PHTLS Pre & Post 5 — Questions and Answers
Question 1: A 28-year-old motorcyclist is ejected at highway speed. Which pre-hospital assessment finding indicates the HIGHEST immediate life threat?
- GCS 14 with road rash on both arms
- Absent breath sounds on the left with tracheal deviation to the right (Correct answer)
- Closed femur fracture with 2+ thigh swelling
- Heart rate of 104 with BP 102/68
Correct answer: Absent breath sounds on the left with tracheal deviation to the right
Absent breath sounds with tracheal deviation indicates tension pneumothorax, which causes obstructive shock and death within minutes if untreated.
Question 2: In the PHTLS framework, which action is classified under 'Scene Size-Up' rather than the Primary Survey?
- Assessing airway patency
- Determining mechanism of injury (Correct answer)
- Checking radial pulse quality
- Evaluating skin color and temperature
Correct answer: Determining mechanism of injury
Mechanism of injury assessment occurs during scene size-up before the provider contacts the patient, informing the index of suspicion for the primary survey.
Question 3: Which PHTLS principle BEST explains why on-scene time should be limited to 10 minutes or less for critical trauma patients?
- To preserve battery life on monitoring equipment
- Because definitive hemorrhage control can only be achieved in the operating room (Correct answer)
- To prevent hypothermia caused by ambient temperature
- Because analgesics cannot be given until the patient reaches the ED
Correct answer: Because definitive hemorrhage control can only be achieved in the operating room
For life-threatening internal hemorrhage, definitive care requires surgical intervention; prolonged scene time delays the only intervention that can stop the bleeding.
Question 4: A post-cardiac-arrest trauma patient has return of spontaneous circulation (ROSC). Which target should the PHTLS provider aim for regarding oxygenation?
- SpO2 of 94–99% to avoid hyperoxia (Correct answer)
- SpO2 of 100% to maximize tissue oxygen delivery
- SpO2 of 88–92% to promote hypoxic ventilatory drive
- SpO2 is not monitored post-ROSC in trauma
Correct answer: SpO2 of 94–99% to avoid hyperoxia
Post-ROSC, PHTLS guidelines recommend targeting SpO2 94–99% because hyperoxia (SpO2 100%) can increase oxidative stress and worsen neurological outcomes.
Question 5: During post-incident critique of a multi-system trauma call, the team identifies that a tourniquet was applied 8 minutes after hemorrhage was recognized. What PHTLS principle does this violate?
- Scene safety
- Load and go
- Hemorrhage control as part of circulation management in the primary survey (Correct answer)
- The Golden Period concept
Correct answer: Hemorrhage control as part of circulation management in the primary survey
In PHTLS, life-threatening external hemorrhage should be controlled during the C (Circulation/Hemorrhage control) step of the primary survey, not deferred.
Question 6: Which pre-hospital finding would MOST strongly suggest a hollow organ injury in an abdominal trauma patient?
- Rigid, board-like abdomen with guarding
- Distended abdomen with dull percussion
- Seat-belt sign with tenderness across the lower abdomen (Correct answer)
- Ecchymosis of the flank (Grey Turner's sign)
Correct answer: Seat-belt sign with tenderness across the lower abdomen
A seat-belt sign combined with lower abdominal tenderness is a classic indicator of hollow organ injury (e.g., small bowel perforation) caused by rapid deceleration.
Question 7: After completing a PHTLS trauma call, which post-event action BEST supports provider psychological wellness?
- Immediately returning to service without discussion to maintain unit readiness
- Conducting a critical incident stress debriefing (CISD) when indicated (Correct answer)
- Reviewing the patient care report alone and filing a self-critique
- Avoiding discussion of the call to prevent reinforcing traumatic memory
Correct answer: Conducting a critical incident stress debriefing (CISD) when indicated
Critical incident stress debriefing (CISD) is a structured peer-support process recommended after high-stress calls to reduce the risk of PTSD and provider burnout.
PHTLS Pre & Post 5
A 28-year-old motorcyclist is ejected at highway speed.
Which pre-hospital assessment finding indicates the HIGHEST immediate life threat?