Free PHTLS Knowledge Questions and Answers 1 — Questions and Answers

Question 1: Applying a traction splint to a fractured foot is mostly done for the following reasons:

Immobilize broken bone ends
Prevent crepitation
Control bleeding (Correct answer)
Reduce pain

Correct answer: Control bleeding

While traction splints are primarily used for long bone fractures (like the femur) to reduce pain and stabilize the limb, stabilization of any severe fracture can indirectly help control bleeding. By preventing movement of jagged bone ends, a splint minimizes further soft tissue and vascular damage, thereby contributing to hemorrhage control. For major fractures, this can be a critical life-saving benefit, even if a traction splint is not typically applied to a foot.

Question 2: Which part of the spine innervates the phrenic nerve the most?

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

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 3: Which of the following accurately describes the difference between an epidural and subdural hemorrhage?

Epidural hemorrhage develops more slowly than subdural hemorrhage
Subdural bleeding is usually arterial
Subdural hematoma patients have a classic lucid period
Epidural hemorrhage may result from a blow to the temple (Correct answer)

Correct answer: Epidural hemorrhage may result from a blow to the temple

An epidural hemorrhage typically results from arterial bleeding, often caused by a direct blow to the temple that fractures the temporal bone and lacerates the middle meningeal artery. This arterial bleed leads to a rapid accumulation of blood between the dura mater and the skull. In contrast, subdural hemorrhages are usually venous, occurring between the dura and arachnoid mater, and often have a slower onset.

Question 4: Both the anterior left arm and the anterior chest of your patient are burned. What percentage of the surface area of their body is burned?

27%
13.50% (Correct answer)
18%
22.50%

Correct answer: 13.50%

The 'Rule of Nines' is a common method for estimating the total body surface area (TBSA) affected by burns in adults. According to this rule, the entire anterior chest accounts for 9% of TBSA. An entire arm is 9%, so the anterior left arm is half of that, or 4.5%. Therefore, the total burned surface area is 9% (anterior chest) + 4.5% (anterior left arm) = 13.5%.

Question 5: Out of all the presentations, which one best represents cardiac tamponade?

Increased respiratory rate and increased pulse rate
Decreased lung sounds and decreased pulse pressure
JVD and decreased pulse pressure (Correct answer)
Decreased pulse rate and increased pulse pressure

Correct answer: JVD and decreased pulse pressure

Cardiac tamponade is a life-threatening condition where fluid accumulates in the pericardial sac, compressing the heart. Beck's Triad, a classic set of signs, includes muffled heart sounds, hypotension (often seen as decreased pulse pressure), and jugular venous distension (JVD). JVD indicates increased venous pressure due to impaired right ventricular filling, while decreased pulse pressure reflects reduced cardiac output, making this combination highly indicative of tamponade.

Question 6: You are getting ready to apply a moist dressing to a bodily part that has been severed. What is the best way to hydrate the dressing?

Any of the above may be used
D5W
Normal Saline (Correct answer)
Sterile water

Correct answer: Normal Saline

When preparing a moist dressing for a severed body part (amputation), it is crucial to use a sterile, isotonic solution to prevent further cellular damage and maintain tissue viability. Normal Saline (0.9% Sodium Chloride) is the preferred solution because it is isotonic with body fluids, preventing harmful fluid shifts into or out of the cells. D5W and sterile water are hypotonic and could cause cell swelling or lysis, respectively.

Question 7: The patient had an abdominal gunshot wound and is clearly in shock. Which action on the situation would you be least likely to take?

Take a blood pressure
Use a hemostatic agent for bleeding control
Immobilize the patient on a backboard (Correct answer)
Perform a head-to-toe examination

Correct answer: Immobilize the patient on a backboard

For a patient with an abdominal gunshot wound and signs of shock, the priority is rapid assessment, hemorrhage control, and transport to a trauma center. While spinal immobilization was once routine, current PHTLS guidelines advocate for selective immobilization. An isolated abdominal gunshot wound, without evidence of head, neck, or back trauma or neurological deficits, typically does not require full spinal immobilization on a backboard, which can delay critical interventions and potentially worsen respiratory compromise.

Question 8: The maximum amount of blood lost from a tibia and fibula fracture is as follows:

1,250 mL
400 mL
500 mL
1,000 mL (Correct answer)

Correct answer: 1,000 mL

Tibia and fibula fractures are significant long bone injuries, and these bones are highly vascular. When fractured, they can cause substantial internal bleeding into the surrounding soft tissues of the leg. A blood loss of up to 1,000 mL (1 liter) is a recognized estimate for such fractures, contributing to potential hypovolemic shock if not managed promptly.

Question 9: 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?

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

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

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

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 11: Which one most accurately describes the process via which pulmonary contusion impairs gas exchange?

Collapse of the alveoli (Correct answer)
Blood in the alveoli
Partial occlusion of the bronchi
Comprehension of the lung tissue

Correct answer: Collapse of the alveoli

A pulmonary contusion is a bruise to the lung tissue, causing hemorrhage and edema within the alveoli and interstitial spaces. This fluid accumulation and inflammation lead to alveolar collapse (atelectasis) and consolidation, preventing proper oxygen and carbon dioxide exchange. The damaged alveoli become non-functional, significantly reducing the lung's ability to oxygenate blood effectively.

Free PHTLS Knowledge Questions and Answers 1

Applying a traction splint to a fractured foot is mostly done for the following reasons: