ATLS protocols — MCQs

A mass casualty incident occurs with 25 casualties arriving simultaneously at a community hospital emergency department. The trauma team has limited resources with 2 operating rooms available and 4 surgeons present. Among the arriving patients: Patient A has traumatic amputation of forearm with tourniquet in place and stable vitals; Patient B has flail chest, respiratory distress, and unstable vitals; Patient C is in cardiac arrest with penetrating chest wound; Patient D has a femur fracture with stable vitals; Patient E has GCS 4 with bilateral blown pupils. Evaluate the triage priority according to ATLS mass casualty protocols.

A 35-year-old pregnant woman at 32 weeks gestation is involved in a motor vehicle collision. She is hemodynamically stable with blood pressure 105/70 mmHg, heart rate 100/min. She has left upper quadrant tenderness and left lower rib fractures. FAST examination shows fluid in the splenorenal recess. Fetal heart tones are 150/min and reassuring. CT scan shows a Grade III splenic laceration. After 6 hours of observation with stable vital signs and hemoglobin, she suddenly develops blood pressure 85/50 mmHg and heart rate 125/min. Evaluate the management priority.

A 50-year-old helmeted motorcyclist is brought to the trauma bay after a collision at 50 mph. He is unconscious with GCS 6. Initial vitals show blood pressure 160/95 mmHg, heart rate 58/min. Pupils are unequal with the right pupil dilated and minimally reactive. He begins to posture with extension of extremities. He is intubated with in-line stabilization. CT scan cannot be immediately obtained due to scanner malfunction. Evaluate the most appropriate immediate management strategy.

A 19-year-old man is stabbed in the left fifth intercostal space at the anterior axillary line. He arrives alert with blood pressure 95/60 mmHg and heart rate 115/min. Chest X-ray shows a small left hemothorax. A chest tube is placed, draining 600 mL of blood initially, then 150 mL/hour for the next 3 hours. His vital signs stabilize after transfusion of 2 units of packed red blood cells. Analyze the indication for thoracotomy.

A 40-year-old woman is brought to the ED after a high-speed rollover collision. She is combative with GCS 13. Blood pressure is 100/65 mmHg, heart rate 110/min. She has abrasions over her abdomen. FAST examination is negative. After receiving 1 liter of crystalloid, her blood pressure improves to 115/70 mmHg and heart rate decreases to 95/min. She continues to complain of severe abdominal pain. Analyze the most appropriate next step in evaluation.