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

Question 1: Ejection from a vehicle during a crash is significant because:

The risk of death increases approximately 300% compared to non-ejected occupants (Correct answer)
Ejected patients always sustain spinal cord injury
Ejection protects the patient from interior vehicle deformation
Seat belt injuries are more severe than ejection injuries

Correct answer: The risk of death increases approximately 300% compared to non-ejected occupants

Ejection exposes the patient to a second, uncontrolled impact with the ground or other objects, increasing the mortality risk roughly threefold compared to remaining inside the vehicle.

Question 2: 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)
Green — Minimal
Yellow — Delayed
Red — Immediate

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 3: A restrained driver involved in a high-speed collision becomes increasingly agitated and then unresponsive. Assessment reveals absent breath sounds on the left, distended neck veins, and hypotension. What is the priority prehospital intervention?

Application of a thoracic pressure dressing
Immediate endotracheal intubation
Needle decompression of the affected side (Correct answer)
Spinal immobilization and rapid transport only

Correct answer: Needle decompression of the affected side

The triad of absent unilateral breath sounds, distended neck veins, and hypotension indicates tension pneumothorax. Needle decompression on the affected side is the immediate life-saving intervention to relieve intrathoracic pressure before it causes cardiac arrest.

Question 4: In the PHTLS model, 'permissive hypotension' targets a systolic BP of approximately how much in penetrating trauma without TBI?

80–90 mmHg (Correct answer)
100–110 mmHg
120 mmHg
60–70 mmHg

Correct answer: 80–90 mmHg

Permissive hypotension targets a systolic BP of 80–90 mmHg to maintain cerebral perfusion while avoiding dilution of clotting factors and clot disruption.

Question 5: A patient in hemorrhagic shock has a suspected pelvic fracture and open femur fracture. Which sequence of interventions is MOST appropriate?

IV access, then pelvic binder, then traction splint before moving patient
Traction splint and pelvic binder simultaneously, then IV en route
Pelvic binder first, control femur hemorrhage, then traction splint during transport (Correct answer)
Traction splint first, then pelvic binder, then IV access

Correct answer: Pelvic binder first, control femur hemorrhage, then traction splint during transport

In a multiply injured patient, hemorrhage control takes priority; the pelvic binder stabilizes the largest source of internal hemorrhage, then visible external femur bleeding is controlled before traction splinting.

Question 6: Which of the following patients with abdominal trauma has the HIGHEST priority for immediate transport?

Patient with distended abdomen, absent bowel sounds, and BP 70/40 (Correct answer)
Patient with isolated penetrating wound and normal hemodynamics
Patient with moderate abdominal tenderness and HR 100
Stable patient with bruising over the left flank and normal vital signs

Correct answer: Patient with distended abdomen, absent bowel sounds, and BP 70/40

Abdominal distension combined with hemodynamic instability (BP 70/40) indicates massive intra-abdominal hemorrhage requiring immediate surgical intervention.

Question 7: End-tidal CO2 (ETCO2) monitoring after intubation in a trauma patient should target which range to avoid secondary brain injury?

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

Correct answer: 35-45 mmHg

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

Question 8: When is a needle decompression indicated in the prehospital setting?

Suspected tension pneumothorax with deteriorating hemodynamics (Correct answer)
SpO2 below 95% after oxygen application
Any patient with a chest wound
Confirmed simple pneumothorax on palpation

Correct answer: Suspected tension pneumothorax with deteriorating hemodynamics

Needle decompression is indicated for suspected tension pneumothorax causing hemodynamic or respiratory deterioration.

Question 9: 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?

Massive internal hemorrhage from aortic shear stress
Tension pneumothorax from mediastinal shift
Anaphylactic shock from histamine release
Hyperkalemia and myoglobinuria leading to cardiac dysrhythmia and renal failure (Correct answer)

Correct answer: Hyperkalemia and myoglobinuria leading to cardiac dysrhythmia and renal failure

Crush syndrome (traumatic rhabdomyolysis) causes release of intracellular potassium and myoglobin upon reperfusion. Hyperkalemia can trigger fatal dysrhythmias, while myoglobin precipitates in renal tubules, causing acute kidney injury. Early aggressive IV fluid resuscitation is the prehospital priority.

Question 10: What positioning does PHTLS recommend for a TBI patient during transport?

Seated upright at 90 degrees
Trendelenburg position to increase cerebral perfusion
Flat supine position only
Head elevated 30 degrees if spinal injury is not suspected and blood pressure is adequate (Correct answer)

Correct answer: Head elevated 30 degrees if spinal injury is not suspected and blood pressure is adequate

Elevating the head 30 degrees promotes venous drainage from the brain, helping to reduce intracranial pressure.

Question 11: What is the most clinically significant limitation of pulse oximetry (SpO2) monitoring in a hemorrhagic trauma patient?

It requires a minimum blood pressure of 80 mmHg to function
It may display falsely normal readings in the presence of poor peripheral perfusion or carbon monoxide poisoning (Correct answer)
It cannot be applied to fingers, only earlobes
It directly measures arterial oxygen partial pressure (PaO2)

Correct answer: It may display falsely normal readings in the presence of poor peripheral perfusion or carbon monoxide poisoning

In hemorrhagic shock, peripheral vasoconstriction reduces signal quality and can cause inaccurate readings. Additionally, carbon monoxide binds hemoglobin similarly to oxygen, causing pulse oximeters to display falsely high SpO2 values. Clinicians must correlate oximetry with the overall clinical picture.

Question 12: A trauma patient has a BP of 80/60 mmHg, HR of 128 bpm, and cool, clammy skin. Which class of hemorrhagic shock does this best represent?

Class II
Class IV
Class III (Correct answer)
Class I

Correct answer: Class III

Class III hemorrhagic shock involves 30–40% blood volume loss and presents with hypotension, tachycardia >120, and altered mental status.

Question 13: Tranexamic acid (TXA) is most effective when administered within what time frame after traumatic injury?

Within 3 hours (Correct answer)
Within 6 hours
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 14: An 80-year-old woman falls from standing height. Compared to a 30-year-old with the identical fall mechanism, why does PHTLS recommend a higher index of suspicion for serious injury?

Risk is identical because the mechanism and kinetic energy are the same
Elderly patients have thicker cortical bone that causes more energy transfer
Osteoporosis, anticoagulant use, and reduced physiologic reserve amplify injury severity from the same mechanism (Correct answer)
Elderly patients have a lower center of gravity, creating more kinetic energy

Correct answer: Osteoporosis, anticoagulant use, and reduced physiologic reserve amplify injury severity from the same mechanism

The same low-energy mechanism causes disproportionately severe injury in elderly patients due to osteoporosis (fractures from minimal force), anticoagulant use (catastrophic bleeding from minor head trauma), and reduced physiologic reserve (inability to compensate). Falls from standing height are a leading cause of fatal injury in patients over 75.

Question 15: 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
Radial pulse presence and strength
Level of consciousness and ability to follow commands
Respirations — presence and rate (Correct answer)

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 16: Which patient presentation is MOST consistent with a hemothorax requiring prehospital intervention?

Bilateral crackles with JVD
Absent breath sounds with tracheal deviation and hypotension
Subcutaneous emphysema with normal vitals
Unilateral absent breath sounds, dull percussion, normal BP (Correct answer)

Correct answer: Unilateral absent breath sounds, dull percussion, normal BP

Hemothorax produces absent or diminished breath sounds with dullness to percussion on the affected side, though BP may be maintained initially.

Question 17: 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 (Correct answer)
10 feet, as household current drops quickly with distance
The distance at which the wire is no longer visible
Only as far as needed to avoid direct contact with the wire

Correct answer: At least one full span (pole to pole) in all directions

A downed energized wire can energize the ground over a wide radius; one full span (pole to pole) in all directions is the minimum safe distance.

Question 18: When should a prehospital provider NOT enter a trauma scene?

When the incident occurred more than 30 minutes ago
When active hazards exist that have not been controlled (Correct answer)
When bystanders are present
When the patient appears critically injured

Correct answer: When active hazards exist that have not been controlled

Providers should never enter a scene with uncontrolled hazards as becoming a victim reduces available resources.

Question 19: A motorcyclist ejected at high speed has distended neck veins, absent breath sounds on the left, and hypotension. After needle decompression fails to improve vitals, what condition should you consider?

Massive hemothorax
Cardiac tamponade (Correct answer)
Neurogenic shock
Hemorrhagic shock from splenic laceration

Correct answer: Cardiac tamponade

Persistent hypotension with distended neck veins after ruling out tension pneumothorax suggests cardiac tamponade (Beck's triad), which requires pericardiocentesis or thoracotomy.

Question 20: A 45-year-old patient with blunt abdominal trauma presents with rigidity, guarding, and a BP of 90/70. Estimated blood loss is 1.5L. What is the PRIORITY prehospital action?

Establish two large-bore IV lines and infuse 2L of NS
Place a Foley catheter to monitor urine output
Rapid transport to a trauma center with hemostatic resuscitation (Correct answer)
Apply an abdominal binder and administer morphine for pain

Correct answer: Rapid transport to a trauma center with hemostatic resuscitation

Internal abdominal hemorrhage cannot be controlled prehospitally; rapid transport and hemostatic resuscitation are the priorities to minimize time to definitive surgical care.

Question 21: How does PHTLS recommend assessing perfusion status in a trauma patient?

Urine output measurement in the field
Blood pressure measurement alone
Integrating mental status, skin signs, heart rate, blood pressure, and capillary refill (Correct answer)
Pulse oximetry reading only

Correct answer: Integrating mental status, skin signs, heart rate, blood pressure, and capillary refill

PHTLS teaches assessment of multiple perfusion indicators because no single vital sign reliably indicates shock.

Question 22: You respond to an assault in a private residence. The scene appears calm, but the patient seems fearful and is glancing at a closed door. Which of the following is the most prudent action?

Ask the patient to speak up and tell you what is wrong.
Maintain a high index of suspicion, ensure an escape route, and consider requesting law enforcement backup. (Correct answer)
Ignore the patient's behavior and focus on the physical assessment.
Position yourself between the patient and the door to block a potential escape.

Correct answer: Maintain a high index of suspicion, ensure an escape route, and consider requesting law enforcement backup.

The safety of the EMS crew is paramount. Subtle cues, such as a patient's nervous behavior or body language, can indicate a potential threat. In this scenario, the provider should trust their instincts, maintain awareness of their surroundings, ensure they have a clear path to an exit, and request police presence to secure the scene before proceeding with patient care in a potentially volatile environment.

Question 23: Which type of fracture pattern is MOST commonly associated with high-velocity gunshot wounds to long bones?

Oblique fracture
Comminuted fracture (Correct answer)
Transverse fracture
Greenstick fracture

Correct answer: Comminuted fracture

High-velocity projectiles transfer massive energy, fragmenting bone into multiple pieces and creating a comminuted fracture pattern.

Question 24: Using START triage, a victim has a respiratory rate of 34 breaths per minute. What triage category is assigned?

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

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 25: In pediatric trauma, the most common mechanism causing significant head injury without external skull fracture is:

Acceleration-deceleration forces causing diffuse axonal injury (Correct answer)
Direct penetrating trauma from sharp objects
Depressed skull fractures from falls on hard surfaces
Basilar skull fractures from lateral impact forces

Correct answer: Acceleration-deceleration forces causing diffuse axonal injury

The child's pliable skull can transmit significant acceleration-deceleration forces to brain parenchyma, causing diffuse axonal injury without fracture.

Question 26: What is the primary prehospital concern with penetrating abdominal trauma?

Need for tetanus prophylaxis
Cosmetic damage to the abdominal wall
Internal hemorrhage and hollow organ injury (Correct answer)
Infection at the wound site

Correct answer: Internal hemorrhage and hollow organ injury

Penetrating abdominal trauma can cause significant internal hemorrhage from solid organ or vascular injury and peritonitis from hollow organ perforation.

Question 27: You arrive on scene to find an unresponsive trauma patient with gurgling sounds coming from their airway. What is the MOST appropriate initial action?

Apply a non-rebreather mask at 15 L/min.
Insert an oropharyngeal airway (OPA).
Log-roll the patient onto their side.
Perform immediate suctioning of the oropharynx. (Correct answer)

Correct answer: Perform immediate suctioning of the oropharynx.

Gurgling sounds indicate the presence of fluid (blood, vomit, or secretions) in the upper airway, creating an immediate obstruction. The first and most critical action is to clear the airway by suctioning. You must clear the airway before you can effectively ventilate or oxygenate the patient. An OPA cannot be properly placed and will not be effective until the fluid is removed.

Question 28: A female patient in her third trimester of pregnancy suffers blunt abdominal trauma. Which placental injury is the MOST life-threatening to the fetus?

Placenta previa
Umbilical cord compression
Uterine contusion
Placental abruption (Correct answer)

Correct answer: Placental abruption

Placental abruption, premature separation of the placenta from the uterine wall, is the leading cause of fetal death following maternal trauma.

Question 29: For a TBI patient WITHOUT signs of active cerebral herniation, what is the recommended target range for end-tidal carbon dioxide (EtCO2) to avoid secondary brain injury?

45-50 mmHg
25-30 mmHg
30-35 mmHg
35-45 mmHg (Correct answer)

Correct answer: 35-45 mmHg

For TBI patients without signs of herniation, the goal is to maintain a normal ventilation status (normocapnia). Both hypocapnia (from hyperventilation) and hypercapnia (from hypoventilation) are harmful. Hypocapnia causes cerebral vasoconstriction and ischemia, while hypercapnia causes vasodilation and can increase ICP. The recommended target EtCO2 range to maintain normocapnia is 35-45 mmHg. [21, 24, 25, 28]

Question 30: PHTLS supports a strategy of 'permissive hypotension' in penetrating trauma patients with uncontrolled internal hemorrhage. What is the PRIMARY goal of this approach?

To reduce cardiac workload and myocardial oxygen demand
To avoid diluting clotting factors and dislodging early clots while maintaining minimal perfusion (Correct answer)
To prevent cerebral herniation from excessive intracranial pressure
To minimize the risk of pulmonary edema from aggressive fluid loading

Correct answer: To avoid diluting clotting factors and dislodging early clots while maintaining minimal perfusion

Aggressive IV fluid resuscitation raises blood pressure, which can mechanically dislodge early clots and dilute remaining clotting factors, worsening coagulopathy. Permissive hypotension targets a mean arterial pressure sufficient for minimal brain and organ perfusion while limiting this harm until surgical hemorrhage control.

Question 31: How should a prehospital provider manage a patient in hemorrhagic shock when IV access cannot be obtained?

Establish intraosseous access as an alternative for fluid and medication administration (Correct answer)
Delay transport to continue IV attempts
Attempt subcutaneous fluid infusion
No fluid can be administered without IV access

Correct answer: Establish intraosseous access as an alternative for fluid and medication administration

Intraosseous access provides a rapid, reliable vascular access route when IV access fails.

Question 32: Which of the following is a contraindication to nasopharyngeal airway (NPA) insertion in a trauma patient?

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

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 33: Which of the following is a sign of vascular injury associated with an extremity fracture?

Mild swelling expected with any fracture
Normal capillary refill in all digits
Expanding hematoma at the fracture site (Correct answer)
Equal skin color bilaterally

Correct answer: Expanding hematoma at the fracture site

An expanding hematoma near a fracture site suggests arterial injury, as blood continues to accumulate under arterial pressure.

Question 34: 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
Five rescue breaths before assigning the Expectant category if still apneic (Correct answer)
Immediate Red tag without any intervention attempt
Classifying all children under 8 as Immediate regardless of vital signs

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 35: A trauma patient with severe facial injuries has an unsecurable airway via orotracheal intubation. What is the next definitive option?

Continue BVM ventilation indefinitely
Increase oxygen flow rate
Nasal intubation without medications
Surgical cricothyrotomy (Correct answer)

Correct answer: Surgical cricothyrotomy

Surgical cricothyrotomy is the definitive rescue airway when oral and nasal intubation are not possible due to facial trauma.

Question 36: During the rapid trauma assessment of an unconscious patient, you identify a tension pneumothorax while examining the chest. What is the correct next action?

Defer treatment until secondary survey is complete
Treat the tension pneumothorax immediately before continuing the assessment (Correct answer)
Transport immediately without any on-scene intervention
Note the finding and complete the full head-to-toe assessment before treating

Correct answer: Treat the tension pneumothorax immediately before continuing the assessment

The rapid trauma assessment is systematic, but life-threatening findings must be treated as they are discovered — not deferred until the exam is complete. A tension pneumothorax causes obstructive shock and cardiac arrest within minutes; immediate needle decompression is required.

Question 37: A mass casualty incident (MCI) is best defined as any event in which:

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

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

Hypothermia, acidosis, and coagulopathy (Correct answer)
Hypovolemia, tachycardia, and coagulopathy
Bradycardia, alkalosis, and thrombocytopenia
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 39: A patient has a closed femur fracture. How much blood can be lost internally from this single injury?

50-100 mL
100-200 mL
1,000-1,500 mL (Correct answer)
500-750 mL

Correct answer: 1,000-1,500 mL

A closed femur fracture can result in 1,000-1,500 mL or more of blood loss into the thigh compartment.

Question 40: Which component of Damage Control Resuscitation (DCR) directly addresses dilutional coagulopathy?

Early surgical hemorrhage control
Large-volume crystalloid infusion
High-ratio packed red blood cells to FFP (Correct answer)
Permissive normotension

Correct answer: High-ratio packed red blood cells to FFP

DCR uses a balanced 1:1:1 ratio of PRBCs to FFP to platelets to replace all lost blood components and prevent dilutional coagulopathy.

Question 41: Which physical finding helps differentiate neurogenic shock from hemorrhagic shock?

Both present identically
Neurogenic shock always causes unconsciousness
Hemorrhagic shock never causes tachycardia
Warm dry skin and bradycardia in neurogenic versus cool clammy skin and tachycardia in hemorrhagic (Correct answer)

Correct answer: Warm dry skin and bradycardia in neurogenic versus cool clammy skin and tachycardia in hemorrhagic

Neurogenic shock causes vasodilation (warm dry skin) and loss of sympathetic cardiac stimulation (bradycardia), while hemorrhagic shock causes vasoconstriction (cool skin) and tachycardia.

Question 42: In a pediatric patient with suspected tension pneumothorax, which needle decompression site is preferred?

Second intercostal space, mid-clavicular line
Third intercostal space, anterior axillary line
Fourth intercostal space, mid-clavicular line
Fifth intercostal space, mid-axillary line (Correct answer)

Correct answer: Fifth intercostal space, mid-axillary line

Current guidelines favor the fifth intercostal space at the mid-axillary line for needle decompression in both adults and pediatric patients due to higher success rates.

Question 43: According to PHTLS, what is the appropriate oxygen saturation target for trauma patients?

100% at all times
88-92%
Greater than or equal to 94% (Correct answer)
85-90% is acceptable

Correct answer: Greater than or equal to 94%

PHTLS recommends maintaining oxygen saturation at 94% or above in trauma patients to ensure adequate tissue oxygenation.

Question 44: In PHTLS, what is the recommended prehospital assessment approach for suspected intra-abdominal hemorrhage?

Focused ultrasound examination by paramedics
Serial abdominal assessments combined with monitoring for signs of shock (Correct answer)
Diagnostic peritoneal lavage in the field
Detailed abdominal palpation with deep pressure in all four quadrants

Correct answer: Serial abdominal assessments combined with monitoring for signs of shock

Since prehospital providers cannot definitively diagnose intra-abdominal hemorrhage, serial assessments monitoring for worsening tenderness, distension, and shock signs guide management.

Question 45: A 30-year-old construction worker fell 20 feet and is confused (GCS 12). His right pupil is 6 mm and non-reactive. Which injury does this MOST suggest?

Concussion with ocular contusion
Subdural hematoma without herniation
Epidural hematoma with uncal herniation (Correct answer)
Diffuse axonal injury

Correct answer: Epidural hematoma with uncal herniation

A unilateral blown pupil following head trauma indicates uncal herniation, classically caused by an expanding epidural hematoma from a torn middle meningeal artery.

Question 46: What is a pulmonary contusion and how does it affect the trauma patient?

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

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 47: Which of the following is an absolute contraindication for the insertion of a nasopharyngeal airway (NPA)?

Suspected basilar skull fracture (Correct answer)
Presence of an intact gag reflex
Patient is actively vomiting
Significant oral trauma

Correct answer: Suspected basilar skull fracture

A suspected or confirmed basilar skull fracture is an absolute contraindication for NPA insertion. There is a risk that the airway adjunct could be inadvertently passed into the cranial vault through the fracture. Signs of a basilar skull fracture include CSF rhinorrhea or otorrhea, Battle's sign, and raccoon eyes.

Question 48: What is the 'talk and die' phenomenon in traumatic brain injury?

Initially lucid patients who deteriorate and die from expanding intracranial hemorrhage, classically epidural hematoma (Correct answer)
Patients who talk excessively after head trauma always recover
Patients who are unable to speak after TBI
A communication disorder following concussion

Correct answer: Initially lucid patients who deteriorate and die from expanding intracranial hemorrhage, classically epidural hematoma

The 'talk and die' phenomenon describes patients who appear neurologically intact initially but rapidly deteriorate from expanding intracranial hemorrhage.

Question 49: What is the appropriate prehospital management of a massive hemothorax?

Needle decompression of the affected side
Elevation of the affected side
Chest compressions to redistribute the blood
Aggressive fluid resuscitation, high-flow oxygen, and rapid transport to a facility capable of emergency thoracotomy (Correct answer)

Correct answer: Aggressive fluid resuscitation, high-flow oxygen, and rapid transport to a facility capable of emergency thoracotomy

Massive hemothorax requires rapid volume replacement, oxygenation support, and urgent surgical intervention; needle decompression does not address blood accumulation.

Question 50: Which of the following is the primary risk associated with hyperventilating a trauma patient with a suspected traumatic brain injury (TBI)?

Increased intracranial pressure (ICP)
Barotrauma to the lungs
Cerebral vasoconstriction and ischemia (Correct answer)
Gastric distention and aspiration

Correct answer: Cerebral vasoconstriction and ischemia

Hyperventilation causes a rapid decrease in arterial carbon dioxide levels (hypocapnia). This leads to vasoconstriction of the cerebral blood vessels, which reduces cerebral blood flow. In a patient with a TBI, this reduction in blood flow can cause or worsen cerebral ischemia and lead to secondary brain injury. PHTLS guidelines emphasize avoiding prophylactic hyperventilation.

Question 51: Which part of the brain might suffer a cerebral contusion if a patient is hit with a baseball bat in the back of the head?

Frontal
Occipital (Correct answer)
Parietal
Frontal and occipital

Correct answer: Occipital

A direct blow to the back of the head primarily impacts the occipital lobe, which is located in that region of the brain. A cerebral contusion is a bruise of the brain tissue, and it typically occurs directly beneath the point of impact (coup injury). Therefore, the occipital lobe is the most likely area to suffer a contusion from such a blow.

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.

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60 min

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