PHTLS Knowledge 2 — Questions and Answers
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.
PHTLS Knowledge 2
Which type of shock results from blood loss due to traumatic injury?