PHTLS - Prehospital Trauma Life Support Special Trauma Considerations 2 — 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.
PHTLS - Prehospital Trauma Life Support Special Trauma Considerations 2
How does pregnancy affect the assessment and management of a trauma patient according to PHTLS?