PHTLS Patient Assessment and Management (XABCDE Primary Survey) — Questions and Answers
Question 1: What does the 'X' in the PHTLS XABCDE patient assessment mnemonic represent?
- External examination of the body surface
- eXsanguinating hemorrhage requiring immediate control (Correct answer)
- Extremity assessment for fractures
- Exposure and environment
Correct answer: eXsanguinating hemorrhage requiring immediate control
The X in XABCDE stands for eXsanguinating hemorrhage. It was added before the classic ABCDE to reflect evidence that uncontrolled, life-threatening external bleeding must be stopped before — or simultaneously with — airway management, since a patient can exsanguinate in minutes.
Question 2: The PHTLS 'Golden Period' concept most directly supports which field decision-making principle?
- Perform all advanced interventions on scene before transport
- Minimize scene time and expedite transport to definitive surgical care (Correct answer)
- Obtain a complete patient history before moving the patient
- Wait for air medical transport regardless of ground transport availability
Correct answer: Minimize scene time and expedite transport to definitive surgical care
PHTLS emphasizes 'load and go' — keeping on-scene time to approximately 10 minutes or less for critical trauma patients. Definitive hemorrhage control and damage control surgery cannot occur in the field; prolonged scene time worsens outcomes by delaying the care only a hospital can provide.
Question 3: During the primary survey, you find no radial pulse but a carotid pulse is present and regular. This finding most likely indicates a systolic blood pressure of approximately:
- 100–110 mmHg
- 80–90 mmHg (Correct answer)
- 60–70 mmHg
- Below 50 mmHg
Correct answer: 80–90 mmHg
Radial pulses typically become impalpable when systolic BP falls to approximately 80–90 mmHg, while carotid pulses persist down to roughly 60 mmHg. An absent radial but present carotid pulse therefore suggests a systolic BP in the 80–90 range — significant hypotension but not yet cardiovascular collapse.
Question 4: Using the AVPU scale, a trauma patient responds only to painful stimuli. This most closely corresponds to which Glasgow Coma Scale range?
- GCS 14–15
- GCS 12–13
- GCS 8–10 (Correct answer)
- GCS 3–5
Correct answer: GCS 8–10
On the AVPU scale, 'P' (responds to Pain only) correlates with a GCS of approximately 8–10. Alert = GCS 14–15; responds to Voice = GCS 11–13; responds to Pain = GCS 8–10; Unresponsive = GCS ≤7. A 'P' rating should prompt consideration of airway protection and TBI.
Question 5: The primary survey is designed to identify and treat conditions in what order?
- All injuries systematically from head to toe, regardless of severity
- The most anatomically obvious injuries first
- Life-threatening conditions in a prioritized physiologic sequence (Correct answer)
- Mechanism of injury and patient history before any physical assessment
Correct answer: Life-threatening conditions in a prioritized physiologic sequence
The primary survey follows the XABCDE sequence to address the most immediately lethal threats first — exsanguinating hemorrhage, airway obstruction, breathing failure, circulatory shock, and disability (neurological status). It is not a head-to-toe anatomical survey; it is a prioritized physiologic assessment.
Question 6: During the rapid trauma assessment of an unconscious patient, you identify a tension pneumothorax while examining the chest. What is the correct next action?
- Note the finding and complete the full head-to-toe assessment before treating
- Treat the tension pneumothorax immediately before continuing the assessment (Correct answer)
- Defer treatment until secondary survey is complete
- Transport immediately without any on-scene intervention
Correct answer: Treat the tension pneumothorax immediately before continuing the assessment
The rapid trauma assessment is systematic, but life-threatening findings must be treated as they are discovered — not deferred until the exam is complete. A tension pneumothorax causes obstructive shock and cardiac arrest within minutes; immediate needle decompression is required.
PHTLS Patient Assessment and Management (XABCDE Primary Survey)
What does the 'X' in the PHTLS XABCDE patient assessment mnemonic represent?