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ATLS - Chapter 4 Thoracic Trauma QUESTIONS AND ANSWERS A+ GRADED 100% VERIFIED 2025/2026
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ATLS - Chapter 4 Thoracic Trauma QUESTIONS AND ANSWERS A+ GRADED 100% VERIFIED 2025/2026
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ATLS - Chapter 4 Thoracic Trauma1. How do you manage a massive hemothorax? - ANS-Restoration of blood volume and
placement of chest tube (4/5th intercostal space, just anterior to the mid axillary line,
36 or 40 French).
2.
3. If there is immediately over 1500ml of blood or if there is ongoing blood >200ml/hr for
2-4 hours, there is indication for thoracotomy.
4. How do you manage an open pneumothorax? - ANS-Place occlusive dressing on
three sides of the wound and place a chest tube remote from the site of the wound.
5.
6. Definitive treatment is closing the defect.
7. How do you manage cardiac tamponade? - ANS-Pericardiocentesis, cardiac surgery
to repair injury.
8. How do you treat a tension pneumothorax? - ANS-Needle decompression - large
caliber needle in the second intercostal space in the mid-clavicular line (8cm needle
reaches >90% of pleural spaces)
9.
10. Definitive treatment is placement of a chest tube (usually 36 or 40 French) placed at
the 4/5th intercostal space at nipple level, just anterior to the mid axillary line.
11. How is cardiac tamponade lethal? - ANS-Decreased arterial pressure causes
hypotension
12. How is flail chest with pulmonary contusion lethal? - ANS-The underlying contusion
causes difficulty with ventilation. Restricted chest wall movement due to pain causes
hypoxia.
13. How is massive hemothorax lethal? - ANS-The loss of blood can cause hypotension
and hemorrhagic shock, the pressure on the lung causes hypoxia.
14. How is open pneumothorax lethal? - ANS-The decrease in ventilation can cause
hypercarbia and hypoxia
15. How is tension pneumothorax lethal? - ANS-The compression of hilar structures from
pressure of the air in the pleural space causes decreased preload, and hypotension.
16. What are 5 lethal injuries secondary to thoracic trauma that need to be identified on
primary survey? - ANS-Tension pneumothorax, flail chest with pulmonary contusion,
open pneumothorax, cardiac tamponade, massive hemothorax
17. What are indications for resuscitative thoracotomy? - ANS-Penetrative thoracic injury
with pulseless electrical activity (PEA)
18.
19. Blunt injury with PEA are not candidates
20. What are some signs of a tension pneumothorax? - ANS-Hypotension, tracheal
deviation away from the side of the injury, neck vein distension, unilateral loss of
breath sounds
21. What is a tension pneumothorax? - ANS-One-way valve in the pleural space causes
build-up of air with no escape, causing collapse and shift of mediastinum to the
opposite side. Decreases preload to the heart, causing hypotension
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