PHTLS Cheat Sheet 2026

The 30 highest-yield PHTLS facts, distilled from real exam questions. Print it, save it as a PDF, or study it here — free, no sign-up.

1. When applying a cervical collar to a trauma patient, what is the FIRST step? → Apply manual in-line stabilization
2. During the scene size-up of a multi-vehicle crash on a highway, which of the following components is essential for resource management? → Determining the total number of patients.
3. Which prehospital intervention has been shown to MOST reliably reduce secondary brain injury from TBI? → Prevention and correction of hypoxia and hypotension
4. When assessing a trauma scene, which of the following best describes the principle of 'situational awareness'? → Continuously re-evaluating the scene for changing conditions and new threats.
5. During rapid sequence intubation (RSI) of a trauma patient, which complication most directly results from excessive ventilation rate? → Reduced venous return and decreased cardiac output
6. A patient with a pelvic fracture receives a pelvic binder. After application, the provider notes the patient's legs are internally rotated. This suggests: → The binder is correctly applied and internal rotation helps close the pelvic ring
7. A construction worker is found with hot, dry skin, confusion, and a core temperature of 41°C (105.8°F). What is the HIGHEST treatment priority? → Begin rapid active cooling immediately
8. What is the current PHTLS terminology for managing the spine of a trauma patient? → Spinal motion restriction
9. In an electrical burn patient, which systemic injury not visible on the skin surface must be assumed and monitored for? → Rhabdomyolysis and myoglobinuria causing renal failure
10. Which of the following is a primary goal of 'permissive hypotension' in the management of a trauma patient with suspected non-compressible torso hemorrhage? → To prevent clot dislodgement by avoiding aggressive fluid resuscitation.
11. JumpSTART modifies the adult START system for pediatric patients primarily by adding which intervention for apneic children who have a palpable pulse? → Five rescue breaths before assigning the Expectant category if still apneic
12. A pediatric TBI patient, age 4, has a GCS of 8 and blood pressure of 70/40 mmHg. What is the minimum acceptable systolic BP target in PHTLS for this child? → 80 mmHg
13. What is the primary danger of applying ice directly to a burn wound? → It causes frostbite and worsens tissue injury while accelerating hypothermia
14. Which of the following is the MOST appropriate initial intervention for a suspected pelvic fracture causing hemodynamic instability in the prehospital setting? → Apply a pelvic binder or sheet wrap
15. Which fracture pattern in a young child, when identified without a plausible mechanism, should raise concern for non-accidental trauma (NAT)? → Spiral fractures of the humerus in a non-ambulatory infant
16. At a trauma scene involving downed electrical wires, the recommended safe distance from the wire is: → At least one full span (pole to pole) in all directions
17. What is the preferred device for transporting a trauma patient requiring spinal motion restriction? → Vacuum mattress or padded scoop stretcher transferred to ambulance stretcher
18. What is the primary goal of PHTLS spinal motion restriction compared to traditional full spinal immobilization? → Limit harmful motion while allowing necessary movement for patient care
19. What thoracic injury should be suspected in a patient who was wearing a seatbelt and has anterior chest bruising with hypotension? → Blunt cardiac injury (myocardial contusion)
20. Which finding would SUPPORT withholding spinal motion restriction in a conscious, alert trauma patient per PHTLS selective SMR criteria? → No midline spinal pain or tenderness and no neurologic deficit
21. Which statement best describes 'upwind and uphill' positioning at a hazmat scene? → It minimizes exposure to toxic vapors that travel downhill and downwind
22. What is the hallmark physical finding of a tension pneumothorax? → Unilateral absent breath sounds with hypotension and jugular venous distention
23. A 4-year-old child has a respiratory rate of 40 breaths per minute following blunt chest trauma. How should you interpret this finding? → Abnormal and indicates respiratory distress
24. Before applying a rigid cervical collar to a trauma patient with a suspected spinal injury, what is the most critical first step the provider must perform? → Manually stabilize the head and neck in a neutral in-line position
25. A trauma patient has no breath sounds on the left after intubation. The most immediate action is to: → Withdraw the ETT 2 cm and reassess breath sounds
26. Which situation requires the EMS provider to wear a high-visibility vest in addition to standard PPE? → Working on or near active roadways
27. A patient has diminished breath sounds on the left with a deviated trachea to the right and a BP of 70/40. Which condition does this represent? → Left-sided tension pneumothorax
28. In START triage, a victim does not breathe after a single attempt to reposition the airway. What triage tag should be applied? → Black — Expectant
29. Which of the following is a primary goal in the prehospital management of a traumatic brain injury (TBI) to prevent or mitigate secondary brain injury? → Preventing episodes of hypoxia and hypotension
30. A provider is caring for a patient when bystanders become increasingly agitated and aggressive. What is the most appropriate response? → Reassess scene safety and prepare to relocate care if needed