PHTLS Knowledge 5 — Questions and Answers
Question 1: Which type of burn injury carries the HIGHEST risk of upper airway obstruction requiring early intubation?
- Partial-thickness burns to the chest
- Burns with singed nasal hairs, hoarseness, and stridor (Correct answer)
- Full-thickness burns to the extremities
- Chemical burns to the skin only
Correct answer: Burns with singed nasal hairs, hoarseness, and stridor
Singed nasal hairs, hoarseness, and stridor signal inhalation injury with impending airway edema, requiring early definitive airway management.
Question 2: In PHTLS, what does the term 'index of suspicion' mean?
- The likelihood a patient is malingering
- Anticipating hidden injuries based on mechanism of injury (Correct answer)
- A scoring tool for burn severity
- A measure of spinal cord function
Correct answer: Anticipating hidden injuries based on mechanism of injury
Index of suspicion means using knowledge of injury mechanisms to anticipate injuries that may not yet be clinically obvious.
Question 3: Which intervention is the FIRST priority for an open (sucking) chest wound?
- Needle decompression
- Occlusive dressing vented on three sides (Correct answer)
- Endotracheal intubation
- IV fluid bolus
Correct answer: Occlusive dressing vented on three sides
A vented (three-sided) occlusive dressing seals the wound while allowing air to escape, preventing conversion to tension pneumothorax.
Question 4: A patient ejected from a vehicle at highway speed is most at risk for which pattern of injury?
- Isolated extremity fracture
- Multi-system trauma due to secondary impact and ground impact (Correct answer)
- Minor contusions only
- Isolated closed head injury
Correct answer: Multi-system trauma due to secondary impact and ground impact
Ejection exposes the patient to multiple impacts — vehicle interior, air, and ground — producing multi-system, high-energy trauma.
Question 5: According to PHTLS, what is the goal of the 'platinum ten minutes' concept?
- Complete all diagnostic tests in the field within 10 minutes
- Limit scene time to 10 minutes or less for critical trauma patients (Correct answer)
- Administer all IV fluids within 10 minutes
- Perform surgical intervention within 10 minutes
Correct answer: Limit scene time to 10 minutes or less for critical trauma patients
The platinum ten minutes concept emphasizes limiting on-scene time to 10 minutes or less for critical trauma patients to expedite definitive surgical care.
Question 6: Which spinal motion restriction strategy is recommended by PHTLS for a conscious, alert trauma patient with no distracting injury and no midline tenderness?
- Rigid cervical collar and full longboard
- Selective spinal immobilization based on clinical criteria (Correct answer)
- Immediate KED device application
- Spinal immobilization regardless of symptoms
Correct answer: Selective spinal immobilization based on clinical criteria
PHTLS supports selective spinal motion restriction using validated criteria rather than routine immobilization of all trauma patients.
Question 7: In a pediatric trauma patient, which finding is MOST concerning for non-accidental trauma (child abuse)?
- A single long-bone fracture consistent with the stated mechanism
- Multiple injuries in various stages of healing inconsistent with the history (Correct answer)
- A scalp laceration from a documented fall
- Bruising over bony prominences in an ambulatory child
Correct answer: Multiple injuries in various stages of healing inconsistent with the history
Multiple injuries at different healing stages that don't match the reported mechanism are classic red flags for non-accidental trauma.
PHTLS Knowledge 5
Which type of burn injury carries the HIGHEST risk of upper airway obstruction requiring early intubation?