PHTLS Special Trauma Considerations 2 — Questions and Answers
Question 1: A pregnant trauma patient is in her 30th week of gestation. Which of the following positions is most appropriate during transport to minimize supine hypotension syndrome?
- Supine with legs elevated 30 degrees
- Left lateral tilt of 15-30 degrees (Correct answer)
- Right lateral decubitus position
- Trendelenburg position
Correct answer: Left lateral tilt of 15-30 degrees
Left lateral tilt of 15-30 degrees relieves uterine compression of the inferior vena cava, improving venous return and cardiac output.
Question 2: When assessing a pediatric trauma patient, which anatomical feature makes airway management more challenging compared to adults?
- Smaller tongue relative to oral cavity
- More anterior and superior larynx (Correct answer)
- Longer trachea with greater diameter
- Harder, more rigid tracheal cartilage
Correct answer: More anterior and superior larynx
The pediatric larynx is positioned more anteriorly and superiorly (at C3-C4 vs. C5-C6 in adults), making visualization during intubation more difficult.
Question 3: An elderly patient involved in a low-speed motor vehicle collision presents with altered mental status and a subdural hematoma on CT. Which age-related factor most increases this patient's susceptibility to intracranial injury?
- Decreased cardiac output reducing cerebral perfusion
- Brain atrophy with stretching of bridging veins (Correct answer)
- Reduced platelet count from bone marrow suppression
- Calcification of the dura mater
Correct answer: Brain atrophy with stretching of bridging veins
Age-related brain atrophy stretches bridging veins across a wider subdural space, making them more vulnerable to tearing even with minor trauma.
Question 4: A morbidly obese trauma patient requires needle thoracostomy for suspected tension pneumothorax. Which modification to the standard technique is most important?
- Use a shorter needle to avoid lung puncture
- Insert the needle at the 5th intercostal space mid-axillary line only
- Use a longer needle or catheter to penetrate the thicker chest wall (Correct answer)
- Avoid the procedure entirely and proceed directly to finger thoracostomy
Correct answer: Use a longer needle or catheter to penetrate the thicker chest wall
Chest wall thickness in obese patients may require a longer needle (≥8 cm) or catheter to successfully reach the pleural space.
Question 5: Which of the following best describes the primary physiological concern when managing a geriatric patient who takes beta-blockers and suffers significant hemorrhage?
- Exaggerated hypertensive response masking true volume status
- Inability to mount a compensatory tachycardia, masking shock severity (Correct answer)
- Accelerated coagulation cascade leading to DIC
- Increased sensitivity to opioid analgesics causing respiratory depression
Correct answer: Inability to mount a compensatory tachycardia, masking shock severity
Beta-blockers blunt the heart rate response to hemorrhage, so the absence of tachycardia does not rule out significant blood loss in these patients.
Question 6: A 7-year-old child is struck by a vehicle and sustains abdominal trauma. The PHTLS provider notes a visible seatbelt mark across the abdomen. Which injury pattern should be highly suspected?
- Splenic laceration and rib fractures
- Chance fracture and hollow viscus injury (Correct answer)
- Liver contusion and diaphragmatic rupture
- Pelvic ring disruption and bladder injury
Correct answer: Chance fracture and hollow viscus injury
The seatbelt sign in children is strongly associated with Chance fractures (flexion-distraction spinal injury) and hollow viscus injuries due to lap-belt mechanics.
Question 7: During a mass casualty incident involving pediatric patients, which triage tool is specifically designed and validated for use in children?
- START triage
- SALT triage
- JumpSTART triage (Correct answer)
- CESIRA triage
Correct answer: JumpSTART triage
JumpSTART was developed specifically for pediatric patients and modifies the START algorithm to account for children's different respiratory rates and inability to follow commands.
PHTLS Special Trauma Considerations 2
A pregnant trauma patient is in her 30th week of gestation.
Which of the following positions is most appropriate during transport to minimize supine hypotension syndrome?