: _neur...gen~e sflcck
e. ante d' .....'!tt Ja';\i
rtor rsplacemcnt of C5 on C6 Children have a higher incidence of complete
spinal cord injury without radiographic abnormalit
33. A ma1c present'> fiollowing a motor ~lucie cosh
re .30-)car-old
s p rratol) rate 18. hcan r.rte 88 blood
S ale 13
~ - .:a
pressur-BOJ - mm g; :rnd....
\; !>Core Laparotom!' is indicated r.en~ .....,,..,.

a. there is a distinct seat belt si~ over tne acdomer.

b. the C:
sc~n demonst.-ates a ~race A L-.~ic n1ucy
c. the re rs e\rdence of an extraperitoneal.;.;;dder ir.'ur
d. CT demonstrates retroperitoneal air
e. the abdomen is distended v.ith locali:wf r:ght uppc:' cwa&--...ntl=:11.dt;ne<~

34. A 2 0-)ear-old male is brought to the hospltai app~ mluruti::> :il~~~~

stabbed in the chest. There is a 3-<entlmeter ;c.w".dJUSl medial ' , .,.
blood pressure is 70 33 mm Hg. and heart l.'3te tS .!0 e:k and .ann .:;re.
distended. Breath sounds are normaL Hear: SCWids are Juninishcd. :K--- ~
been established and warm crystalloid is in:fus,rr.g. 1.-.e Qe:X1.tnost unpi"~
immediate management is:

a. CT scan of the chest

b. 12-Jead ECG e
c. left tube thoracostom~
d. begin infusion of packed RBCs
e. FASTexam

''"'"11\)~11 II bwuglttln urtcr u frorrta1 1mpact colh~on tits \Ita\

' H ill 11ltl
1 ' " '" h,i!ll r '' I Ill hlutid '" urc 8' (,(1 rnrn Jig. and r~pnaiDf)'
rate 36 nrcalh
' 111 "'1 llu Olfinnl II "WlllrlulnntgiJIUcrl) of ahdomirt:~l p:un lllcrt: seems
"' 1" 11 1, ll 1 111!h dt~~ tlllll~)' und tXtcrnol rvtauon of the ten leg. \\'hJCh one of the
hllht\\ IU I 111 Itt t:tlt~Cfiiiii!J tlu Jlltllcnt I\ I rut?

I' I\ 1111"'(IIIII>~: rut d nut lta'ICd on the rncch:uusm of injury. c

''" llhth '" lllll\lltl; I) ha~ II dl Uti rcmur frKlUrC
~ tll ft tl tit ~ h "' ""'' JlclVtlltrc nntKJrtantn the initial evaluauon
lntlllltll .lnllllll"ll'\ '"'"' nlthc lett lvwcr ltmb i~ expected.
' ""'"'I'' Ill I tlll>C 111 \Itt"" huulll he \On idtrcd
,,, \ '~ I""'
11lol h IIIIth:' lull~ llt~\\n n lltuht ul tnirJI. She has extensive bruisinS of her
"' tuhllh 11.1 I II 1 lt~:tul till~ " 1211, hluud prcs~urr: is 'J()/70 mm II g. an rcspll'll
11 " d
tnh' ~ 'II Ill("'''"'"''" '"lllllllltttl~ llllt\lu:.uhly explained by:

II "" .,,l,ttnllh'td til jill y

h '""'''''''"''" lt.un ,,J,.Jonllnnlw pelvic injury
' llll 1111111 lllhl\ h 11111111
d pi11.11 5hlll J.; ltullllCIVIlIJ J'IIIC: injury
' I\"'''"
ll~'"'"l!~llh lu i\: ~c:rviutl JIIIIC injury

17. \\hi, h ""' .. 1 the lolhJ\\ '"I> t.1to:m~nt~ "true c(lnccming cranial anatomy?
II lllC '',tip is lllllljK.JSCd ol ~kill, uhC:UtilllCOUS tissue, galea aponeurotica,JOOSC
Ill l'< lt~r IISMIC, 111.! dur11
I> I h. llll'""'S~' IIIC ~ompn.;cd ul the uuro~, pia, arachnoid. and cystema. d
t. I ft, arh:ry ltes bct\\ccn the: dura and pia mater.
d I he l'>leAII5, \\llldt produces ccrebro~pinal fluid, lies in the lateral and
thud \ ClllrtliCS
~ lin h:na.uilltlllerchcllt!ICJ>arntes the cerebral bcmisphcres from the temporal

\ .!.!\l'" ,,1,1 ''''""'" fall~ 1\hilc skiing. She prcsenb on a spine board "" : c~n ica\
~ oll.u: ,,,~ c''" m.1~k ,tt S I und t\\o antecubital IVs. Iler Glasgo\\ Coma "~a.c ,core
is 12. pupils ,trl' t'qtrnl, hlnod pres\ltre is 135176 mm Hg. hcan rate b 1 O'> ,md
rl'spi ,11111 > Ill It' is I1), < hcst \ r!IY is normal. 1 his patient's management priorilic~ are:
ll ( 1 ul llw head und rc pctll Cilasgow Coma Scale
tk linili H ' aimuy. ct nf rhc head. and intracranial pressure monitor
1y runnn itnl. airway.(' I ,,~ t he h~:ad. and ncurosurgcl') COthuh
( 1 uf rhc ltcud. U <. cerebral perfusiOn pressure monitorinu~ and h\ pcnontc
saI in~
c. IV 1>ilttntin. IV mannitol, mild hyperventilation. and serial anerial blood gase
39. A ~oung male patient is brought to the emergency dcp3nment followin~& 5-met.:r
(16-foot) fall from a roof. He responds to pain b) pushing nwoy your hand, op;;nlll~
his eyes, and verbalizing inappropriate words. Pupils ore equal . The m~l hnporhtnl
s tep in management of this patient would be:

a. immediate intubation to protect his airway

b. administer 25 mglkg IV bolus mannitol
c. insert nvo large-bore IVs
d. alcohol and drug screening .
e. detennine w hether amnesia is present and. if so, for what period ofume

40. ln a patient with a spinal cord injury, sacral sparing:

a. refers to a fracture of the sacrum

b . is part of the spinal shock syndrome
c. is a good prognostic sign
d. is diagnostic of a Power's ratio < I . d
e . occurs only with complete transection of the lumbosaccal spnal cor
Mlllt;l lliUI 111.-Uill'lff Ul ~llflJl'OltD

MuiHplc-rhoit\ Rt'!'I IHi n 'it' Sheet

ATLS Writh'n 113
( l~r' iwd 201.' )

N;mlc Ah~M.l=<o...'rv.eM. ...... osrv,blu~.P ~ ).u~ ,_. 1

Course Site
- - -- ---
l,nportn nt instructions: Use a pencil only. If y~1u l'lnngt u rt~J'Km~. pknsc crtt~c your fitst mark completely.
Select the one best answer according to the AILS' Cou!'Sl' content

3-1. (a) (b) (c) (d) 3-21. (n) (b) (c) (d)
3-2. (a) (b) (d) (c) 3-22. (a) (b) (c) (e)
1-3. (a) (b) (c) (d) 3-23. (b) (c) (d) (e)
3-4. (a) (b) (c) (d) 3-24. (a) (b) c (d) (e)
3-5. (a) (b) (c) (d) 3-25. (b) (c) (d) (e)
3-6. (a) (b) (c) (d) 3-26. (a) (b) (c) (e)
3-7. (a) (b) (c) (d) 3-27. (a) (b) (c) (d)
3-8. (a) (b) (c) (e) 3-28. (a) (b) (c) (d)
3-9. (a) (b) (d) (e) 3-29. (a) (b) (c) (d)
3-10. (a) (b) (d) (e) 3-30. (a) (b) (d) (e)
3-11. .I) (b) (c) (d) (e) 3-31. (a) ( (c) (d) (e)
3-J 2. (a) IJ) (c) (d) (c) 3-32. (a) (l'i) (c) (d) (e)
3-13. (a) (c) (d) (e) 3-33. (a) (b) (c) (e)

3-14. (a) (b) (c) ( (e) 3-34. (a) (b) (c) (d)
(a) (b)
(c) (d)



3-17. (a) (b) (c) (e) 3-37. (a) (b) (c) (e)

3-18. (a) (b) (c) (d)

(b) (c) (d) (e)

3-19. (a) (b) (c)

(e) 3-39.
(b) (c) (d) (e)

3-20. (b) (c) (d) (e) 3-40. (a) (b)

(d) (e)
Multilumen Esophageal Airway Multilumen esophageal airway devices are used by some prehospital personnel to achieve an
airway when a definitive airway is not feasible (n FIGURE 2-9). One of the ports communicates with the esophagus and the other
with the airway. The personnel who use this device are trained to observe which port occludes the esophagus and which provides
air to the trachea. The esophageal port is then occluded with a balloon, and the other port is ventilated. A CO2 detector improves
the accuracy of this apparatus. The multilumen esophageal airway device must be removed and/or a definitive airway provided
after appropriate assessment.
When diagnostic peritoneal lavage (DPL) is used to detect diaphragmatic injury, a false-negative result may occur
An isolated penetrating injury from the chest can cause bleeding into the lesser sac, which may not communicate with
the rest of the peritoneal cavity. A DPL in this situation would show no evidence of bleeding.
Drainage of lavage fluid from the chest tube has been reported and is a positive result.
7d==e trauma-life-support/shock.html