PHTLS 7th Edition 5 — Questions and Answers
Question 1: A motorcyclist struck a guardrail at high speed and presents with paradoxical chest wall movement over the left chest. The MOST likely diagnosis is:
- Open pneumothorax
- Tension pneumothorax
- Flail chest (Correct answer)
- Massive hemothorax
Correct answer: Flail chest
Paradoxical movement (segment moves inward on inspiration) with multiple rib fractures indicates a flail segment.
Question 2: In pediatric trauma, which physiological characteristic allows children to maintain normal blood pressure longer despite significant blood loss?
- Higher baseline heart rate
- Greater compensatory vasoconstriction reserve (Correct answer)
- Larger total blood volume relative to body weight
- More compliant cardiac muscle
Correct answer: Greater compensatory vasoconstriction reserve
Children have a robust sympathetic response and can vasoconstrict effectively, maintaining BP until 25-30% blood loss.
Question 3: According to PHTLS principles, which intervention has the HIGHEST priority in a patient with an isolated penetrating neck injury and expanding hematoma?
- IV access and fluid resuscitation
- Cervical collar application
- Airway management (Correct answer)
- Wound packing with hemostatic gauze
Correct answer: Airway management
An expanding hematoma can rapidly compress the airway; securing the airway before it is lost is the immediate priority.
Question 4: The PHTLS concept of 'platinum ten minutes' refers to:
- Maximum time for CPR before cessation
- Recommended on-scene time before transporting a critical trauma patient (Correct answer)
- Time from injury to first surgical intervention
- Duration of permissive hypotension before fluid resuscitation
Correct answer: Recommended on-scene time before transporting a critical trauma patient
PHTLS recommends limiting on-scene time to 10 minutes or less for critical trauma patients to reach definitive surgical care quickly.
Question 5: A construction worker falls 20 feet and lands feet-first. Besides calcaneal fractures, which associated injuries should the PHTLS provider MOST suspect?
- Bilateral wrist fractures and clavicle injuries
- Lumbar spine compression fractures and hip fractures (Correct answer)
- Cervical spine fractures and rib fractures
- Pelvic ring disruption and femur fractures
Correct answer: Lumbar spine compression fractures and hip fractures
Axial loading from a feet-first fall transmits force up through the calcanei, ankles, and long bones into the lumbar spine and hips.
Question 6: Which PHTLS assessment finding MOST strongly indicates the need for immediate needle thoracostomy?
- Bilateral breath sounds with tachycardia
- Absent breath sounds, tracheal deviation, hypotension, and JVD (Correct answer)
- Crepitus over the ribs with normal SpO2
- Dullness to percussion with tachypnea only
Correct answer: Absent breath sounds, tracheal deviation, hypotension, and JVD
The combination of absent breath sounds, tracheal deviation away from affected side, hypotension, and JVD indicates tension pneumothorax requiring immediate decompression.
Question 7: In PHTLS, hemorrhage from an extremity wound that cannot be controlled with a tourniquet (e.g., groin or axilla) should be managed with:
- Pressure dressing and elevation only
- Wound packing with hemostatic gauze and direct pressure (Correct answer)
- Proximal arterial compression point only
- Circumferential elastic bandage wrap
Correct answer: Wound packing with hemostatic gauze and direct pressure
Junctional wounds inaccessible to tourniquets require wound packing with hemostatic gauze followed by sustained direct pressure.
PHTLS 7th Edition 5
A motorcyclist struck a guardrail at high speed and presents with paradoxical chest wall movement over the left chest.
The MOST likely diagnosis is: