PHTLS - Prehospital Trauma Life Support Shock and Hemorrhage Control Questions and Answers

Question 1

A 25-year-old male has sustained a gunshot wound to the upper right thigh. Bright red blood is spurting from the wound. Direct pressure is ineffective. What is the MOST appropriate next step in managing this hemorrhage?

Accepted Answer

Immediately apply a tourniquet high and tight on the extremity.

Answer

PHTLS guidelines prioritize immediate control of life-threatening external hemorrhage. For massive extremity bleeding that is not controlled by direct pressure, the application of a tourniquet is the indicated life-saving intervention. It should be placed proximal to the wound, often 'high and tight' on the limb, to effectively stop arterial blood flow.

Question 2

Which of the following is a primary goal of 'permissive hypotension' in the management of a trauma patient with suspected non-compressible torso hemorrhage?

Accepted Answer

To prevent clot dislodgement by avoiding aggressive fluid resuscitation.

Answer

Permissive hypotension is a strategy used in trauma patients with suspected internal bleeding to maintain a blood pressure that is just high enough for vital organ perfusion (e.g., SBP of 80-90 mmHg) without being so high that it dislodges newly formed clots or dilutes clotting factors. The goal is to avoid 'popping the clot' before the patient can get to definitive surgical care.

Question 3

According to PHTLS principles, Tranexamic Acid (TXA) is most effective when administered to a trauma patient with significant hemorrhage under which condition?

Accepted Answer

Within 3 hours of the injury.

Answer

Clinical evidence, such as the CRASH-2 trial, has shown that TXA provides the greatest mortality benefit when administered as early as possible, specifically within the first 3 hours following the injury. Administration after this window may not be beneficial and could potentially be harmful.

Question 4

You are treating a patient with a suspected unstable pelvic fracture after a high-speed MVC. The patient is tachycardic and hypotensive. Besides IV access and fluid administration, which intervention is critical for controlling internal hemorrhage?

Accepted Answer

Application of a pelvic binder or sheet.

Answer

An unstable pelvic fracture can lead to massive internal hemorrhage by increasing the pelvic volume and damaging blood vessels. Applying a pelvic binder or a circumferential sheet wrap is a critical intervention to stabilize the pelvis, reduce its volume, and help tamponade the bleeding source.

Question 5

In the PHTLS patient assessment sequence (XABCDE), what does the 'X' represent and why is it addressed first?

Accepted Answer

eXsanguinating Hemorrhage, because it is the most immediate threat to life.

Answer

The PHTLS assessment model uses XABCDE to prioritize care. The 'X' stands for eXsanguinating Hemorrhage. This step was placed before the traditional 'ABC's to emphasize that catastrophic external bleeding must be controlled immediately, as a patient can bleed to death in minutes, making airway and breathing interventions futile if circulation is lost.

PHTLS - Prehospital Trauma Life Support Practice Test

PHTLS - Prehospital Trauma Life Support Practice Test

PHTLS - Prehospital Trauma Life Support Shock and Hemorrhage Control Questions and Answers