Special Trauma Considerations Flashcards

A pregnant trauma patient is in her 30th week of gestation. Which of the following positions is most appropriate during transport to minimize supine hypotension syndrome?

Answer: Left lateral tilt of 15-30 degrees

Left lateral tilt of 15-30 degrees relieves uterine compression of the inferior vena cava, improving venous return and cardiac output.

When assessing a pediatric trauma patient, which anatomical feature makes airway management more challenging compared to adults?

Answer: More anterior and superior larynx

The pediatric larynx is positioned more anteriorly and superiorly (at C3-C4 vs. C5-C6 in adults), making visualization during intubation more difficult.

An elderly patient involved in a low-speed motor vehicle collision presents with altered mental status and a subdural hematoma on CT. Which age-related factor most increases this patient's susceptibility to intracranial injury?

Answer: Brain atrophy with stretching of bridging veins

Age-related brain atrophy stretches bridging veins across a wider subdural space, making them more vulnerable to tearing even with minor trauma.

A morbidly obese trauma patient requires needle thoracostomy for suspected tension pneumothorax. Which modification to the standard technique is most important?

Answer: Use a longer needle or catheter to penetrate the thicker chest wall

Chest wall thickness in obese patients may require a longer needle (≥8 cm) or catheter to successfully reach the pleural space.

Which of the following best describes the primary physiological concern when managing a geriatric patient who takes beta-blockers and suffers significant hemorrhage?

Answer: Inability to mount a compensatory tachycardia, masking shock severity

Beta-blockers blunt the heart rate response to hemorrhage, so the absence of tachycardia does not rule out significant blood loss in these patients.

A 7-year-old child is struck by a vehicle and sustains abdominal trauma. The PHTLS provider notes a visible seatbelt mark across the abdomen. Which injury pattern should be highly suspected?

Answer: Chance fracture and hollow viscus injury

The seatbelt sign in children is strongly associated with Chance fractures (flexion-distraction spinal injury) and hollow viscus injuries due to lap-belt mechanics.

During a mass casualty incident involving pediatric patients, which triage tool is specifically designed and validated for use in children?

Answer: JumpSTART triage

JumpSTART was developed specifically for pediatric patients and modifies the START algorithm to account for children's different respiratory rates and inability to follow commands.

A trauma patient is found to be 8 months pregnant and has no palpable pulse after blunt chest trauma. After 4 minutes of unsuccessful resuscitation, the most appropriate next step is:

Answer: Perform field cesarean delivery to improve maternal CPR effectiveness

Perimortem cesarean delivery (resuscitative hysterotomy) performed within 4-5 minutes of cardiac arrest can relieve aortocaval compression and improve maternal CPR outcomes.

Which of the following best explains why children are at higher risk for hypothermia following trauma compared to adults?

Answer: Children have a greater surface area-to-body mass ratio

Children's larger surface area relative to their body mass results in more rapid heat loss to the environment after trauma.

An intoxicated trauma patient has a GCS of 12. The PHTLS provider should:

Answer: Assume a concurrent traumatic brain injury until proven otherwise

Alcohol intoxication and TBI present similarly; providers must assume TBI in any intoxicated trauma patient to avoid undertreating a potentially life-threatening injury.

When managing an obese trauma patient, which assessment finding is most likely to be UNDERESTIMATED due to body habitus?

Answer: Severity of abdominal tenderness and rigidity

Thick abdominal adipose tissue can mask peritoneal signs, leading to underestimation of intra-abdominal injury severity on physical exam.

A trauma patient who is a Jehovah's Witness declines blood transfusion. The patient is conscious, alert, and has decision-making capacity. The PHTLS provider should:

Answer: Document the refusal, focus on volume-sparing hemorrhage control, and transport

A competent adult has the right to refuse treatment; the provider should respect this, document it thoroughly, optimize hemorrhage control without blood products, and transport.

Which of the following physiological changes in pregnancy most significantly affects fluid resuscitation decisions in a trauma patient?

Answer: Plasma volume increase of 40-50% with relative hemodilution

Plasma volume expands 40-50% during pregnancy while red cell mass increases only 20-30%, causing dilutional anemia that may mask hemorrhage severity.

A geriatric patient on warfarin sustains a head injury with a brief loss of consciousness. CT is negative initially. The PHTLS provider should advise the receiving team that this patient:

Answer: Needs close observation for delayed hemorrhage despite normal initial imaging

Anticoagulated patients can develop delayed intracranial hemorrhage hours after injury even with an initially normal CT, requiring prolonged observation.

A child with an isolated femur fracture is found to have bruising in multiple stages of healing across the body. What is the most appropriate PHTLS provider action?

Answer: Document all findings objectively and report suspicion of non-accidental trauma per protocol

Prehospital providers are mandated reporters; objective documentation and notification per local protocol is required when non-accidental trauma is suspected.

When using the Broselow tape to guide pediatric trauma care, what does the tape primarily determine?

Answer: Weight-based drug dosing and equipment sizing by body length

The Broselow tape correlates body length with estimated weight to guide weight-based drug dosing and appropriate equipment sizes in pediatric emergencies.

An elderly patient with a hip fracture following a ground-level fall is in significant pain. Regarding pain management, the PHTLS principle is:

Answer: Provide appropriate analgesia while monitoring for respiratory depression

PHTLS supports humane pain management for trauma patients, with careful dose titration and monitoring in the elderly who may be more sensitive to opioids.

During assessment of a bariatric trauma patient, pulse oximetry readings may be unreliable due to:

Answer: Poor peripheral perfusion and probe placement difficulties on thick digits

In obese patients, poor peripheral perfusion and difficulty obtaining a reliable probe fit can reduce pulse oximetry accuracy.

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

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.

Which of the following is TRUE regarding spinal motion restriction in elderly trauma patients with suspected cervical spine injury?

Answer: Kyphotic deformity may require padding modifications to maintain neutral alignment

Pre-existing cervical kyphosis may require void-filling padding behind the head to maintain the patient's anatomical neutral position rather than forcing hyperextension.