PHTLS Special Trauma Considerations 3 — Questions and Answers
Question 1: A trauma patient is found to be 8 months pregnant and has no palpable pulse after blunt chest trauma. After 4 minutes of unsuccessful resuscitation, the most appropriate next step is:
- Continue CPR and rapid transport only
- Perform field cesarean delivery to improve maternal CPR effectiveness (Correct answer)
- Administer high-dose epinephrine and reassess in 2 minutes
- Initiate immediate transport while performing bilateral needle thoracostomy
Correct answer: Perform field cesarean delivery to improve maternal CPR effectiveness
Perimortem cesarean delivery (resuscitative hysterotomy) performed within 4-5 minutes of cardiac arrest can relieve aortocaval compression and improve maternal CPR outcomes.
Question 2: Which of the following best explains why children are at higher risk for hypothermia following trauma compared to adults?
- Children have a lower metabolic rate and produce less heat
- Children have a greater surface area-to-body mass ratio (Correct answer)
- Children's peripheral vasculature is more dilated at baseline
- Children have thicker subcutaneous fat insulating core organs
Correct answer: Children have a greater surface area-to-body mass ratio
Children's larger surface area relative to their body mass results in more rapid heat loss to the environment after trauma.
Question 3: An intoxicated trauma patient has a GCS of 12. The PHTLS provider should:
- Attribute all neurological findings to alcohol intoxication and monitor
- Assume a concurrent traumatic brain injury until proven otherwise (Correct answer)
- Administer naloxone to reverse potential opioid co-ingestion before assessment
- Delay spinal motion restriction until the patient sobers
Correct answer: Assume a concurrent traumatic brain injury until proven otherwise
Alcohol intoxication and TBI present similarly; providers must assume TBI in any intoxicated trauma patient to avoid undertreating a potentially life-threatening injury.
Question 4: When managing an obese trauma patient, which assessment finding is most likely to be UNDERESTIMATED due to body habitus?
- Respiratory rate
- Pupillary response
- Severity of abdominal tenderness and rigidity (Correct answer)
- Blood pressure by auscultation
Correct answer: Severity of abdominal tenderness and rigidity
Thick abdominal adipose tissue can mask peritoneal signs, leading to underestimation of intra-abdominal injury severity on physical exam.
Question 5: A trauma patient who is a Jehovah's Witness declines blood transfusion. The patient is conscious, alert, and has decision-making capacity. The PHTLS provider should:
- Override the refusal and administer blood given the life threat
- Document the refusal, focus on volume-sparing hemorrhage control, and transport (Correct answer)
- Administer blood only after obtaining family consent
- Delay transport until law enforcement can authorize treatment
Correct answer: Document the refusal, focus on volume-sparing hemorrhage control, and transport
A competent adult has the right to refuse treatment; the provider should respect this, document it thoroughly, optimize hemorrhage control without blood products, and transport.
Question 6: Which of the following physiological changes in pregnancy most significantly affects fluid resuscitation decisions in a trauma patient?
- Decreased maternal heart rate of 10-15 bpm
- Plasma volume increase of 40-50% with relative hemodilution (Correct answer)
- Reduced renal blood flow causing decreased urine output
- Increased systemic vascular resistance elevating blood pressure
Correct answer: Plasma volume increase of 40-50% with relative hemodilution
Plasma volume expands 40-50% during pregnancy while red cell mass increases only 20-30%, causing dilutional anemia that may mask hemorrhage severity.
Question 7: A geriatric patient on warfarin sustains a head injury with a brief loss of consciousness. CT is negative initially. The PHTLS provider should advise the receiving team that this patient:
- Requires no further neurological monitoring given negative CT
- Is at low risk for delayed intracranial hemorrhage due to anticoagulation
- Needs close observation for delayed hemorrhage despite normal initial imaging (Correct answer)
- Should receive fresh frozen plasma prophylactically in the field
Correct answer: Needs close observation for delayed hemorrhage despite normal initial imaging
Anticoagulated patients can develop delayed intracranial hemorrhage hours after injury even with an initially normal CT, requiring prolonged observation.
PHTLS Special Trauma Considerations 3
A trauma patient is found to be 8 months pregnant and has no palpable pulse after blunt chest trauma.
After 4 minutes of unsuccessful resuscitation, the most appropriate next step is: