PHTLS Special Trauma Considerations 5 — Questions and Answers
Question 1: A 45-year-old male with morbid obesity (BMI 52) requires spinal motion restriction after a diving injury. The most significant challenge is:
- Increased intracranial pressure from positioning
- Inability of standard cervical collars to fit and provide neutral alignment (Correct answer)
- Excessive bone density preventing adequate imaging at the hospital
- Contraindication to long backboard use in all bariatric patients
Correct answer: Inability of standard cervical collars to fit and provide neutral alignment
Standard cervical collars often do not fit obese patients properly, requiring improvised or bariatric-specific devices to maintain spinal alignment.
Question 2: Which fetal heart rate finding, if obtainable in the field, would indicate fetal distress following maternal trauma?
- Fetal heart rate of 130-160 beats per minute
- Fetal heart rate less than 100 or greater than 180 beats per minute (Correct answer)
- Fetal movement felt by the mother during assessment
- Uterine fundal height appropriate for gestational age
Correct answer: Fetal heart rate less than 100 or greater than 180 beats per minute
Normal fetal heart rate is 120-160 bpm; bradycardia (<100 bpm) or tachycardia (>180 bpm) indicates fetal compromise requiring urgent intervention.
Question 3: A 6-year-old restrained passenger presents after a high-speed crash. The child appears stable but is crying and guarding the abdomen. Regarding transport decision-making, the PHTLS principle is:
- Perform a full secondary assessment on scene before transport decision
- Transport to the nearest emergency department regardless of trauma center availability
- Prioritize transport to a pediatric trauma center or trauma center with pediatric capability (Correct answer)
- Delay transport until the child is calm enough for accurate abdominal assessment
Correct answer: Prioritize transport to a pediatric trauma center or trauma center with pediatric capability
Pediatric trauma patients should be transported to facilities with appropriate pediatric trauma capabilities to optimize outcomes.
Question 4: An elderly patient who takes aspirin daily sustains a scalp laceration with brisk bleeding. Compared to a patient not on antiplatelet therapy, the provider should anticipate:
- Faster clot formation due to reflex vasospasm compensation
- Prolonged bleeding time requiring more aggressive hemorrhage control (Correct answer)
- No clinically significant difference in bleeding characteristics
- Risk of paradoxical thrombosis from platelet activation rebound
Correct answer: Prolonged bleeding time requiring more aggressive hemorrhage control
Antiplatelet agents impair primary hemostasis, prolonging bleeding time and requiring more aggressive direct pressure and wound management.
Question 5: When managing a trauma patient who is also pregnant, fetal outcome is MOST directly dependent on:
- Immediate fetal monitoring initiated in the field
- Aggressive maternal resuscitation and stabilization (Correct answer)
- Early administration of tocolytics to prevent preterm labor
- Avoidance of supplemental oxygen to prevent hyperoxia-related fetal injury
Correct answer: Aggressive maternal resuscitation and stabilization
Fetal survival depends on maternal survival; aggressive maternal resuscitation to maintain perfusion pressure is the most critical prehospital intervention.
Question 6: A teenager involved in a sports collision has a suspected concussion with no loss of consciousness and GCS 15. According to PHTLS, this patient should:
- Be cleared to return to play if GCS remains 15 after 10 minutes
- Be evaluated by a physician before returning to activity and transported if any concern (Correct answer)
- Receive spinal immobilization due to the high risk of cervical injury in sports concussions
- Be monitored on scene for 30 minutes and released if asymptomatic
Correct answer: Be evaluated by a physician before returning to activity and transported if any concern
Any suspected concussion warrants physician evaluation before return to activity; prehospital providers should transport any patient with concern for TBI regardless of GCS.
Question 7: Which of the following best describes the 'diamond of death' concept relevant to special trauma populations including the elderly and pregnant patients?
- Hypothermia, hypoxia, hypotension, and hyperglycemia as compounding factors
- Hypothermia, acidosis, coagulopathy, and hypocalcemia as a lethal combination (Correct answer)
- Tachycardia, hypotension, altered mental status, and diaphoresis as shock indicators
- Hypovolemia, tension pneumothorax, cardiac tamponade, and neurogenic shock as obstructive causes
Correct answer: Hypothermia, acidosis, coagulopathy, and hypocalcemia as a lethal combination
The lethal diamond of death — hypothermia, acidosis, coagulopathy, and hypocalcemia — represents interacting physiological derangements that accelerate hemorrhagic death.
PHTLS Special Trauma Considerations 5
A 45-year-old male with morbid obesity (BMI 52) requires spinal motion restriction after a diving injury.
The most significant challenge is: