PHTLS - Prehospital Trauma Life Support Airway and Ventilation Questions and Answers — Questions and Answers
Question 1: A 34-year-old male is found unconscious after a motorcycle crash. He has sonorous respirations and an obvious facial injury. His respiratory rate is 6 breaths/minute and shallow. What is the MOST appropriate initial airway intervention?
- Oropharyngeal airway (OPA)
- Jaw-thrust maneuver (Correct answer)
- Nasopharyngeal airway (NPA)
- Immediate endotracheal intubation
Correct answer: Jaw-thrust maneuver
The patient's sonorous (snoring) respirations indicate an upper airway obstruction, likely by the tongue. Due to the significant mechanism of injury, a cervical spine injury must be suspected. The jaw-thrust maneuver is the most appropriate initial intervention because it opens the airway by displacing the mandible forward without extending the neck, thus protecting the cervical spine. Basic maneuvers should always precede advanced ones.
Question 2: Which of the following is the primary risk associated with hyperventilating a trauma patient with a suspected traumatic brain injury (TBI)?
- Gastric distention and aspiration
- Increased intracranial pressure (ICP)
- Cerebral vasoconstriction and ischemia (Correct answer)
- Barotrauma to the lungs
Correct answer: Cerebral vasoconstriction and ischemia
Hyperventilation causes a rapid decrease in arterial carbon dioxide levels (hypocapnia). This leads to vasoconstriction of the cerebral blood vessels, which reduces cerebral blood flow. In a patient with a TBI, this reduction in blood flow can cause or worsen cerebral ischemia and lead to secondary brain injury. PHTLS guidelines emphasize avoiding prophylactic hyperventilation.
Question 3: You are managing a 45-year-old female with severe blunt chest trauma and paradoxical chest wall motion. She is breathing spontaneously at 30 breaths/minute, has a GCS of 13, and her SpO2 is 88% on a non-rebreather mask. What is the most appropriate next step?
- Immediately perform endotracheal intubation.
- Assist ventilations with a bag-valve-mask (BVM). (Correct answer)
- Perform a needle decompression of the chest.
- Apply continuous positive airway pressure (CPAP).
Correct answer: Assist ventilations with a bag-valve-mask (BVM).
This patient has a flail chest and is showing signs of respiratory failure (tachypnea, hypoxia despite high-flow O2). The underlying pulmonary contusion is the primary cause of hypoxia. The most appropriate immediate intervention is to assist her inadequate ventilations with a BVM to improve tidal volume and oxygenation. Intubation may be required, but assisting ventilations is the critical first step to address the respiratory failure.
Question 4: What is the most reliable indicator of effective bag-valve-mask (BVM) ventilation in a trauma patient?
- Improvement in the patient's skin color
- The feeling of good compliance (less resistance) in the bag
- The presence of bilateral breath sounds on auscultation
- Adequate and equal chest rise and fall (Correct answer)
Correct answer: Adequate and equal chest rise and fall
While other signs are useful, observing adequate and equal chest rise and fall is the most immediate and reliable indicator that air is entering the lungs during BVM ventilation. Skin color changes can be delayed, bag compliance can be misleading, and auscultation can be difficult in a noisy prehospital environment. PHTLS emphasizes visually confirming chest rise with each ventilation.
Question 5: Which of the following is an absolute contraindication for the insertion of a nasopharyngeal airway (NPA)?
- Presence of an intact gag reflex
- Patient is actively vomiting
- Suspected basilar skull fracture (Correct answer)
- Significant oral trauma
Correct answer: Suspected basilar skull fracture
A suspected or confirmed basilar skull fracture is an absolute contraindication for NPA insertion. There is a risk that the airway adjunct could be inadvertently passed into the cranial vault through the fracture. Signs of a basilar skull fracture include CSF rhinorrhea or otorrhea, Battle's sign, and raccoon eyes.
Question 6: You arrive on scene to find an unresponsive trauma patient with gurgling sounds coming from their airway. What is the MOST appropriate initial action?
- Perform immediate suctioning of the oropharynx. (Correct answer)
- Insert an oropharyngeal airway (OPA).
- Apply a non-rebreather mask at 15 L/min.
- Log-roll the patient onto their side.
Correct answer: Perform immediate suctioning of the oropharynx.
Gurgling sounds indicate the presence of fluid (blood, vomit, or secretions) in the upper airway, creating an immediate obstruction. The first and most critical action is to clear the airway by suctioning. You must clear the airway before you can effectively ventilate or oxygenate the patient. An OPA cannot be properly placed and will not be effective until the fluid is removed.
PHTLS - Prehospital Trauma Life Support Airway and Ventilation Questions and Answers
A 34-year-old male is found unconscious after a motorcycle crash.
He has sonorous respirations and an obvious facial injury.
His respiratory rate is 6 breaths/minute and shallow.
What is the MOST appropriate initial airway intervention?