PHTLS Airway and Ventilation 5 — Questions and Answers
Question 1: In a pediatric trauma patient, which anatomical difference increases the risk of airway obstruction compared to adults?
- Smaller tongue relative to mouth size
- Proportionally larger tongue and more anterior, cephalad larynx (Correct answer)
- Longer trachea with larger diameter
- Stiffer epiglottis that holds airway open
Correct answer: Proportionally larger tongue and more anterior, cephalad larynx
Children have a proportionally larger tongue, more anterior and superior larynx, and a floppy epiglottis, all increasing obstruction risk.
Question 2: What is the appropriate oxygen delivery device for a spontaneously breathing, conscious trauma patient with suspected hypoxia in the prehospital setting?
- Nasal cannula at 2 L/min
- Simple face mask at 6 L/min
- Non-rebreather mask at 15 L/min (Correct answer)
- Venturi mask at 28%
Correct answer: Non-rebreather mask at 15 L/min
A non-rebreather mask at 15 L/min delivers the highest available FiO2 (~0.85-0.90) for spontaneously breathing trauma patients needing supplemental oxygen.
Question 3: A trauma patient is intubated and ETCO2 waveform shows a sudden drop to near zero. What is the most likely cause?
- Tension pneumothorax developing
- Esophageal intubation or ET tube displacement (Correct answer)
- Hyperventilation by provider
- Pulmonary embolism
Correct answer: Esophageal intubation or ET tube displacement
Loss of ETCO2 waveform after a previously confirmed tube position most commonly indicates esophageal placement or tube dislodgement.
Question 4: Which finding on auscultation after intubation suggests right mainstem bronchus intubation?
- Equal breath sounds bilaterally
- Absent breath sounds over right side
- Breath sounds only over right side, absent on left (Correct answer)
- Gurgling over the epigastrium
Correct answer: Breath sounds only over right side, absent on left
Right mainstem intubation results in ventilation of only the right lung, producing breath sounds on the right but absent sounds on the left.
Question 5: During transport of an intubated trauma patient, how often should tube position be confirmed?
- Once at scene and no further confirmation needed
- Only if SpO2 drops below 85%
- Continuously via waveform capnography throughout transport (Correct answer)
- Every 30 minutes by auscultation only
Correct answer: Continuously via waveform capnography throughout transport
Continuous waveform ETCO2 monitoring is the standard for ongoing confirmation of tube position and ventilation adequacy during transport.
Question 6: Which intervention is the highest priority in the PHTLS airway management sequence for an unresponsive trauma patient with gurgling respirations?
- Apply cervical collar
- Suction the airway (Correct answer)
- Establish IV access
- Administer epinephrine
Correct answer: Suction the airway
Gurgling indicates fluid (blood, secretions, vomit) in the airway requiring immediate suction before any other intervention.
Question 7: A PHTLS provider encounters a trauma patient with trismus (clenched jaw). Which airway adjunct bypasses this problem without requiring mouth opening?
- Oropharyngeal airway (OPA)
- Nasopharyngeal airway (NPA) (Correct answer)
- King LT airway
- Endotracheal tube
Correct answer: Nasopharyngeal airway (NPA)
A nasopharyngeal airway is inserted through the nostril and does not require the mouth to be open, making it useful when trismus prevents oral access.
PHTLS Airway and Ventilation 5
In a pediatric trauma patient, which anatomical difference increases the risk of airway obstruction compared to adults?