A&e atls test – answers at the end 1 a 22-year-old man sustains a shotgun wound to the left shoulder. His blood

1-5. A previously healthy, 70 kg (175 pound) man suffers an estimated acute blood loss of two liters. Which one of the following statements apply to this patient?
a. His pulse pressure will be widened.

b. His urinary output will be at the lower limits of normal.

c. He will have tachycardia, but no change in his systolic blood pressure.

d. His systolic blood pressure will be decreased with a narrowed, pulse pressure.

e. His systolic blood pressure will be maintained with an elevated diastolic pressure.

a. b.

C.

d. e.

a scoop stretcher.

a long spine board. a short spine board. cervical traction tongs.

the pneumatic antishock garment.

1-6. The "physiologic hypervolemia" of pregnancy has clinical significance in the management of the severely injured, gravid woman by
a. reducing the need for blood transfusion.

b. increasing the risk of pulmonary edema.

c. complicating the management of closed head injury.

d. increasing the volume of blood loss to produce shock.

e. reducing the volume of crystalloid required for resuscitation.

1-7. A 17-year-old helmeted motorcyclist loses consciousness when he is struck broad side by an automobile at an intersection. He arrives in the emergency department with a blood pressure of 140/92, pulse rate of 88_. beats per minute, a respiratory rate of 18 breaths per minute, and a Glasgow Coma Scale Score of seven. Appropriate initial immobilization of this patient should include a semi-rigid cervical collar and

1-8. A 34-year-old man is brought to the hospital after being pinned to the wall of a building by a cement truck. He is in obvious shock, and has deformities and marked swelling of both thighs, although no open wounds are present. His shock
a. cannot be explained without concomitant pelvic fracture.

b. signifies a loss of approximately 15 % of his blood volume.

c. is consistent with blood loss from bilateral femoral fractures.

d. will likely be reversed if appropriate traction splints are applied.

e. cannot be explained by his observed injuries unless a major arterial injury exists.

a b.

C.

d. e.
1-9. Prior to passage of a urinary catheter in a man, it is essential to

examine the abdomen.

determine pelvic stability. examine the rectum and perineum. perform a retrograde urethrogram.

know the history and mechanism of injury.

1-10. The best guide for adequate fluid resuscitation of the burn patient is

a. adequate urinary output.

b. reversal of systemic acidosis.

c. normalization of the heart rate.

d. a normal central venous pressure.

e. four ml/kg/percent body burn/24 hours.

1-11. The LEAST likely cause of a depressed level of consciousness in the multisystem injured patient is
a. shock.

b. head injury.

c. hyperglycemia.

d. impaired oxygenation.

e. alcohol and other drugs.

1-12. Establishing a diagnosis of shock must include
a. confirming hypoxemia.

b. the finding of acidosis.

c. confirming increased vascular resistance.

d. documenting hypotension and low cardiac output.

e. evidence of inadequate perfusion of the body's organs.

1-13. A seven-year-old boy is brought to the emergency department by his parents several minutes after he fell through a window. He is bleeding profusely from a 6-cm (2.4-inch) wound of his medial right thigh. Immediate management of the wound should consist of

a. application of a tourniquet.

b. direct pressure on the wound.

c. apply a hemostat to bleeding vessels.

d. direct pressure on the femoral artery at the groin.

e. application of the pediatric PASG and inflation of the right leg compartment.

1-14. For the trauma patient with cerebral edema, hypercarbia should be avoided to prevent
a. metabolic acidosis.

b. respiratory acidosis.

c. cerebral vasodilatation.

d. neurogenic pulmonary edema.

e. reciprocal high levels of PaCO₂.

1-15. A 25-year-old man is brought to the hospital after being involved in a motor vehicular crash when his car struck a bridge abutment. He is intoxicated, has a Glasgow Coma Scale Score of 13, and complains of abdominal pain. His blood pressure was 80 mm Hg systolic by palpation on admission to the hospital, but it rapidly increased to 110/70 with the administration of intravenous fluids. His heart rate is now 120 beats per minute. The chest roentgenogram shows loss of the aortic knob, widening of the mediastinum, no rib fractures, and no hemopneumothorax. Contrast angiography
a. is not indicated.

b. should be performed after a CT scan of the chest.

c. is not necessary if the CT scan of the chest is normal.

d. should be performed.after diagnostic peritoneal lavage.

e. is positive for aortic rupture in 80% of similar cases.

1-16. Which one of the following statements regarding abdominal trauma in the pregnant patient is TRUE?
a. The fetus is in jeopardy only with major abdominal trauma.

b. Leakage of amniotic fluid is an indication for hospital admission.

c. Indications for peritoneal lavage are different from those in the nonpregnant

patient.

d. Penetration of an abdominal hollow viscus is more common in late than in early pregnancy.

e. The secondary survey follows a different pattern from that of the nonpregnant patient.

1-17. The first maneuver to improve oxygenation after chest injury is
a. intubate the patient.

b. assess arterial blood gases.

C. administer supplemental oxygen.

d. ascertain the need for a chest tube.

e. obtain a lateral cervical spine roentgenogram.