PHTLS Special Trauma Considerations 4 — Questions and Answers
Question 1: A child with an isolated femur fracture is found to have bruising in multiple stages of healing across the body. What is the most appropriate PHTLS provider action?
- Treat only the acute injury and transport without documentation of findings
- Document all findings objectively and report suspicion of non-accidental trauma per protocol (Correct answer)
- Confront the caregivers about suspected abuse before transport
- Defer reporting until the emergency department physician confirms abuse
Correct answer: Document all findings objectively and report suspicion of non-accidental trauma per protocol
Prehospital providers are mandated reporters; objective documentation and notification per local protocol is required when non-accidental trauma is suspected.
Question 2: When using the Broselow tape to guide pediatric trauma care, what does the tape primarily determine?
- Injury severity score based on mechanism
- Weight-based drug dosing and equipment sizing by body length (Correct answer)
- Age-specific vital sign norms for triage classification
- Predicted blood volume based on height and weight
Correct answer: Weight-based drug dosing and equipment sizing by body length
The Broselow tape correlates body length with estimated weight to guide weight-based drug dosing and appropriate equipment sizes in pediatric emergencies.
Question 3: An elderly patient with a hip fracture following a ground-level fall is in significant pain. Regarding pain management, the PHTLS principle is:
- Withhold all analgesia to preserve accurate neurological assessment
- Provide appropriate analgesia while monitoring for respiratory depression (Correct answer)
- Avoid opioids entirely in the elderly due to absolute contraindication
- Defer pain management to the hospital to avoid masking injury severity
Correct answer: Provide appropriate analgesia while monitoring for respiratory depression
PHTLS supports humane pain management for trauma patients, with careful dose titration and monitoring in the elderly who may be more sensitive to opioids.
Question 4: During assessment of a bariatric trauma patient, pulse oximetry readings may be unreliable due to:
- Elevated hemoglobin levels from chronic hypoxia
- Poor peripheral perfusion and probe placement difficulties on thick digits (Correct answer)
- Interference from excess subcutaneous fat with signal transmission
- Increased respiratory rate producing motion artifact
Correct answer: Poor peripheral perfusion and probe placement difficulties on thick digits
In obese patients, poor peripheral perfusion and difficulty obtaining a reliable probe fit can reduce pulse oximetry accuracy.
Question 5: A 32-week pregnant trauma patient presents with vaginal bleeding and uterine rigidity after a motor vehicle collision. Which condition should be immediately suspected?
- Placenta previa from cervical dilation
- Placental abruption from direct or deceleration forces (Correct answer)
- Uterine rupture from pre-existing scar only
- Normal Braxton-Hicks contractions exacerbated by stress
Correct answer: Placental abruption from direct or deceleration forces
Placental abruption is the most common cause of fetal death in blunt abdominal trauma and presents with uterine rigidity, pain, and vaginal bleeding.
Question 6: Which of the following is TRUE regarding spinal motion restriction in elderly trauma patients with suspected cervical spine injury?
- Hard collars are always preferred over soft alternatives in elderly patients
- Kyphotic deformity may require padding modifications to maintain neutral alignment (Correct answer)
- The elderly tolerate full spinal immobilization better due to reduced range of motion
- Spinal motion restriction is contraindicated in patients over 65 years of age
Correct answer: Kyphotic deformity may require padding modifications to maintain neutral alignment
Pre-existing cervical kyphosis may require void-filling padding behind the head to maintain the patient's anatomical neutral position rather than forcing hyperextension.
Question 7: In pediatric trauma, the most common mechanism causing significant head injury without external skull fracture is:
- Direct penetrating trauma from sharp objects
- Acceleration-deceleration forces causing diffuse axonal injury (Correct answer)
- Depressed skull fractures from falls on hard surfaces
- Basilar skull fractures from lateral impact forces
Correct answer: Acceleration-deceleration forces causing diffuse axonal injury
The child's pliable skull can transmit significant acceleration-deceleration forces to brain parenchyma, causing diffuse axonal injury without fracture.
PHTLS Special Trauma Considerations 4
A child with an isolated femur fracture is found to have bruising in multiple stages of healing across the body.
What is the most appropriate PHTLS provider action?