PHTLS - Prehospital Trauma Life Support Thoracic Trauma Questions and Answers

Question 1

A 28-year-old male involved in a fight has a single stab wound to the left 4th intercostal space, midclavicular line.
He is anxious, with a respiratory rate of 28, heart rate of 120, and BP of 100/78.
Breath sounds are diminished on the left.
You apply an occlusive dressing.
During transport, his anxiety increases, he becomes cyanotic, his heart rate is now 140, and his radial pulses are absent.
What is the most appropriate next action?

Accepted Answer

Lift one side of the occlusive dressing.

Answer

Initiate rapid fluid resuscitation.

Answer

Perform needle decompression on the right side of the chest.

Answer

Assist ventilations with a bag-valve mask.

Question 2

A 55-year-old female was the unrestrained driver in a frontal motor vehicle collision. She is complaining of severe chest pain and difficulty breathing. Assessment reveals paradoxical motion of the right lateral chest wall. Her breathing is shallow at 32 breaths/minute, and SpO2 is 89%. Which of the following is the most critical initial intervention for this patient?

Accepted Answer

Administering high-flow oxygen and assisting ventilations.

Answer

Stabilizing the flail segment with a bulky dressing.

Answer

Establishing two large-bore IVs for fluid resuscitation.

Answer

Performing a needle decompression of the right chest.

Question 3

Which set of findings is most indicative of cardiac tamponade in a trauma patient?

Accepted Answer

Distended neck veins, hypotension, and muffled heart sounds.

Answer

Flat neck veins, hypertension, and muffled heart sounds.

Answer

Paradoxical chest motion, hypotension, and tracheal deviation.

Answer

Absent breath sounds, hypertension, and distended neck veins.

Question 4

A patient with blunt chest trauma becomes progressively harder to ventilate with a bag-valve mask. You note absent breath sounds on the left side, tracheal deviation to the right, and severe hypotension. This clinical picture is most consistent with:

Accepted Answer

Tension pneumothorax

Answer

Massive hemothorax

Answer

Simple pneumothorax

Answer

Flail chest

Question 5

You are treating a patient with a suspected traumatic aortic injury after a severe deceleration event. The patient is conscious, hypotensive, and tachycardic, with a significant difference in blood pressure between the arms. According to PHTLS principles, what is the primary prehospital management goal for this patient's blood pressure?

Accepted Answer

Maintain a state of permissive hypotension with a target systolic BP of 80-90 mmHg.

Answer

Aggressively administer fluids to achieve a systolic BP above 120 mmHg.

Answer

Withhold all fluids to prevent clot dislodgement.

Answer

Administer nitroglycerin to reduce cardiac afterload.

Question 6

When treating an open pneumothorax (sucking chest wound), which of the following is the most appropriate initial action?

Accepted Answer

Apply a vented or three-sided occlusive dressing.

Answer

Insert a chest tube at the wound site.

Answer

Pack the wound with sterile gauze.

Answer

Immediately perform needle decompression adjacent to the wound.