Shaun Fix

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PHTLS
PREPARATION
PACKET
10th Edition

Note: This packet contains the latest trauma guidelines, review information and pre-test. It is
mandatory that participants review the textbook, complete the pre-test and be familiar with the
PHTLS assessment and management criteria prior to the course. A pre-test score of 76% is
required for this course. Feel free to contact our office should you have any questions
The pre-test will be collected at the beginning of the class.
Ó 2023

(772) 878-3085 * Fax: (772) 878-7909 * Email: [email protected]

597 SE Port Saint Lucie Blvd * Port Saint Lucie, Florida 34984
Visit Our Website… MedicalTraining.cc
*
 Pre-Hospital Trauma Life Support_10th edition
Day 1
40 min Lesson 1 Welcome, Course Intro, Collect Pre-test
45 min Lesson 2 (Trauma Assess & eXsanguinating Hemorrhage)
10 min BREAK
60 min Lesson 3 (Airway)
10 min BREAK
60 min Lesson 4 (Breathing, Oxygenation & Ventilation)
10 min BREAK
60 min Lesson 5 (Circulation)
60 min LUNCH
Skills Stations- 45 minutes each
Skills Patient Simulation
Station 1: -PHTLS Assessment Baseline 1
Assessment Sequence
(Practice full PHTLS sequence) Baseline 2

-Helmet Removal
(Sports, Motorcycle)

-Perilaryngeals Airways

Station 2: Skills Case

Airway -Jaw Thrust (chin lift 2 Airway Case 1
rescuer)
Airway Case 4
-OPA,NPA
Airway Case 5
-BVM – 1 & 2 person
Airway Case 7
-Trauma Intubation
(Neutral C-Spine, frontal,
bougie)

-Cricothyrotomy

Station 3: Skills Case

Bleeding Control & -Plural Decompression Breathing Case 1
Breathing Control -Tourniquet
-Wound packing Circulation Case 1
(Hemostatic agents)
Circulation Case 5

Circulation Case 9

End of Day 1
Day 2
Pre-Hospital Trauma Life Support_10th edition

60 min Lesson 6 (Secondary Survey)

10 min BREAK

60 min Lesson 7A (Disability-Traumatic Brain Injury)

10 min BREAK

60 min Lesson 7B (Disability- Spinal Injury)

60 min LUNCH

60 min Lesson 8 (Special Considerations)

Stations 1-3 are found Final Scenario Evaluations- 45 minutes each

in Day 1 (Each student is team leader in 1 case)
Station 4: Skills Case
Review Rapid Circulation Case 3
Student led scenarios Extrication Circulation Case 4
Special Case 16
Special Case 22

Station 5: Skills Case

Review IO for Circulation Case 1
Student led scenarios Trauma eXsanguinating Case 1
Multisystem Case 2
Circulation Case 2
Station 6: Skills Case
Review Traction eXsanguinating Case 3
Student led scenarios Splint Exposure Case 4
Review Pelvic Disability Case 5
Binder Special Case 16

60 min Written Exam

End of Day 2
 Prehospital External Hemorrhage Control Protocol
Apply direct pressure/pressure dressing to injury

Direct pressure effective Direct pressure ineffective or impractical

(hemorrhage controlled) (hemorrhage not controlled)

Wound amenable to Wound not amenable to

tourniquet placement tourniquet placement
(e.g. extremity injury) (e.g. junctional injury)

Apply a tourniquet* Apply a topical hemostatic agent

with direct pressure#

Pack wound if necessary

Spine Board Debate

It is agreed that the long board is an appropriate device for extrication and patient movement on scene and to a
stretcher, but 2015 brought about documented controversy as to its effectiveness at truly immobilizing the spine
and its benefits; Key Issues:
- There are no documented studies to support that straight rigid board immobilization with a collar is
beneficial.
- Some patients’ anatomy actually flexes the head forward while others hyperextend the head when placed on
a board.
- Patients will all begin to complain of neck and back pain if left on a hard board.
- Skin breakdown can occur at points that contact the board.
- Obese patients are at risk for positional asphyxia
- Emergency airway procedures are more difficult to perform on immobilized patients

The lack of supporting benefit and the growing potential for detrimental side effects has led many areas to decrease
or completely remove the use of spine boards for anything more than extrication or movement. Instead opting for
placing a collar on the patient and lying the spine on the stretcher.

*Some protocols for ruling “in” or “out” the use of spinal immobilization are still utilized.
 PHTLS Shock
There are three types of shock:

• Hypovolemic shock
• Vascular volume smaller than normal vascular size
• Loss of fluid and electrolytes
• Dehydration
• Loss of blood and fluid
• Hemorrhagic shock
• Distributive shock
• Vascular space is larger than normal
• Neurogenic “shock” (hypotension)
• Psychogenic shock
• Septic shock
• Anaphylactic shock
• Cardiogenic shock
• Pump failure

Classification of Hemorrhagic Shock

Class I Class II Class III Class IV
Blood loss (mL) Up to 750 750-1500 1500-2000 >2000
Blood loss (% vol) Up to 15% 15%-30% 30%-40% >40%
Pulse rate <100 100-120 120-140 >140
Blood pressure Normal Normal Decreased Decreased
Pulse pressure Normal or increased Decreased Decreased Decreased
Respiratory rate 14-20 20-30 30-40 >35
Urine output (mL/hr) >30 20-30 5-15 Negligible
CNS/ mental status Slightly anxious Mildly anxious Anxious, confused Confused, lethargic
Fluid replacement Crystalloid Crystalloid Crystalloid and blood Crystalloid and blood

Signs Associated with Types of Shock

Vital Sign Hypovolemic Neurogenic Septic Cardiogenic
Skin temperature Cool, clammy Warm, dry Cool, clammy Cool, clammy
Skin color Pale, cyanotic Pink Pale, mottled Pale, cyanotic
Blood pressure Drops Drops Drops Drops
Level of Altered Lucid Altered Altered
consciousness
Capillary refilling Slowed Normal Slowed Slowed
time

Shock Assessment

Vital Sign Compensated Decompensated

Pulse Increased; Greatly increased;
Type of Fracture Blood Loss Potential
tachycardia marked tachycardia Rib 125 mL
that can progress to
Radius or ulna 250-500 mL
bradycardia
Humerus 500-750 mL
Tibia or fibula 500-1000 mL
Skin White, cool, moist White, cold waxy
Femur 1000-2000 mL
Blood pressure range Normal Decreased Pelvis 1000-unlimited mL

Level of Unaltered Altered, ranging

consciousness from disoriented to
coma

Management
-Ensure oxygenation and ventilation
-Control hemorrhage (external or internal)
-External- direct pressure or tourniquet or homeostatic agent
-Internal-direct pressure (extremity immobilization/ PASG for pelvis/ low abd.)
-Move toward a definitive facility
-Control body temp (lower the pt)
-Fluid replacement for Class II, III, or IV shock
-Isotonic crystalloids (lactated Ringers preferred; warm if possible)
-Ideally blood or packed RBC’s (now being used prehospital)
-Controllable bleeds- 1-2 liters (adult) (20 mL/kg peds) – Titrated to SBP 80-90 mmHg
-Uncontrolled (internal) bleeds- the least amount of fluid required to maintain SBP 80-90 mmHg
 PHTLS 10 Ed. FINAL EVALUATION STATION FLOW SHEET

Student (Leader):
Evaluator: Scenario Number:
Beginning Time: Ending Time

Completed
Yes No Assessment & Treatment
Identify Safe Scene
Proper Standard Precautions
Perform Primary Survey
Level of Consciousness/Response
X – Stop Exsanguinating hemorrhage
Airway
Breathing
Ventilation/Air Exchange
Circulation/Perfusion
External Hemorrhage Control
Pulse
Skin Condition
Disability
Exposure of All Critical Body Areas for Assessment
Properly Identify Critical and Non-Critical Trauma Patients NOTES:
Use of Appropriate Spinal Immobilization Technique(s)
Proper Use of Padding/Buttress Material
Identification of All Life-Threatening Injuries
Proper Treatment of All Life-Threatening Injuries
Performed Only Lifesaving Treatment(s) While On-Scene
Timely Transported When Indicated
Appropriate Level Trauma Facility When Indicated
Identification of All Non-Critical Injuries
Proper Treatment Performed En-Route
Completed Secondary Survey When Indicated
Completed Scenario Within 10 Minutes On-Scene Time
Reassessment of Patient's Conditions
Safety Observed Throughout Scenarios
Worked Together as A Team

Successful Station Completion: YES NO

 Sample Scenario Evaluation Skill Station

Instructor Information Patient Information

This skill station involves a skier who lost control while skiing. The Moulage: Pale and diaphoretic, cyanotic lips and nails, multiple body
patient’s LOC is altered and he requires airway management and rapid abrasions, blood at mouth
transport. Follow the written scenario, and provide Position: Laying on his side in a basket stretcher
information to all team members as the scenario progresses or as the team Actions: Eyes open to pain, incoherent moaning, and withdraws from
members ask. pain

Dispatch Information
You and your partner work for a rural emergency medical service. Your ambulance has been dispatched to a local ski resort for a skiing accident in a remote
section of your response area. It is noontime in late winter, clear sky with 17°F (–8°C). The closest hospital with an emergency department is 40 minutes
away by ground; the closest level I trauma center is a 60-minute ride by ground or 15 minutes by air ambulance.

Scene Assessment/General impression

Resort staff direct you to the first aid building. There you find three members of the ski patrol and the patient’s wife. The ski patrol packaged the patient and
moved him to the aid station at the base of the hill. No interventions have occurred. The ski patrol reports the patient lost control and tumbled into trees. They
arrived 5 minutes after the accident and his condition has not changed. The accident happened 20 minutes ago.

Primary Survey Treatments/Critical Actions

31-year-old male, approximately 270 lb (122 kg); patient dressed in *Note: ★ icon indicates a Critical Action
heavy winter clothing and ski boots
• Spinal motion restriction ★
X: No major external hemorrhage • Manual opening of the airway with suctioning of the
A: Partially obstructed—gurgling
oropharynx ★
B: Rapid and shallow
C: Fast radial pulse, skin pale and clammy • Insert NPA and assist ventilations with high-flow oxygen and bag
D: 8 (E-2, V-2, M-4), PERRLA, moves all four extremities mask ★
E: Various small abrasions on hands, knees where the ski suit ripped, • Drug assisted intubation if within scope of practice ★
blood at mouth • Rapid transport to trauma center, request air medical
transport ★
• Maintain body heat
• IV during transport to maintain BP at 90 mm Hg systolic

Copyright 202I0 National Association of Emergency Medical Technicians (NAEMT). *Course materials are developed by NAEMT for the sole purpose of conducting NAEMT
education courses and may not be utilized for any other

BP: 112/72 (MAP 85)

GCS: 8 (E-2, V-2, M-4)

Initial Patient Impression: Critical/Rapid Transport

Temp: 98.8°F (37.1°C)

 Sample Scenario Evaluation Skill Station

Reassessment Vital Signs

Critical actions done Critical actions NOT done

BP: 126/74 (MAP 91) BP: 92/60 (MAP 71)

P: 130, weak P: 150, weak, rapid, irregular

R: 20, assisted R: 8, irregular

Skin: Pale, cool, clammy Skin: Cyanosed, cool, clammy

Spo2: 94%/O2 Spo2: 90%/O2

GCS: 8 (E-2, V-2, M-4) GCS: 4 (E-1, V-1, M-3)

Glucose: 90 mg/dl (5 mmol/l) Glucose: 90 mg/dl (5 mmol/l)

etco2: 38 mm Hg etco2: 60 mm Hg

Pain: Unable to obtain Pain: Unable to obtain

Temp: 98.8°F (37.1°C) Temp: 98.8°F (37.1°C)

Sample
Signs/symptoms: Reduced LOC

Allergies: Penicillin (per wife)

Medications: None

Past medical history: Back surgery 8 years ago (per wife)

Last oral intake: Breakfast, 3 hours ago

Event leading to incident: Skiing

Transport and Destination

Transport Timing: Emergent/Rapid
Head: Obvious deformity and bleeding from jaw transport Destination: Trauma center
Neck: Unremarkable

Chest: Equal, bilateral breath sounds and shallow

Discussion Points
Abdomen: Soft, nontender
• What are the basic and advanced methods to maintain
Pelvis: Stable an airway?
Extremities: Abrasion of hands and knees, scant bleeding • Are there any perceived complications with the cold
winter gear the patient is wearing?
Back: Unremarkable
*
NAME: This answer sheet will be collected

COURSE: PHTLS 10th Edition Mandatory Pre-Test

# MISSED: GRADE:

1. A B C D E 26. A B C D E

2. A B C D E 27. A B C D E

3. A B C D E 28. A B C D E Grade Scale

4. A B C D E 29. A B C D E -1= 97.8

-2= 95.6
5. A B C D E 30. A B C D E -3= 93.4
6. A B C D E 31. A B C D E -4= 91.2
-5= 89
7. A B C D E 32. A B C D E -6= 86.8
-7= 84.6
8. A B C D E 33. A B C D E -8=82.4
-9= 80.2
9. A B C D E 34. A B C D E -10= 78
10. A B C D E 35. A B C D E -11=75.8
-12=73.6
11. A B C D E 36. A B C D E

12. A B C D E 37. A B C D E

13. A B C D E 38. A B C D E

14. A B C D E 39. A B C D E

15. A B C D E 40. A B C D E

16. A B C D E 41. A B C D E

17. A B C D E 42. A B C D E

18. A B C D E 43. A B C D E

19. A B C D E 44. A B C D E

20. A B C D E 45. A B C D E

21. A B C D E

22. A B C D E

23. A B C D E

24. A B C D E

25. A B C D E
*
 PHTLS 10th Edition Pre-Test
Please record your answers on the answer sheet provided.

1. A 15 year-old was involved in a convenience store robbery and has sustained a gunshot
wound to his lower left abdomen. He is semi-conscious with a blood pressure of 74/40, pulse
136 and a respiratory rate of 28. What should you do first?
a. Cover the wound with occlusive dressing.
b. Prepare for immediate transfer to a trauma center; establish IV on the way.
c. Start 2 large bore IV’s and infuse warmed normal saline 1000mL.
d. Apply an abdominal binder to the area to control the blood loss and minimize movement.

2. A 20 year-old female has fallen off the back of a truck while off road racing with friends. Her
jaw is clenched; she is responding to noxious stimuli only, and has an increasing ETCO2 with
a oxygen saturation of 80%. Initially, you unsuccessfully attempt to assist her ventilations
with a bag valve mask. The next best step to secure the airway would be:
a. Provide 100% oxygen with a non-rebreather mask
b. Insert a Laryngeal Tube Airway. (LTA)
c. Initiate a pharmacologically assisted intubation
d. Place the patient on a backboard for spinal motion control.

3. A young man fell 25 feet while rock climbing. He is alert but complaining of left sided chest
pain when he breathes. He has tenderness noted to the left side with severely diminished
breath sounds to that area. What is your initial thought regarding his presentation?
a. Simple pneumothorax
b. Flail chest
c. Torn diaphragm
d. Pulmonary contusion

4. A 45 y.o. man fell from a roof and has a Glasgow Coma Scale of 3. Ideally, what is the best
plan to proceed for advanced airway management?
a. Transport immediately; preform a cricothyrotomy en route.
b. Intubate using a video laryngoscope while maintaining spinal precautions.
c. If the patient has an intact gag reflex-insert a Perilaryngeal airway.
d. Open the airway with a head tilt maneuver and insert an oral airway.

5. Decerebrate posturing is a sign of?

a. Critically low blood sugar
b. Cheyne Stokes breathing
c. Basilar skull fracture
d. Herniation of the brain stem

6. A 24 week old pregnant woman is involved in a high speed car accident. She was wearing a
seat belt and you arrive to find her sitting by the side of the car and making a phone call to
her husband. She is crying and visibly upset but denies any cramping or bleeding. What is
your first priority of care?
a. Resume a focused pregnancy screening.
b. Place her on her left side to encourage optimal fetal blood return.
c. Assess her c-spine and consider spinal motion restriction.
d. Place on a backboard and apply a c-collar.
 7. You are attending to a 22 year-old man who was involved in a street fight. He sustained
some direct punches to his head. Although initially unconscious; he is now awake but
responds very slowly and now seems confused. What do you initially suspect?
a. Epidural hematoma
b. Hypoglycemia
c. Subdural hematoma
d. CVA

8. A 30 year-old woman fell from a galloping horse and has obvious facial trauma. She has a
respiratory rate of 8 and is not responding to verbal stimuli. You note gurgling type noises
coming from her airway. How would you proceed?
a. Insert a Laryngeal Mask Airway
b. Apply a rigid c-collar
c. Do a comprehensive neurological exam.
d. Perform a modified jaw thrust

9. You are responding to the local deli shop where the new kid has just amputated half of his
thumb on the meat slicer. After hemorrhage control, what is your initial treatment plan?
a. Place the thumb in the freezer
b. Put the severed part in isopropyl alcohol.
c. Wrap the thumb in moistened gauze
d. Place the severed part in a baggie for transport.

10. When multisystem trauma is suspected the focus shifts to?

a. Controlling significant external hemorrhage
b. Inserting an oral airway
c. Obtaining a Glasgow Coma score
d. Immobilizing fractures

11. A 20 year-old who hit the steering wheel during a MVA is complaining of shortness of breath
and pain to the chest. He is experiencing crepitus to the area and difficulty taking a deep
breath. What is the current priority?
a. Assisting his respirations with a bag valve mask
b. Inserting a chest tube for drainage.
c. Administer high flow oxygen.
d. Preform a pericardiocentesis.

12. What is the initial priority when a patient has an obvious open fracture of an extremity with
severe bleeding from the wound?
a. Splint with an air splint to provide pressure to the wound while immobilizing.
b. Apply direct pressure to the wound.
c. Apply a tourniquet to the area above the fracture to control blood loss.
d. Utilize an occlusive dressing to control the bleeding.

13. What can decrease the fall risk for an elderly individual?
a. Walking barefoot
b. Adding throw rugs along hallways and other open floor areas.
c. Eating a diet rich in antioxidants.
d. Regular visual screenings to maintain/assist with visual acuity.
14. One of the key points to consider when administering fluids to patients in shock is?
a. Fluids should be titrated to obtain a systolic blood pressure >120mmHg.
b. Transport should be delayed to secure 2 large bore IV’s for fluid resuscitation.
c. Ideally, IV fluids should be warmed: not room temperature or cold.
d. Synthetic colloid solutions such as dextran should be administered ASAP in the prehospital
setting.

15. Distributive shock includes which of the following?

a. Neurogenic and Anaphylactic
b. Spinal and Obstructive
c. Anaphylactic and Spinal
d. Cardiogenic and Obstructive

16. Which of the following regarding helmet removal is important to know?

a. Two trained rescuers are necessary to preform helmet removal.
b. Helmet removal ensures that no hidden bleeding is occurring into the posterior helmet.
c. It is necessary to assess and manage the airway.
d. All of the above.

17. A 6 year-old child was thrown from a roller coaster at a local amusement park. He has a
traumatic avulsion to his left lower calf area, and the bleeding has not been controlled by
direct pressure. What is your next action?
a. Apply a tourniquet
b. Pack a hemostatic agent dressing firmly into the wound.
c. Place an abdominal binder to slow blood flow to the legs.
d. Start an intraosseous IV to obtain rapid vascular access for fluid replacement.

18. Hitting the steering wheel during a violent head on collision often results in which type of
injury?
a. Traumatic brain injury
b. Cardiac contusion
c. Pelvic fracture
d. Open femur fracture

19. Which of the following symptoms might you see with a Basilar skull fracture?
a. ‘Raccoon eyes’ – discoloration around the eyes.
b. Leakage of cerebrospinal fluid from the nose or ears.
c. Blood behind the eardrum visualized via otoscope.
d. All of the above

20. When placing a pregnant patient on spinal motion restriction, which of the following will help
to minimize hypotension.
a. Place her on her left side and stack pillows for comfort.
b. On her left side; by elevating the right side of a backboard.
c. In a modified Trendelenburg
d. Supine

21. Which best describes a full thickness burn?

a. Painful blisters
b. Red painful areas that are oozing clear fluids
c. Thick dry white leathery burns.
d. None of the above.
22. A train accident has resulted in you caring for a patient that is conscious and alert with stable
vital signs. However, she has an angulated fracture to her arm with absent radial pulses. What
should you do next?
a. Elevate the extremity and apply ice for transport
b. Apply an ace bandage to the area to minimize movement for transport.
c. Attempt to realign the extremity prior to splinting.
d. It is not safe to realign a closed fracture. Splint to position and transport immediately.

23. A victim of gang violence has been stabbed in the chest. The wound is oozing blood slightly to
the left of the sternum. The patient is hypotensive and tachycardic with distant heart sounds
and jugular vein distention. What is your initial impression?
a. Flail chest
b. Tension pneumothorax
c. Cardiac contusion
d. Cardiac tamponade

24. A splint or cast that is applied too tightly may cause which of the following ‘limb threatening’
conditions characterized by pain, pallor and pulselessness to the affected extremity?
a. Necrosis
b. Fasciitis
c. Crush Syndrome
d. Compartment Syndrome

25. Circumferential burns are characterized as:

a. Life threatening due to the constriction of injured tissues.
b. A blistered pattern that is round
c. Burns that cover the torso and the extremities
d. Burns that measure greater that 50% of body surface area.

26. When intubation cannot be accomplished due to extrication difficulties; another life saving
option might be to:
a. Insert a nasopharyngeal airway.
b. Insert a supraglottic airway device
c. Administer ketamine and retry intubation.
d. Perform a cricothyrotomy

27. An elderly man slipped off a deck and hit his head yesterday. His wife now call for help and
reports he has decreased mental status, a headache and is going in and out of
consciousness.?
a. Stroke
b. Brain herniation
c. Subdural hematoma
d. Coup-countercoup injury

28. You are managing the care for a 19 yo old female who had a jet ski accident. She collided
with a boat and has sustained multiple fractures. She is on oxygen and bleeding is controlled
and she is semi-conscious. After 3 unsuccessful IV attempts, your supervisor suggests which
of the following?
a. Intraosseous access
b. Attempt another IV in the femoral area
c. Apply a non-rebreather mask.
d. Medicate for pain and have another provider attempt a peripheral IV.
29. Principles of physics suggest that when a solid object collides with a human body, a transfer
of significant energy occurs. Which of the following characteristics determine damage
severity?
a. Density of the moving object
b. The contact area of the impact
c. The cavitation that is created by the impact
d. All of the above

30. A difficult intubation should be anticipated for which individual?

a. A 12 year old drowning victim
b. A 29 year old burn victim with a weak cry and inspiratory stridor.
c. A 56 year old with an abdominal gunshot wound
d. An 85 year old stroke patient

31. A teenager was thrown from the back of a pickup truck and is complaining of severe pain in
her right chest area. Vital signs are stable, and she is alert, orientated and crying from pain.
What would you do to specifically address the pain?
a. Administer 20 mg of Morphine sublingually.
b. Administer 100 mcg of Fentanyl.
c. Administer 800 mg of Ibuprofen PO.
d. Administer 25 mcg of Ketamine.

32. A 45 yo man was pulled from a burning truck. Burns are noted to his entire left arm & hand
as well as the entire posterior surface of his torso. What is your estimation for body surface
that is affected by these burns?
a. 28%
b. 40%
c. 15%
d. 60%

33. You have responded to a nursing home where a 94 y.o. woman slipped and fell in the hallway
and is slow to respond to verbal stimuli; responsive to pain. Bleeding to the scalp is controlled.
Glascow Coma Scale is 5, BP 160/90, P 50, R 28 (irreg), Glucose 144. What should you
consider next?
a. Administer Fentanyl for pain.
b. Place in a hard c-collar.
c. Ask if the patient has a MOLST form or advanced directives.
d. Preform a head tilt chin-lift maneuver and insert an oral airway.

34. A 63 y.o. has been pulled from a high speed train accident. She does not have obvious signs
of bleeding but appears disoriented, pale, diaphoretic. Her BP is 74/52, P 134, R24. What type
of shock do you suspect?
a. Cardiogenic
b. Anaphylactic
c. Hemorrhagic
d. Neurogenic

35. The safety of the EMS team cannot be stressed enough. Which of the following events causes
the majority of deaths to EMS personnel?
a. Fire related injuries
b. Gun violence
c. Hazardous materials
d. Vehicle collisions (on scene or in an EMS unit)
36. A 14 y.o. fell from a high jump at the skateboard park. He is complaining of abrasions to his
left hip, knee and arm and hands. There was no loss of consciousness. Vitals are all stable.
What action should you take next?
a. Start an IV and administer meds for pain control.
b. Complete a primary and secondary survey.
c. Clean the abrasions with saline and apply dry bandages.
d. Apply oxygen via a nasal cannula.

37. When is rapid extrication indicated?

a. The patient has a life-threatening condition that cannot be corrected where the patient is
found.
b. The scene is unsafe for the EMS personnel and patient.
c. The patient needs to be moved rapidly to access other patients.
d. All of the above

38. A primary concern when a patient has an obvious traumatic facial injury is?
a. Altered mental status
b. Obstruction of the airway
c. How the patient will be able to communicate effectively
d. Depressed skull fracture

39. An explosion at a local warehouse has left a 50 y.o. man with back injuries from an impact.
He has sensation and movement to this lower legs. BP 140/92, P 108, R 28. His chief
complaint is excruciating back pain and guarding of the rib area. What pain medication would
be indicated?
a. high dose NSAID
b. Ketamine
c. Propofol
d. No pain meds until neuro can evaluate.

40. What should you do first if a burn victim with stridor suddenly stops breathing during the
initial assessment?
a. Insert an oropharyngeal airway and assist respirations.
b. Apply 100% O2 with a non-rebreather mask.
c. Suction with saline lavage to clear the airway.
d. Preform a needle cricothyrotomy.

41. Critical thinking on the scene is essential for optimizing patient outcomes. Which of the
following is utilized in the PHTLS primary surveys to assess the trauma patient?
a. PHTLS secondary assessment
b. XABCDE Assessment
c. The Golden Hour Review
d. MOLST Evaluation

42. The time to obtain the SAMPLER information is:

a. During the Primary Assessment
b. Upon scene arrival to determine the need for additional resources.
c. During the secondary survey, after life threatening conditions have been ruled out.
d. During the hospital hand off of patient care.
43. Which of the following is not a goal of the Golden Period?
a. Identify and treat life threatening injuries.
b. Minimize on scene time
c. Follow the strict one-hour time frame
d. Rapidly transport the patient to the closest facility.

44. The correct sequence for pre-hospital trauma care is:

a. Control significant hemorrhage, identify life threatening conditions, airway management.
b. Airway management, primary survey, control significant hemorrhage.
c. Airway management, identify mechanism of injury, control significant hemorrhage.
d. None of the above are correct.

45. One of the goals of prehospital trauma care is to keep the scene time brief when life
threatening conditions such as significant internal or external hemorrhage are present. Which
of the following represents the goal of adequate scene time to transport?
a. 15 min
b. 5 min
c. 10 min
d. None