PHTLS Airway and Ventilation 4 — Questions and Answers
Question 1: A trauma patient with severe facial injuries has an unsecurable airway via orotracheal intubation. What is the next definitive option?
- Continue BVM ventilation indefinitely
- Surgical cricothyrotomy (Correct answer)
- Nasal intubation without medications
- Increase oxygen flow rate
Correct answer: Surgical cricothyrotomy
Surgical cricothyrotomy is the definitive rescue airway when oral and nasal intubation are not possible due to facial trauma.
Question 2: In PHTLS, what does the mnemonic 'MOANS' help assess?
- Severity of traumatic brain injury
- Anticipated difficulty of bag-valve-mask ventilation (Correct answer)
- Likelihood of hemorrhagic shock
- Spinal cord injury level
Correct answer: Anticipated difficulty of bag-valve-mask ventilation
MOANS (Mask seal, Obesity/Obstruction, Age, No teeth, Stiff) predicts difficulty with BVM ventilation before intubation.
Question 3: What physiologic effect does hyperventilation cause in a trauma patient with TBI that makes it harmful?
- Increases cerebral blood flow leading to herniation
- Causes cerebral vasoconstriction reducing blood flow and oxygen delivery (Correct answer)
- Raises blood pressure causing rebleeding
- Causes metabolic alkalosis worsening coagulopathy
Correct answer: Causes cerebral vasoconstriction reducing blood flow and oxygen delivery
Hyperventilation lowers CO2, causing cerebral vasoconstriction that reduces cerebral blood flow and worsens ischemia in the injured brain.
Question 4: A patient has diminished breath sounds on the left with a deviated trachea to the right and a BP of 70/40. Which condition does this represent?
- Left-sided hemothorax
- Left-sided tension pneumothorax (Correct answer)
- Right-sided simple pneumothorax
- Pericardial tamponade
Correct answer: Left-sided tension pneumothorax
Left-sided absent breath sounds, rightward tracheal deviation, and shock are classic signs of left-sided tension pneumothorax.
Question 5: When using a two-handed BVM technique during trauma resuscitation, why is it preferred over single-handed technique?
- It delivers higher oxygen concentrations
- It achieves a better mask seal and reduces leak, improving ventilation (Correct answer)
- It allows faster compression rates
- It prevents regurgitation
Correct answer: It achieves a better mask seal and reduces leak, improving ventilation
A two-person technique with two hands on the mask creates a superior seal, ensuring more consistent tidal volume delivery.
Question 6: Which patient presentation is MOST consistent with a hemothorax requiring prehospital intervention?
- Bilateral crackles with JVD
- Unilateral absent breath sounds, dull percussion, normal BP (Correct answer)
- Absent breath sounds with tracheal deviation and hypotension
- Subcutaneous emphysema with normal vitals
Correct answer: Unilateral absent breath sounds, dull percussion, normal BP
Hemothorax produces absent or diminished breath sounds with dullness to percussion on the affected side, though BP may be maintained initially.
Question 7: Pulseoximetry (SpO2) may give falsely normal readings in which trauma scenario?
- Hypoxia from tension pneumothorax
- Carbon monoxide poisoning from smoke inhalation (Correct answer)
- Airway obstruction from tongue
- Hemorrhagic shock with hemoglobin drop
Correct answer: Carbon monoxide poisoning from smoke inhalation
Pulse oximetry cannot distinguish carboxyhemoglobin from oxyhemoglobin, so CO poisoning can produce falsely normal SpO2 readings.
PHTLS Airway and Ventilation 4
A trauma patient with severe facial injuries has an unsecurable airway via orotracheal intubation.
What is the next definitive option?