PHTLS - Prehospital Trauma Life Support Prehospital Trauma Life Support Special Trauma Considerations 1

Question 1

A pediatric trauma patient presents with rapid respiratory rate, normal blood pressure, and mottled skin after a motor vehicle crash.
Which statement BEST explains why hypotension is a late and ominous sign in pediatric trauma?

Accepted Answer

Children compensate through increased heart rate and vasoconstriction before blood pressure drops

Answer

Children have lower circulating blood volumes, so any loss is immediately critical

Answer

Children's vasculature is more rigid, preventing pressure changes until complete decompensation

Answer

Children lose blood faster due to higher metabolic demands

Question 2

During a rescue operation, a patient is extricated after being pinned under heavy machinery for 2 hours. PHTLS guidelines caution that reperfusion following prolonged crush injury can cause which life-threatening complication?

Accepted Answer

Hyperkalemia and myoglobinuria leading to cardiac dysrhythmia and renal failure

Answer

Anaphylactic shock from histamine release

Answer

Tension pneumothorax from mediastinal shift

Answer

Massive internal hemorrhage from aortic shear stress

Question 3

A 78-year-old patient on warfarin therapy sustains a seemingly minor head impact after a ground-level fall. PHTLS emphasizes which assessment priority for this patient?

Accepted Answer

Even minor mechanisms warrant high suspicion for intracranial hemorrhage; expedite transport to a trauma center

Answer

Spinal immobilization takes precedence over all other interventions due to osteoporosis risk

Answer

Field reversal of anticoagulation with oral vitamin K is recommended before transport

Answer

Neurological examination findings reliably exclude significant intracranial injury in anticoagulated patients

Question 4

According to PHTLS, which component of the 'lethal triad' is specifically exacerbated by prolonged scene time, wet clothing, and inadequate patient packaging in trauma patients?

Accepted Answer

Hypothermia

Answer

Coagulopathy

Answer

Acidosis

Answer

Hypoxia

Question 5

PHTLS providers respond to a patient with a known pre-existing complete spinal cord injury at C6 who was involved in a vehicle collision. The patient has a BP of 80/50 and bradycardia. What is the MOST likely cause of this hemodynamic pattern?

Accepted Answer

Neurogenic shock from a new spinal injury at a higher level

Answer

Tension pneumothorax causing obstructive shock

Answer

Hemorrhagic shock masked by baseline hypotension

Answer

Cardiogenic shock from pre-existing cardiac disease

Question 6

A trauma patient with severe burns to 40% total body surface area (TBSA) also has signs of airway involvement — singed nasal hairs, hoarseness, and carbonaceous sputum. According to PHTLS, what is the MOST critical prehospital airway intervention?

Accepted Answer

Secure a definitive airway early, before progressive edema makes intubation impossible

Answer

Apply a non-rebreather mask and reassess at the hospital

Answer

Delay airway management until fluid resuscitation is established

Answer

Perform nasotracheal intubation to avoid stimulating the burn-injured oropharynx