Prehospital Trauma Life Support Airway and Ventilation 1 Flashcards

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

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.

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?

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.

A nasopharyngeal airway (NPA) is preferred over an oropharyngeal airway (OPA) in which of the following trauma scenarios?

Answer: A semiconscious patient with an active gag reflex

The NPA is tolerated by patients with an intact or active gag reflex who are semiconscious, because it bypasses the oropharynx where the gag reflex is triggered. The OPA is reserved for deeply unresponsive patients without a gag reflex to avoid inducing vomiting.

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

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.

In the prehospital setting, when is a surgical airway (cricothyrotomy) indicated for a trauma patient?

Answer: After failed endotracheal intubation attempts when oxygenation cannot be maintained by BVM alone

Cricothyrotomy is a rescue technique for the 'can't intubate, can't oxygenate' scenario. It is only performed after less invasive airway methods have failed, because it is an invasive procedure with significant risks and is not a first-line intervention.

What is the correct tidal volume target when ventilating an adult trauma patient with a bag-valve-mask device?

Answer: Sufficient to produce visible chest rise, approximately 500–600 mL

PHTLS recommends delivering just enough volume to produce visible chest rise, roughly 500–600 mL for an average adult. Excessive tidal volumes cause gastric insufflation, regurgitation risk, and increased intrathoracic pressure, which can compromise venous return and cardiac output in trauma patients.