PHTLS PHTLS - Prehospital Trauma Life Support Pediatric Trauma 4 — Questions and Answers
Question 1: A 4-year-old is unresponsive after a motor vehicle collision. Which airway maneuver is preferred to open the airway given possible cervical spine injury?
- Head-tilt chin-lift
- Jaw thrust without head extension (Correct answer)
- Nasopharyngeal airway insertion
- Oropharyngeal airway insertion alone
Correct answer: Jaw thrust without head extension
The jaw thrust without head extension maintains spinal alignment while opening the airway in trauma patients with possible cervical spine injury.
Question 2: Which of the following is the MOST reliable early indicator of shock in a pediatric trauma patient?
- Hypotension
- Bradycardia
- Tachycardia (Correct answer)
- Decreased urine output
Correct answer: Tachycardia
Tachycardia is the earliest and most reliable sign of shock in children, as hypotension is a late and often pre-terminal finding.
Question 3: When using the Broselow tape for a pediatric trauma patient, what does the color zone primarily determine?
- Approximate age and developmental stage
- Weight-based drug doses and equipment sizes (Correct answer)
- Glasgow Coma Scale interpretation
- Respiratory rate norms by gender
Correct answer: Weight-based drug doses and equipment sizes
The Broselow tape uses the child's length to estimate weight, then correlates that to color-coded weight-based medication doses and equipment sizes.
Question 4: A 7-year-old with blunt abdominal trauma has a rigid abdomen and signs of hemorrhagic shock. What is the most appropriate prehospital intervention?
- Aggressive IV fluid resuscitation to restore normal blood pressure
- Permissive hypotension with rapid transport to trauma center (Correct answer)
- Nasogastric tube insertion to decompress the stomach
- Application of PASG/MAST trousers
Correct answer: Permissive hypotension with rapid transport to trauma center
Permissive hypotension (targeting MAP ~50 mmHg or systolic ~80–90 mmHg) limits hemodilution and coagulopathy while minimizing time to definitive surgical care.
Question 5: During pediatric trauma assessment, which anatomical feature makes children more prone to airway obstruction compared to adults?
- Larger tracheal diameter
- More anterior and superior larynx (Correct answer)
- Longer epiglottis in proportion to airway
- Smaller tongue relative to oral cavity
Correct answer: More anterior and superior larynx
The pediatric larynx is positioned more anteriorly and superiorly, making visualization during intubation more difficult and increasing obstruction risk.
Question 6: A 9-year-old trauma patient has a GCS of 10 and suspected traumatic brain injury. What is the target end-tidal CO2 (EtCO2) range during transport?
- 25–30 mmHg
- 35–40 mmHg (Correct answer)
- 45–50 mmHg
- 50–55 mmHg
Correct answer: 35–40 mmHg
Normal EtCO2 of 35–40 mmHg is maintained to avoid both hypercapnia (vasodilation, increased ICP) and excessive hyperventilation (vasoconstriction, ischemia).
Question 7: Which intraosseous (IO) site is preferred in a 2-year-old requiring emergency vascular access after two failed IV attempts?
- Distal femur
- Proximal tibia (Correct answer)
- Iliac crest
- Calcaneus
Correct answer: Proximal tibia
The proximal tibia is the preferred IO site in children under 6 years due to its large, flat medial surface and accessibility during resuscitation.
PHTLS PHTLS - Prehospital Trauma Life Support Pediatric Trauma 4
A 4-year-old is unresponsive after a motor vehicle collision.
Which airway maneuver is preferred to open the airway given possible cervical spine injury?