A 22-year-old man is hypotensive and tachycardic after a shotgun wound to the left shoulder. His blood pressure is initially 80/40 mm Hg. After 2 liters of crystalloid solution his blood pressure increases to 122/84 mm Hg. His heart rate is now 100 beats per minute and his respiratory rate is 28 breaths per minute. His breath sounds are decreased in the left hemithorax, and after initial IV fluid resuscitation, a closed tube thoracostomy is performed for decreased left breath sounds with the return of a small amount of blood and no air leak. After chest tube insertion, the most appropriate next step isre-examine chestperform aortogramget a CT of chestobtain ABGperform TEE.
1 PLATO, Leiden University, P.O. Box 9555, 2300 RB Leiden, The Netherlands. Electronic address: [email protected]. 2 ATLS Netherlands, Tilburg, The Netherlands. Electronic address: [email protected]. 3 Department of Surgery, University of Calgary and Alberta Health Services - Calgary Foothills Medical Center, Department of Surgery, 10th Floor N. Tower, 1403-29th Street, NW Calgary, AB, Canada T2N 2T9.
If you have questions or need further information, please call the ATLS Department at 312-202-5160 e-mail address: [email protected]: We are transitioning to a new Course Management System for ATLS in Fall/Winter 2019. This site will no longer be available once the new system is available. Advanced Trauma Life Support (ATLS) has formed the backbone of trauma evaluation and management. However, in recent years, literature has outpaced the ability of ATLS to remain current with best practice.
4 Department of Surgery, Medical College of Wisconsin, Milwaukee, USA. Electronic address: [email protected]. 5 Faculty of Health Witten-Herdecke University, Alfred-Herrhausen-Str 50, 584 Witten, NRW, Germany.
Electronic address: [email protected]. 6 Department of Trauma Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Electronic address: [email protected]. BACKGROUND:In Advanced Trauma Life Support (ATLS©) courses, multiple choice question (MCQ) tests are used to assess student's post course knowledge. As part of the ninth Edition Revision Process, existing MCQ tests were reviewed and revised by an International MCQ Revision group. The aim of this study was to evaluate the revision procedure and its effects. METHODS:Based on psychometric data and evidence based guidelines for adequate MCQ item and test development, a detailed stepwise approach was determined and followed to evaluate the existing MCQs, and to guide test item revision or replacement. RESULTS:The MCQ Revision group composed three new draft test versions comprising of 40 MCQs each. These were beta-tested among ATLS Instructors in various countries involved in ATLS.
Psychometric analysis demonstrated that a minority of MCQ items required revision to create three equally balanced tests. After these final adjustments, a new set of three validated MCQ tests was available for use in 9th edition ATLS provider courses. Beta testing was performed using instructors but not students. The failure rate amongst students of ATLS provider courses increased significantly after introduction of the new MCQ tests. CONCLUSION:ATLS tests were revised and updated using current evidence based guidelines and psychometric analysis. Difficulty of the tests was not initially beta-tested on students. Increasing test item discrimination and quality resulted in lower test scores by students.Copyright © 2015 Elsevier Ltd.
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