PHTLS - Prehospital Trauma Life Support Airway and Ventilation 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?

Accepted Answer

Jaw-thrust maneuver

Answer

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)?

Accepted Answer

Cerebral vasoconstriction and ischemia

Answer

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?

Accepted Answer

Assist ventilations with a bag-valve-mask (BVM).

Answer

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?

Accepted Answer

Adequate and equal chest rise and fall

Answer

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)?

Accepted Answer

Suspected basilar skull fracture

Answer

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.

PHTLS - Prehospital Trauma Life Support Practice Test

PHTLS - Prehospital Trauma Life Support Practice Test

PHTLS - Prehospital Trauma Life Support Airway and Ventilation Questions and Answers