PHTLS PHTLS - Prehospital Trauma Life Support Pediatric Trauma 5 — Questions and Answers
Question 1: A 6-year-old restrained passenger has tenderness across the lower abdomen at the lap belt line. Which injuries should the provider specifically suspect?
- Splenic laceration and pneumothorax
- Lumbar spine fracture and hollow viscus injury (Correct answer)
- Cardiac contusion and aortic injury
- Bladder rupture and pelvic fracture
Correct answer: Lumbar spine fracture and hollow viscus injury
The 'lap belt syndrome' in children includes lumbar flexion-distraction fractures (Chance fractures) and bowel/mesenteric injuries from the lap belt compressing abdominal contents.
Question 2: Which finding in a pediatric burn patient would indicate need for emergent airway management?
- Burns covering 15% TBSA on the extremities
- Singed nasal hairs with hoarse voice and stridor (Correct answer)
- Superficial burns to the face without respiratory symptoms
- Heart rate of 110 bpm in a 5-year-old
Correct answer: Singed nasal hairs with hoarse voice and stridor
Singed nasal hairs, hoarseness, and stridor indicate upper airway thermal injury with progressive edema, requiring immediate airway control before obstruction develops.
Question 3: When calculating fluid resuscitation for a pediatric burn patient in the prehospital setting, what is the initial recommended IV fluid bolus?
- 10 mL/kg of normal saline over 30 minutes
- 20 mL/kg of lactated Ringer's over 30–60 minutes (Correct answer)
- 5 mL/kg of hypertonic saline over 1 hour
- 1 mL/kg per %TBSA of lactated Ringer's
Correct answer: 20 mL/kg of lactated Ringer's over 30–60 minutes
Initial prehospital burn resuscitation uses 20 mL/kg of lactated Ringer's solution, with additional fluid calculated using the Parkland formula for definitive care.
Question 4: A 3-year-old is found unresponsive at the scene of a house fire. The provider notes cherry-red skin coloration. Which treatment is the HIGHEST priority?
- IV fluid resuscitation for burn shock
- High-flow 100% oxygen via non-rebreather mask (Correct answer)
- Immediate endotracheal intubation
- Cooling with sterile water to burned areas
Correct answer: High-flow 100% oxygen via non-rebreather mask
Cherry-red skin is a classic sign of carbon monoxide poisoning; 100% oxygen via non-rebreather mask is the priority treatment to displace CO from hemoglobin.
Question 5: During pediatric spinal motion restriction, which of the following is TRUE regarding cervical collar sizing?
- An oversized collar provides better immobilization than a properly sized one
- An improperly sized collar can cause hyperextension or flexion of the cervical spine (Correct answer)
- Adult collars can be used for children over 8 years without modification
- Manual stabilization is unnecessary once a collar is applied
Correct answer: An improperly sized collar can cause hyperextension or flexion of the cervical spine
An improperly fitted collar can cause flexion or hyperextension, potentially worsening a cervical injury, so correct sizing and continued manual stabilization are essential.
Question 6: A 10-year-old bicyclist struck by a car has an open femur fracture with significant external hemorrhage. What is the FIRST priority intervention for the bleeding?
- Immediate splinting of the femur fracture
- Application of a tourniquet proximal to the wound (Correct answer)
- Direct pressure with a hemostatic dressing
- Wound irrigation with normal saline
Correct answer: Application of a tourniquet proximal to the wound
For extremity hemorrhage that is life-threatening and not controlled by direct pressure, a tourniquet is applied proximal to the wound as the priority intervention.
Question 7: Which pain management approach is appropriate for a 5-year-old with an isolated closed femur fracture and stable vital signs during transport?
- Withhold all analgesia to preserve neurological assessment accuracy
- Administer weight-based intranasal fentanyl or IV morphine with dose titration (Correct answer)
- Administer adult-dose oral acetaminophen immediately
- Apply ice packs as the only prehospital pain management
Correct answer: Administer weight-based intranasal fentanyl or IV morphine with dose titration
Weight-based intranasal fentanyl or IV/IO morphine with dose titration provides safe, effective analgesia for pediatric fracture pain without masking neurological changes.
PHTLS PHTLS - Prehospital Trauma Life Support Pediatric Trauma 5
A 6-year-old restrained passenger has tenderness across the lower abdomen at the lap belt line.
Which injuries should the provider specifically suspect?