Shaun Fix

Florida’s Premier Provider Of Quality Medical Training Programs

Nationally Accredited and OSHA Programs
CEU Provider
Since 1988

ITLS
International Trauma Life Support
9th Edition

Preparation Packet
Advanced Provider
Version
The ITLS Course is an intense program that emphasizes out of hospital basic and advanced
trauma management. It is mandatory that participants read the textbook prior to entering
the course – the text is available from ITLS international or we may have a limited supply
in our office. The skills stations require you to be familiar with the procedures in order to
get the most hands on time.

You must, review the text, read this packet and complete the pretest at the back of this
booklet before entering the course.

Pretest will be collected at the beginning of the class.

(772) 878-3085 * Fax: (772) 878-7909 * Email: [email protected]

597 SE Port Saint Lucie Blvd * Port Saint Lucie, Florida 34984
Visit Our Website… MedicalTraining.cc
 Shaun Fix

Florida’s Premier Provider Of Quality Medical Training Programs

Nationally Accredited and OSHA Programs
CEU Provider
Since 1988

Welcome to Emergency Medical Consultants’ International Trauma Life Support Course. We are
pleased that you have chosen us to provide you with this outstanding course and are sure that this will be a
worthwhile seminar for you as a medical professional. The course will begin at 8:30am.

**Please remember, prior to the course, you will need to read the text and complete the pretest. The
pretest will be collected prior to registration on day one.

The ITLS course is an intense 16-hour program, which emphasizes out of hospital basic and advanced
trauma management. It is mandatory that participants read the textbook prior to entering the course. The
skill stations will require you to be familiar with the procedures in order to get the most hands on practice
time.

We have also attached the mandatory skills testing criteria for your review. The ITLS book can be
purchased from ITLS International 1-888-495-4857, online at www.itrauma.org or from our website
www.medicaltraining.cc in the “purchase discounted texts” section. (you can check other sites as well)

We look forward to having you at the course and will be happy to answer any questions you may have;
just call our office at 772-878-3085.

Sincerely,

Shaun Fix

(772) 878-3085 * Fax: (772) 878-7909 * Email: [email protected]

597 SE Port Saint Lucie Blvd * Port Saint Lucie, Florida 34984
Visit Our Website… MedicalTraining.cc
Day 1 Day 2

Lecture Faculty - Lecture Faculty –

8:30 - 9:00 Welcome, overview & collect pre-tests 8:30 - 9:00 Head Trauma – Chapter 10
9:00 - 9:30 Size up, standard precautions
9:00 - 9:30 Trauma arrest – Chapter 21
9:30 - 10:30 Trauma assessment and trauma arrest
Assessment DVD 9:30 - 10:00 Pediatric trauma – Chapter 17
10:00 - 10:30 Geriatric trauma – Chapter 18
10:30 - 10:45 Break
10:30 - 10:45 Break
10:45 - 11:15 Trauma airway management – Chapter 4
10:45 - 11:15 Extremity trauma – Chapter 14
11:15 - 11:45 Thoracic trauma – Chapter 6
11:15 -11:45 Burns – Chapter 16
11:45 - 12:15 Shock - Chapter 8
11:45 - 12:15 Abdominal trauma – Chapter 13
12:15 - 12:45 Spinal cord trauma – Chapter 11

12:45 - 1:45 Lunch

12:15 - 1:00 Lunch
Skills stations
1:45 - 5:00 Skills Faculty –

• Advanced airway - 1:00 - 2:30 Practice / Evaluation

Neutral C-spine *** All Faculty ***
Frontal while supine & seated Patient assessment skills practice
Bougie Stylette
2:30 Patient assessment evaluation stations
Perilaryngeal Airways
Cric
Plural decompression

• Back boarding & rapid extrication – 5:30 Written exam

Rapid extrication from car
KED review All Day 2 Instructors arrive at 12:00 to set up
Supine straddle slide onto board
Supine 45º slide onto board
Adult IO & fluid resuscitation

• Patient assessment, splints & helmets –

ITLS assessment skills
Traction splint
Vacuum or other splints
Helmet Management
Reverse Spine Board (removing patient from LSB)
 ITLS – Acronyms

INJURIES
D eformity
C ontinusions INTERVIEW / HISTORY

A brasions S igns symptoms

P enetrations A llergies

P aradoxical Movement (in chest) M edication

B urns P ast medical hx

T enderness L ast oral intake

L acerations E vents

S welling

CNS
P ulses
M otor
S ensation

A lert
V erbal
P ain
U nresponsive
 ITLS Primary Survey

Scene Size-Up
Standard Precautions
Scene Hazards
Number of Patients
Need for More Help or Equipment
Mechanism of Injury

Initial Assessment
General Impression of the Patient
(life threatening bleeding?)
Level of Consciousness
Control Bleeding
Airway
Breathing
Circulation
(is bleeding controlled?)

Mechanism of
Injury

Generalized Localized
of Unknown MOI
MOI

Rapid Focused
Trauma Exam
Survey -Check injured area
-Quick head to toe -Vital Signs
-Vital Signs -Neuro/Pupils
-Neuro/Pupils -Glasgow Coma
-Glasgow Coma
Load-and-Go
Situation?

ITLS Secondary Survey

-Repeat of initials
-“Monitors”
-more thorough head to toe

ITLS Ongoing Exam

-Q 5 for Critical patients
-Q 15 for Stable patients
 International Trauma Life Support Testing Criteria
The ITLS course requires attendance at all lectures and skills stations. The written exam is 50 questions and requires 74%
as a passing rate. Students who do not make 74% may not retest on the same day.

The skills scenario exam is graded as a pass / fail with emphasis on safety, recognition of potentially life threatening
conditions, complete and proper assessment, management, and transport. Instructors will evaluate the participant using
the following criteria.

Inadequate Rating
1. Disorganized survey
2. Prolonged on-scene times in the setting of “load and go” situations
3. Critical actions missed (such a hyperventilation of coma patient)
4. Missing specific items listed on individual grading sheets
5. Making fatal errors (such as poor cervical spine management)
6. Causes “death” of patient

Adequate Rating

1. Reasonable organization of assessment survey

2. Accurate identification of “load and go”
3. Abbreviated on-scene times for “load and go”
4. Performs critical actions
5. Makes no “fatal” errors

Good Rating

1. Organized survey and solid overall performance

2. Interacts well with patient and team members
3. Performs all critical action
4. Abbreviated on-scene times for “load and go” situations
5. Correctly performs or oversees performance of all critical interventions

Excellent Rating

1. Excellent survey organization

2. Excellent patient care
3. Interacts well with patient and team members
4. Directs the team well, displays leadership
5. Performs all critical actions
6. Demonstrates clear understanding of out of hospital trauma assessment and management
7. Cooperative and supportive in the learning environment
8. Conveys attitude of interest and desire to help teach trauma assessment and management
 ITLS SCENARIO GRADE SHEET (TASK ANALYSIS)
[ ] Basic
[ ] Practice [ ] Test [ ] RT
Student Name: Date: Scenario #: [ ] Advanced
Time Time Time Time
Started: Primary completed: Transported: Secondary completed:

ACTION ✓ COMMENTS ACTION ✓ COMMENTS

PATIENT ASSESSMENT - PRIMARY SURVEY
Baseline Vital Signs HR, RR, BP
Scene Size-up
Standard precautions History SAMPLE

Scene Hazards IF ALTERED MENTAL STATUS

Pupils Size? Reactive? Equal?
Number of Patients
Glasgow coma scale
Need for More Help or Equipment
Orientation, emotional state
Mechanism of Injury
Signs of cerebral herniation
General Impression
Age, Sex, Weight Medical identification devices

General Appearance Blood glucose

Body Position Critical transport decision

Position in Environment

Patient Activity ACTION ✓ COMMENTS

Obvious Severe Injury or Major Bleeding PATIENT ASSESSMENT - REASSESSMENT EXAM
Subjective Ask patient if changes in how feels
LOC AVPU
Reassess mental status LOC, pupils
Airway Snoring, Gurgling, Stridor, Silence
If altered mental status Recheck GCS
Breathing Present? Rate, Depth, Effort
Reassess airway
Radial/Carotid Pulses
Present? Rate, Rhythm, Quality Reassess breathing and circulation
Skin Color, Temp, Moisture, Capillary Refill Recheck vital signs

Uncontrollable external hemorrhage? Skin color, condition, temperature

Head and Neck Check for neck vein distention

Major facial injuries
Check for tracheal deviation
Bruising, swelling, penetrations
Recheck chest
Subcutaneous emphysema?
Breath sounds: Quality? Equal?
Neck vein distention?
Reassess heart sounds
Tracheal deviation?
Reassess abdomen - if possible injury
Chest Look: Asymmetry, Contusion, Development of tenderness, distention, rigidity
Penetrations, Paradoxical Motion, Chest Rise
Check all identified injuries
Feel: Tenderness, Instability, Crepitation
For example:
Breath Sounds Lacerations for bleeding
Present? Equal? PMS distal to injuries on extremities
If decreased breath sounds, percussion Flail segments
Pneumothorax
Heart Tones Open chest wounds

Abdomen Check all interventions

Look: bruising, penetration/evisceration For example:
Gently palpate: tenderness, rigidity, distention ET tube for patency and position
Oxygen for flow rate
Pelvis Deformity, penetrating wounds, TIC IVs for patency and fluid rate
Seals on sucking chest wounds
Lower Extremities Patency of decompression needle
Upper: swelling, deformity, TIC Splints and dressings
Impaled objects for stabilization
Lower: scan wounds, swelling, deformity If pregnant, body position
Cardiac monitor, Sp02, ETCO2
Motor, sensory before transfer to backboard

Upper Extremities
Scan wounds, swelling, deformity
Motor, sensory before transfer to backboard

Posterior Penetrations, deformity, edema GRADE KEY: [ ✓ ] Completed, skill performed in sequence
[ D ] Delayed, performed out of sequence
IF CRITICAL, TRANSFER TO AMBULANCE [ X ] Skill not performed, too late or incorrectly Sept 2019
 ACTION ✓ COMMENTS CRITICAL ACTIONS
PATIENT ASSESSMENT - SECONDARY SURVEY Completes scene size-up and uses universal precautions
Repeat Initial Assessment
Performs initial assessment and interacts with patient
Repeat vital signs
Performs organized rapid trauma survey or focused exam
Consider Cardiac monitor, Sp02, EtCO2
Ensures spinal motion restriction when clinically indicated
LOC
AVPU Ensures appropriate oxygenation and ventilation

If conscious, orientation and emotional state Recognizes and treats all life-threatening injuries
If altered mental status, GCS Uses appropriate equipment and techniques
If altered mental status, blood glucose
Recognizes critical trauma, time and transport priorities
If altered mental status, Sp02
Performs ITLS Secondary Survey (when time permits)
If altered mental status, consider naloxone
Pupils Size, equality, response to light
IMPORTANT ACTIONS
Motor Move fingers and toes?
Performs ITLS Reassessment Exam (when time permits)
Sensation Feel fingers and toes?
Utilizes time efficiently
If unconscious, respond to pinch?
Head If critical, notifies medical direction early
DCAP-BTLS-TIC
Gives appropriate report to medical direction
Raccoon eyes
Demonstrates acceptable skill techniques
Battle’s signs
Displays leadership and teamwork
Drainage from ears or nose

Mouth
ADDITIONAL ACTIONS
Reassess airway
Neck Finish bandaging and splinting after ITLS Secondary Survey (when time permits)
DCAP-BTLS-TIC
Vital signs every 5 minutes for critical patents, every 15 minutes for stable
Neck vein distention?
Repeats Reassessment Exam each time patient moved or intervention performed
Tracheal deviation?
Chest Repeats Reassessment Exam if patient condition worsens
DCAP-BTLS-TIC, paradoxical movement
Appropriately interacts with patient, family and bystanders
Instability and crepitation
Communicates with patients and/or bystanders
Breath sounds Present? Equal? Quality?

If decreased breath sounds, percussion

Heart sounds

Recheck wound seals, injuries

Abdomen
Signs of blunt or penetrating trauma
Palpate all quadrants for tenderness, rigidity
Pelvis and Extremities
DCAP-BTLS-TIC
PMS distal to injuries on extremities
IF CRITICAL, TRANSPORT IMMEDIATELY

OVERALL GRADE

[ ] Proficient (IP) [ ] Competent [ ] Inadequate

Comments:

Lead Instructor Name (print): Signature:

Instructor Name (print): Signature:

Instructor Name (print): Signature:

 Spinal Immobilization Controversy

The NAEMSP (National Association of EMS Physicians) is reported to have hotly debated the following draft
of a “spinal immobilization” position paper before signing on the ACS (American College of Surgeons)
version, “Position Statement EMS spinal precautions and the use of the long backboard”.

The National Association of EMS Physicians believes that:

• There is no demonstrated outcome benefit of maintaining rigid spinal immobilization with a long backboard
during EMS transport of a trauma patient.
• The long backboard can induce respiratory compromise, patient agitation and additional pain. Further, the
backboard can decrease tissue perfusion at pressure points, leading to the development of pressure sores.
• A long backboard or similar device may be useful to facilitate spinal precautions during patient extrication.
• Patient time on long backboards should be minimized.
• Securing a trauma patient to an EMS stretcher without a long backboard is acceptable for maintaining spinal
precaution during transport.
• Implementation of protocols that deemphasize the use of the long backboard should involve all affected partners
in the EMS system.
• This is not a protocol change – This is general info.
 ITLS Advanced Pre-Test 9th Edition

1. In a rear-impact motor vehicle collision, which area of the spine is most susceptible to
injury?
A. Cervical
B. Thoracic
C. Lumbar
D. Sacral-coccygeal

2. A 36-year-old male sustains blunt force thoracic trauma and fits the criteria for a load-
and-go patient. Which of the following should be performed on the scene?
A. Obtain an ECG
B. Establish vascular access
C. Obtain a finger-stick serum lactate level
D. Assess for other potentially life-threatening conditions

3. The use of external laryngeal manipulation:

A. Decreases the risk of airway trauma
B. Reduces gastric distention
C. Improves glottic visualization
D. Causes aspiration

4. A pericardiocentesis is performed to:

A. To remove fluid from the lining around the lungs
B. To remove fluid from the lining around the heart
C. To inject medications directly into the heart
D. To monitor stroke volume

5. A 56-year-old male sustains a gunshot wound to the abdomen. Vital signs are BP
74/32, P 136 present only at the carotid, and R 24 and shallow. The target of fluid
resuscitation is:
A. Return of peripheral pulses
B. Maintenance of central pulses
C. Systolic blood pressure of 110-120
D. Pulse rate of 100

6. An unconscious 15-year-old male was struck on the head with a baseball bat. His arms
and legs are extended and his right pupil is dilated and fixed. You should:
A. Insert an oropharyngeal airway, administer oxygen, and restrict fluids
B. Apply a non-rebreather mask, restrict fluids, and administer Mannitol
C. Perform nasotracheal intubation, restrict fluids, and provide adequate
ventilation
D. Perform bag-mask ventilation at 20 per minute

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 ITLS Advanced Pre-Test 9th Edition

7. Which of the following mechanisms of injury does not commonly cause damage to the
spinal cord?
A. Hyperextension
B. Hyperflexion
C. Lateral stress
D. Compression

8. A 4-year-old female is unconscious after falling off a bicycle. Which of the following is
the best method to open the airway?
A. Modified jaw-thrust
B. Head tilt
C. Neck flexion
D. Neck lift

9. When performing the ITLS Primary Survey, the team leader may minimize errors by:
A. Performing all interventions
B. Limiting crew roles
C. Permitting crew to continue the assessment
D. Delegating interventions

10. You have placed an NPA in your patient and now observe mild hemorrhage from the
nares. You should:
A. Immediately remove the NPA and pack the nose with gauze
B. Immediately remove the NPA and reinsert on the opposite nare
C. Leave the NPA in place so as not to disturb the clot or reactivate bleeding
D. Contact medical control as an NPA will not cause hemorrhage

11. A 27-year-old male with blunt chest trauma from a motor vehicle collision was
successfully intubated at the scene. While ventilating the patient, you note resistance
with absence of right chest wall movement. You should suspect a:
A. Flail chest
B. Gastric distention
C. Mucus obstruction
D. Tension pneumothorax

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 ITLS Advanced Pre-Test 9th Edition

12. A 34-year-old man has a gunshot wound to the right groin area. Arterial bleeding,
which cannot be controlled with direct pressure or tourniquet, is coming from the
wound. The patient appears confused, diaphoretic, and has weak peripheral pulses.
What is the appropriate fluid resuscitation regimen for this patient?
A. Intravenous fluid at a "keep open" rate
B. Intravenous fluid; give enough fluid to maintain peripheral pulses
C. Intravenous fluid at a “wide open” rate
D. No intravenous access should be established in this situation

13. The gold standard to confirm that the endotracheal tube is placed in the trachea is:
A. Evaluation of breath sounds
B. Equal chest rise and fall
C. Waveform capnography
D. Presence of condensation in the tube

14. Common mechanisms of injury for the pediatric patient include all of the following
except:
A. Falls
B. Animal bites
C. Burns
D. Motor vehicle collisions

15. Which of the following injuries would change a trauma patient's transport
classification from "stable" to "load and go"?
A. Clavicle fracture
B. Pelvic fracture
C. Bilateral humerus fractures
D. Bilateral tibia fractures

16. Which of the following findings would not make a patient difficult to ventilate with a
bag-valve mask?
A. Beard
B. Obesity
C. Elderly patient
D. Multiple nose piercings

17. What is the most frequent cause for an intubated trauma patient to develop poor lung
compliance while being ventilated?
A. Tracheal extubation
B. Pericardial tamponade
C. Gastric distention
D. Tension pneumothorax

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 ITLS Advanced Pre-Test 9th Edition

18. Hemostatic agents applied directly to the source of bleeding must be used in
conjunction with:
A. Direct pressure to the wound
B. Tourniquets proximal to the wound
C. Pressure points to arteries proximal to the wound
D. Elevation of the wound above the level of the heart

19. Routine use of hyperventilation in the traumatic brain injury (TBI) patient will:
A. Cause vasoconstriction and increased cerebral ischemia
B. Cause vasodilation and decreased intracranial pressure (ICP)
C. Cause an increase of end-tidal CO2
D. Cause peripheral hypoxia and cyanosis

20. Which finding requires interruption of the ITLS Primary Survey?

A. Complete airway obstruction
B. Gasping respirations
C. Impaled object in abdomen
D. Very weak pulse

21. Bag-valve-mask ventilation:

A. Rarely causes gastric distention due to low airway pressures
B. Is more effective in patients whose dentures have been removed
C. Is easily accomplished by one rescuer at the head
D. May exceed 60 cm H2O pressure in the airway

22. Which of the following is true regarding pulmonary contusion?

A. It is uncommon in chest trauma
B. It is caused by hemorrhage into the lung parenchyma
C. It is only caused by blunt force trauma
D. It rapidly develops after injury

23. A 25-year-old female was stabbed in the left arm. She presents with an altered mental
status and signs of shock. Bleeding is controlled by direct pressure and use of a
tourniquet. Which intravenous fluid therapy is appropriate?
A. Estimate blood loss and administer fluid at a 3:1 ratio
B. Fluid administration of 250 mL
C. Fluid administration to maintain systolic pressure of 60 mmHg
D. Intravenous fluid administration bolus of 500 mL, then reassess

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 ITLS Advanced Pre-Test 9th Edition

24. In the absence of herniation syndrome, adult patients with suspected traumatic brain
injury should be ventilated as a rate of:
A. 8-10 per minute
B. 12-14 per minute
C. 16-18 per minute
D. 20-22 per minute

25. What is the most likely cause of unequal pupils in a patient whose mental status is
altered due to a head injury?
A. Increased intracranial pressure
B. Pre-existing condition
C. Alcohol intoxication
D. Hypotension

26. A 57-year-old male has a respiratory rate of 36, ETCO2 of 30 mmHg, and an oxygen
saturation of 80%. You should:
A. Coach the patient to slow his breathing as his ETCO2 level indicates
hyperventilation
B. Ventilate with a BVM at a higher rate to increase the patient’s oxygen levels
C. Ventilate with a BVM at a rate of 6 to increase the patient’s ETCO2 level
D. Provide supplemental oxygen

27. A 31-year-old male presents with difficulty breathing, rapid and weak pulse, flat neck
veins, and midline trachea. Your assessment of the left side of the chest reveals
decreased breath sounds and dullness to percussion. You should suspect:
A. Cardiac tamponade
B. Flail chest
C. Tension pneumothorax
D. Massive hemothorax

28. A 45-year-old female is found unconscious at the scene of a motor vehicle collision.
Her vital signs are BP 80/40, P 130, and R 30. Which of the following is the most likely
cause for her vital signs?
A. Fractured lower legs
B. Intracranial hemorrhage
C. Bleeding into the chest or abdomen
D. Spinal cord injury with neurogenic shock

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 ITLS Advanced Pre-Test 9th Edition

29. The cause of a secondary brain injury is:

A. Contra-coup
B. Coup
C. Hemorrhage
D. Hypoxia

30. Which one of the following is a reason to interrupt the initial assessment?
A. Cardiac arrest
B. Multiple open (compound) fractures
C. Severe head injury with brain tissue visible
D. Severe shock

31. Which of the following is not a desired characteristic of a suction device?

A. It can be carried in an airway kit with an oxygen cylinder and other airway
equipment
B. It can be hand powered or battery powered
C. It can generate sufficient suction and volume displacement to remove pieces of
food, blood clots, and thick secretions from the oropharynx
D. It can be powered by your portable O2 cylinder so it is not dependent on battery
power

32. What is the most serious early complication of burns from electrical contact?
A. Cervical spine injury
B. Cardiac arrhythmia
C. Hypovolemic shock
D. Renal failure

33. Which of the following changes is most useful to monitor in the child with head
injury?
A. Frequency of vomiting
B. Level of consciousness
C. Reflexes
D. Sensory exam

34. A disoriented 23-year-old male is injured in a motorcycle collision. The patient appears
to be intoxicated and does not want medical attention despite a large laceration on
his scalp, which is actively bleeding. You should:
A. Have the patient call a friend or family member and have them drive him home
and sleep it off
B. Discuss the impact of alcohol abuse with him
C. Treat him as a head injured patient
D. Wait until the patient loses consciousness and then transport

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 ITLS Advanced Pre-Test 9th Edition

35. When performing a needle decompression, which of the following is the best
anatomical location?
A. Directly over the top of the fifth rib in the anterior axillary line
B. Directly over the top of the fourth rib in anterior axillary line
C. Directly under the bottom of the third rib in the midclavicular line
D. Directly over the top of the second rib in the anterior axillary line

36. Which of the following is true regarding trauma in the elderly?

A. Elderly patients are less likely to bleed internally than younger patients
B. Elderly patients have better outcomes following burns than younger patients
C. Fatal outcomes are more likely in the elderly than in the young
D. Motor vehicle collisions are an uncommon mechanism of injury

37. Which of the following organs will suffer the least structural damage from a gunshot
wound from a rifle?
A. Spleen
B. Kidney
C. Liver
D. Lung

38. Which of the following should always be performed prior to transport?

A. Splint all fractures
B. Control major external bleeding
C. Perform the ITLS Secondary Survey
D. Assess vital signs

39. Which of the following distinguishes a tension pneumothorax from a simple

pneumothorax?
A. Tachycardia
B. Shock
C. Dyspnea
D. Anxiety

40. A 25-year-old female was stabbed in the left arm. She presents with an altered mental
status and signs of shock. Bleeding is uncontrolled despite direct pressure. You should:
A. Apply a tourniquet directly over the wound
B. Elevate the extremity above the level of the heart
C. Apply a pressure point
D. Apply a tourniquet proximal to the injury

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41. An unresponsive 36-year-old female was involved in a motorcycle collision. Vital signs
are BP 170/100, P 50, R 8 and GCS 3. You should suspect:
A. Hypovolemia
B. Increased intracranial pressure
C. Pain and anxiety
D. Spinal cord injury

42. A 42-year-old male is involved in a motorcycle collision. Which of the following

assessment findings should be managed first?
A. Airway obstruction
B. Hypotension
C. External arterial bleeding
D. Open lower leg fracture

43. A 32-year-old male is involved in a motor vehicle collision. The steering wheel is bent.
Your assessment reveals present and equal bilateral breath sounds and a rapid and
weak radial pulse that disappears upon inspiration. You should suspect:
A. Cardiac contusion
B. Cardiac tamponade
C. Flail chest
D. Tension pneumothorax

44. Medical Director requests application of a second tourniquet. Which of the following
is the appropriate site?
A. Distal to the injury site
B. Just below the first tourniquet
C. Directly over the first tourniquet
D. Directly over the wound

45. A 35-year-old male is alert and oriented at the scene of a motor vehicle collision
complaining of knee pain and a headache. Your assessment reveals a contusion above
the left eye, swelling to the left knee and unequal pupils (left is dilated). Vital signs
are: BP 116/72, P 88 and R 16. You should suspect:
A. Alcohol intoxication
B. Cerebral herniation
C. Decreased intracranial pressure
D. Ocular trauma

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46. You have a patient with an isolated stab wound to the lateral chest. According to
recent studies, which of the following procedures should be avoided?
A. Bag-valve-mask ventilations
B. Supplemental oxygen administration
C. Application of an occlusive dressing
D. Spinal motion restriction

47. What is the most common cause of cardiopulmonary arrest in the trauma patient?
A. Brain injury
B. Hypoxemia
C. Myocardial contusion
D. Ventricular arrhythmia

48. A 34-year-old female was struck by a vehicle, causing blunt force chest trauma. She is
unconscious with gasping respirations, almost no air movement, a rapid, thready
carotid pulse and flat neck veins. You should:
A. Perform a head-tilt
B. Perform chest thrusts
C. Continue the ITLS Primary Survey
D. Provide positive pressure ventilation

49. A 34-year-old male is injured in a motor vehicle collision. He complains of diffuse

abdominal tenderness. Vital signs are BP 100/60, P 120 and R 28 and shallow. You
should:
A. Administer sufficient intravenous fluids to maintain peripheral pulses
B. Obtain his blood sugar
C. Complete spinal motion restriction, start ventilations as needed, and transport
immediately
D. Administer intravenous fluids to maintain a 130 mmHg systolic BP

50. An unresponsive 52-year-old male was struck in the head by the bucket of a crane.
Vital signs are BP 134/80, P 88 and R 8 and shallow. The patient should be ventilated
at a rate of:
A. 8-10 per minute
B. 12-14 per minute
C. 18-20 per minute
D. 20-24 per minute

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COURSE:

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