PHTLS - Prehospital Trauma Life Support Prehospital Trauma Life Support Thoracic Trauma 1

Question 1

A patient sustains a gunshot wound to the left chest and presents with a large open chest wound, audible air movement through the wound, and increasing respiratory distress.
What is the immediate PHTLS-recommended prehospital intervention?

Accepted Answer

Apply an occlusive dressing sealed on three sides

Answer

Apply a fully occlusive dressing sealed on all four sides

Answer

Perform immediate needle decompression at the second intercostal space

Answer

Pack the wound with hemostatic gauze and apply direct pressure

Question 2

Which of the following clinical findings is most consistent with cardiac tamponade in a trauma patient?

Accepted Answer

Hypotension, distended neck veins, and muffled heart sounds

Answer

Unilateral absent breath sounds, tracheal deviation, and hypotension

Answer

Paradoxical chest wall movement and severe respiratory distress

Answer

Massive subcutaneous emphysema with oxygen saturation below 80%

Question 3

A restrained driver is involved in a high-speed frontal collision. He is conscious but has severe chest pain, tachycardia, and a blood pressure of 80/50 mmHg. Breath sounds are equal bilaterally and neck veins are flat. Which injury should be highest on the differential?

Accepted Answer

Massive hemothorax

Answer

Tension pneumothorax

Answer

Cardiac tamponade

Answer

Traumatic aortic disruption

Question 4

When assessing a trauma patient for pulmonary contusion, which statement best reflects PHTLS guidance on this injury?

Accepted Answer

Signs and symptoms may be subtle initially and worsen over hours as alveolar hemorrhage and edema develop

Answer

Pulmonary contusion is immediately apparent on physical exam and produces visible bruising over the chest wall

Answer

Pulmonary contusion only occurs in patients who also have rib fractures on the same side

Answer

High-flow oxygen is contraindicated because it worsens alveolar damage in contused lung tissue

Question 5

During rapid assessment of a multi-system trauma patient, you note paradoxical inward movement of a segment of the right chest wall during inspiration. Oxygen saturation is 88% on room air. After applying high-flow oxygen, what is the next priority in managing this patient's thoracic injury?

Accepted Answer

Provide positive-pressure ventilation if the patient cannot maintain adequate tidal volume

Answer

Immediate needle decompression to relieve underlying pneumothorax

Answer

Stabilize the flail segment with sandbags or manual pressure before transport

Answer

Apply a circumferential chest wrap to immobilize all rib fractures

Question 6

A patient who was struck by a vehicle presents with left-sided chest pain, decreased breath sounds on the left, bowel sounds auscultated over the left lower chest, and an oxygen saturation of 91%. What injury does this presentation suggest?

Accepted Answer

Traumatic diaphragmatic rupture with herniation of abdominal contents

Answer

Left-sided tension pneumothorax requiring immediate needle decompression

Answer

Massive left hemothorax requiring aggressive IV fluid resuscitation

Answer

Left pulmonary contusion with associated pleural effusion