Trauma Care and Emergency Response, Exams of Nursing

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PHTLS REVIEW EXAM 2024/2025 WITH

100% ACCURATE SOLUTIONS

PHTLS REVIEW EXAM 2024/2025 WITH

100% ACCURATE SOLUTIONS

How many people die from trauma annually? - Precise Answer ✔✔Over 5 million What is the leading cause of trauma deaths? - Precise Answer ✔✔MVA Where do over 90% of trauma deaths occur? - Precise Answer ✔✔Low- Middle income countries. What is the leading cause of death in people aged 1-44? - Precise Answer ✔✔Trauma What are the goals of PHTLS? - Precise Answer ✔✔Reduce morbidity and mortality from trauma, and provide appropriate care to the patient in the field. What is the PHTLS philosophy? - Precise Answer ✔✔Deliver the patient to the right facility, utilizing the right mode of transportation, in the right amount of time, as safely as possible. What are the components of scene assessment? - Precise Answer ✔✔Safety, Pre arrival information, arrival on scene, MOI, and Patients.

What is paramount for scene assessment? - Precise Answer ✔✔Personal and Personnel safety. What is the global view? - Precise Answer ✔✔What you get before you get out of your vehicle. What is the goal of the Primary Survey? - Precise Answer ✔✔To immediately identify life threatening situations and manage them as they are identified. What are the components of the primary survey? - Precise Answer ✔✔Airway, Breathing, Circulation, Disability, Exposure When does assessment of the incident begin? - Precise Answer ✔✔Before arriving at the patients side. The findings of the scene assessment and primary survey help to determine what? - Precise Answer ✔✔If the patient is sick, not yet sick, or not sick When should the secondary survey be completed? - Precise Answer ✔✔Only if time and situation permit.

What are the components of the secondary survey? - Precise Answer ✔✔Vital Signs, History, Physical Examination, Treatment, Level of Care, Transportation, and Communication. What are the components of a radio report? - Precise Answer ✔✔Timely, Scene Description, Number of Patients, Current Patient Status, Treatment Provided, ETA What is a tracheal consideration with pediatric patients in regards to ETT intubation? - Precise Answer ✔✔Potential for right main-stem intubation. What is the most common cause of airway obstruction in the trauma patient? - Precise Answer ✔✔The tongue. When are basic maneuvers applied in regards to trauma airway management? - Precise Answer ✔✔First When are advanced airway maneuvers performed for trauma patients? - Precise Answer ✔✔After basic, only if needed. What is the goal of managing a patients airway? - Precise Answer ✔✔Maintain an open and patent airway that allows for adequate breathing, ventilation, and oxygenation.

What does airway management entail? - Precise Answer ✔✔Anticipating difficulties and planning for alternate methods of airway control. What is ALWAYS the FIRST airway maneuver for the trauma patient? - Precise Answer ✔✔Trauma Jaw Thrust/Chin Lift What should be considered SECOND for maintaining a patent airway in the trauma patient? - Precise Answer ✔✔OPA or NPA What adjunct should be considered THIRD for airway management in the trauma patient? - Precise Answer ✔✔Supra-Glottic Airways When should glottic airways be considered? - Precise Answer ✔✔After jaw thrusts, OPA/NPA, and Supra Glottic airways have failed. What are some assessment criteria for Endotracheal Intubation? - Precise Answer ✔✔Decreased LOC (GCS<8), Inability to maintain patent airway, Upper Airway Burns, Signs of pending airway obstructions. Which type of airway management should be considered last? - Precise Answer ✔✔Surgical. What types of methods should be used to verify tube placement? - Precise Answer ✔✔One physiological and one mechanical method.

When the patients breathing draws your attention you should...? - Precise Answer ✔✔Assume there is a problem until proven otherwise. What are some s/s you are looking for in a trauma patients breathing assessment? - Precise Answer ✔✔Increased respiratory effort, visible trauma, paradoxical chest wall movement, sucking chest wound. What are some s/s you are feeling for in a trauma patients breathing assessment? - Precise Answer ✔✔Boney crepitus, subcutaneous emphysema. What is the BIGGEST difference between a simple and a tension pneumothorax? - Precise Answer ✔✔A TENSION has hemodynamic compromise. Which ribs are most at risk for rib fracture? - Precise Answer ✔✔Ribs 4-8 laterally What is the most common cause of hemothorax? - Precise Answer ✔✔Fractures to ribs 4- What are common complaints of rib fractures? - Precise Answer ✔✔Pain and SOB

Under what circumstances should you withhold oxygen from a patient? - Precise Answer ✔✔Never withhold oxygen from a patient in respiratory distress. When should you assist ventilations? - Precise Answer ✔✔When the RR is above 28 or less than 10. What is the ventilatory rate for adults? - Precise Answer ✔✔10-12 bpm for 500-800cc What is the ventilatory rate for Children? - Precise Answer ✔✔16- bpm for 100-500 cc or good chest rise What is the ventilatory rate for infants? - Precise Answer ✔✔25bpm for 6-8ml/kg What end tidal CO2 reading should you maintain? - Precise Answer ✔✔35-45 mmHg Where should a needle decompression be placed? - Precise Answer ✔✔2nd intercostal space mid clavicular line, over the 3rd rib. What is shock? - Precise Answer ✔✔A result of inadequate energy production to sustain life.

What are the brain, heart, and lungs tolerance to hypoxia? - Precise Answer ✔✔4-6 minutes. What are the kidneys, liver, and GI tracts tolerance to hypoxia? - Precise Answer ✔✔45-90 minutes. What are the muscle, bone, and skins tolerance to hypoxia? - Precise Answer ✔✔4-6 hours. What is the most common cause of shock in the trauma patient? - Precise Answer ✔✔Hypovolemia due to hemorrhage until proven otherwise. What is the most common cause of neurogenic shock in the trauma patient? - Precise Answer ✔✔Spinal Cord injury. What does adequate perfusion of the body tissues require? - Precise Answer ✔✔An effective pump, intact blood vessels, adequate blood volume, vascular resistance. What is cardiac output? - Precise Answer ✔✔Stroke Volume x Heart Rate What is blood pressure? - Precise Answer ✔✔Cardiac Output x Systemic Vascular Resistance.

Vasocontriction leads to which phase of shock? - Precise Answer ✔✔The ischemic phase. What causes an altered LOC in the shock patient? - Precise Answer ✔✔Decreased cerebral perfusion. What may be the earliest sign of shock? - Precise Answer ✔✔Increasing Respiratory Rate caused by hypoxia and acidosis stimulating the respiratory centers of the brain. How much blood loss is required before a drop in BP occurs? - Precise Answer ✔✔30.00% In shock without obvious cause what should you assume? - Precise Answer ✔✔The patient is bleeding somewhere, internal hemorrhage, fracture. Where is a significant container of blood volumes lost to hemorrhage? - Precise Answer ✔✔The abdomen. What is the mortality rate of aortic rupture in the prehospital setting? - Precise Answer ✔✔80-85% How much blood can each hemothorax hold? - Precise Answer ✔✔3000-4000ml of blood

How much blood loss can occur from a single rib fracture? - Precise Answer ✔✔125ml How much blood loss can occur from a fractured radius or ulnar? - Precise Answer ✔✔250-500 ml How much blood loss can occur from a fractured humerus? - Precise Answer ✔✔750ml How much blood loss can occur from a fractured tibia or fibula? - Precise Answer ✔✔500-1000ml How much blood loss can occur from a fractured femur? - Precise Answer ✔✔1000-2000ml How much blood loss can occur from a fractured pelvis? - Precise Answer ✔✔Massive What is the most common thoracic injury? - Precise Answer ✔✔Rib fractures. What four questions guide management of shock? - Precise Answer ✔✔- What is the cause of this shock?

• What is the care for this type of shock?
• What can and should be done between now and the time the patient reaches definitive care?

• Were is the best place for the patient to get definitive care? What does proper management of shock achieve? - Precise Answer ✔✔Improves the oxygenation of RBCs and improves the delivery of RBCs to the tissue. How should the shock patient be positioned? - Precise Answer ✔✔Supine, as the trendelenburg position is no longer recommended. What temperature should the patient compartment be maintained at? - Precise Answer ✔✔85F What are the three responses to fluid therapy? - Precise Answer ✔✔- Rapid response
• Transient Response
• Minimal or No Response. What is the frontal lobe responsible for? - Precise Answer ✔✔Foresight, personality, judgement What is the Parietal lobe responsible for? - Precise Answer ✔✔Sensation from the body What is the Temporal lobe responsible for? - Precise Answer ✔✔Hearing and speech

What is the Occipital lobe responsible for? - Precise Answer ✔✔Vision What is primary damage? - Precise Answer ✔✔Damage that occurs at the moment of impact. What is secondary damage? - Precise Answer ✔✔Damage that occurs subsequent to the initial impact. What are some systemic causes of secondary brain injury? - Precise Answer ✔✔Hypoxia, CO2 abnormalities, Anemia, Hypotension, CBG abnormalities. What are some intrinsic causes of secondary brain injury? - Precise Answer ✔✔Seizures, Edema, Hematomas, increased ICP What is a typical ICP? - Precise Answer ✔✔10-15 mmHg What does hypercarbia cause? - Precise Answer ✔✔Cerebral vasodilation Onto which brain structure does pressure produce vomiting? - Precise Answer ✔✔The hypothalamus

What are the six components of a complete prehospital neurological exam? - Precise Answer ✔✔Mental Status, Cranial Nerves, Motor Responses, Sensory Response, Coordination, Reflexes When do you score the GCS? - Precise Answer ✔✔AFTER the correctable causes of ALOC have been addressed. What is normal pupil size? - Precise Answer ✔✔3-5 mm. Difference greater than 1mm is abnormal. What does paralysis of lateral gaze indicate? - Precise Answer ✔✔Possible rising ICP What does paralysis of upward gaze indicate? - Precise Answer ✔✔Possible fracture of orbital floor. Most of the bad TBI stuff presents in which ways? - Precise Answer ✔✔Headache, Vomiting, Altered Mentation, Neurological Deficits What is the earliest and best indicator of a patients ICP? - Precise Answer ✔✔A change in LOC What are warning signs of possible increasing ICP and impending herniation? - Precise Answer ✔✔GCS drop of 2 or more, development of sluggish or no reactive pupils, development of hemiplegia or hemiparesis, Cushing's phenomenon

What is the ventilatory rate for Adults with suspected intercranial herniation? - Precise Answer ✔✔20 bpm What is the ventilatory rate for Children with suspected intercranial herniation? - Precise Answer ✔✔25 bpm What is the ventilatory rate for Infants with suspected intercranial herniation? - Precise Answer ✔✔30 bpm How much blood must be lost before children show signs of hypotension? - Precise Answer ✔✔30.00% What is a fourth degree burn? - Precise Answer ✔✔A burn to the bone. What is special in the fluid therapy of a child in burn management? - Precise Answer ✔✔They should receive 5% dextrose in LR solution. Level 1 Trauma Center - Precise Answer ✔✔Regional Trauma Center, All types of specialty surgical care 24/7, (Surgical suites, Surgeons, Blood, CT, X-Ray ... all in house), Tertiary - all levels of care Ex... County USC, Cedars, UCLA- Ronald Regan, UCLA- Harbor General

Level 2 Trauma Center - Precise Answer ✔✔Area Trauma Center, Most common trauma emergencies with surgical capabilities 24/7, (can handle most common types of trauma) Ex.... St. Francis Level 3 Trauma Center - Precise Answer ✔✔Community Trauma Center, Specialized ED and some surgical capability (the speciality staff is on call and has 30 mins to get to hospital) Level 4 Trauma Center - Precise Answer ✔✔small community hospitals, (they have to stabilize and transfer) Have ER DR but no surgeon What are run sheets used for? - Precise Answer ✔✔QI, Research, Trauma Registry, What are the 4 E's? - Precise Answer ✔✔Engineering -(roads, airbags, pool alarms) Enforcement -(laws) Education -(safety classes) Economics -(government grants)

What is an injury? - Precise Answer ✔✔being hurt or killed What is trauma? - Precise Answer ✔✔inflicted wounds or injury What is an accident? - Precise Answer ✔✔an event that is unforeseen or without apparent cause What is a disease? - Precise Answer ✔✔an unhealthy condition, illness, or disorder Why is the Highway Safety Act of 1966 important? - Precise Answer ✔✔lead to development of EMS "White Paper" - Accidental Death & Disability, The Neglected Disease of a Modern Society Why is the American College of Surgeons important? - Precise Answer ✔✔1990: trauma care systems planning and development act (established guidelines, funding and state-level leadership for the development of trauma systems) What are the leading causes of death in adults & children? - Precise Answer ✔✔Adults - MVC Children - Falls

In trauma how many die in 1st hr? - Precise Answer ✔✔50% Fix = Injury Prevention In trauma how many die in 4 hrs? - Precise Answer ✔✔30% Fix = good prehospital and hospital care In trauma how many die days or weeks later? - Precise Answer ✔✔20% (due to hypoxia, hypotension, end organ failure) Fix = aggressive shock management What is Precrash? - Precise Answer ✔✔Age, medical hx, drugs, alcohol What are the 3 phases of a Crash? - Precise Answer ✔✔1. car into tree

2. person into steering wheel
3. organs into body What is the main purpose of car restraints? - Precise Answer ✔✔to slow the occupant down with the vehicle Platinum 10 mins are used for what? - Precise Answer ✔✔1. identify life-threats
4. perform key interventions
5. rapid extrication were indicated

4. timely transport to an appropriate facility
5. early notification to the receiving facility Trauma is the leading cause of death in what age group? - Precise Answer ✔✔1 - 44 What is anatomical trauma criteria? - Precise Answer ✔✔Specific injuries (bi-lat femur fx) What is mechanical trauma criteria? - Precise Answer ✔✔Type of incident / MOI (blunt head, penetrating trauma, PSI) What is physiological trauma criteria? - Precise Answer ✔✔vitals signs (ALOC, hypotension GCS < 15) What is newtons 1st law? - Precise Answer ✔✔Body at rest will remain at rest and a body in motion will remain in motion until acted upon by an outside force What is law of conservation? - Precise Answer ✔✔Energy cannot be created or destroyed, but can change forms. Car breaks = friction = heat = fire

What is the formula for kinetic energy? - Precise Answer ✔✔1/2 of mass x velocity(squared) What is more important velocity of mass? - Precise Answer ✔✔velocity If you increase the stopping distance what happens to the potential for injury? - Precise Answer ✔✔potential for injury is decreased What is important info in regards to GSWs? - Precise Answer ✔✔hand guns & rifles - velocity shotguns - what was the distance What is permanent cavitation? - Precise Answer ✔✔tissue that is destroyed and not coming back What is temporary cavitation? - Precise Answer ✔✔tissue that falls back into place 6x the diameter of per,anent caviation Concerns with up & over injuries? - Precise Answer ✔✔Laryngeal fx (may hear stridor) Sub-Q Emphysema Diaphragmatic tear Concerns with down & under injuries? - Precise Answer ✔✔Pelvic fx

Femur fx Patellar fx Concerns with lateral impacts? - Precise Answer ✔✔Less metal to protect people in car Look for injuries to that same side of body Concerns with rotational forces? - Precise Answer ✔✔shearing forces to heart, liver, kidneys What % of ejection victims die? - Precise Answer ✔✔ 75 How much more likely are you to die if you are involved in a rollover? - Precise Answer ✔✔6x Concern with rear impacts? - Precise Answer ✔✔whiplash injuries Good thing about wearing helmets? - Precise Answer ✔✔they save lives & decrease injuries Auto vs. Ped facts? - Precise Answer ✔✔Child - Freeze "deer in headlights", get drug under car, multi-system trauma Adult - turn & run, extremity trauma

Important aspects of falls? - Precise Answer ✔✔15 feet or 3x their height & the surface they land on = (severity of fall) Body part they land on = (type of injury) what are the 5 phases of bast injuries? - Precise Answer ✔✔1. Primary - pressure wave, effects hollow organs

2. Secondary - Bomb fragments
3. Tertiary - person in thrown, or falling debris
4. Quaternary - heat/thermal burns
5. Quinary - bio/chemical/implanted objects sprayed from the object What is an intimate injury? - Precise Answer ✔✔Stabbing. Close proximity. Look for more than one wound, be cautious of "cone of injury, any direction", length of knife? In regards to violence what should you do? - Precise Answer ✔✔1. DONT BE THERE!!!!
6. Retreat
7. Defuse the situation (word ninja)
8. Defend yourself 30 - 2, Can Do = what color? - Precise Answer ✔✔Green

30 - 2, Cant Do = what color? - Precise Answer ✔✔Yellow Deficit to 30 - 2, Can Do (ALOC, Respirations, Circulation) = what color? - Precise Answer ✔✔Red What is the goal of the primary assessment? - Precise Answer ✔✔to find & correct life threats What is the most common threat to life? - Precise Answer ✔✔inadequate tissue perfusion/shock (a early sign is ALOC) If you dont know ______ then your already behind the 8 ball?! - Precise Answer ✔✔the MOI Injury to solid organs =? - Precise Answer ✔✔hemmorage Injury to hollow organs =? - Precise Answer ✔✔Spill which leads to infection/peritonitis) What is Grey Turners sign? - Precise Answer ✔✔ecchymosis at the flank due to retroperitoneal bleed What is Cullens Sign? - Precise Answer ✔✔ecchymosis at the umbilicus due to retroperitoneal bleed

Mass pants can be used for what? - Precise Answer ✔✔1. belly, retroperitoneal, pelvis bleed w/ BP less than 90 & pelvis fx stabilization

2. wide spread hemorrhage with BP less than 60 (NOT FOR USE ON PENETRATING TRAUMA) What is the % for Fi02? - Precise Answer ✔✔at least 85% What is the % for SP02? - Precise Answer ✔✔95% Can you typically remove impaled objects? - Precise Answer ✔✔Only if it is occluding the airway otherwise No, it maybe stopping the bleeding!! Abdominal evisceration key points are what? - Precise Answer ✔✔1. moist sterile dressing
3. occlusive dressing
4. keep PT warm
5. keep PT still What is more important minute volume or tidal volume? - Precise Answer ✔✔Minute volume What is the most important mechanism for ventilation? - Precise Answer ✔✔the plural linings staying intact

In the PHTLS world what are the essential airway skills? - Precise Answer ✔✔bls skills What is the PHTLS airway key factor? - Precise Answer ✔✔Dont do the same thing over & over, try something different In PHTLS what is the best ET-Tube confirmation in a PT with a pulse? - Precise Answer ✔✔capography What is the best ET-Tube confirmation in a PT without a pulse? - Precise Answer ✔✔lung sounds If you cant intubate or ventilate then what? - Precise Answer ✔✔needle / surgical cric Normal capography value? - Precise Answer ✔✔35-45 Closed head injury capography range is what? - Precise Answer ✔✔ 35 or less What is the most common type of shock? - Precise Answer ✔✔hypovolemic / hemorrhagic What is most sensitive to ischemia? - Precise Answer ✔✔The brain, heart and lungs (can last about 4-6 mins w/o 02)

What the 2nd most sensitive to ischemia? - Precise Answer ✔✔The kidneys, liver & GI tract (can last 45-90 mins w/o 02) What is the least sensitive to ischemia? - Precise Answer ✔✔Skin and bones (can last 4-6 hrs w/o 02) What is cell & organ death? - Precise Answer ✔✔1. it starts with aerobic to anaerobic metabolism 2. Na and H20 go into the cell (edema)

3. Potassium and lactic acid leak out of cell and enter blood stream (makes body acidic & hyperkalemic) What happens during the ischemic phase? - Precise Answer ✔✔vascular sphincters shut closed What happens during the stagnant phase? - Precise Answer ✔✔Sphincters relax and blood pools in the extremities What happens during the wash out phase? - Precise Answer ✔✔systemic acidosis What is Shock Class 1? - Precise Answer ✔✔1-15% 750 ml compensated> HR normal What is Shock Class 2? - Precise Answer ✔✔15-30% 750-1500 ml> HR greater 100