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ITLS Advanced Pre-Test – Annotated Key 8th Edition 1. A Objective: Chapter 1, Objective 3 Page: 14 Rationale: The sudden increase in acceleration produces posterior displacement of the occupants and possible hyperextension of the cervical spine if the headrest is not properly adjusted. The potential for cervical-spine injuries is great. 2. D Objective: Chapter 2, Objective 6 Page: 34 Rationale: The purpose of the initial assessment is to priori
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   ITLS Advanced Pre-Test – Annotated Key 8 th  Edition Exam Version 8.1 – November 2015 Page 1 1. A Objective: Chapter 1, Objective 3 Page: 14 Rationale: The sudden increase in acceleration produces posterior displacement of the occupants and possible hyperextension of the cervical spine if the headrest is not properly adjusted. The potential for cervical-spine injuries is great. 2. D Objective: Chapter 2, Objective 6 Page: 34 Rationale: The purpose of the initial assessment is to prioritize the patient and to identify all immediately life-threatening conditions. The information gathered is used to make decisions about critical interventions and time of transport. 3. C Objective: Chapter 4, Objective 6 Page: 68 Rationale: Manipulating the thyroid cartilage can help bring the vocal cords into view during endotracheal intubation. This is called external laryngeal manipulation (ELM). The movement is usually pressing the thyroid cartilage backward against the esophagus and then upward and slightly to the patient’s right side. 4. B Objective: Chapter 6, Objective 9 Page: 136 Rationale: The pericardial sac is an inelastic membrane that surrounds the heart. If blood collects rapidly between the heart and pericardium from a cardiac injury, the ventricles of the heart will be compressed, making the heart less able to refill, and cardiac output falls. 5. A Objective: Chapter 8, Objective 5 Page: 169 Rationale: This is an example of internal, uncontrolled hemorrhage. Administer sufficient normal saline to maintain peripheral perfusion, following local or EMS agency medical direction policies. Maintaining peripheral perfusion is generally defined as giving enough fluid—usually in boluses—to return a peripheral pulse, such as a radial pulse.   ITLS Advanced Pre-Test – Annotated Key 8 th  Edition Exam Version 8.1 – November 2015 Page 2 6. D Objective: Chapter 10, Objective 6 Page: 194 Rationale: The classic findings of this life-threatening situation are a decreasing level of consciousness (LOC) that rapidly progresses to coma, dilation of the pupil and an outward–downward deviation of the eye on the side of the injury, paralysis of the arm and leg on the side opposite the injury, or decerebrate posturing (arms and legs extended). The danger of immediate herniation outweighs the risk of cerebral ischemia that can follow hyperventilation. The cerebral herniation syndrome is the only situation in which hyperventilation is still indicated. (You must ventilate every three seconds [20/minute] for adults.) 7. C Objective: Chapter 11, Objective 1 Page: 214 Rationale: Certain mechanisms of trauma can overcome the protective properties, injuring the spinal column and cord. The most common mechanisms are hyperextension, hyperflexion, compression, and rotation. Less commonly, lateral stress or distraction will injure the cord. 8. A Objective: Chapter 17, Objective 3 Page: 332 Rationale: Look for signs of airway obstruction in the child, including apnea, stridor, and “gurgling” respirations. If identified, perform a jaw-thrust maneuver without moving the neck. 9. D Objective: Chapter 2, Objective 2 Page: 34 Rationale: This team approach makes the most efficient use of time and allows you to rapidly perform the initial assessment without becoming distracted by performing the necessary interventions yourself, which can interrupt your thought process and cause errors. 10. C Objective: Chapter 4, Objective 4 Page: 75 Rationale: Mild hemorrhage from the nose after insertion of the airway is not an indication to remove it. In fact, it is probably better to keep an NPA in place so as not to disturb the clot or reactivate the bleeding.   ITLS Advanced Pre-Test – Annotated Key 8 th  Edition Exam Version 8.1 – November 2015 Page 3 11. D Objective: Chapter 6, Objective 7 Page: 135 Rationale: The development of decreased lung compliance (difficulty in squeezing the bag-mask device) in the intubated patient should always alert you to the possibility of a tension pneumothorax. 12. B Objective: Chapter 8, Objective 5 Page: 168 Rationale: Give only enough normal saline to maintain a blood pressure high enough for adequate peripheral perfusion. Maintaining peripheral perfusion may be defined as producing a peripheral pulse (such as a radial pulse). 13. C Objective: Chapter 10, Objective 11 Page: 110 Rationale: Although the most reliable method of ensuring proper placement is actually visualizing the tube passing through the glottic opening, even this is not 100% sure. In fact, it is only reliable for the moment you see it. The gold standard for confirming and monitoring ETT placement is waveform capnography. 14. B Objective: Chapter 17, Objective 2 Page: 330 Rationale: Children are most commonly injured from falls (either from standing height or higher), motor vehicle collisions, automobile–pedestrian or bicycle crashes, burns, submersion injuries (drowning), and child abuse. 15. B Objective: Chapter 2, Objective 6 Page: 40 Rationale: Conditions that can rapidly lead to shock include penetrating wounds to the torso, abnormal chest exam, tender distended abdomen pelvic instability and bilateral fractures.   ITLS Advanced Pre-Test – Annotated Key 8 th  Edition Exam Version 8.1 – November 2015 Page 4 16. D Objective: Chapter 4, Objective 5 Page: 82 Rationale: Predictors of difficult mask ventilation can be remembered using the “BOOTS” mnemonic: B – Beards O – Obesity O – Older patients T – Toothlessness S – Snores or stridor 17. D Objective: Chapter 6, Objective 7 Page: 135 Rationale: The development of decreased lung compliance (difficulty in squeezing the bag-mask device) in the intubated patient should always alert you to the possibility of a tension pneumothorax. 18. A Objective: Chapter 8, Objective 6 Page: 168 Rationale: Pack the hemostatic agent in the wound, and hold firm pressure. Hemostatic agent is an “adjunct” to assist in controlling hemorrhage, not a hemorrhage control by itself. 19. A Objective: Chapter 10, Objective 8 Page: 193 Rationale: Hyperventilation actually has only a slight effect on brain swelling, but causes a significant decrease in cerebral perfusion from that same vasoconstriction, resulting in cerebral hypoxia. Thus, both hyperventilation and hypoventilation can cause cerebral ischemia and increased mortality in the TBI patient. 20. A Objective: Chapter 2, Objective 4 Page: 38 Rationale: You may interrupt the assessment sequence only if (1) the scene becomes unsafe, (2) you must treat exsanguinating hemorrhage, (3) you must treat an airway obstruction, or (4) you must treat cardiac arrest. (Respiratory arrest, dyspnea, or bleeding management should be delegated to other team members while you continue assessment of the patient.)
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