PHTLS - Prehospital Trauma Life Support Special Trauma Considerations — Questions and Answers
Question 1: How does pregnancy affect the assessment and management of a trauma patient according to PHTLS?
- Pregnant patients should be treated identically to non-pregnant patients
- Physiologic changes of pregnancy alter vital sign interpretation and positioning, and there are two patients to consider (Correct answer)
- Trauma in pregnancy never affects the fetus
- Pregnant patients should not receive fluid resuscitation
Correct answer: Physiologic changes of pregnancy alter vital sign interpretation and positioning, and there are two patients to consider
Pregnancy causes physiologic changes that alter vital sign interpretation, and both maternal and fetal well-being must be considered.
Physiologic changes include increased blood volume (30-50%), baseline tachycardia, and decreased blood pressure. Supine hypotension syndrome occurs when the gravid uterus compresses the IVC; left lateral tilt prevents this. The best treatment for the fetus is resuscitation of the mother.
Question 2: What unique considerations apply to geriatric trauma patients in PHTLS?
- Elderly patients always present with classic shock signs
- Decreased physiologic reserve, medication effects, and atypical presentations make assessment more challenging (Correct answer)
- Age alone determines injury severity
- Geriatric patients should not be triaged to trauma centers
Correct answer: Decreased physiologic reserve, medication effects, and atypical presentations make assessment more challenging
Elderly patients have diminished physiologic reserve, take medications that mask shock signs, and often present atypically.
Beta-blockers may prevent tachycardia. Anticoagulants increase bleeding risk. Osteoporotic bones fracture from lower-energy mechanisms. A 'normal' blood pressure may represent shock in a patient whose baseline is higher.
Question 3: How should PHTLS providers approach trauma patients with obesity?
- No modifications to standard assessment are needed
- Airway management is more challenging, landmarks are obscured, medication dosing may differ, and extrication requires planning (Correct answer)
- Obese patients cannot go into shock
- Standard equipment works for all body types
Correct answer: Airway management is more challenging, landmarks are obscured, medication dosing may differ, and extrication requires planning
Obesity presents unique challenges including difficult airway management, obscured anatomic landmarks, and equipment limitations.
Airway challenges include difficult mask seal, shorter neck, and rapid oxygen desaturation. Assessment challenges include obscured landmarks for needle decompression. Standard backboards may be inadequate, and helicopter weight limits may be exceeded.
Question 4: What is the primary prehospital concern with blast injuries according to PHTLS?
- Superficial burns only
- Multi-mechanism injuries from blast wave, fragmentation, body displacement, and structural collapse (Correct answer)
- Only hearing loss
- Blast injuries are always immediately fatal
Correct answer: Multi-mechanism injuries from blast wave, fragmentation, body displacement, and structural collapse
Blast injuries produce four distinct mechanisms of injury simultaneously, creating complex multi-system trauma.
Primary injuries from blast overpressure damage air-filled organs. Secondary injuries from fragmentation are the most common cause of blast casualties. Tertiary injuries from body displacement cause blunt trauma. Quaternary injuries include burns and inhalation injury.
Question 5: How does PHTLS recommend managing trauma in patients with physical disabilities?
- Disability does not affect trauma assessment
- Baseline functional status must be established to identify new deficits, and standard protocols may need modification (Correct answer)
- Disabled patients should not be immobilized
- Only specialized teams can treat disabled trauma patients
Correct answer: Baseline functional status must be established to identify new deficits, and standard protocols may need modification
Knowing the patient's pre-injury baseline is essential to distinguish new deficits from pre-existing conditions.
A patient with pre-existing paraplegia cannot be assessed for new spinal cord injury using standard motor/sensory exams below their existing injury level. Communication barriers require alternative methods. The key principle is individualized care.
Question 6: What environmental emergency does PHTLS teach as a complication of prolonged extrication in trauma?
- Only dehydration
- Crush syndrome with risk of hyperkalemia and renal failure upon release (Correct answer)
- Mild hypothermia only
- No environmental complications occur during extrication
Correct answer: Crush syndrome with risk of hyperkalemia and renal failure upon release
Crush syndrome occurs when prolonged compression of muscle tissue causes rhabdomyolysis, and upon release, toxic substances flood the circulation.
While compressed, muscle cells die, releasing potassium, myoglobin, and lactic acid. Upon release, these flood the systemic circulation causing hyperkalemia, renal failure, and metabolic acidosis. PHTLS teaches pre-release preparation including IV fluid loading and cardiac monitoring.
Question 7: According to PHTLS, how does alcohol or drug intoxication affect trauma patient assessment?
- Intoxicated patients never have serious injuries
- Intoxication masks pain responses, alters mental status assessment, and increases the risk of aspiration and missed injuries (Correct answer)
- Intoxicated patients should not receive pain management
- Intoxication has no effect on trauma assessment
Correct answer: Intoxication masks pain responses, alters mental status assessment, and increases the risk of aspiration and missed injuries
Intoxication complicates trauma assessment by masking pain, altering GCS scoring, and increasing aspiration risk.
PHTLS teaches providers to maintain a high index of suspicion and never attribute altered mental status solely to intoxication without ruling out traumatic causes. 'Alcohol is a diagnosis of exclusion' is a key principle.
Question 8: What special considerations does PHTLS identify for pediatric trauma patients?
- Children are simply small adults and can be treated identically
- Children have proportionally larger heads, more flexible skeletons, and greater surface area-to-mass ratio affecting injury patterns and heat loss (Correct answer)
- Pediatric patients never develop shock
- Only pediatric surgeons can assess injured children
Correct answer: Children have proportionally larger heads, more flexible skeletons, and greater surface area-to-mass ratio affecting injury patterns and heat loss
Children's unique anatomy and physiology create different injury patterns and treatment considerations.
Proportionally larger heads increase TBI risk. Flexible rib cages mean significant internal organ injury without rib fractures. Higher surface area accelerates hypothermia. Children compensate effectively until sudden cardiovascular collapse. A quiet, non-interactive child is often sicker than a crying one.
Question 9: How does PHTLS recommend managing trauma patients who are on anticoagulant therapy?
- Anticoagulant use has no impact on trauma management
- These patients are at significantly increased risk of hemorrhage and may bleed from injuries that would normally be self-limiting (Correct answer)
- Anticoagulants should be reversed in the field
- Only warfarin affects trauma outcomes
Correct answer: These patients are at significantly increased risk of hemorrhage and may bleed from injuries that would normally be self-limiting
Anticoagulated patients bleed more profusely and for longer from injuries that might otherwise be self-limiting.
PHTLS recommends aggressive hemorrhage control measures, lower triage thresholds, and clear documentation of anticoagulant type for the receiving facility. The CDC triage guidelines include anticoagulant use as a Step 4 consideration.
Question 10: What does PHTLS teach about trauma in patients with implanted medical devices (pacemakers, defibrillators)?
- Devices have no relevance to trauma management
- Devices may malfunction after trauma, affect cardiac rhythm interpretation, and require awareness during defibrillation and procedures (Correct answer)
- All devices must be removed before assessment
- Only cardiologists can manage these patients
Correct answer: Devices may malfunction after trauma, affect cardiac rhythm interpretation, and require awareness during defibrillation and procedures
Implanted devices can malfunction after blunt trauma, complicate rhythm interpretation, and require specific precautions during defibrillation.
Pacemakers may malfunction producing inappropriate rhythms. ICDs may deliver inappropriate shocks. Defibrillation pads should be placed at least 1 inch from the device. The device may mask tachycardic response to hemorrhage by maintaining a set rate.
Question 11: According to PHTLS, what are the key considerations for managing trauma in an austere or prolonged field care environment?
- Standard protocols apply regardless of transport time
- Extended care capabilities, resource conservation, documentation, and reassessment cycles become critical priorities (Correct answer)
- No treatment should be attempted if transport time exceeds 30 minutes
- Only wilderness EMTs can provide extended care
Correct answer: Extended care capabilities, resource conservation, documentation, and reassessment cycles become critical priorities
When transport times are prolonged, providers must plan for extended patient care including ongoing monitoring and resource management.
Key considerations include serial reassessment, resource conservation, wound management evolving to infection prevention, hypothermia prevention, fluid management with limited supply, pain management, and monitoring for delayed complications.
Question 12: How does PHTLS address the management of trauma in patients experiencing a behavioral health crisis?
- Behavioral health is unrelated to trauma care
- Safety precautions, de-escalation, and maintaining a trauma-focused assessment despite behavioral challenges are essential (Correct answer)
- These patients should not receive trauma care until sedated
- Only psychiatric professionals can manage these patients
Correct answer: Safety precautions, de-escalation, and maintaining a trauma-focused assessment despite behavioral challenges are essential
Patients in behavioral crisis may still have significant trauma. Safety, de-escalation, and methodical trauma evaluation must proceed while managing behavioral components.
Altered behavior may be a symptom of traumatic injury rather than a psychiatric condition. Self-harm patients may have serious injuries. Agitated patients from head injury, hypoxia, or substance use may resist assessment. Never assume agitation is purely psychiatric.
PHTLS - Prehospital Trauma Life Support Special Trauma Considerations
How does pregnancy affect the assessment and management of a trauma patient according to PHTLS?
What Practice Test Geeks adds beyond an AI chat for PHTLS
An AI chatbot can quiz you, but it can't reproduce the exam conditions or keep your record. Here you get:
- A timed, full-length PHTLS mock exam — 50 questions in 60 minutes with a 76% pass mark, modeled on the official exam's question count and time limit, followed by a score report broken down by exam domain.
- A fixed PHTLS question bank: the same test every attempt, so your score is comparable from one try to the next instead of changing with every regenerated quiz.
- Progress saved on your device: completed tests, scores and missed questions stay in My Progress, so you can retake only what you got wrong.
- A printable PHTLS cheat sheet you can print or save as a PDF.
- PHTLS flashcards built from the same question bank.
These practice questions were written with AI tools. They are not real exam questions. Exam facts are checked against the official sources listed below. Not reviewed by a subject-matter expert. Editorial policy
Sources & references
Exam facts on this page (fees, format, dates, passing scores) are checked against these official sources; the date is our last check. Editorial policy