PHTLS 7th Edition 2 — Questions and Answers
Question 1: According to PHTLS 7th Edition, what is the recommended sequence for primary survey in a trauma patient?
- ABCDE approach (Correct answer)
- Head-to-toe physical exam
- Vital signs first then airway
- Scene safety then transport
Correct answer: ABCDE approach
The PHTLS 7th Edition emphasizes the ABCDE approach (Airway, Breathing, Circulation, Disability, Exposure) as the standard primary survey sequence for trauma patients.
The ABCDE approach is the cornerstone of PHTLS primary survey. It ensures life-threatening conditions are identified and treated in order of priority: Airway with cervical spine protection, Breathing and ventilation, Circulation with hemorrhage control, Disability (neurologic status), and Exposure/Environment. This systematic approach prevents providers from being distracted by dramatic but non-life-threatening injuries.
Question 2: In the PHTLS 7th Edition, which principle guides the concept of the 'Golden Period'?
- All trauma patients must arrive at the hospital within 60 minutes
- The time from injury to definitive care should be minimized (Correct answer)
- Patients have exactly one hour before irreversible damage occurs
- Field treatment should always take priority over rapid transport
Correct answer: The time from injury to definitive care should be minimized
The Golden Period concept in PHTLS emphasizes minimizing the time between injury and definitive care, recognizing that this timeframe varies by patient and injury type.
PHTLS 7th Edition evolved from the rigid 'Golden Hour' to the 'Golden Period' concept, acknowledging that some patients may have less than an hour while others may tolerate longer intervals. The key principle is that definitive care should not be unnecessarily delayed. This shift recognizes individual patient variability in injury tolerance and emphasizes clinical judgment over arbitrary time limits.
Question 3: According to PHTLS 7th Edition, which finding during the primary survey requires immediate intervention before proceeding?
- Bruising on the abdomen
- Absent breath sounds on one side of the chest (Correct answer)
- A laceration on the forehead
- Mild tenderness in the extremities
Correct answer: Absent breath sounds on one side of the chest
Absent breath sounds on one side suggest tension pneumothorax or hemothorax, which is a life-threatening condition requiring immediate intervention during the primary survey.
PHTLS teaches that the primary survey is a 'treat as you go' process. When a life-threatening condition is identified, such as absent breath sounds suggesting tension pneumothorax, it must be addressed immediately before continuing the assessment. Unilateral absent breath sounds combined with respiratory distress may require needle decompression or chest seal application.
Question 4: The PHTLS 7th Edition identifies which mechanism of injury as most likely to produce multi-system trauma?
- Fall from standing height
- Isolated stab wound to the arm
- High-speed motor vehicle collision with ejection (Correct answer)
- Superficial burn to the hand
Correct answer: High-speed motor vehicle collision with ejection
High-speed motor vehicle collisions with ejection involve massive energy transfer and are strongly associated with multi-system trauma affecting multiple body regions.
Ejection from a vehicle during a high-speed collision dramatically increases mortality and morbidity. The patient experiences multiple impacts: initial collision forces, ejection through the windshield or door, and then impact with the ground or objects outside the vehicle. PHTLS emphasizes that ejection is one of the most dangerous mechanisms, with mortality rates approximately 6 times higher than for non-ejected occupants.
Question 5: What does PHTLS 7th Edition recommend as the first action when arriving at a trauma scene?
- Begin patient assessment immediately
- Ensure scene safety for providers and patients (Correct answer)
- Call for additional resources
- Apply a cervical collar to the patient
Correct answer: Ensure scene safety for providers and patients
Scene safety is always the first priority in PHTLS. Providers cannot help patients if they become casualties themselves.
PHTLS consistently emphasizes that scene safety is the absolute first priority upon arrival. This includes assessing for hazards such as traffic, fire, hazardous materials, unstable structures, violent perpetrators, and downed power lines. Only after the scene is deemed safe should providers approach the patient.
Question 6: According to PHTLS 7th Edition, which assessment tool is used to rapidly evaluate neurologic status during the primary survey?
- Cincinnati Prehospital Stroke Scale
- Glasgow Coma Scale
- AVPU scale (Correct answer)
- NIH Stroke Scale
Correct answer: AVPU scale
The AVPU scale (Alert, Voice, Pain, Unresponsive) is the rapid neurologic assessment tool recommended during the primary survey's Disability component.
During the primary survey's 'D' (Disability) step, PHTLS recommends the AVPU scale for rapid neurologic assessment: Alert, responds to Voice, responds to Pain, or Unresponsive. While the Glasgow Coma Scale provides a more detailed neurologic evaluation, it is typically performed during the secondary survey. The AVPU scale's simplicity allows rapid categorization of consciousness level without delaying the primary survey.
PHTLS 7th Edition 2
According to PHTLS 7th Edition, what is the recommended sequence for primary survey in a trauma patient?