PHTLS Airway and Ventilation 2 — Questions and Answers
Question 1: A trauma patient has a GCS of 8 and is breathing with an irregular pattern. What is the most appropriate airway intervention?
- Nasopharyngeal airway only
- Oropharyngeal airway and BVM ventilation
- Definitive airway management via endotracheal intubation or supraglottic device (Correct answer)
- High-flow oxygen via non-rebreather mask
Correct answer: Definitive airway management via endotracheal intubation or supraglottic device
A GCS ≤8 with inadequate breathing indicates the need for a definitive airway to protect and control ventilation.
Question 2: Which finding during airway assessment indicates immediate life-threatening airway obstruction?
- Mild stridor during exertion
- Complete absence of breath sounds bilaterally with no chest rise (Correct answer)
- Expiratory wheeze in both lung fields
- SpO2 of 94% on room air
Correct answer: Complete absence of breath sounds bilaterally with no chest rise
No breath sounds and no chest rise with ventilation attempts signals complete airway obstruction requiring immediate action.
Question 3: When performing bag-valve-mask ventilation on a trauma patient, what tidal volume and rate are recommended to avoid iatrogenic harm?
- Large tidal volumes at 20 breaths/min
- Tidal volumes causing visible chest rise at 10-12 breaths/min (Correct answer)
- Minimal volumes at 6 breaths/min
- Forceful ventilation at 24 breaths/min to maximize oxygenation
Correct answer: Tidal volumes causing visible chest rise at 10-12 breaths/min
PHTLS recommends ventilations sufficient to produce visible chest rise at 10-12/min to prevent hyperventilation and gastric insufflation.
Question 4: A patient with suspected cervical spine injury needs airway management. Which approach is preferred?
- Hyperextend the neck to open the airway fully
- Use jaw thrust maneuver with in-line spinal stabilization (Correct answer)
- Avoid all airway maneuvers until imaging confirms injury
- Perform immediate cricothyrotomy
Correct answer: Use jaw thrust maneuver with in-line spinal stabilization
Jaw thrust with manual in-line stabilization opens the airway while minimizing cervical spine movement.
Question 5: Which supraglottic airway device is considered acceptable for definitive airway management when endotracheal intubation is not feasible in PHTLS?
- Simple face mask
- Laryngeal mask airway (LMA) or King LT (Correct answer)
- Nasopharyngeal airway
- Oropharyngeal airway
Correct answer: Laryngeal mask airway (LMA) or King LT
Supraglottic devices like the LMA or King LT are acceptable rescue airways when intubation cannot be performed.
Question 6: During rapid sequence intubation (RSI) of a trauma patient, which complication most directly results from excessive ventilation rate?
- Hypoxia from oxygen consumption
- Reduced venous return and decreased cardiac output (Correct answer)
- Esophageal intubation
- Laryngospasm
Correct answer: Reduced venous return and decreased cardiac output
Hyperventilation raises intrathoracic pressure, reducing venous return and can cause or worsen hypotension in trauma patients.
Question 7: A patient with a penetrating neck injury is maintaining their own airway but has progressive swelling and voice changes. What is the most appropriate prehospital action?
- Wait and reassess in 5 minutes
- Apply a cervical collar tightly to tamponade swelling
- Initiate early definitive airway before complete obstruction occurs (Correct answer)
- Administer albuterol for swelling
Correct answer: Initiate early definitive airway before complete obstruction occurs
Progressive airway compromise from expanding hematoma requires early airway intervention before complete obstruction makes it impossible.
PHTLS Airway and Ventilation 2
A trauma patient has a GCS of 8 and is breathing with an irregular pattern.
What is the most appropriate airway intervention?