PHTLS Pre & Post 4 — Questions and Answers
Question 1: During scene size-up, which finding most strongly suggests a high-energy mechanism of injury requiring full spinal precautions?
- Patient complaining of neck pain
- Intrusion of >12 inches into the passenger compartment (Correct answer)
- Obvious extremity deformity
- Airbag deployment without windshield damage
Correct answer: Intrusion of >12 inches into the passenger compartment
Greater than 12 inches of intrusion into the passenger compartment indicates high-energy transfer and mandates full spinal precautions regardless of symptoms.
Question 2: A PHTLS provider arrives at a mass casualty incident with 20 patients. What is the FIRST action to take?
- Begin treating the most critically injured patient
- Establish incident command and request additional resources
- Start triage using the START algorithm
- Secure the scene and ensure personal safety (Correct answer)
Correct answer: Secure the scene and ensure personal safety
Scene safety is always the first priority; providers cannot help patients if they become casualties themselves.
Question 3: Which pre-hospital vital sign trend in a trauma patient BEST indicates early decompensated shock?
- Heart rate 110, BP 110/70, RR 18
- Heart rate 130, BP 88/60, RR 26 (Correct answer)
- Heart rate 88, BP 130/80, RR 14
- Heart rate 70, BP 90/60, RR 12
Correct answer: Heart rate 130, BP 88/60, RR 26
A heart rate >120, systolic BP <90, and RR >20 together represent the classic triad of decompensated hemorrhagic shock.
Question 4: In PHTLS, 'permissive hypotension' during fluid resuscitation of a penetrating torso trauma patient targets a systolic BP of approximately:
- 60–70 mmHg
- 80–90 mmHg (Correct answer)
- 100–110 mmHg
- 120 mmHg
Correct answer: 80–90 mmHg
Permissive hypotension targets a systolic BP of 80–90 mmHg to maintain end-organ perfusion while minimizing clot disruption before surgical hemorrhage control.
Question 5: A post-resuscitation patient who was GCS 8 on arrival improves to GCS 14 after airway management and oxygenation. What does this MOST likely indicate?
- Epidural hematoma is resolving spontaneously
- The initial GCS was incorrectly assessed
- Hypoxia was a major contributor to the altered mental status (Correct answer)
- The patient has a functional neurological disorder
Correct answer: Hypoxia was a major contributor to the altered mental status
Rapid improvement in GCS following airway management strongly suggests hypoxia was the primary driver of altered mental status rather than structural brain injury.
Question 6: Which of the following is a contraindication to applying a pelvic binder in the prehospital setting?
- Open book pelvic fracture
- Lateral compression pelvic fracture with suspected internal rotation (Correct answer)
- Vertically unstable pelvic fracture
- Hemodynamic instability with suspected pelvic source
Correct answer: Lateral compression pelvic fracture with suspected internal rotation
Lateral compression injuries involve internal rotation of the hemipelvis, and a circumferential pelvic binder can worsen this pattern by further compressing an already-narrowed pelvic volume.
Question 7: After a successful trauma resuscitation, which post-event action is MOST important for PHTLS quality improvement?
- Restocking the ambulance with used supplies
- Completing a detailed patient care report with times and interventions (Correct answer)
- Debriefing with family members at the hospital
- Notifying the medical director only if the patient died
Correct answer: Completing a detailed patient care report with times and interventions
An accurate, time-stamped patient care report is the cornerstone of PHTLS quality improvement, providing data for case review and outcome tracking.
PHTLS Pre & Post 4
During scene size-up, which finding most strongly suggests a high-energy mechanism of injury requiring full spinal precautions?