Question 1: Which type of shock results from blood loss due to traumatic injury?

• Neurogenic shock
• Cardiogenic shock
• Hypovolemic hemorrhagic shock (Correct answer)
• Septic shock

Correct answer: Hypovolemic hemorrhagic shock

Hypovolemic hemorrhagic shock occurs when significant blood loss reduces circulating volume, decreasing cardiac output and oxygen delivery to tissues.

Hemorrhagic shock is the most common type of shock in trauma patients. PHTLS classifies it into four classes based on estimated blood loss: Class I (<15%), Class II (15-30%), Class III (30-40%), and Class IV (>40%). Treatment priorities include hemorrhage control, fluid resuscitation using permissive hypotension principles, and rapid transport to definitive care.

Question 2: What is the primary purpose of the trauma triage decision scheme in PHTLS?

• To determine which patients can be treated and released at the scene
• To ensure the right patient reaches the right facility in the right time (Correct answer)
• To calculate the exact severity score of each injury
• To assign priority levels for emergency department treatment

Correct answer: To ensure the right patient reaches the right facility in the right time

The triage decision scheme helps identify patients who need trauma center care versus those who can be treated at closer facilities.

The PHTLS trauma triage decision scheme is a step-wise algorithm that evaluates physiologic criteria, anatomic criteria, mechanism of injury, and special considerations to determine the most appropriate receiving facility. This systematic approach reduces undertriage, which is associated with preventable trauma deaths.

Question 3: In PHTLS, what does the term 'load and go' refer to?

• Loading equipment onto the ambulance before responding
• Rapidly packaging a critical patient for immediate transport (Correct answer)
• Transferring patient care to the receiving hospital
• Performing all procedures before leaving the scene

Correct answer: Rapidly packaging a critical patient for immediate transport

'Load and go' describes the strategy of rapidly packaging a critically injured patient with minimal on-scene interventions, prioritizing transport to definitive care.

The 'load and go' approach is appropriate for patients with time-sensitive, life-threatening injuries that require surgical intervention. PHTLS teaches that only critical interventions such as airway management, hemorrhage control, and decompression should be performed on scene. All other interventions should be done en route.

Question 4: According to PHTLS, which of the following is a component of the SAMPLE history?

• Scene safety assessment
• Allergies the patient may have (Correct answer)
• Number of casualties at the scene
• Distance from the nearest hospital

Correct answer: Allergies the patient may have

SAMPLE stands for Signs/Symptoms, Allergies, Medications, Past medical history, Last oral intake, and Events leading to the injury.

The SAMPLE history is a standardized mnemonic for gathering essential patient information. This information guides treatment decisions and is communicated to the receiving facility. SAMPLE is typically obtained during the secondary survey or transport.

Question 5: What is the primary goal of hemorrhage control in the PHTLS framework?

• To completely stop all bleeding before transport
• To prevent further blood loss and maintain perfusion to vital organs (Correct answer)
• To normalize the patient's blood pressure at the scene
• To identify the source of internal bleeding through palpation

Correct answer: To prevent further blood loss and maintain perfusion to vital organs

The primary goal is preventing further blood loss while maintaining adequate organ perfusion, recognizing that some bleeding can only be definitively controlled surgically.

PHTLS emphasizes a stepwise approach to hemorrhage control: direct pressure, wound packing, tourniquets for extremity hemorrhage, and hemostatic agents. The paradigm has shifted to include early tourniquet use for life-threatening extremity hemorrhage, a major change from earlier editions.

Question 6: In PHTLS, what class of hemorrhage is characterized by blood loss of 30-40% of total blood volume?

• Class I
• Class II
• Class III (Correct answer)
• Class IV

Correct answer: Class III

Class III hemorrhage involves 30-40% blood loss, presenting with significant tachycardia, hypotension, and altered mental status.

PHTLS classifies hemorrhagic shock into four classes: Class I (<15%) with minimal symptoms; Class II (15-30%) with tachycardia and anxiety; Class III (30-40%) with significant tachycardia, hypotension, and confusion; Class IV (>40%) with severe hypotension and obtundation. Class III is a critical threshold where crystalloid alone is often insufficient.

Question 7: Which PHTLS principle states that the absence of a history of trauma does not exclude the presence of injury?

• The Golden Period principle
• The Treat as You Find principle
• The Index of Suspicion principle (Correct answer)
• The Platinum Ten principle

Correct answer: The Index of Suspicion principle

The Index of Suspicion principle reminds providers to maintain awareness of potential injuries even when the mechanism is not clearly reported.

PHTLS teaches that providers should maintain a high index of suspicion for occult injuries. Patients may not report mechanisms accurately due to altered mental status, intoxication, or distraction by pain. Environmental clues, vehicle damage patterns, and kinematics analysis help identify potential injuries.

Question 8: According to PHTLS, which of the following patients should be transported to a trauma center?

• An adult with an isolated wrist fracture from a fall
• A patient with a gunshot wound to the abdomen (Correct answer)
• A patient with a superficial laceration to the forearm
• An adult with a sprained ankle from sports

Correct answer: A patient with a gunshot wound to the abdomen

Penetrating injuries to the torso meet anatomic criteria for trauma center transport under the triage decision scheme.

The PHTLS triage decision scheme identifies penetrating injuries to the head, neck, torso, and proximal extremities as requiring transport to the highest level of trauma care available. A gunshot wound to the abdomen carries high risk of injury to multiple organs and major vascular structures.

Question 9: What does PHTLS identify as the most common preventable cause of death in trauma?

• Unrecognized tension pneumothorax
• Airway compromise
• Uncontrolled hemorrhage (Correct answer)
• Spinal cord injury

Correct answer: Uncontrolled hemorrhage

Uncontrolled hemorrhage is the leading preventable cause of death in trauma, which is why PHTLS emphasizes early hemorrhage recognition and aggressive bleeding control.

Hemorrhage accounts for approximately 30-40% of trauma deaths, and many are potentially preventable with earlier recognition and intervention. PHTLS has increasingly emphasized hemorrhage control, including the adoption of tourniquets as first-line treatment for life-threatening extremity bleeding.

Question 10: In PHTLS, what is the recommended method for assessing breathing during the primary survey?

• Pulse oximetry reading alone
• Look, listen, and feel for chest rise, air movement, and abnormalities (Correct answer)
• Auscultation with stethoscope in all four quadrants
• Capnography measurement only

Correct answer: Look, listen, and feel for chest rise, air movement, and abnormalities

The look, listen, and feel method allows rapid assessment of breathing effectiveness using the provider's senses.

During the 'B' step of the primary survey, PHTLS teaches: Look for chest rise symmetry and respiratory effort; Listen for breath sounds and abnormal sounds; Feel for crepitus, flail segments, and subcutaneous emphysema. While pulse oximetry and capnography provide valuable data, they should not delay the hands-on assessment.

Question 11: According to PHTLS, when should a tourniquet be applied?

• Only as a last resort after all other methods fail
• Immediately for life-threatening extremity hemorrhage that cannot be controlled by direct pressure (Correct answer)
• Only by physicians in a hospital setting
• For any visible bleeding from an extremity

Correct answer: Immediately for life-threatening extremity hemorrhage that cannot be controlled by direct pressure

PHTLS recommends early tourniquet application for life-threatening extremity hemorrhage when direct pressure is ineffective or impractical.

Current PHTLS guidelines recommend early tourniquet application for life-threatening extremity hemorrhage, especially in tactical or mass casualty situations. Commercial tourniquets (CAT, SOFTT-W) are preferred over improvised ones. Tourniquets should be applied proximal to the wound, tightened until bleeding stops, and the application time documented.

Question 12: What does PHTLS recommend regarding pain management in trauma patients?

• Pain medication should never be given in the field
• Appropriate analgesia should be provided without compromising patient assessment (Correct answer)
• Only oral pain medications are acceptable prehospitally
• Pain management should wait until hospital arrival

Correct answer: Appropriate analgesia should be provided without compromising patient assessment

PHTLS recognizes that pain management is an important component of trauma care, provided it does not compromise ongoing assessment or patient safety.

PHTLS advocates for appropriate pain management as part of compassionate trauma care. Uncontrolled pain causes physiologic stress responses that can worsen outcomes. Options include splinting, IV/IN opioids in titrated doses, and ketamine in appropriate settings.

Question 13: Which mechanism best explains why tension pneumothorax causes hemodynamic collapse?

• Massive hemorrhage into the pleural space
• Mediastinal shift compresses the vena cava, reducing venous return (Correct answer)
• Bronchospasm causes severe hypoxia
• Air embolism enters the coronary circulation

Correct answer: Mediastinal shift compresses the vena cava, reducing venous return

Tension pneumothorax shifts the mediastinum, kinking the vena cava and dramatically reducing preload, leading to obstructive shock.

Question 14: In PHTLS, which finding most specifically indicates increased intracranial pressure after head trauma?

• GCS of 14
• Pupils equal and reactive
• Cushing's triad (hypertension, bradycardia, irregular respirations) (Correct answer)
• Diaphoresis and tachycardia

Correct answer: Cushing's triad (hypertension, bradycardia, irregular respirations)

Cushing's triad is the classic late sign of herniation due to rising ICP and represents a neurological emergency.

Question 15: A trauma patient has absent breath sounds on the left and the trachea deviated to the right. What is the MOST likely diagnosis?

• Left hemothorax
• Left tension pneumothorax (Correct answer)
• Right pneumothorax
• Cardiac tamponade

Correct answer: Left tension pneumothorax

Left tension pneumothorax causes absent breath sounds on the affected side and tracheal deviation away from the lesion.

Question 16: According to PHTLS principles, permissive hypotension targets a systolic BP of approximately how much in penetrating torso trauma without TBI?

• 60 mmHg
• 80–90 mmHg (Correct answer)
• 120 mmHg
• 140 mmHg

Correct answer: 80–90 mmHg

Permissive hypotension targets SBP of 80–90 mmHg to maintain perfusion while minimizing clot disruption in penetrating trauma without TBI.

Question 17: Which of the following is the MOST reliable early indicator of hemorrhagic shock in a healthy adult?

• Decreased blood pressure
• Narrowed pulse pressure and anxiety (Correct answer)
• Loss of consciousness
• Bradycardia

Correct answer: Narrowed pulse pressure and anxiety

Early hemorrhagic shock causes compensatory vasoconstriction that narrows pulse pressure and produces anxiety before overt hypotension develops.

Question 18: When using the PHTLS primary survey, which action has the highest priority in a patient with uncontrolled extremity hemorrhage?

• Establish IV access
• Control the hemorrhage immediately (Correct answer)
• Assess airway patency
• Obtain a SAMPLE history

Correct answer: Control the hemorrhage immediately

PHTLS now places hemorrhage control (X — Exsanguinating hemorrhage) before airway management in the XABCDE sequence.

Question 19: A patient with blunt abdominal trauma develops hypotension and distension. Which organ is MOST commonly injured?

• Bladder
• Spleen (Correct answer)
• Stomach
• Pancreas

Correct answer: Spleen

The spleen is the most commonly injured solid abdominal organ in blunt trauma and is a major source of hemorrhagic shock.