PHTLS Patient Assessment and Management (XABCDE Primary Survey)

Question 1

What does the 'X' in the PHTLS XABCDE patient assessment mnemonic represent?

Accepted Answer

eXsanguinating hemorrhage requiring immediate control

Answer

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?

Accepted Answer

Minimize scene time and expedite transport to definitive surgical care

Answer

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:

Accepted Answer

80–90 mmHg

Answer

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?

Accepted Answer

GCS 8–10

Answer

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?

Accepted Answer

Life-threatening conditions in a prioritized physiologic sequence

Answer

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.

PHTLS - Prehospital Trauma Life Support Practice Test

PHTLS - Prehospital Trauma Life Support Practice Test

PHTLS Patient Assessment and Management (XABCDE Primary Survey)