- Prehospital Trauma Life Support Thoracic Trauma Flashcards
12 cards from real PHTLS practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 12 - Prehospital Trauma Life Support Thoracic Trauma flashcards as text
What is the hallmark physical finding of a tension pneumothorax?
Answer: Unilateral absent breath sounds with hypotension and jugular venous distention
Tension pneumothorax classically presents with absent breath sounds on the affected side, hypotension from impaired venous return, and JVD from increased intrathoracic pressure.
How does PHTLS recommend performing needle decompression for tension pneumothorax?
Answer: Insert a 14-gauge needle in the 2nd intercostal space, midclavicular line or 5th intercostal space, anterior axillary line on the affected side
PHTLS teaches needle decompression at two acceptable sites: 2nd intercostal space midclavicular line or 5th intercostal space anterior axillary line.
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 is the appropriate prehospital management of a massive hemothorax?
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.
How does PHTLS differentiate between tension pneumothorax and massive hemothorax on physical exam?
Answer: Tension pneumothorax shows JVD and hyperresonance; massive hemothorax shows flat neck veins and dullness to percussion
Key differentiating features are neck vein status and percussion findings: air causes hyperresonance and JVD while blood causes dullness and flat veins.
What is cardiac tamponade and how is it recognized in the prehospital setting?
Answer: Blood accumulation in the pericardial sac compressing the heart, recognized by Beck's triad: JVD, muffled heart sounds, and hypotension
Cardiac tamponade occurs when blood fills the pericardial sac, compressing the heart chambers and reducing cardiac output.
What is a pulmonary contusion and how does it affect the trauma patient?
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.
How does PHTLS recommend managing a patient with an open pneumothorax (sucking chest wound)?
Answer: Apply a vented chest seal or three-sided occlusive dressing, monitor for tension pneumothorax development
An occlusive dressing sealed on three sides or commercial vented chest seal creates a flutter valve effect while monitoring for tension development.
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, what is the significance of subcutaneous emphysema found during chest assessment?
Answer: It indicates air leaking from the respiratory tract into subcutaneous tissues, suggesting pneumothorax, tracheobronchial injury, or esophageal perforation
Subcutaneous emphysema indicates air has escaped from the respiratory tract into soft tissues, suggesting significant thoracic injury.
What is the PHTLS approach to managing rib fractures in a trauma patient?
Answer: Provide supplemental oxygen, encourage deep breathing, manage pain, and monitor for associated injuries
Rib fracture management focuses on oxygenation support, pain management, and monitoring for underlying injuries.
According to PHTLS, what immediate action is required for a patient with traumatic cardiac arrest from thoracic penetrating trauma?
Answer: Rapid transport for emergency department thoracotomy, with CPR and bilateral needle decompression en route
Penetrating thoracic trauma causing cardiac arrest has survivable causes that can only be treated surgically, making rapid transport essential.
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