PHTLS - Prehospital Trauma Life Support Prehospital Trauma Life Support Musculoskeletal Trauma 1

Question 1

Which of the following is the earliest and most reliable sign of developing compartment syndrome in a fractured extremity?

Accepted Answer

Pain that is disproportionate to the injury and worsened with passive stretch

Answer

Pain out of proportion to the injury — especially pain worsened by passively stretching the muscles in the compartment — is the earliest and most sensitive indicator of compartment syndrome, preceding the '6 P's' late findings such as pulselessness and paralysis.

Question 2

When managing an open (compound) fracture in the prehospital setting, what is the correct treatment of the wound before splinting?

Accepted Answer

Cover the wound with a moist sterile dressing and do not attempt to push exposed bone back into the wound

Answer

Open fractures should be covered with a moist sterile dressing to prevent further contamination and tissue desiccation. Exposed bone should never be pushed back into the wound in the field, as this risks driving contamination deeper into the tissue.

Question 3

A patient involved in a high-speed MVC is found with a suspected pelvic fracture. What is the maximum estimated internal blood loss possible from an unstable pelvic ring disruption?

Accepted Answer

More than 2,000 mL — potentially life-threatening hemorrhage

Answer

An unstable pelvic ring fracture can result in hemorrhage exceeding 2,000–3,000 mL due to injury to the pelvic venous plexus and nearby arterial structures, making it one of the most lethal musculoskeletal injuries. Early pelvic binder application is critical.

Question 4

In which situation should a prehospital provider NOT attempt to realign a deformed extremity fracture before splinting?

Accepted Answer

When a joint is involved and any attempt at realignment produces resistance or causes severe pain

Answer

Fractures involving joints (dislocations) should not be forcibly realigned in the field. Resistance or severe pain during an attempt signals that reduction could cause additional neurovascular damage. Splint in the position found and transport immediately.

Question 5

What is the correct prehospital approach when a long bone fracture is associated with an absent distal pulse?

Accepted Answer

Gently realign the limb toward anatomical position once, reassess pulses, then splint

Answer

When a distal pulse is absent due to a long bone fracture, a single gentle attempt to realign the limb toward anatomical position is indicated to relieve vascular compromise. Pulses should be reassessed immediately after; if still absent, expedite transport to a trauma center.

PHTLS - Prehospital Trauma Life Support Practice Test

PHTLS - Prehospital Trauma Life Support Practice Test

PHTLS - Prehospital Trauma Life Support Prehospital Trauma Life Support Musculoskeletal Trauma 1