ATLS FINAL TEST 2024 10th Edition WITH 100 %
CORRECT QUESTIONS AND ANSWERS // 200 +
QUESTIONS // LATEST 2024/2025 // GRADED A + //
ATLS
to increases intravascular volume, pregnant patients can lose a significant amount
of blood before tachycardia, hypotension, and other signs of hypovolemia occur.
Thus, what do stable vital signs in a pregnant patient indicate about the fetus? -
ANSWER-The fetus may be in distress and the placenta deprived of vital perfusion
while the mother's condition and vital signs appear stable. Administer crystalloid
fluid resuscitation and blood to support the physiological hypervolemia of
pregnancy. vasopressors should be an absolute last resort in restoring maternal
blood pressure as they further reduce uterine blood flow, resulting in fetal hypoxia.
What does a normal fibrinogen level indicate in a pregnant patient? - ANSWER-
Fibrinogen level may double in late pregnancy and a normal level may indicate
early disseminated intravascular coagulation
Most common cause of fetal death? - ANSWER-maternal shock and maternal
death. Placental abruption is second. Placental abruption is suggested by vaginal
bleeding, uterine tenderness, frequent uterine contractions, uterine tetany, and
uterine irritability (uterus contracts when touched). In 30% of cases of abruption,
bleeding may not occur. Uterine ultrasound may be helpful in diagnosis, but is
NOT definitive.
Signs of uterine rupture - ANSWER-abdominal tenderness, guarding, rigidity, or
rebound tenderness. Signs of peritonitis are hard to tell due to expansion and
attenuation of the abdominal wall musculature. Other findings include abdominal
,fetal lie (oblique or transverse lie), easy palpation of the fetal parts because of their
extrauterine location and inability to readily palpate the uterine fundus when there
is fundal rupture. X-ray evidence of rupture include extended fetal extremities,
abnormal fetal position, and free intraperitoneal air.
Perform continuous fetal monitoring with a tocodynamometer beyond 20-24 weeks
of gestation. - ANSWER-Patients with no risk factors for fetal loss should have
continuous monitoring for 6 hours, whereas, patients with risk factors for fetal loss
or placental abruption should be monitored for 24 hours. RISK FACTORS ARE:
heart rate > 110, an injury severity score >9, evidence of placental abruption, fetal
heart rate >160 or less than 120, ejection during MV, and motorcycle or pedestrian
collisions
REMEMBER: maternal bicarbonate is low during pregnancy to compensate for
respiratory alkalosis. - ANSWER-17-22 in pregnant patient. (non pregnant patient
is 22-28)
Fetal heart rate is a sensitive indicator of maternal blood volume status and fetal
well-being. - ANSWER-normal range for fetus is 120-160. abnormal heart rate,
repetitive decelerations, absence of accelerations or beat to beat variability and
frequent uterine activity can be signs of impending maternal and or fetal
decompensation (hypoxia or acidosis) and should prompt immediate obstetrical
consultation.
If a DPL is to be placed in a pregnant trauma patient, place the catheter above the
umbilicus using the open technique. Be alert to uterine contractions which suggest
early labor and tetanic contractions which suggest placental abruption. -
ANSWER-evidence of ruptured chorioamniotic membranes include amniotic fluid
in vagina evidenced by a pH of 4.5
Bleeding in 3rd trimester may indicate placental abruption and impending death of
the fetus, a vaginal exam is vital - ANSWER-however, avoid repeating vaginal
,examination, CT abdominal imaging can be done and radiation doses less than
50mGy are not associated with fetal anomalies or higher risk of fetal loss.
Admission to hospital for pregnant patients: - ANSWER-vaginal bleeding, uterine
irritability, abdominal tenderness, pain or cramping, evidence of hypovolemia,
changes in or absence of fetal heart tones and or leakage of amniotic fluid
Reliable ways to detect proper intubation - ANSWER-proper placement of the tube
is suggested but not confirmed:
1. hearing equal breath sounds bilaterally
2. detecting no borborygmi (rumbling or gurgling noises) in the epigastrium. the
presence of this with inspiration suggestion esophageal intubation and warrants
removal of tube
3. A CO2 detector ideally capnograph or colorimetric CO2 monitoring device. If
CO2 is not detected in exhaled air, then esophageal intubation has occurred.
4. Proper position of the tube is best confirmed via chest x-ray
definitive control of hemorrhage and restoration of adequate circulating volume are
the goals of treating hemorrhagic shock. - ANSWER-never give vasopressors as
the first line treatment as they worsen tissue perfusion. most injured patients who
are in hemorrhagic shock require early surgical intervention or angioembolization
to reverse the shock state. The presence of shock in a trauma patient warrants the
immediate involvement of a surgeon.
An injured patient who is cool to the touch and is tachycardic should be considered
to be in shock until proven otherwise. Massive blood loss may only produce a
slight decrease in HCT/Hgb. - ANSWER-relying solely on BP as an indicator of
shock can delay recognition of the condition b/c compensatory mechanisms can
prevent measurable fall in systolic pressure until up to 30% of the patient's blood
volume is loss. A narrowed pulse pressure suggests significant blood loss and
involvement in compensatory mechanisms.
, tachycardia is diagnosed as > 100 in adults
> 160 in infants
>140 in preschool aged children
>120 in children from school age to puberty.
Tachycardia, muffled heart sounds, dilated engorged neck veins, hypotension and
insufficient response to fluid therapy is what? - ANSWER-cardiac tamponade,
which is commonly caused by penetrating thoracic trauma, but can result from
blunt injury to the thorax. Definitive treatment is operative intervention as
pericardiocentesis is temporary measure.
Tension pneumothorax differs because it presents with distended neck veins and
hypotension as well as absent breath sounds and hyper resonant percussion
Acute respiratory distress, subcutaneous emphysema, absent unilateral breath
sounds, hyperresonance to percussion, and tracheal shift supports the diagnosis
of???? - ANSWER-tension pneumothorax. needle or finger decompression
temporarily relieves this life threatening condition and follow this with a chest tube
isolated intracranial injuries do not cause shock, unless the brainstem is injured. A
narrowed pulse pressure is not seen in neurogenic shock. - ANSWER-The classic
presentation of neurogenic shock is hypotension (due to loss of sympathetic tone)
without tachycardia. A narrowed pulse pressure is not seen in neurogenic shock.
The failure of fluid resuscitation to restore organ perfusion and tissue oxygenation
suggest either continuing hemorrhage or neurogenic shock
Less than 15% blood loss. no change in HR, BP, pulse pressure, RR, urine output. -
ANSWER-this is class 1 hemorrhage and requires monitoring with base deficit of
0- -2
