PHTLS 10TH EDITION
FINAL EXAMINATION
________________________________________
Prehospital Trauma Life Support
Comprehensive Trauma Care Competency Assessment
National Association of Emergency Medical Technicians
American College of Surgeons Committee on Trauma
2026/2027 Academic Year
Total Questions: 50 Multiple-Choice Questions
Testing Time: 90 Minutes
Passing Score: 80% (40/50 Correct)
Certification Validity: 4-Year Renewal
Format: Computer-Based or Proctored Written
Edition Alignment: PHTLS 10th Edition (NAEMT/ACS-COT)
, EXAMINATION INSTRUCTIONS
This examination consists of 50 multiple-choice questions aligned with the PHTLS 10th Edition
curriculum, NAEMT standards, and American College of Surgeons Committee on Trauma guidelines.
Questions cover critical domains including trauma assessment and management (XABCDE), physiology of
life and death, kinematics of trauma, scene management, airway and ventilation, shock and hemorrhage
control, chest/abdominal/pelvic/spinal/head/extremity trauma, special populations, and MCI triage
principles.
Each question has four answer options (A, B, C, D). Select the single best answer for each question. Some
questions are scenario-based and require application of PHTLS principles to clinical decision-making. Read
each question carefully before selecting your answer.
You have 90 minutes to complete this examination. A passing score of 80% (40 out of 50 correct
answers) is required for PHTLS certification eligibility. The PHTLS provider credential requires 4-year
renewal with recertification course or continuing education per NAEMT guidelines.
Mark your answers clearly. If you change an answer, ensure your final selection is unambiguous. No
additional points are deducted for incorrect answers, so you should attempt every question.
, PHTLS 10TH EDITION FINAL EXAMINATION
50 Questions | 90 Minutes | Passing Score: 80%
1. In the XABCDE primary survey, what is the FIRST priority when assessing a trauma
patient?
A. Airway management
B. Breathing assessment
C. eXsanguination control
D. Disability evaluation
Correct Answer: C
Rationale: The XABCDE approach replaces the traditional ABC sequence by placing eXsanguination
control first. This change reflects the evidence that exsanguinating hemorrhage can kill a patient faster
than an airway compromise. Massive external hemorrhage must be addressed immediately with direct
pressure, tourniquet application, or hemostatic dressings before proceeding to airway management. The
PHTLS 10th Edition emphasizes that catastrophic bleeding can cause death within 2-3 minutes, whereas a
patient with a patent airway can typically maintain adequate oxygenation for several minutes through
existing reserves. This paradigm shift underscores the critical importance of controlling life-threatening
hemorrhage as the absolute first intervention in the primary survey.
2. During the primary survey of a trauma patient, you note absent breath sounds on the left
side, jugular venous distension, and tracheal deviation to the right. What is the MOST
appropriate immediate intervention?
A. Needle decompression of the left chest
B. Endotracheal intubation
C. Rapid fluid bolus administration
D. Chest tube insertion
Correct Answer: A
Rationale: The clinical presentation described is the classic triad of tension pneumothorax: absent breath
sounds on the affected side, jugular venous distension, and tracheal deviation away from the affected side.
Tension pneumothorax is a life-threatening condition that requires immediate needle decompression before
any other intervention. The PHTLS standard approach is to perform needle decompression at the second
intercostal space, midclavicular line, or alternatively at the fourth or fifth intercostal space, midaxillary
line (the lateral approach is increasingly recommended in the 10th Edition). Delaying decompression for
intubation or chest tube placement can result in cardiovascular collapse and death. The needle
decompression converts the tension pneumothorax into a simple pneumothorax, providing immediate relief
of the positive intrathoracic pressure that is compromising venous return and cardiac output.
3. When performing the secondary survey on a stable trauma patient, which of the following
components is included in the AMPLE history?
A. Allergies, Medications, Past medical history, Last meal, Events of injury
B. Airway, Breathing, Circulation, Disability, Exposure
C. Assessment, Management, Plan, Laboratory, Evaluation
D. Anatomy, Mechanism, Physiology, Laboratory, Evaluation
Correct Answer: A
Rationale: The AMPLE history is a focused, efficient mnemonic used during the secondary survey of
trauma patients. AMPLE stands for Allergies, Medications, Past medical history, Last meal, and Events
surrounding the injury. This abbreviated history is designed to gather critical information that may affect
clinical decision-making without consuming excessive time during the golden hour of trauma care.
Knowing allergies prevents administration of contraindicated medications, current medications may
reveal anticoagulant use or chronic conditions, past medical history may identify comorbidities affecting
treatment, last meal timing is relevant if anesthesia becomes necessary, and understanding the events of
injury helps anticipate specific injury patterns. The ABCDE and XABCDE sequences refer to the primary
survey, not the AMPLE history.
4. According to PHTLS 10th Edition guidelines, what is the recommended interval for
reassessment of a trauma patient during transport?
A. Every 5 minutes
B. Every 10 minutes
C. Every 15 minutes
D. Every 20 minutes
FINAL EXAMINATION
________________________________________
Prehospital Trauma Life Support
Comprehensive Trauma Care Competency Assessment
National Association of Emergency Medical Technicians
American College of Surgeons Committee on Trauma
2026/2027 Academic Year
Total Questions: 50 Multiple-Choice Questions
Testing Time: 90 Minutes
Passing Score: 80% (40/50 Correct)
Certification Validity: 4-Year Renewal
Format: Computer-Based or Proctored Written
Edition Alignment: PHTLS 10th Edition (NAEMT/ACS-COT)
, EXAMINATION INSTRUCTIONS
This examination consists of 50 multiple-choice questions aligned with the PHTLS 10th Edition
curriculum, NAEMT standards, and American College of Surgeons Committee on Trauma guidelines.
Questions cover critical domains including trauma assessment and management (XABCDE), physiology of
life and death, kinematics of trauma, scene management, airway and ventilation, shock and hemorrhage
control, chest/abdominal/pelvic/spinal/head/extremity trauma, special populations, and MCI triage
principles.
Each question has four answer options (A, B, C, D). Select the single best answer for each question. Some
questions are scenario-based and require application of PHTLS principles to clinical decision-making. Read
each question carefully before selecting your answer.
You have 90 minutes to complete this examination. A passing score of 80% (40 out of 50 correct
answers) is required for PHTLS certification eligibility. The PHTLS provider credential requires 4-year
renewal with recertification course or continuing education per NAEMT guidelines.
Mark your answers clearly. If you change an answer, ensure your final selection is unambiguous. No
additional points are deducted for incorrect answers, so you should attempt every question.
, PHTLS 10TH EDITION FINAL EXAMINATION
50 Questions | 90 Minutes | Passing Score: 80%
1. In the XABCDE primary survey, what is the FIRST priority when assessing a trauma
patient?
A. Airway management
B. Breathing assessment
C. eXsanguination control
D. Disability evaluation
Correct Answer: C
Rationale: The XABCDE approach replaces the traditional ABC sequence by placing eXsanguination
control first. This change reflects the evidence that exsanguinating hemorrhage can kill a patient faster
than an airway compromise. Massive external hemorrhage must be addressed immediately with direct
pressure, tourniquet application, or hemostatic dressings before proceeding to airway management. The
PHTLS 10th Edition emphasizes that catastrophic bleeding can cause death within 2-3 minutes, whereas a
patient with a patent airway can typically maintain adequate oxygenation for several minutes through
existing reserves. This paradigm shift underscores the critical importance of controlling life-threatening
hemorrhage as the absolute first intervention in the primary survey.
2. During the primary survey of a trauma patient, you note absent breath sounds on the left
side, jugular venous distension, and tracheal deviation to the right. What is the MOST
appropriate immediate intervention?
A. Needle decompression of the left chest
B. Endotracheal intubation
C. Rapid fluid bolus administration
D. Chest tube insertion
Correct Answer: A
Rationale: The clinical presentation described is the classic triad of tension pneumothorax: absent breath
sounds on the affected side, jugular venous distension, and tracheal deviation away from the affected side.
Tension pneumothorax is a life-threatening condition that requires immediate needle decompression before
any other intervention. The PHTLS standard approach is to perform needle decompression at the second
intercostal space, midclavicular line, or alternatively at the fourth or fifth intercostal space, midaxillary
line (the lateral approach is increasingly recommended in the 10th Edition). Delaying decompression for
intubation or chest tube placement can result in cardiovascular collapse and death. The needle
decompression converts the tension pneumothorax into a simple pneumothorax, providing immediate relief
of the positive intrathoracic pressure that is compromising venous return and cardiac output.
3. When performing the secondary survey on a stable trauma patient, which of the following
components is included in the AMPLE history?
A. Allergies, Medications, Past medical history, Last meal, Events of injury
B. Airway, Breathing, Circulation, Disability, Exposure
C. Assessment, Management, Plan, Laboratory, Evaluation
D. Anatomy, Mechanism, Physiology, Laboratory, Evaluation
Correct Answer: A
Rationale: The AMPLE history is a focused, efficient mnemonic used during the secondary survey of
trauma patients. AMPLE stands for Allergies, Medications, Past medical history, Last meal, and Events
surrounding the injury. This abbreviated history is designed to gather critical information that may affect
clinical decision-making without consuming excessive time during the golden hour of trauma care.
Knowing allergies prevents administration of contraindicated medications, current medications may
reveal anticoagulant use or chronic conditions, past medical history may identify comorbidities affecting
treatment, last meal timing is relevant if anesthesia becomes necessary, and understanding the events of
injury helps anticipate specific injury patterns. The ABCDE and XABCDE sequences refer to the primary
survey, not the AMPLE history.
4. According to PHTLS 10th Edition guidelines, what is the recommended interval for
reassessment of a trauma patient during transport?
A. Every 5 minutes
B. Every 10 minutes
C. Every 15 minutes
D. Every 20 minutes
