Mixed Deck — All PHTLS Topics Flashcards

A construction worker falls from scaffolding and complains of severe chest pain. Palpation reveals crepitus along the left lateral chest wall. Which immediate life threat should be highest on your differential?

Answer: Rib fractures with potential hemothorax or pneumothorax

Crepitus over the chest wall indicates rib fractures, which carry significant risk of associated hemothorax or pneumothorax requiring rapid assessment.

A patient with a cervical spinal cord injury presents with bradycardia and hypotension but warm, dry skin. This pattern is MOST consistent with:

Answer: Neurogenic shock

Neurogenic shock from high cervical cord injury causes loss of sympathetic tone, producing hypotension and bradycardia with warm, dry (vasodilated) skin.

Which anatomical feature of a child's airway makes intubation more challenging compared to an adult?

Answer: Larger, more anterior larynx positioned higher in the neck

In children, the larynx is higher and more anterior, making visualization and intubation technically more difficult.

In a child with an isolated closed head injury and increased intracranial pressure, what ventilation rate is recommended to avoid hyperventilation?

Answer: Ventilate at the normal rate for the child's age

Routine hyperventilation is harmful because it causes cerebral vasoconstriction and ischemia; ventilate at normal age-appropriate rates unless herniation is imminent.

A prehospital provider arrives at a scene involving a motor vehicle collision with downed power lines across the vehicle. What is the correct initial action?

Answer: Stage at a safe distance and request utility company response before entering

Downed power lines represent an immediate life threat to responders. The correct action is to stage at a safe distance and request the utility company to de-energize the lines. Appearance alone cannot confirm a line is de-energized — even still lines can be lethal.

A 2-year-old trauma patient has a GCS of 9. Using the modified pediatric GCS, what adjustment must be made to the verbal component?

Answer: Verbal responses are scored based on age-appropriate vocalizations rather than adult criteria

The pediatric modification of the GCS verbal score accounts for age-appropriate vocalizations such as crying, babbling, or words rather than adult verbal responses.

In PHTLS, which finding most specifically indicates increased intracranial pressure after head trauma?

Answer: Cushing's triad (hypertension, bradycardia, irregular respirations)

Cushing's triad is the classic late sign of herniation due to rising ICP and represents a neurological emergency.

Which circumferential burn complication requires escharotomy and presents with absent distal pulses and a tight, pale extremity?

Answer: Compartment syndrome from eschar constriction

Circumferential full-thickness burns create rigid eschar that constricts swelling tissue, causing compartment syndrome that requires escharotomy to restore circulation.

What is a flail chest and why is it clinically significant?

Answer: Two or more ribs fractured in two or more places creating a free-floating segment that impairs ventilation

A flail segment is created when multiple adjacent ribs are fractured at two points, producing a free-floating section that moves paradoxically during breathing.

What does the 'talk and die' phenomenon describe in the context of TBI, and why is it clinically important?

Answer: A patient may have a lucid interval after TBI and then deteriorate rapidly as an intracranial hematoma expands

The 'talk and die' pattern — classically associated with epidural hematoma — describes a lucid interval after injury followed by sudden neurological collapse as an expanding intracranial hemorrhage compresses the brain. It underscores that an initially alert TBI patient must still be monitored closely and transported rapidly.

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

Answer: Hypotension, distended neck veins, and muffled heart sounds

Beck's Triad — hypotension, distended jugular veins (JVD), and muffled heart sounds — classically describes cardiac tamponade. Blood accumulating in the pericardial sac compresses the heart, reducing cardiac output while venous pressure rises. This distinguishes it from tension pneumothorax, which also causes JVD and hypotension but includes absent breath sounds and tracheal deviation.

Which of the following is the earliest and most reliable sign of developing compartment syndrome in a fractured extremity?

Answer: Pain that is disproportionate to the injury and worsened with passive stretch

Pain out of proportion to the injury — especially pain worsened by passively stretching the muscles in the compartment — is the earliest and most sensitive indicator of compartment syndrome, preceding the '6 P's' late findings such as pulselessness and paralysis.

According to PHTLS principles, which assessment finding most reliably indicates that a trauma patient has transitioned from compensated to decompensated hemorrhagic shock?

Answer: A falling systolic blood pressure despite ongoing care

A falling systolic blood pressure signals that the body's compensatory mechanisms (vasoconstriction, tachycardia, fluid shifts) have been overwhelmed. PHTLS identifies this drop as the marker of decompensated shock and an immediate threat to life requiring aggressive hemorrhage control and rapid transport.

Which of the following scenarios calls for a patient to be labeled as having suffered a major trauma?

Answer: Preexisting major medical problem

A preexisting major medical problem significantly impacts a trauma patient's physiological reserve and ability to compensate for injuries. Conditions like heart disease, diabetes, or chronic lung disease increase the risk of complications and adverse outcomes, thus classifying the patient as having suffered major trauma, regardless of the initial injury mechanism.

You are treating a patient with a suspected unstable pelvic fracture after a high-speed MVC. The patient is tachycardic and hypotensive. Besides IV access and fluid administration, which intervention is critical for controlling internal hemorrhage?

Answer: Application of a pelvic binder or sheet.

An unstable pelvic fracture can lead to massive internal hemorrhage by increasing the pelvic volume and damaging blood vessels. Applying a pelvic binder or a circumferential sheet wrap is a critical intervention to stabilize the pelvis, reduce its volume, and help tamponade the bleeding source.

A patient with blunt abdominal trauma has gross hematuria. This finding MOST likely indicates injury to which structure?

Answer: Urinary tract (kidney, ureter, or bladder)

Gross hematuria following trauma is a hallmark indicator of urinary tract injury, most commonly involving the kidneys or bladder.

What thoracic injury should be suspected in a patient who was wearing a seatbelt and has anterior chest bruising with hypotension?

Answer: Blunt cardiac injury (myocardial contusion)

Anterior chest bruising from seatbelt impact combined with hemodynamic instability suggests blunt cardiac injury.

In PHTLS, the preferred approach to fluid resuscitation in a patient with suspected intra-abdominal hemorrhage and a palpable radial pulse is:

Answer: Permissive hypotension, targeting a systolic BP of 80–90 mmHg

Permissive hypotension (SBP 80–90 mmHg) is preferred to avoid diluting clotting factors and disrupting forming clots before surgical hemorrhage control.

A patient is immobilized on a long spine board and complains of pain at the occiput and heels. After 30 minutes en route, the BEST action is:

Answer: Pad the bony prominences without removing the board or straps

Padding bony prominences such as the occiput and heels reduces pressure injury risk while maintaining spinal immobilization during transport.

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

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

Pulmonary contusion is deceptive: the injury to alveolar-capillary membranes causes progressive hemorrhage and edema that worsens over the first 24–48 hours. Initial presentation may show only mild tachypnea and hypoxia that deteriorates significantly. External chest wall appearance can be misleading — the force transfers to the lung parenchyma even without dramatic surface findings.