Advanced Trauma Life Support

Chapter 155 Advanced Trauma Life Support




Clinical Case Problem 1: A 27-Year-Old Man Injured in a Motor Vehicle Accident


Paramedics wheel a 27-year-old man, in a cervical collar and strapped to a stretcher, into the emergency department of a small, rural hospital. The nearest trauma center is 180 miles away. He was extracted from the driver’s seat of a midsize sedan after a head-on collision with a similar-sized car. Airbags deployed; the patient was not wearing a seat belt.


The cervical spine appears to be adequately immobilized, and the patient is in acute respiratory distress, with a respiratory rate of 32 breaths/minute. Breath sounds are absent in the right lung field. There is blood and pink-tinged fluid leaking from his nose, and a large scalp laceration is present.



Select the best answer to the following questions




1. At this time, what should be your first priority?


a. carry on a complete assessment

b. establish an intravenous (IV) line

c. send the patient to the radiology department for a stat chest radiograph

d. send the patient to the radiology department for a lateral radiograph of the cervical spine

e. secure the airway

2. What is the most likely cause of this patient’s respiratory distress?


a. flail chest

b. tension pneumothorax

c. acute pulmonary embolus

d. pericardial tamponade

e. none of the above

3. After establishing an airway and dealing with the patient’s respiratory status, what should you do?


a. complete the neurologic examination

b. perform a Glasgow Coma Scale assessment

c. establish a central venous pressure (CVP) line or two large peripheral IV lines

d. perform a diagnostic paracentesis

e. perform a stat electrocardiogram (ECG)

4. What is the most likely cause of this patient’s dilated right pupil?


a. a middle meningeal artery tear

b. a chronic subdural hematoma

c. an acute subdural hematoma

d. a or c

e. none of the above

The patient’s neurologic status changes are as follows: (1) eyes: closed, no response to verbal commands but eyes open in response to pain; (2) best verbal response: none; and (3) best motor response: flexion withdrawal to pressure on the brachial plexus.



5. What is the patient’s Glasgow Coma Scale score?


a. 12

b. 8

c. 7

d. 4

e. 2

6. Which of the following would be an indication for a head computed tomography (CT) scan in this patient?


a. a Glasgow Coma Scale score of less than 13

b. a post-traumatic seizure

c. sign of basal skull fracture

d. more than one episode of vomiting after injury

e. all of the above

7. A diagnostic peritoneal lavage is performed and draws bloody fluid. On examination, pain is maximal in the left upper quadrant. What is the most likely cause of this patient’s abdominal pain?


a. liver laceration

b. duodenal rupture

c. renal hematoma

d. splenic rupture

e. pancreatic tear

8. After blunt abdominal trauma, physical examination is


a. less important than obtaining an abdominal CT scan

b. able to predict with better than 90% effectiveness surgically significant intraabdominal injury

c. minimally predictive unless it is paired with significant blood chemistry results

d. important only for the hemodynamically unstable patient

e. unnecessary if imaging is readily available


Clinical Case Problem 2: Car-Motorcycle Collision


A 51-year-old man is brought to the emergency department after having been involved in a car-motorcycle collision in which he was driving motorcycle.


On examination, he is drowsy but conscious. His respiratory rate is 40 breaths/minute. His blood pressure is 70/50   mm Hg. His heart sounds are muffled. He has significant elevation of the jugular venous pressure (JVP) and a large contusion over the sternal area. There is a laceration seen over the precordial region. No other significant abnormalities are noted on primary survey.



9. What is the most likely diagnosis in this patient?


a. myocardial contusion

b. pericardial tamponade

c. aortic rupture

d. pulmonary contusion

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Oct 1, 2016 | Posted by in GENERAL SURGERY | Comments Off on Advanced Trauma Life Support

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