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

1-37. A 64-year-old man, involved in a high-speed car crash, is resuscitated initially in a small rural hospital with limited resources. He has a closed head injury with a Glasgow Coma Scale Score of 13. He has a widened mediastinum on chest roentgenogram with fractures of left ribs two through four, but no pneumothorax. After infusing four liters of Ringer's lactate solution, hid blood pressure is 100/74, pulse rate is 110 beats per minute, and respiratory rate is 18 breaths per minute. He has gross hematuria and a pelvic fracture. The referring physician decides to transfer this patient to a facility capable of delivering a higher level of care which is 128 km (80 miles) away. Before transfer, the physician should first
a. intubate the patient.

b. perform diagnostic peritoneal lavage.

c. apply the pneumatic antishock garment.

d. call the receiving hospital and speak to the surgeon on call.

e. discuss the advisability of transfer with the patient's family.

1-3S. Hemorrhage of 20% of the patient's blood volume is associated usually with

a. oliguria.

b. confusion.

c. hypotension.

d. tachycardia.

e. blood transfusion requirement.

1-39. Which one of the following statements concerning intraosseous infusion in children is TRUE?

a. Only crystalloid solutions may be safely infused through the needle.

b. Aspiration of bone marrow confirms appropriate positioning of the needle.

c. Intraosseous infusion is the preferred route for volume resuscitation in small children.

d. Intraosseous infusion may be utilized indefinitely in the management of injured children.

e. Swelling in the soft tissue around the intraosseous site is not a reason to discontinue infusion.

a. undergo peritoneal lavage.

b. undergo prompt celiotomy = (laparotomy)

c. be carefully observed for further evidence of intra-abdominal injury.

d. have a contrast roentgenographic study of her gastrointestinal tract_,

e. be suspected of having a ruptured diaphragm and accompanying pneumothorax.
1-40. A 26-year-old seat-belted driver is brought to the hospital after a car crash. Primary survey reveals no evidence of serious injury except for diffuse, mild abdominal tenderness. Bowel sounds are hypoactive and liver dullness is questionable. Abdominal films reveal free air. The patient should

POSSIBLE ANSWERS

1. 
   (a)
   
2. 
   (b)
   
3. 
   (e)
   
4. 
   (a)
   
5. 
   (d)
   
6. 
   (d)
   
7. 
   (b)
   
8. 
   (c)
   
9. 
   (c)
   
10. 
    (a)
    
11. 
    (c )
    
12. 
    (e)
    
13. 
    (b)
    
14. 
    (c )
    
15. 
    (d)
    
16. 
    (b)
    
17. 
    (c )
    
18. 
    (d)
    
19. 
    (e)
    
20. 
    (e)
    
21. 
    (d)
    
22. 
    (d)
    
23. 
    (c )
    
24. 
    (e)
    
25. 
    (c )
    
26. 
    (a)
    
27. 
    (d)
    
28. 
    (b)
    
29. 
    (b)
    
30. 
    (c )
    
31. 
    (d)
    
32. 
    (e)
    
33. 
    (a)
    
34. 
    (d)
    
35. 
    (e)
    
36. 
    (c)
    
37. 
    (d)
    
38. 
    (d)
    
39. 
    (b)
    
40. 
    (b)
    

ACS ATLS 1993 Test #1 9