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PHTLS 10th Edition With Complete Solution 1. Which of the following requires you to develop a plan of action, initiate the plan, reassess the plan as care for the patient moves forward, and adjust the plan as the patient's condition or circumstances change? A. Principles of PHTLS B. The Golden Period C. The XABCDE assessment D. Critical thinking process - ans- Question 1: D To help achieve the PHTLS goals, you will apply your critical thinking skills in the field. Critical thinking in medicine is a process in which the healthcare practitioner assesses the situation, the patient, and the resources available and uses the information to decide on and provide the best care for the patient. 2. When using the XABCDE assessment, which of the following takes precedence over all other actions? A. Controlling severe bleeding from a limb or other compressible site B. Airway stabilization and assessing circulatory status C. Exposing the body to allow a thorough evaluation D. Ensuring adequate breathing - ans- Question 2: A The "X" placed before "ABCDE" in the primary survey refers to the need to address exsanguinating hemorrhage immediately after establishing scene safety and before addressing airway. Severe exsanguinating hemorrhage, particularly arterial bleeding, has the potential to lead to loss of total or near total blood volume in a relatively short period of time. 3. Which of the following is the basis on which a patient's chance of survival is maximized? A. Preferences B. Phases C. Principles D. Transport - ans- Question 3: C The science of medicine provides the principles of medical care. Simply stated, principles define the duties required of the prehospital care practitioner in optimizing patient survival and outcome. 4. Which of the following is a goal of the Golden Period? A. Provide written documentation from field care to receiving hospital. B. Expedite the field care and transport of the patient. C. Use a team approach for optimal patient care. D. Use the XABCDE approach to patient assessment. - ans- Question 4: B One of your most importantresponsibilities as a prehospital carepractitioner is to spend as little time onthe scene as possible and expedite yourfield care and transport of the patient.Studies show that the time from injuryto arrival at the appropriate site fordefinitive care is critical to survival 1. You are called to the scene of a possible mass casualty motor vehicle collision on the highway. Once you arrive on scene, what is your first priority? A. Immediately begin triaging patients. B. Treat the patient with the most visible blood loss. C. Determine the need for additional resources. D. Assess the scene and ensure it is safe. - ans- Question 1: D Ensure safety for responders, bystanders, and patient(s). The first consideration when approaching any scene is the safety of all emergency responders. When EMS personnel become victims, they not only can no longer assist others, but also add to the number of patients. 2. Atrauma patient from the highway incident is holding her right arm, and you note a significant amount of blood steadily flowing from a long gash. This is an example of what type of hemorrhage? A. Capillary bleeding B. Venous bleeding C. Arterial bleeding D. Road rash - ans- Question 2: B Venous bleeding typically results in a steady flow of dark red blood 11/15 3. What is the best way to control the bleeding? A. Direct pressure B. Elevation of the arm above the heart C. Tourniquet D. Occlusive dressing - ans- Question 3: A With venous bleeds, direct pressure isusually sufficient to stop the flow. 4. The patient is wearing long sleeves, and you are having trouble visualizing the wound. What should you do? A. Cut the cloth away from the site until the entire wound site is visible. B. Leave the clothing in place. Put gauze over the wound. C. Remove the patient's shirt. D. Cut through the slash on the sleeve, and use the material as a makeshift tourniquet. - ans- Question 4: A Clothing can be quickly removed by cutting. You cannot treat what you cannot see. 1. You are called to the scene of an explosion and fire at a chemical plant where you find multiple casualties Triage has begun. Your first patient is a 40-year-old man who was near the source of the explosion. He is unconscious and has extensive injuries. You note gurgling respirations. Why should you use the trauma jaw thrust maneuver first when dealing with a trauma patient? A. It's an easy technique that always works to open the airway. B. It allows you to open the airway with little or no movement of the head and cervical spine. C. Other techniques and interventions don't work as well. D. It can relieve a variety of anatomic airway obstructions in patients who are breathing spontaneously. - ans- Question 1:B Manual maneuvers like the trauma jaw thrust or chin lift are always the first airway maneuver you should make when treating a trauma patient. In patients with suspected head, neck, orfacial trauma, the cervical spine is maintained in a neutral in-line position. The trauma jaw thrust maneuver allows you to open the airway with little or no movement of the head and cervical spine. 2. The patient becomes apneic. You suspect he has a cervical injury. Which type of airway should you use? A. Supraglottic airway B. Blind nasotracheal intubation C. Oropharyngeal airway D. Surgical airway - ans- Question 2: A The supraglottic airway's greatest advantage is that it can be inserted independent of the patient's position, which may be especially important in trauma patients with high suspicion of cervical injury. 3. Why might it be more difficult to deal with an airway obstruction in a child? A. Children have longer tracheas. B. Children have larger heads and tongues so there is a greater potential for airway obstruction. C. Children have smaller heads, so there is less room to clear the obstruction. D. A child's epiglottis is smaller and stiffer than an adult's. - ans- Question 3: B Children have larger heads and tongues as compared to an adult so there is a greater potential for airway obstruction in a pediatric patient. You must pay special attention to the proper positioning of a pediatric patient to maintain a patent airway. 4. Why might you consider early mechanical ventilation via bag-mask device in a geriatric patient? A. Shorter tracheas in geriatric patients create the need for ventilation assistance. B. Laxity of the rib cage makes hyperventilation more likely. C. Geriatric patients have greatly limited physiologic reserve. D. Geriatric patients have a greater alveolar surface area of the lungs. - ans- Question 4: C Early mechanical ventilation via bag mask device or advanced airway measures should be considered in geriatric trauma patients because of their greatly limited physiologic reserve. 1. You have been performing ongoing management on a 35-year-old female patient who sustained thoracic trauma when a car hit her as she crossed the street. Originally, your electronic monitoring devices all produce results consistent with your patient's clinical condition. However, en route the trauma center, the monitors start to differ from your patient's current clinical condition each time you reassess. How should you handle this situation? A. Treat the patient's condition, not the monitor results. B. Continue to reassess the patient and record the results for the trauma center. C. Treat your patient based on the test results. D. Stop testing and wait until you arrive at the trauma center for them to perform an assessment. - ans- Question 1: A If there are inconsistent data from electronic monitoring devices, reassess to be sure the monitor matches the patient's current clinical condition. However, it is most important to treat the patient, not the monitor, so use other signs and symptoms of potential patient deterioration. 2/15 The patient does not need more fluids right now. Giving morphine in a shocked patient is a risky move and could lead to dangerous hypotension. 5. You now perform a secondary survey. You notice a sternotomy scar. Your patient tells you he is on oral clopidogrel since he had a coronary artery bypass graft 2 years ago. Is this information useful? A. No, he should stop talking and breathe. B. Yes, he should see a cardiologist once in the local hospital. C. Yes, he will need platelets and a heart surgeon ASAP. D. Yes, you should raise his blood pressure up to 130 mm Hg systolic. - ans- Question 5: C Because he is on clopidogrel, his platelets are out of order for at least 5 days, so he will require urgent platelet transfusion. 1. You're called out to an assisted living facility for a 72-year-old woman complaining of a severe headache and experiencing increased confusion. Staff reports she fell out of her wheelchair earlier in the week but didn't appear to be hurt; however, she's become increasingly disoriented over the last day or so. Vital signs show: BP 110/90; heartrate 118 and irregularly regular; ventilation rate 20 and slightly labored; SpO2 93% on room air. She is taking warfarin for a clotting issue. Which of the following should you suspect? A. Cerebral contusion B. Epidural hematoma C. Subarachnoid hemorrhage D. Subdural hematoma - ans- Question 1: D The patient's age, use of a blood thinner, and the fact she fell recently point to a subdural hematoma 2. Upon examination, you find the patient responsive to your presence, although she is clearly confused. Motor response shows reduced pain response but normal flexion. What's her GCS score? A15 B.12 c.10 D. 8 -ans- Question 2: B Eye opening: 4; verbal response: 4; motor response: 4 = 12 3. What does the GCS score indicate? A. Mild TBI B. Moderate TBI C. Severe TBI D. No TBI - ans- Question 3: B Atotal GCS score of 13 to 15 likely indicates a mild TBI whereas a score of 9 to 12 is indicative of moderate TBI. A GCS score of 3 to 8 suggests severe TBI. 4. When you examine the patient's pupils, you notice the right one is dilated significantly and her motor response on the left is delayed. What does this suggest? A. Coup-countercoup injury B. Hyphema C. Hypoxia D. Uncal herniation - ans- Question 4: D When the medial portion of the temporal lobe (uncus) is pushed toward the tentorium and puts pressure on the brain stem, herniation compresses CN lll, the motor tract, and the reticular activating system on the same side, resulting in a dilated or blown pupil on the same side, motor weakness on the opposite side, and respiratory dysfunction, progressing to coma. 5. Which of the following signs would be most concerning at this point? A. A drop in systolic blood pressure to 88 mm Hg B. SpO, of 93% C.A field GCS motor score of 4 D. Hemiplegia on the left side - ans- Question 5: A Asystolic blood pressure of less than 90 mm Hg indicates secondary brain injury. Her SpO2 is > 90%, and a motor score of 4 is not as concerning. 6. According to the Monro-Kellie doctrine, what happens to the brain when it is still ina compensated state after a TBI? A. CSF, ICP, heart rate, and blood pressure are still within normal range. B. CSF increases, ICP decreases, heart rate increases, and blood pressure decreases. C. CSF and blood volume decrease, while heart rate and blood pressure are still within normal range. D. CSF decreases, ICP increases, heart rate decreases, and blood pressure increases. - ans- Question 6: C 4115 In a compensated state, CSF and blood volume decrease, while heart rate and blood pressure are still within normal range. 1. You are responding to a call for 25-year-old, fit and healthy female who fell off a mountain bike. Upon arrival, you find the patient walking around. She is alert but complaining of pain in her clavicle and on her right side when she inhales. You notice that her helmet is split in two. What is the first thing you need to do? A. Complete a review of the ABCs. B. Check motor and sensory function. C. Perform manual in-line stabilization. D. Place her on a backboard. - ans- Question 1: C Because there's a possibility of spinal injury, you should bring the patient's head into a neutral in-line position. 2. During primary survey, you find the following: . LOC: alert and oriented; speaking in full sentences . GCS: 15 Airway: good air entry to bases . Breathing: bilateral . Circulation: skin warm, flushed, dry Pulse rate: 112 bpm, strong andregular . BP: 90/42 mm Hg . Pain: Patient complains of severe pain at clavicle site and pain on inspiration at site of possible fractured ribs. No other injuries detected. What is your next step? A. Apply a cervical collar and in-line immobilization device. B. Treat for hypovolemic shock. C. Apply an arm sling for the clavicle injury. D. Administer pain medication. - ans- Question 2: A Although the patient's GCS is normal, she does have a distracting injury, and the state of her helmet indicates possible spinal compression/flexion, so you should immobilize the patient. 3. When securing a patient to a backboard, which body part should you secure first? A. Head B. Torso C. Legs D. Pelvis - ans- Question 3: B When immobilizing a patient, you should secure the torso first, then the head, the legs, and the pelvis. 4. What type of padding should you provide for this patient? A. Use compressible padding under the shoulders and torso to prevent hyperflexion. B. Use firm padding between the back of the head and the backboard to prevent hyperextension. C. Do not use any padding. It can cause extension or flexion in the neck. D. No padding needed, but to avoid decreased venous return you should tip the backboard to a left lateral position. - ans- Question 4: B Because the patient is an adult, you should use firm padding between the back of the head and the backboard to prevent hyperextension. You would pad a child's shoulder and torso to prevent hyperflexion, and you would tip the backboard for a pregnant patient to prevent decreased venous return. 5. While attempting to lay the patient supine for spinal motion restriction she becomes increasingly distressed and complains of shortness of breath and difficulty breathing. The fractured clavicle appears to move distally and increases the difficulty of breathing as the patient lies back. What should you do? A. Tip the backboard to a left lateral position. B. Raise the back of the stretcher. C. Let her sit up in a position of comfort. D. Administer morphine. - ans- Question 5: B Because laying the patient supine increases the risk of airway/ventilation problems, raising the back of the stretchers slightly fundamentally maintains spinal alignment while reducing the ventilation issues. 1. You and your partner are responding to a call for a 2-year-old patient with a burn injury to the hand. He has a visible burn to the left hand, ending at the level above the wrist, red color, and wet in appearance. What type of burn do you suspect the patient has sustained? A. Superficial (first degree) B. Partial thickness (second degree) C. Full thickness (third degree) 
