Prehospital Trauma Life Support (PHTLS) Provider Exam — Questions and Answers

Question 1: According to PHTLS, which of the following patients should be transported to a trauma center?

A patient with a superficial laceration to the forearm
A patient with a gunshot wound to the abdomen (Correct answer)
An adult with an isolated wrist fracture from a fall
An adult with a sprained ankle from sports

Correct answer: A patient with a gunshot wound to the abdomen

Penetrating injuries to the torso meet anatomic criteria for trauma center transport under the triage decision scheme.

Question 2: On a PHTLS pre-test, what does the 'E' in the ABCDE primary survey stand for?

Emergency transport decision
Exposure and Environment (Correct answer)
Evaluation of all injuries
Examination of extremities

Correct answer: Exposure and Environment

The 'E' stands for Exposure and Environment, requiring the patient to be fully exposed to identify all injuries while preventing hypothermia.

Question 3: A PHTLS provider encounters a trauma patient with trismus (clenched jaw). Which airway adjunct bypasses this problem without requiring mouth opening?

King LT airway
Endotracheal tube
Oropharyngeal airway (OPA)
Nasopharyngeal airway (NPA) (Correct answer)

Correct answer: Nasopharyngeal airway (NPA)

A nasopharyngeal airway is inserted through the nostril and does not require the mouth to be open, making it useful when trismus prevents oral access.

Question 4: How should a fracture near a joint be splinted differently from a midshaft long bone fracture?

Always straighten the joint before splinting
Use only rigid splints for joint injuries
Splint the joint in the position found, immobilizing the bones above and below (Correct answer)
Joint fractures do not require splinting

Correct answer: Splint the joint in the position found, immobilizing the bones above and below

Fractures near or involving joints should be splinted in the position found because attempts to straighten them risk further neurovascular injury.

Question 5: In the PHTLS patient assessment sequence (XABCDE), what does the 'X' represent and why is it addressed first?

eXsanguinating Hemorrhage, because it is the most immediate threat to life. (Correct answer)
X-factor, for considering unknown variables in the mechanism of injury.
eXamine, for a detailed head-to-toe examination before other steps.
Xiphoid process, as a landmark for chest compressions if needed.

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

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.

Question 6: End-tidal CO2 (ETCO2) monitoring after intubation in a trauma patient should target which range to avoid secondary brain injury?

50-60 mmHg
35-45 mmHg (Correct answer)
20-25 mmHg
60-70 mmHg

Correct answer: 35-45 mmHg

Normal ETCO2 (35-45 mmHg) prevents both hypercapnia (increases ICP) and hypocapnia (causes cerebral vasoconstriction and ischemia).

Question 7: How does PHTLS recommend managing junctional hemorrhage (neck, axilla, groin)?

Wound packing with hemostatic gauze and sustained direct pressure (Correct answer)
No intervention is possible prehospitally
Tourniquet application at the wound site
Immediate surgical clamping in the field

Correct answer: Wound packing with hemostatic gauze and sustained direct pressure

Junctional hemorrhage is managed with wound packing using hemostatic agents and sustained direct pressure.

Question 8: A patient with an open chest wound is becoming hypoxic. What is the immediate intervention?

Pack the wound with gauze and apply pressure
Perform immediate needle decompression
Apply a fully occlusive dressing on all four sides
Apply a vented (3-sided) chest seal or commercial vented device (Correct answer)

Correct answer: Apply a vented (3-sided) chest seal or commercial vented device

A vented chest seal allows air to escape on exhalation, preventing conversion to tension pneumothorax while sealing the wound.

Question 9: In the context of PHTLS, the term 'lethal triad' refers to which combination of conditions?

Hemorrhage, hypoxia, and hypovolemia
Pain, hypoxia, and hyperthermia
Hypotension, tachycardia, and altered mental status
Hypothermia, acidosis, and coagulopathy (Correct answer)

Correct answer: Hypothermia, acidosis, and coagulopathy

The lethal triad of hypothermia, acidosis, and coagulopathy creates a vicious cycle that dramatically increases mortality in trauma patients.

Question 10: What is the preferred site for needle decompression according to current PHTLS guidelines?

4th or 5th intercostal space, anterior axillary line (Correct answer)
7th intercostal space, midaxillary line
1st intercostal space, midclavicular line
2nd intercostal space, midclavicular line

Correct answer: 4th or 5th intercostal space, anterior axillary line

PHTLS and TCCC guidelines now recommend the 4th or 5th ICS at the anterior axillary line due to higher success rates in muscular patients.

Question 11: How should eviscerated abdominal organs be managed in the prehospital setting?

Cover with moist sterile dressings and protect from further injury (Correct answer)
Apply direct pressure to the eviscerated organs
Push the organs back into the abdomen
Leave completely uncovered for continuous monitoring

Correct answer: Cover with moist sterile dressings and protect from further injury

Eviscerated organs should be covered with moist sterile dressings moistened with saline to prevent drying and contamination.

Question 12: Which of the following findings on abdominal exam is MOST consistent with intraperitoneal hemorrhage rather than retroperitoneal hemorrhage?

Diffuse rebound tenderness throughout the abdomen (Correct answer)
Periumbilical ecchymosis (Cullen's sign)
Flank ecchymosis (Grey Turner's sign)
Isolated flank pain with hematuria

Correct answer: Diffuse rebound tenderness throughout the abdomen

Diffuse rebound tenderness indicates peritoneal irritation from blood or bowel contents freely in the peritoneal cavity, characteristic of intraperitoneal injury.

Question 13: You are assessing a patient who was assaulted and struck in the head. You note their right pupil is 6mm and non-reactive to light, while the left pupil is 3mm and briskly reactive. This finding is most likely caused by:

Compression of the third cranial (oculomotor) nerve (Correct answer)
Direct trauma to the left eyeball
The influence of opiate intoxication
Bilateral optic nerve damage

Correct answer: Compression of the third cranial (oculomotor) nerve

A unilaterally dilated and non-reactive pupil (a "blown pupil") is a classic and critical sign of compression of the third cranial nerve (the oculomotor nerve). [17, 18, 23] This compression is typically caused by uncal herniation, where rising intracranial pressure on one side of the brain forces the temporal lobe across the tentorium, compressing the nerve on the same side as the injury and dilated pupil. [17, 23]

Question 14: When assessing a 78-year-old trauma patient who appears confused, what is the MOST important initial step before attributing the confusion to head injury?

Determine the patient's baseline mental status from available history or family (Correct answer)
Obtain a blood glucose immediately to rule out hypoglycemia before any other assessment
Assume intoxication and proceed to physical examination
Age-related dementia makes further neurological assessment unreliable

Correct answer: Determine the patient's baseline mental status from available history or family

Altered mental status in an elderly trauma patient may reflect their baseline (pre-existing dementia) or a new change (TBI, hypoperfusion). PHTLS emphasizes establishing the baseline from family, caregivers, or medical records. A subtle decline from normal in a sharp elder may be more clinically significant than the same presentation in someone with baseline dementia.

Question 15: Primary blast injury is caused by which mechanism?

Fragmentation projectiles striking the body
The body being thrown against a hard surface
The overpressure wave passing through the body (Correct answer)
Burns from the fireball

Correct answer: The overpressure wave passing through the body

The primary blast wave produces a rapidly changing overpressure that damages air-fluid interfaces — particularly in the lungs, ears, and bowel — without external physical contact.

Question 16: A patient with 30% TBSA burns is agitated, tachycardic, and has a blood pressure of 88/60 mmHg 2 hours after injury despite IV fluid resuscitation. What is the most likely cause of the hemodynamic instability?

Cardiogenic shock from burn-induced myocardial depression
Hypovolemic shock from fluid shifts and increased capillary permeability (Correct answer)
Neurogenic shock from pain-mediated vasodilation
Septic shock from early wound contamination

Correct answer: Hypovolemic shock from fluid shifts and increased capillary permeability

Massive fluid shifts due to increased capillary permeability in the early post-burn period cause hypovolemic shock requiring aggressive crystalloid resuscitation.

Question 17: Which of the following is a contraindication to nasopharyngeal airway (NPA) insertion in a trauma patient?

Active gag reflex
Suspected basilar skull fracture (Correct answer)
Nasal hair present
Patient over age 60

Correct answer: Suspected basilar skull fracture

Suspected basilar skull fracture is a relative contraindication to NPA because of the theoretical risk of intracranial placement.

Question 18: A pediatric patient sustains a fracture through the growth plate of the distal tibia. Which fracture classification system specifically addresses physeal (growth plate) injuries?

Salter-Harris Classification (Correct answer)
Gustilo-Anderson Classification
Denis Classification
AO/OTA Classification

Correct answer: Salter-Harris Classification

The Salter-Harris classification describes fractures involving the physis (growth plate) in pediatric patients, which are significant because they can affect bone growth.

Question 19: Using START triage, a victim has a respiratory rate of 34 breaths per minute. What triage category is assigned?

Red — Immediate, based on respiratory rate alone (Correct answer)
Green — Minimal, as the patient is breathing
Yellow — Delayed, pending perfusion and mental status checks
Black — Expectant, as the rate is abnormally elevated

Correct answer: Red — Immediate, based on respiratory rate alone

In START, a respiratory rate greater than 30 breaths per minute immediately classifies the patient as Red (Immediate). No further assessment steps are needed once this threshold is crossed. A rate below 10 is also classified as Immediate (Red). Only rates of 10–29 prompt advancing to the perfusion and mental status steps.

Question 20: A PHTLS provider notes that a patient immobilized on a long spine board has developed increasing anxiety, difficulty breathing, and worsening oxygen saturation. What is the MOST likely cause related to positioning?

The straps have compressed the femoral arteries
The cervical collar has displaced into the trachea
The head block foam has caused an allergic reaction
The supine position on the board restricts diaphragm excursion (Correct answer)

Correct answer: The supine position on the board restricts diaphragm excursion

Supine positioning on a rigid board can restrict diaphragm movement, especially in obese patients or those with abdominal injuries, impairing ventilation.

Question 21: A provider arrives at a shooting scene and finds the patient on the ground. Law enforcement has not yet arrived. Which action reflects correct PHTLS scene safety principles?

Stage in a safe location and await law enforcement clearance before entering (Correct answer)
Enter with a partner, keeping one provider watching for threats
Approach from behind available cover and assess from a distance
Rapidly approach and begin hemorrhage control since time is critical

Correct answer: Stage in a safe location and await law enforcement clearance before entering

PHTLS is clear that providers must not enter an active or unsecured violent scene. Staging and waiting for law enforcement to secure the scene is the correct action. Even with a critically injured patient, a provider who becomes a victim adds to the problem rather than solving it.

Question 22: What is the recommended ventilation rate when providing BVM ventilation to an apneic adult trauma patient?

One breath every 8–10 seconds (6–8 breaths/min)
One breath every 3 seconds (20 breaths/min)
Two rapid breaths followed by a 30-second pause
One breath every 5–6 seconds (10–12 breaths/min) (Correct answer)

Correct answer: One breath every 5–6 seconds (10–12 breaths/min)

PHTLS guidelines recommend 10–12 breaths per minute (one breath every 5–6 seconds) for apneic adult trauma patients. This rate maintains adequate oxygenation and CO2 clearance without the risks of hyperventilation, such as increased intracranial pressure or impaired venous return.

Question 23: An elderly trauma patient has a blood pressure of 122/80 mmHg. Why might PHTLS consider this finding concerning even though it falls within a 'normal' range?

Diastolic pressure above 80 is always abnormal in elderly patients
Elderly patients' systolic pressure should exceed 160, making 122 dangerously low
The pulse pressure is too narrow, indicating tamponade
Many elderly patients have chronic hypertension, so 122/80 may represent relative hypotension from their normal baseline (Correct answer)

Correct answer: Many elderly patients have chronic hypertension, so 122/80 may represent relative hypotension from their normal baseline

A geriatric patient with a chronic baseline of 170/90 mmHg who presents at 122/80 has experienced a nearly 50-point systolic drop — significant hemorrhagic compromise despite a 'normal-looking' reading. PHTLS emphasizes always determining the patient's baseline BP, ideally from the patient, family, or medical history.

Question 24: 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?

Initiate rapid fluid resuscitation.
Assist ventilations with a bag-valve mask.
Lift one side of the occlusive dressing. (Correct answer)
Perform needle decompression on the right side of the chest.

Correct answer: Lift one side of the occlusive dressing.

The patient's initial injury was an open pneumothorax, which was appropriately treated with an occlusive dressing. However, the subsequent rapid deterioration with signs of obstructive shock (increased heart rate, cyanosis, loss of radial pulses) strongly indicates the development of a tension pneumothorax. An occlusive dressing can act as a one-way valve, allowing air to escape the lung into the pleural space but not exit the chest, leading to a buildup of pressure. The immediate treatment is to relieve the tension by lifting a side of the dressing to allow the trapped air to escape, a process sometimes called 'burping' the seal.

Question 25: What is a pulmonary contusion and how does it affect the trauma patient?

A laceration of the lung requiring immediate surgery
An infection of the lung from aspirated material
Bruising of the lung tissue causing hemorrhage and edema within the alveoli, progressively impairing gas exchange (Correct answer)
Collapse of the lung from air leak

Correct answer: Bruising of the lung tissue causing hemorrhage and edema within the alveoli, progressively impairing gas exchange

Pulmonary contusion is bruising of lung parenchyma that causes bleeding and edema within the alveoli, progressively impairing oxygenation over 24-48 hours.

Question 26: When treating a patient with burns involving the genitalia and perineum, what is the primary prehospital concern beyond wound management?

Application of topical antiseptic to prevent fecal contamination
Immediate urinary catheter insertion to prevent urethral swelling and obstruction (Correct answer)
Careful patient positioning to prevent pressure on burned tissue
Splinting of the lower extremities to prevent contracture formation

Correct answer: Immediate urinary catheter insertion to prevent urethral swelling and obstruction

Genital and perineal burns cause rapid edema that can occlude the urethra; early catheterization before swelling progresses is necessary to ensure urinary drainage.

Question 27: PHTLS teaches that which trauma mechanism most frequently leads to airway compromise?

Blunt abdominal trauma
Isolated extremity fractures
Maxillofacial trauma with bleeding and structural disruption (Correct answer)
Simple rib fractures

Correct answer: Maxillofacial trauma with bleeding and structural disruption

Maxillofacial trauma commonly causes airway compromise through structural disruption, bleeding, loose teeth or bone fragments, and soft tissue swelling.

Question 28: According to PHTLS, what is the significance of lactate levels in trauma patients?

Normal lactate confirms the patient is not in shock
Elevated lactate indicates anaerobic metabolism from inadequate tissue perfusion, serving as a marker of shock severity (Correct answer)
Lactate only rises in septic shock
They have no clinical relevance

Correct answer: Elevated lactate indicates anaerobic metabolism from inadequate tissue perfusion, serving as a marker of shock severity

When cells receive inadequate oxygen, they switch to anaerobic metabolism producing lactate. Rising lactate levels indicate worsening tissue hypoperfusion.

Question 29: A trauma patient has a GCS of 8 and is breathing with an irregular pattern. What is the most appropriate airway intervention?

Nasopharyngeal airway only
Definitive airway management via endotracheal intubation or supraglottic device (Correct answer)
High-flow oxygen via non-rebreather mask
Oropharyngeal airway and BVM ventilation

Correct answer: Definitive airway management via endotracheal intubation or supraglottic device

A GCS ≤8 with inadequate breathing indicates the need for a definitive airway to protect and control ventilation.

Question 30: In START triage, a victim does not breathe after a single attempt to reposition the airway. What triage tag should be applied?

Black — Expectant (Correct answer)
Red — Immediate
Yellow — Delayed
Green — Minimal

Correct answer: Black — Expectant

A victim who does not breathe after one airway repositioning attempt is classified Black (Expectant) in START triage. Resources cannot be expended on airway management for a single patient when many others are waiting. This is one of the most difficult MCI decisions but is essential to saving the greatest number of lives.

Question 31: In the START triage system, after directing all walking wounded away from the immediate scene, what is the FIRST physiologic parameter assessed in remaining victims?

Presence of major external hemorrhage
Respirations — presence and rate (Correct answer)
Level of consciousness and ability to follow commands
Radial pulse presence and strength

Correct answer: Respirations — presence and rate

START (Simple Triage And Rapid Treatment) assesses three parameters in sequence: (1) Respirations — if absent, one attempt to reposition the airway; (2) Perfusion — radial pulse or capillary refill; (3) Mental status — ability to follow a simple command. Respiratory assessment is always the first step after the walking-wounded sort.

Question 32: The 'lethal triad' in trauma, which PHTLS providers are taught to recognize and prevent, consists of:

Hypothermia, acidosis, and coagulopathy (Correct answer)
Bradycardia, alkalosis, and thrombocytopenia
Hypovolemia, tachycardia, and coagulopathy
Hypoxia, hypotension, and hyperkalemia

Correct answer: Hypothermia, acidosis, and coagulopathy

The lethal triad — hypothermia, acidosis, and coagulopathy — is a self-reinforcing cycle in trauma patients. Hypothermia impairs clotting enzyme function, acidosis worsens coagulopathy, and ongoing bleeding deepens acidosis; PHTLS providers focus on prevention through rapid hemorrhage control and warming.

Question 33: A mass casualty incident (MCI) is best defined as any event in which:

Air medical transport is activated
The number or severity of patients exceeds available local EMS resources (Correct answer)
More than 10 patients are injured simultaneously
A hazardous materials component is present

Correct answer: The number or severity of patients exceeds available local EMS resources

An MCI is defined by the relationship between patient load and available resources — not by a fixed patient count. Two critically injured patients can constitute an MCI for a single-unit rural system, while a major urban trauma center may manage 20 patients without declaring an MCI. The threshold is resource-relative, not numerically absolute.

Question 34: What is the significance of end-tidal CO2 monitoring (capnography) in prehospital trauma care?

It only confirms endotracheal tube placement
It is only useful during CPR
It provides continuous monitoring of ventilation adequacy, perfusion status, and tube position (Correct answer)
It replaces pulse oximetry entirely

Correct answer: It provides continuous monitoring of ventilation adequacy, perfusion status, and tube position

Capnography provides continuous data on ventilation adequacy, confirms airway device placement, monitors perfusion status, and can detect deterioration in real time.

Question 35: In hemorrhagic shock, which organ is MOST vulnerable to ischemic injury due to its high metabolic demand and limited tolerance for hypoperfusion?

Kidney tubular cells
Cardiac myocytes (Correct answer)
Skeletal muscle
Skin

Correct answer: Cardiac myocytes

Cardiac myocytes have very high oxygen demands and limited anaerobic capacity, making the heart extremely vulnerable to ischemia during states of reduced perfusion.

Question 36: A 32-week pregnant trauma patient presents with vaginal bleeding and uterine rigidity after a motor vehicle collision. Which condition should be immediately suspected?

Placenta previa from cervical dilation
Uterine rupture from pre-existing scar only
Normal Braxton-Hicks contractions exacerbated by stress
Placental abruption from direct or deceleration forces (Correct answer)

Correct answer: Placental abruption from direct or deceleration forces

Placental abruption is the most common cause of fetal death in blunt abdominal trauma and presents with uterine rigidity, pain, and vaginal bleeding.

Question 37: How does PHTLS recommend managing a patient with suspected bladder rupture following blunt pelvic trauma?

Apply ice packs to the suprapubic region
Catheterize immediately to decompress the bladder
Monitor for signs of peritonitis and shock, apply pelvic binder, and transport rapidly (Correct answer)
Perform suprapubic needle aspiration

Correct answer: Monitor for signs of peritonitis and shock, apply pelvic binder, and transport rapidly

Prehospital management focuses on treating associated pelvic fracture hemorrhage with a pelvic binder, monitoring for peritonitis and shock, and rapid transport.

Question 38: You are managing a 45-year-old female with severe blunt chest trauma and paradoxical chest wall motion. She is breathing spontaneously at 30 breaths/minute, has a GCS of 13, and her SpO2 is 88% on a non-rebreather mask. What is the most appropriate next step?

Assist ventilations with a bag-valve-mask (BVM). (Correct answer)
Immediately perform endotracheal intubation.
Perform a needle decompression of the chest.
Apply continuous positive airway pressure (CPAP).

Correct answer: Assist ventilations with a bag-valve-mask (BVM).

This patient has a flail chest and is showing signs of respiratory failure (tachypnea, hypoxia despite high-flow O2). The underlying pulmonary contusion is the primary cause of hypoxia. The most appropriate immediate intervention is to assist her inadequate ventilations with a BVM to improve tidal volume and oxygenation. Intubation may be required, but assisting ventilations is the critical first step to address the respiratory failure.

Question 39: What is the current PHTLS terminology for managing the spine of a trauma patient?

Spinal motion restriction (Correct answer)
Spinal fixation
Spinal immobilization
Spinal stabilization

Correct answer: Spinal motion restriction

PHTLS has adopted the term 'spinal motion restriction' to more accurately describe the goal of limiting spinal movement rather than true immobilization.

Question 40: During reassessment of a trauma patient, you note the original tourniquet site has been on for 90 minutes. The patient is now at the hospital. What is the CORRECT action?

Replace the tourniquet with a pressure dressing during handoff
Notify the receiving team of the application time and leave removal to the surgical team (Correct answer)
Remove the tourniquet immediately to restore perfusion
Loosen the tourniquet slightly to allow intermittent perfusion

Correct answer: Notify the receiving team of the application time and leave removal to the surgical team

Tourniquet removal should be performed only by the surgical team in a controlled setting; prehospital providers must document and communicate the application time to the receiving team.

Question 41: JumpSTART modifies the adult START system for pediatric patients primarily by adding which intervention for apneic children who have a palpable pulse?

Checking capillary refill before assessing respirations
Classifying all children under 8 as Immediate regardless of vital signs
Five rescue breaths before assigning the Expectant category if still apneic (Correct answer)
Immediate Red tag without any intervention attempt

Correct answer: Five rescue breaths before assigning the Expectant category if still apneic

JumpSTART adds a critical rescue breath step: if a child is apneic but has a palpable pulse, give 5 rescue breaths. If breathing resumes, classify as Red (Immediate). If the child remains apneic, classify as Black (Expectant). This modification reflects that pediatric arrest more commonly begins with primary respiratory failure rather than primary cardiac failure.

Question 42: Cavitation in penetrating trauma refers to:

Air entering the pleural space through a chest wound
The temporary or permanent tissue displacement around the projectile path (Correct answer)
Gas embolism from vascular injury
Collapse of small airways from blunt chest impact

Correct answer: The temporary or permanent tissue displacement around the projectile path

As a projectile passes through tissue it displaces tissue radially, creating a temporary cavity larger than the projectile itself; inelastic organs like the liver suffer greater permanent damage than elastic tissue like muscle.

Question 43: During transport of a severe TBI patient, SpO2 drops to 88%. What is the correct action?

Hyperventilate the patient to compensate
Increase supplemental oxygen and reassess airway positioning immediately (Correct answer)
Administer furosemide to reduce cerebral edema
Continue transport without adjustment as this is acceptable in trauma

Correct answer: Increase supplemental oxygen and reassess airway positioning immediately

Hypoxia (SpO2 <90%) causes secondary brain injury; correcting it immediately with supplemental oxygen and airway optimization is the priority.

Question 44: A patient is found with a deformed, shortened, and externally rotated lower extremity after a fall from a ladder. What injury does this presentation MOST suggest?

Tibial plateau fracture
Anterior hip dislocation
Femoral shaft fracture
Hip fracture (femoral neck or intertrochanteric) (Correct answer)

Correct answer: Hip fracture (femoral neck or intertrochanteric)

A shortened, externally rotated lower extremity after trauma in an elderly patient is classic for a proximal femur (hip) fracture.

Question 45: Which PHTLS assessment finding MOST strongly indicates the need for immediate needle thoracostomy?

Bilateral breath sounds with tachycardia
Dullness to percussion with tachypnea only
Crepitus over the ribs with normal SpO2
Absent breath sounds, tracheal deviation, hypotension, and JVD (Correct answer)

Correct answer: Absent breath sounds, tracheal deviation, hypotension, and JVD

The combination of absent breath sounds, tracheal deviation away from affected side, hypotension, and JVD indicates tension pneumothorax requiring immediate decompression.

Question 46: When performing bag-valve-mask ventilation on a trauma patient, what tidal volume and rate are recommended to avoid iatrogenic harm?

Minimal volumes at 6 breaths/min
Forceful ventilation at 24 breaths/min to maximize oxygenation
Tidal volumes causing visible chest rise at 10-12 breaths/min (Correct answer)
Large tidal volumes at 20 breaths/min

Correct answer: Tidal volumes causing visible chest rise at 10-12 breaths/min

PHTLS recommends ventilations sufficient to produce visible chest rise at 10-12/min to prevent hyperventilation and gastric insufflation.

Question 47: The male patient, age 20, was diving to catch a football when he banged his head on a teammate's knee. There was no helmet on him. He has a GCS of 4, indicating decerebrate posturing. His blood pressure is 180/102, his left pupil is dilated, and his heart rate is 58. Which breathing rate is ideal for this patient's care?

20 breaths per minute
30 breaths per minute
10 breaths per minute (Correct answer)
35 breaths per minute

Correct answer: 10 breaths per minute

This patient exhibits classic signs of severe traumatic brain injury (TBI) with increased intracranial pressure (ICP), including a low GCS, decerebrate posturing, Cushing's triad (hypertension, bradycardia), and a dilated pupil. For severe TBI, the recommended ventilation rate is typically 10 breaths per minute to maintain normocapnia (PaCO2 35-45 mmHg). This avoids hyperventilation, which can cause cerebral vasoconstriction and worsen brain ischemia, while preventing hypoventilation which would increase ICP.

Question 48: Tranexamic acid (TXA) is most effective when administered within what time frame after traumatic injury?

Within 6 hours
Within 3 hours (Correct answer)
Within 1 hour
Within 30 minutes

Correct answer: Within 3 hours

The CRASH-2 trial demonstrated TXA is most effective when given within 3 hours of injury; after this window it may increase mortality.

Question 49: You are treating a patient with a stab wound to the abdomen resulting in an evisceration of the small intestine. What is the most appropriate prehospital management for the exposed organ?

Gently reinsert the intestine and cover the wound with a dry dressing.
Cover the intestine with a moist, sterile dressing, then an occlusive dressing. (Correct answer)
Apply a dry sterile dressing directly over the intestine to absorb blood.
Pack the wound tightly with sterile gauze to prevent further evisceration.

Correct answer: Cover the intestine with a moist, sterile dressing, then an occlusive dressing.

The proper management for an abdominal evisceration is to cover the exposed organs with a saline-moistened sterile dressing to prevent the tissue from drying out. [17, 18, 22] This should then be covered with an occlusive dressing to minimize heat and fluid loss. Organs should never be pushed back into the abdomen in the field, and dry dressings can adhere to the tissue and cause damage. [22, 24]

Question 50: What is the 'lethal diamond' concept that expands on the traditional trauma triad of death?

Hypothermia, acidosis, coagulopathy, and hypocalcemia from massive transfusion (Correct answer)
Four common mechanisms of traumatic death
Four types of shock occurring simultaneously
Hypothermia, acidosis, coagulopathy, and calcium depletion

Correct answer: Hypothermia, acidosis, coagulopathy, and hypocalcemia from massive transfusion

The lethal diamond adds hypocalcemia to the traditional triad, recognizing that calcium depletion from citrated blood products further impairs coagulation and cardiac function.

Question 51: What is the primary goal of administering blood products rather than crystalloids in hemorrhagic shock resuscitation?

Prevent electrolyte imbalances from large-volume resuscitation
Rapidly expand intravascular volume with minimal cost
Restore oxygen-carrying capacity and coagulation factors simultaneously (Correct answer)
Lower the viscosity of blood to improve flow

Correct answer: Restore oxygen-carrying capacity and coagulation factors simultaneously

Blood products restore both oxygen-carrying capacity (via RBCs) and coagulation factors (via FFP/platelets), addressing the root causes of hemorrhagic shock without the dilutional effects of crystalloids.

Prehospital Trauma Life Support (PHTLS) Provider Exam

This exam certifies prehospital professionals in the assessment and management of trauma patients, emphasizing rapid assessment and intervention.

Questions

60 min

Time Limit

76%

To Pass

Checking for saved progress...

Exam Rules

You can skip questions and return to them later
Flag questions for review before submitting
No feedback shown until you submit the entire exam
Unanswered questions count as wrong — answer everything
10 pretest questions are mixed in and don't affect your score
Timer auto-submits when time runs out
Your progress is auto-saved every 30 seconds