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Prehospital Trauma Life Support (PHTLS) concepts, 10th Edition
Question 1: What is the primary purpose of understanding the kinematics of trauma at
a scene?
A. To determine who is at fault for the incident
B. To predict likely injury patterns based on the forces and mechanisms involved
C. To calculate scene time only
D. To determine transport destination based on distance alone
Answer: B. To predict likely injury patterns based on the forces and mechanisms
involved
Rationale: PHTLS teaches that analyzing kinematics — the mechanism, direction, and
magnitude of forces applied to the body — allows the provider to form an index of
suspicion for specific injuries that may not be immediately obvious, guiding a more
thorough and targeted assessment.
Question 2: In the PHTLS approach, what does the acronym 'MARCH' primarily help
providers prioritize?
A. Scene documentation order
B. The sequence of critical interventions: Massive hemorrhage, Airway, Respiration,
Circulation, Hypothermia/Head injury
C. The order in which patients are triaged at a mass casualty incident only
, D. Medication administration order
Answer: B. The sequence of critical interventions: Massive hemorrhage, Airway,
Respiration, Circulation, Hypothermia/Head injury
Rationale: PHTLS 10th Edition emphasizes the MARCH algorithm (Massive hemorrhage,
Airway, Respiration, Circulation, Hypothermia/Head injury) as the priority sequence for
the primary survey, reflecting that uncontrolled hemorrhage is now recognized as the
most time-critical, preventable cause of death in trauma.
Question 3: During the scene size-up, what is the single highest priority before
approaching any trauma patient?
A. Beginning the primary survey immediately
B. Ensuring scene safety for the provider and crew
C. Determining the patient's identity
D. Calling for additional resources
Answer: B. Ensuring scene safety for the provider and crew
Rationale: PHTLS stresses that scene safety must always be verified first; a provider who
becomes injured or incapacitated cannot help the patient and becomes an additional
casualty, compounding the incident and diverting resources.
Question 4: What information does the mechanism of injury (MOI) in a motor vehicle
crash provide that is most clinically useful?
A. The exact insurance liability
B. An index of suspicion for specific injury patterns based on the type and direction of
impact
C. The patient's pre-existing medical history
D. The legal speed limit of the roadway
Answer: B. An index of suspicion for specific injury patterns based on the type and
direction of impact
Rationale: Frontal, lateral, rear, rotational, and rollover impacts each produce
characteristic injury patterns (e.g., frontal impacts are associated with lower extremity,
chest, and head injuries via the 'up-and-over' or 'down-and-under' pathways), which
PHTLS uses to heighten suspicion during assessment even absent obvious external
trauma.
,Question 5: What does the concept of the 'Golden Period' in trauma care emphasize?
A. Exactly 60 minutes from injury to definitive care is mandatory for survival
B. Minimizing scene time and time to definitive care as injury severity increases,
since the interval to appropriate treatment affects outcomes
C. Only surgical patients benefit from time-based care
D. Transport should always be delayed until full assessment is complete
Answer: B. Minimizing scene time and time to definitive care as injury severity
increases, since the interval to appropriate treatment affects outcomes
Rationale: PHTLS teaches that the 'Golden Period' is a conceptual, not a literal fixed time,
principle: the sooner a critically injured patient reaches definitive surgical or hospital
care, the better the potential outcome, driving the philosophy of limiting scene time for
critical patients to essential, life-saving interventions only.
Question 6: Which of the following best describes 'load and go' or the PHTLS concept of
limiting on-scene time for critical trauma patients?
A. Performing all possible interventions before moving the patient
B. Rapidly packaging and transporting critical patients while performing only
essential life-saving interventions en route or immediately prior to transport
C. Waiting for the patient to stabilize on scene before transport
D. Only applies to penetrating trauma, never blunt trauma
Answer: B. Rapidly packaging and transporting critical patients while performing only
essential life-saving interventions en route or immediately prior to transport
Rationale: For patients identified as critical during the primary survey, PHTLS
recommends limiting scene time (often targeting approximately 10 minutes when
feasible) and performing only essential interventions (airway, hemorrhage control)
before rapid transport, since definitive treatment such as surgery cannot be provided in
the field.
Question 7: In falls, what factor is most predictive of injury severity according to PHTLS
kinematics principles?
A. The patient's age alone
B. The height of the fall, the surface landed on, and the body part that impacted first
C. The time of day the fall occurred
D. Whether the fall was witnessed
, Answer: B. The height of the fall, the surface landed on, and the body part that
impacted first
Rationale: PHTLS teaches that fall injury severity correlates with the distance fallen
(energy = mass x gravity x height), the hardness/compliance of the landing surface, and
the pattern of energy transmission through the body based on which part struck first, all
of which shape the index of suspicion for specific injuries.
Question 8: What is the significance of a 'contrecoup' injury in blunt trauma?
A. Injury occurring only at the point of direct impact
B. Injury occurring on the side of the brain opposite the point of impact, due to the
brain's continued motion within the skull
C. A type of penetrating wound
D. An injury exclusive to the abdomen
Answer: B. Injury occurring on the side of the brain opposite the point of impact, due
to the brain's continued motion within the skull
Rationale: In blunt head trauma, the brain can strike the skull at the point of impact
(coup injury) and then rebound to strike the opposite interior skull surface (contrecoup
injury) due to its continued momentum, which PHTLS identifies as a key kinematic
concept explaining bilateral or diffuse brain injury patterns.
Question 9: For penetrating trauma such as gunshot wounds, what factors determine
the extent of tissue damage per PHTLS cavitation principles?
A. Only the entry wound size
B. Kinetic energy, the projectile's yaw/tumble, fragmentation, and the density of
tissue struck, contributing to temporary and permanent cavitation
C. The color of the weapon used
D. Only the caliber of the bullet
Answer: B. Kinetic energy, the projectile's yaw/tumble, fragmentation, and the
density of tissue struck, contributing to temporary and permanent cavitation
Rationale: PHTLS explains that a projectile's damage results from kinetic energy transfer
(proportional to mass and the square of velocity), along with yaw, tumble, and
fragmentation, creating both a permanent cavity (crushed tissue track) and temporary
cavity (stretched tissue), with denser tissues like liver or bone sustaining more damage
than elastic tissues like lung.