PHTLS Pre & Post 2 — Questions and Answers
Question 1: On a PHTLS pre-test, which is the correct order for assessing a trauma patient?
- Detailed physical exam, vital signs, history
- Scene size-up, primary survey, secondary survey (Correct answer)
- Transport decision, treatment, documentation
- Patient interview, blood pressure, pulse oximetry
Correct answer: Scene size-up, primary survey, secondary survey
The correct assessment order in PHTLS is scene size-up first, followed by the primary survey to identify life threats, then the secondary survey for detailed assessment.
PHTLS teaches a systematic approach that begins before patient contact. Scene size-up assesses safety, mechanism, patient count, and resource needs. The primary survey (ABCDE) rapidly identifies and treats life-threatening conditions. Only after the primary survey is complete does the secondary survey begin.
Question 2: A PHTLS post-test question asks about the management of an open pneumothorax. What is the correct initial treatment?
- Needle decompression of the affected side
- Apply a three-sided occlusive dressing over the wound (Correct answer)
- Perform endotracheal intubation immediately
- Place the patient in Trendelenburg position
Correct answer: Apply a three-sided occlusive dressing over the wound
An open pneumothorax is initially managed with a three-sided occlusive dressing that allows air to escape during exhalation but prevents air entry during inhalation.
An open pneumothorax occurs when a chest wall defect allows air to enter the pleural space during inspiration. The three-sided occlusive dressing acts as a one-way valve. Commercially available chest seals with valves have largely replaced improvised three-sided dressings in modern practice.
Question 3: Which vital sign change is typically the earliest indicator of hemorrhagic shock in a young adult trauma patient?
- Hypotension
- Decreased respiratory rate
- Tachycardia (Correct answer)
- Hypothermia
Correct answer: Tachycardia
Tachycardia is usually the earliest measurable vital sign change in hemorrhagic shock, as the heart rate increases to compensate for decreased blood volume.
In young, healthy adults, compensatory mechanisms are robust. The sympathetic nervous system responds to decreased blood volume by increasing heart rate. Blood pressure may remain normal until 30% or more of blood volume is lost. PHTLS emphasizes recognizing tachycardia, narrowing pulse pressure, and anxiety as early shock indicators before overt hypotension develops.
Question 4: On a PHTLS pre-test, what does the 'E' in the ABCDE primary survey stand for?
- Evaluation of all injuries
- Exposure and Environment (Correct answer)
- Emergency transport decision
- Examination of extremities
Correct answer: Exposure and Environment
The 'E' stands for Exposure and Environment, requiring the patient to be fully exposed to identify all injuries while preventing hypothermia.
Exposure involves removing the patient's clothing to identify injuries that may be hidden. Environment reminds providers to protect the patient from hypothermia, which is part of the 'lethal triad.' After assessment, the patient should be covered with warm blankets.
Question 5: A PHTLS post-test asks: What is the most appropriate prehospital management for a suspected pelvic fracture with hemodynamic instability?
- Apply traction splint to both legs
- Apply a pelvic binder and initiate fluid resuscitation (Correct answer)
- Perform external compression of the iliac arteries
- Log roll the patient to prone position
Correct answer: Apply a pelvic binder and initiate fluid resuscitation
A pelvic binder reduces pelvic volume to help tamponade bleeding, and fluid resuscitation supports circulating volume.
Unstable pelvic fractures can cause life-threatening hemorrhage from disruption of the presacral venous plexus and branches of the internal iliac arteries. A pelvic binder is applied at the level of the greater trochanters to reduce pelvic volume and promote clot formation.
Question 6: According to PHTLS pre-test material, which of the following is a contraindication to performing needle decompression?
- The patient is unconscious
- There is no clinical evidence of tension pneumothorax (Correct answer)
- The patient has a history of COPD
- The patient is over 65 years old
Correct answer: There is no clinical evidence of tension pneumothorax
Needle decompression should only be performed when clinical signs of tension pneumothorax are present.
Needle decompression is indicated for tension pneumothorax, identified clinically by respiratory distress, unilateral absent breath sounds, jugular venous distention, tracheal deviation, and hemodynamic instability. Without these clinical findings, needle decompression is not warranted and carries risks.
PHTLS Pre & Post 2
On a PHTLS pre-test, which is the correct order for assessing a trauma patient?