Prehospital Trauma Life Support (PHTLS) Provider Exam — Questions and Answers

Question 1: Which feature MOST reliably distinguishes heat exhaustion from heat stroke in a field setting?

Heat stroke presents with a higher heart rate than heat exhaustion
Heat exhaustion is associated with normal or near-normal mentation; heat stroke involves CNS dysfunction (Correct answer)
Heat exhaustion affects only younger patients; heat stroke affects only the elderly
Heat exhaustion causes anhidrosis (dry skin); heat stroke causes diaphoresis

Correct answer: Heat exhaustion is associated with normal or near-normal mentation; heat stroke involves CNS dysfunction

The defining feature that separates heat stroke from heat exhaustion is CNS involvement. Heat exhaustion patients have intact or near-intact mentation and are typically still diaphoretic. Heat stroke patients have altered mental status (confusion, agitation, coma) and often anhidrosis. This distinction drives the urgency of active cooling, which is critical in heat stroke and less urgent in heat exhaustion.

Question 2: What is the primary risk of hyperventilation in a trauma patient with a head injury?

Cerebral vasoconstriction causing decreased cerebral perfusion (Correct answer)
Gastric distension leading to vomiting
Pulmonary edema from over-inflation
Cardiac arrhythmia from respiratory alkalosis

Correct answer: Cerebral vasoconstriction causing decreased cerebral perfusion

Hyperventilation causes hypocapnia leading to cerebral vasoconstriction, which reduces cerebral blood flow and can worsen secondary brain injury.

Question 3: In START triage, a victim does not breathe after a single attempt to reposition the airway. What triage tag should be applied?

Green — Minimal
Black — Expectant (Correct answer)
Red — Immediate
Yellow — Delayed

Correct answer: Black — Expectant

A victim who does not breathe after one airway repositioning attempt is classified Black (Expectant) in START triage. Resources cannot be expended on airway management for a single patient when many others are waiting. This is one of the most difficult MCI decisions but is essential to saving the greatest number of lives.

Question 4: A patient with TBI has CSF rhinorrhea (clear fluid from the nose). This finding indicates:

Maxillary sinus hemorrhage
Nasal bone fracture only
Anterior fossa basilar skull fracture with dural tear (Correct answer)
Elevated intracranial pressure without skull fracture

Correct answer: Anterior fossa basilar skull fracture with dural tear

CSF rhinorrhea results from a basilar skull fracture that tears the dura in the anterior fossa, allowing CSF to drain through the cribriform plate into the nasal cavity.

Question 5: A 22-year-old stab victim has a wound to the right groin with pulsatile bright red bleeding. After failed tourniquet placement, what is the best hemorrhage control technique?

Elevate both legs and apply circumferential pressure dressings
Apply ice packs to slow bleeding
Wrap the entire pelvis with an elastic bandage
Use a junctional tourniquet device (e.g., SAM-JT or JETT) or deep wound packing (Correct answer)

Correct answer: Use a junctional tourniquet device (e.g., SAM-JT or JETT) or deep wound packing

Groin wounds with arterial hemorrhage require junctional hemorrhage control devices or deep wound packing since standard limb tourniquets cannot achieve adequate compression at this location.

Question 6: Which of the following is a contraindication to nasopharyngeal airway (NPA) insertion in a trauma patient?

Active gag reflex
Nasal hair present
Patient over age 60
Suspected basilar skull fracture (Correct answer)

Correct answer: Suspected basilar skull fracture

Suspected basilar skull fracture is a relative contraindication to NPA because of the theoretical risk of intracranial placement.

Question 7: A mass casualty incident (MCI) is best defined as any event in which:

The number or severity of patients exceeds available local EMS resources (Correct answer)
A hazardous materials component is present
Air medical transport is activated
More than 10 patients are injured simultaneously

Correct answer: The number or severity of patients exceeds available local EMS resources

An MCI is defined by the relationship between patient load and available resources — not by a fixed patient count. Two critically injured patients can constitute an MCI for a single-unit rural system, while a major urban trauma center may manage 20 patients without declaring an MCI. The threshold is resource-relative, not numerically absolute.

Question 8: When calculating fluid resuscitation using the Parkland formula for a 70 kg adult with 40% TBSA burns, how much Lactated Ringer's should be given in the first 8 hours post-burn?

1,400 mL
5,600 mL (Correct answer)
11,200 mL
2,800 mL

Correct answer: 5,600 mL

Parkland formula: 4 mL × kg × %TBSA = 4 × 70 × 40 = 11,200 mL total; half (5,600 mL) is given in the first 8 hours from time of burn.

Question 9: Which of the following vehicle safety devices can cause injury if a patient is out of position at the time of deployment?

Pretensioner seatbelt
Side curtain airbag deployed in a lateral crash
Front airbag when the occupant is too close to the steering wheel (Correct answer)
Collapsible steering column

Correct answer: Front airbag when the occupant is too close to the steering wheel

An occupant positioned less than 10 inches from a deploying frontal airbag can sustain serious facial, thoracic, and upper extremity injuries.

Question 10: A TBI patient is breathing at a rate of 6 breaths per minute. What is the PHTLS-recommended bag-valve-mask intervention?

Assist ventilations to achieve 20 breaths/min
Assist ventilations to achieve 10 breaths/min for adults (Correct answer)
Immediately hyperventilate at 20 breaths/min to decrease ICP
Allow the patient to self-regulate and provide supplemental O2 only

Correct answer: Assist ventilations to achieve 10 breaths/min for adults

PHTLS recommends assisting ventilation to approximately 10 breaths/min in adults to correct hypoventilation without causing harmful hypocapnia.

Question 11: You are assessing a patient who was assaulted and struck in the head. You note their right pupil is 6mm and non-reactive to light, while the left pupil is 3mm and briskly reactive. This finding is most likely caused by:

The influence of opiate intoxication
Direct trauma to the left eyeball
Compression of the third cranial (oculomotor) nerve (Correct answer)
Bilateral optic nerve damage

Correct answer: Compression of the third cranial (oculomotor) nerve

A unilaterally dilated and non-reactive pupil (a "blown pupil") is a classic and critical sign of compression of the third cranial nerve (the oculomotor nerve). [17, 18, 23] This compression is typically caused by uncal herniation, where rising intracranial pressure on one side of the brain forces the temporal lobe across the tentorium, compressing the nerve on the same side as the injury and dilated pupil. [17, 23]

Question 12: When managing an open (compound) fracture in the prehospital setting, what is the correct treatment of the wound before splinting?

Apply a tourniquet proximal to the wound regardless of bleeding severity
Pack the wound tightly with dry gauze and apply a circumferential pressure wrap
Cover the wound with a moist sterile dressing and do not attempt to push exposed bone back into the wound (Correct answer)
Irrigate the wound thoroughly with sterile saline before applying a dressing

Correct answer: Cover the wound with a moist sterile dressing and do not attempt to push exposed bone back into the wound

Open fractures should be covered with a moist sterile dressing to prevent further contamination and tissue desiccation. Exposed bone should never be pushed back into the wound in the field, as this risks driving contamination deeper into the tissue.

Question 13: JumpSTART modifies the adult START system for pediatric patients primarily by adding which intervention for apneic children who have a palpable pulse?

Five rescue breaths before assigning the Expectant category if still apneic (Correct answer)
Immediate Red tag without any intervention attempt
Checking capillary refill before assessing respirations
Classifying all children under 8 as Immediate regardless of vital signs

Correct answer: Five rescue breaths before assigning the Expectant category if still apneic

JumpSTART adds a critical rescue breath step: if a child is apneic but has a palpable pulse, give 5 rescue breaths. If breathing resumes, classify as Red (Immediate). If the child remains apneic, classify as Black (Expectant). This modification reflects that pediatric arrest more commonly begins with primary respiratory failure rather than primary cardiac failure.

Question 14: In a helmet-wearing athlete with suspected cervical spine injury, PHTLS recommends leaving the helmet in place UNLESS:

The event occurred during a contact sport
The patient is responsive and cooperative
The helmet prevents adequate airway assessment or management (Correct answer)
Bystanders have already partially removed it

Correct answer: The helmet prevents adequate airway assessment or management

Helmets should remain in place unless they prevent airway assessment/management, are improperly fitted, or the patient is in cardiac arrest.

Question 15: Which anatomical feature of a child's airway makes intubation more challenging compared to an adult?

Lower position of the cricoid cartilage
Larger, more anterior larynx positioned higher in the neck (Correct answer)
Smaller tongue relative to mouth size
Wider trachea with firmer cartilage

Correct answer: Larger, more anterior larynx positioned higher in the neck

In children, the larynx is higher and more anterior, making visualization and intubation technically more difficult.

Question 16: Which of the following is a primary goal of 'permissive hypotension' in the management of a trauma patient with suspected non-compressible torso hemorrhage?

To prevent clot dislodgement by avoiding aggressive fluid resuscitation. (Correct answer)
To increase urine output and confirm adequate renal perfusion.
To aggressively administer crystalloids until the radial pulse is bounding.
To rapidly normalize blood pressure to 120/80 mmHg.

Correct answer: To prevent clot dislodgement by avoiding aggressive fluid resuscitation.

Permissive hypotension is a strategy used in trauma patients with suspected internal bleeding to maintain a blood pressure that is just high enough for vital organ perfusion (e.g., SBP of 80-90 mmHg) without being so high that it dislodges newly formed clots or dilutes clotting factors. The goal is to avoid 'popping the clot' before the patient can get to definitive surgical care.

Question 17: According to PHTLS hemorrhagic shock classification, a patient presenting with heart rate of 118 bpm, mildly anxious affect, and normal blood pressure most likely falls into which class?

Class IV
Class III
Class I
Class II (Correct answer)

Correct answer: Class II

Class II hemorrhage (750–1500 mL blood loss, 15–30% volume) typically causes tachycardia (100–120 bpm) and anxiety while systolic BP is still maintained through compensatory vasoconstriction. BP drop is not yet measurable at this stage.

Question 18: A trauma patient with facial burns develops progressive hoarseness and stridor. What does PHTLS recommend?

Monitor closely and transport; intubation can wait
Administer nebulized epinephrine and observe
Early definitive airway management before complete obstruction occurs (Correct answer)
Apply supplemental oxygen only and reassess

Correct answer: Early definitive airway management before complete obstruction occurs

Progressive hoarseness and stridor in a burn patient indicate developing airway edema that may rapidly progress to complete obstruction.

Question 19: A trauma patient has a gunshot wound to the right flank and is hemodynamically stable. During transport, vital signs suddenly deteriorate. The MOST likely explanation is:

Delayed rupture of a solid organ or vascular structure (Correct answer)
Tension pneumothorax from a missed chest wound
Neurogenic shock from a spinal cord injury
Medication reaction from IV fluids administered

Correct answer: Delayed rupture of a solid organ or vascular structure

Delayed hemodynamic deterioration following penetrating abdominal trauma typically indicates delayed solid organ rupture or vascular injury that was not bleeding initially.

Question 20: Which of the following injuries is most likely to cause immediate exsanguination and death before hospital arrival in thoracic trauma?

Tension pneumothorax
Pulmonary contusion
Simple pneumothorax
Traumatic aortic disruption with full transection (Correct answer)

Correct answer: Traumatic aortic disruption with full transection

Complete transection of the thoracic aorta causes massive hemorrhage and is nearly universally fatal at the scene; survivors typically have a contained pseudoaneurysm.

Question 21: A patient involved in a high-speed MVC is found ambulatory at the scene but complains of neck pain. What is the PHTLS-recommended approach to spinal motion restriction (SMR)?

Spinal precautions are unnecessary if the patient is walking
Advise the patient to walk to the ambulance carefully
Immobilize only if the patient is unconscious
Apply a cervical collar and consider full SMR based on mechanism and symptoms (Correct answer)

Correct answer: Apply a cervical collar and consider full SMR based on mechanism and symptoms

PHTLS recommends applying a cervical collar and evaluating for full SMR when significant mechanism is combined with neck pain, even in ambulatory patients.

Question 22: Which of the following describes an adult patient who should be sent to a trauma hospital in accordance with the Centers for Disease Control Trauma Triage Guidelines?

Amputated finger
Respirations of 30 per minute (Correct answer)
GCS of 14
Fall of 10 feet

Correct answer: Respirations of 30 per minute

The Centers for Disease Control (CDC) Trauma Triage Guidelines use physiological criteria to identify patients needing immediate transport to a trauma center. A respiratory rate of 30 breaths per minute in an adult indicates significant respiratory distress or compromise, exceeding the normal range. This physiological derangement is a critical indicator for trauma center activation, suggesting potential life-threatening injury affecting oxygenation and ventilation.

Question 23: A patient in a rear-end collision reports neck pain. Which kinematic event explains the mechanism of cervical injury in rear impacts?

The torso accelerates forward while the unsupported head initially lags behind, causing hyperextension (Correct answer)
The headrest absorbs all energy, preventing injury
The seatbelt locks and pulls the cervical spine posteriorly
The head is thrown forward into the steering wheel

Correct answer: The torso accelerates forward while the unsupported head initially lags behind, causing hyperextension

In rear-end collisions, the torso is accelerated forward by the seat while the head momentarily remains stationary, producing rapid cervical hyperextension.

Question 24: In the context of PHTLS, 'damage control resuscitation' in the prehospital phase refers to:

Aggressive crystalloid resuscitation to maintain normal blood pressure
Immediate surgical hemostasis in the field
Applying tourniquets to all extremity injuries first
Limiting crystalloids, using blood products when available, and permissive hypotension (Correct answer)

Correct answer: Limiting crystalloids, using blood products when available, and permissive hypotension

Damage control resuscitation limits crystalloids to prevent dilutional coagulopathy, uses blood products, and accepts permissive hypotension until surgical control.

Question 25: In which situation should a prehospital provider NOT attempt to realign a deformed extremity fracture before splinting?

When pulses are absent distal to the fracture and transport time is less than 10 minutes
When the patient reports significant pain with the deformity
When the fracture is in the midshaft of the radius
When a joint is involved and any attempt at realignment produces resistance or causes severe pain (Correct answer)

Correct answer: When a joint is involved and any attempt at realignment produces resistance or causes severe pain

Fractures involving joints (dislocations) should not be forcibly realigned in the field. Resistance or severe pain during an attempt signals that reduction could cause additional neurovascular damage. Splint in the position found and transport immediately.

Question 26: How does PHTLS recommend managing junctional hemorrhage (neck, axilla, groin)?

Immediate surgical clamping in the field
No intervention is possible prehospitally
Tourniquet application at the wound site
Wound packing with hemostatic gauze and sustained direct pressure (Correct answer)

Correct answer: Wound packing with hemostatic gauze and sustained direct pressure

Junctional hemorrhage is managed with wound packing using hemostatic agents and sustained direct pressure.

Question 27: Using START triage, a victim has a respiratory rate of 34 breaths per minute. What triage category is assigned?

Green — Minimal, as the patient is breathing
Yellow — Delayed, pending perfusion and mental status checks
Black — Expectant, as the rate is abnormally elevated
Red — Immediate, based on respiratory rate alone (Correct answer)

Correct answer: Red — Immediate, based on respiratory rate alone

In START, a respiratory rate greater than 30 breaths per minute immediately classifies the patient as Red (Immediate). No further assessment steps are needed once this threshold is crossed. A rate below 10 is also classified as Immediate (Red). Only rates of 10–29 prompt advancing to the perfusion and mental status steps.

Question 28: What complication should be anticipated when using a supraglottic airway device in a patient with active upper airway bleeding?

Increased intracranial pressure
Automatic deflation of the device cuff
Device malfunction from blood exposure
Aspiration of blood around an imperfect seal (Correct answer)

Correct answer: Aspiration of blood around an imperfect seal

Supraglottic devices do not provide a definitive seal around the trachea, so active bleeding can track around the device and be aspirated.

Question 29: In PHTLS, which physiologic mechanism is the PRIMARY cause of death in hemorrhagic shock when the body's compensatory mechanisms fail?

Inadequate cellular oxygen delivery leading to anaerobic metabolism and organ failure (Correct answer)
Neurogenic depression of the cardiac conduction system
Severe metabolic alkalosis from bicarbonate loss
Systemic inflammatory response overwhelming the immune system

Correct answer: Inadequate cellular oxygen delivery leading to anaerobic metabolism and organ failure

PHTLS defines shock as inadequate tissue perfusion and oxygenation. When compensatory mechanisms (vasoconstriction, tachycardia) are exhausted, cells shift to anaerobic metabolism, producing lactic acidosis, which progresses to multi-organ failure and death.

Question 30: When packing a wound for junctional hemorrhage control, approximately how long should direct pressure be maintained after packing?

5 minutes
30 seconds
3 minutes (Correct answer)
1 minute

Correct answer: 3 minutes

PHTLS and TCCC guidelines recommend at least 3 minutes of direct pressure after wound packing to allow clot formation with hemostatic agents.

Question 31: According to PHTLS 7th Edition, which assessment tool is used to rapidly evaluate neurologic status during the primary survey?

NIH Stroke Scale
Cincinnati Prehospital Stroke Scale
AVPU scale (Correct answer)
Glasgow Coma Scale

Correct answer: AVPU scale

The AVPU scale (Alert, Voice, Pain, Unresponsive) is the rapid neurologic assessment tool recommended during the primary survey's Disability component.

Question 32: Which clinical sign is the most reliable indicator of adequate ventilation in a prehospital trauma patient?

Pink skin color
SpO2 reading above 90%
Patient can speak
Symmetric chest rise with each breath (Correct answer)

Correct answer: Symmetric chest rise with each breath

Symmetric chest rise with each ventilation confirms bilateral lung inflation and is the most direct assessment of adequate ventilation.

Question 33: Which of the following is the MOST appropriate initial intervention for a suspected pelvic fracture causing hemodynamic instability in the prehospital setting?

Apply a pelvic binder or sheet wrap (Correct answer)
Place the patient in Trendelenburg position
Perform external cardiac compression
Initiate IV fluid bolus of 2L normal saline

Correct answer: Apply a pelvic binder or sheet wrap

A pelvic binder or sheet wrap reduces pelvic volume and tamponades internal hemorrhage in unstable pelvic fractures.

Question 34: When is a needle decompression indicated in the prehospital setting?

SpO2 below 95% after oxygen application
Suspected tension pneumothorax with deteriorating hemodynamics (Correct answer)
Any patient with a chest wound
Confirmed simple pneumothorax on palpation

Correct answer: Suspected tension pneumothorax with deteriorating hemodynamics

Needle decompression is indicated for suspected tension pneumothorax causing hemodynamic or respiratory deterioration.

Question 35: A restrained driver involved in a high-speed collision becomes increasingly agitated and then unresponsive. Assessment reveals absent breath sounds on the left, distended neck veins, and hypotension. What is the priority prehospital intervention?

Spinal immobilization and rapid transport only
Needle decompression of the affected side (Correct answer)
Application of a thoracic pressure dressing
Immediate endotracheal intubation

Correct answer: Needle decompression of the affected side

The triad of absent unilateral breath sounds, distended neck veins, and hypotension indicates tension pneumothorax. Needle decompression on the affected side is the immediate life-saving intervention to relieve intrathoracic pressure before it causes cardiac arrest.

Question 36: Which of the following describes a spine injury patient as meeting the NEXUS criteria?

Determining if the patient is intoxicated (Correct answer)
Inability to ambulate
Pain or tenderness of the spine with motion
Verifying distal pulses

Correct answer: Determining if the patient is intoxicated

The NEXUS (National Emergency X-Radiography Utilization Study) criteria are used to clinically clear the cervical spine without imaging. One of the key criteria is that the patient must not be intoxicated, as intoxication can impair their ability to reliably report pain or tenderness, or to cooperate with the physical examination. If a patient is intoxicated, their spine cannot be cleared based on NEXUS criteria, and further imaging or immobilization is required.

Question 37: Which part of the spine innervates the phrenic nerve the most?

T2 through T4
T9 and T10
C3 through the C5 (Correct answer)
C1 and C2

Correct answer: C3 through the C5

The phrenic nerve is vital for respiration as it innervates the diaphragm, the primary muscle responsible for breathing. It originates from the cervical spinal nerves, specifically C3, C4, and C5. Damage to the spinal cord at or above these levels can lead to paralysis of the diaphragm and subsequent respiratory arrest, making this anatomical knowledge crucial for trauma assessment and management.

Question 38: A 6-year-old restrained passenger presents after a high-speed crash. The child appears stable but is crying and guarding the abdomen. Regarding transport decision-making, the PHTLS principle is:

Delay transport until the child is calm enough for accurate abdominal assessment
Perform a full secondary assessment on scene before transport decision
Prioritize transport to a pediatric trauma center or trauma center with pediatric capability (Correct answer)
Transport to the nearest emergency department regardless of trauma center availability

Correct answer: Prioritize transport to a pediatric trauma center or trauma center with pediatric capability

Pediatric trauma patients should be transported to facilities with appropriate pediatric trauma capabilities to optimize outcomes.

Question 39: Which component of Damage Control Resuscitation (DCR) directly addresses dilutional coagulopathy?

Permissive normotension
Early surgical hemorrhage control
High-ratio packed red blood cells to FFP (Correct answer)
Large-volume crystalloid infusion

Correct answer: High-ratio packed red blood cells to FFP

DCR uses a balanced 1:1:1 ratio of PRBCs to FFP to platelets to replace all lost blood components and prevent dilutional coagulopathy.

Question 40: A 17-year-old bicyclist struck a fixed post, impacting his left upper abdomen and flank on the handlebar. He is pale and tachycardic with a BP of 88/58 mmHg. Based on the mechanism and location of injury, which organ is most likely the source of his hypovolemia?

Liver
Stomach
Appendix
Spleen (Correct answer)

Correct answer: Spleen

The spleen is a highly vascular, solid organ located in the left upper quadrant (LUQ) of the abdomen. [15, 16] It is the most commonly injured organ in blunt abdominal trauma. [19] A direct blow to the LUQ, such as from a handlebar, is a classic mechanism for splenic injury, which can lead to rapid and severe internal hemorrhage. [16, 21]

Question 41: During a farm accident, a patient is trapped under agricultural equipment with a running diesel engine nearby. What hazard requires immediate attention?

Carbon monoxide accumulation in a low-lying area (Correct answer)
Risk of hydraulic fluid skin irritation
Sunburn risk for rescuers
Potential for agricultural dust inhalation

Correct answer: Carbon monoxide accumulation in a low-lying area

Diesel engines in enclosed or low-lying areas produce carbon monoxide that accumulates rapidly and can incapacitate rescuers and patients.

Question 42: What is the PRIMARY purpose of the SAMPLE history in prehospital TBI assessment?

To calculate the Revised Trauma Score
To determine if the patient has advance directives
To identify medications, allergies, and baseline conditions that affect TBI management and triage (Correct answer)
To document the scene for legal purposes

Correct answer: To identify medications, allergies, and baseline conditions that affect TBI management and triage

SAMPLE history reveals anticoagulants, antiplatelets, prior neurologic conditions, and allergies that directly influence TBI management and hospital destination decisions.

Question 43: Which type of shock results from a mismatch between oxygen supply and demand due to cellular inability to utilize oxygen, despite adequate delivery?

Distributive shock
Hypovolemic shock
Obstructive shock
Cellular/metabolic shock (Correct answer)

Correct answer: Cellular/metabolic shock

Cellular or metabolic shock (e.g., from cyanide poisoning) occurs when cells cannot use delivered oxygen, leading to anaerobic metabolism despite normal or high oxygen supply.

Question 44: Which airway adjunct is most appropriate for an unconscious trauma patient with an intact gag reflex?

Combitube
Oropharyngeal airway (OPA)
Nasopharyngeal airway (NPA) (Correct answer)
Laryngeal mask airway

Correct answer: Nasopharyngeal airway (NPA)

The nasopharyngeal airway is better tolerated than the OPA in patients with an intact gag reflex.

Question 45: A patient presents after sustaining radiation burns from an industrial source. After removing contaminated clothing, what additional step unique to radiation exposure must occur before transport?

Immediate application of lead shielding over the burn wound
Radiation survey and decontamination of the patient to protect rescuers and hospital staff (Correct answer)
Hyperventilation to accelerate elimination of inhaled radioactive particles
Administration of potassium iodide to block radioactive uptake

Correct answer: Radiation survey and decontamination of the patient to protect rescuers and hospital staff

Patients exposed to radioactive contamination must be surveyed with a Geiger counter and decontaminated before transport to prevent exposing EMS personnel and hospital staff.

Question 46: Pulseoximetry (SpO2) may give falsely normal readings in which trauma scenario?

Airway obstruction from tongue
Hemorrhagic shock with hemoglobin drop
Hypoxia from tension pneumothorax
Carbon monoxide poisoning from smoke inhalation (Correct answer)

Correct answer: Carbon monoxide poisoning from smoke inhalation

Pulse oximetry cannot distinguish carboxyhemoglobin from oxyhemoglobin, so CO poisoning can produce falsely normal SpO2 readings.

Question 47: How should PHTLS providers approach trauma patients with obesity?

No modifications to standard assessment are needed
Airway management is more challenging, landmarks are obscured, medication dosing may differ, and extrication requires planning (Correct answer)
Standard equipment works for all body types
Obese patients cannot go into shock

Correct answer: Airway management is more challenging, landmarks are obscured, medication dosing may differ, and extrication requires planning

Obesity presents unique challenges including difficult airway management, obscured anatomic landmarks, and equipment limitations.

Question 48: What is the most clinically significant limitation of pulse oximetry (SpO2) monitoring in a hemorrhagic trauma patient?

It requires a minimum blood pressure of 80 mmHg to function
It directly measures arterial oxygen partial pressure (PaO2)
It may display falsely normal readings in the presence of poor peripheral perfusion or carbon monoxide poisoning (Correct answer)
It cannot be applied to fingers, only earlobes

Correct answer: It may display falsely normal readings in the presence of poor peripheral perfusion or carbon monoxide poisoning

In hemorrhagic shock, peripheral vasoconstriction reduces signal quality and can cause inaccurate readings. Additionally, carbon monoxide binds hemoglobin similarly to oxygen, causing pulse oximeters to display falsely high SpO2 values. Clinicians must correlate oximetry with the overall clinical picture.

Question 49: On a PHTLS pre-test, which is the correct order for assessing a trauma patient?

Patient interview, blood pressure, pulse oximetry
Transport decision, treatment, documentation
Scene size-up, primary survey, secondary survey (Correct answer)
Detailed physical exam, vital signs, history

Correct answer: Scene size-up, primary survey, secondary survey

The correct assessment order in PHTLS is scene size-up first, followed by the primary survey to identify life threats, then the secondary survey for detailed assessment.

Question 50: When is it appropriate to convert a field-applied tourniquet to a pressure dressing during prolonged transport?

Only under direct medical oversight when hemorrhage is confirmed controlled and total tourniquet time is less than 2 hours (Correct answer)
After 30 minutes in all cases to prevent limb loss
Whenever the patient's blood pressure normalizes
Never — tourniquets should remain in place until surgical removal

Correct answer: Only under direct medical oversight when hemorrhage is confirmed controlled and total tourniquet time is less than 2 hours

Tourniquet conversion may be considered under medical direction when bleeding is controlled, ischemia risk is increasing, and the wound can be managed with an alternative technique, but this is rarely done prehospitally.

Question 51: In the START triage system, after directing all walking wounded away from the immediate scene, what is the FIRST physiologic parameter assessed in remaining victims?

Respirations — presence and rate (Correct answer)
Level of consciousness and ability to follow commands
Radial pulse presence and strength
Presence of major external hemorrhage

Correct answer: Respirations — presence and rate

START (Simple Triage And Rapid Treatment) assesses three parameters in sequence: (1) Respirations — if absent, one attempt to reposition the airway; (2) Perfusion — radial pulse or capillary refill; (3) Mental status — ability to follow a simple command. Respiratory assessment is always the first step after the walking-wounded sort.

Prehospital Trauma Life Support (PHTLS) Provider Exam

This exam certifies prehospital professionals in the assessment and management of trauma patients, emphasizing rapid assessment and intervention.

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60 min

Time Limit

76%

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