PREHOSPITAL TRAUMA LIFE SUPPORT (PHTLS)
FINAL EXAM QUESTIONS AND CORRECT ANSWERS
What is the most common cause of shock in the trauma patient?
blood loss/ hypovolemia
What is used prehospital isotonic, hypertonic or hypotonic?
isotonic
When oxygen does not reach the cell, what happens to the cell?
hypoxia
Internal Blood Loss: rib, radius or ulna, humerus, tibia or fubula, femur, pelvis
rib: 125, radius or ulna: 250-500, humerus: 500-750, tibia or fubula: 500-1000,
femur: 1000-2000, pelvis: 1000-massive
osteomyelitis
In an open fracture, a bone punctures the skin and the end can be contaminated
with bacteria from the skin or environment.
Contraindications to use of traction splint
-suspected pelvic fracture
-suspected femoral neck (hip) fracture
,-avulsion or amputation of the ankle and foot
-suspected fractures adjacent to the knee
Rami fracture
Isolated fracture of the inferior or superior rami which are generally minor and
do not require surgical stabilization.
Acetabular fracture
These fractures occur when the head of the femur is driven into the acetabulum
of the pelvis.
Pelvic ring fractures
Fractures of the pelvic ring are typically classified into three categories. Life-
threatening hemorrhage is probably most common with vertical shear fractures,
but it may be associated with each type of pelvic ring fracture.
3 categories of pelvic ring fractures:
1. Lateral compression fractures
2. anterior-posterior compression fractures
3. vertical shear fractures
1. Lateral compression fractures- occur when forces are applied to the lateral
aspects.
,2. anterior-posterior compression fractures- occur when forces are applied in an
anterior or posterior direction.
3. vertical shear fractures- (worst of all) occur when a vertical force is applied to
the hemi-pelvis. Blood vessels are often torn resulting in severe hemorrhage.
How do you splint dislocations?
Splint dislocations in "position found." However, when pulse is absent or weak,
gentle manipulation of the joint can be done to try to return blood flow.
Life takes precedence over limb
When faced with a critically injured trauma PT with extremity injuries that are not
bleeding, the focus should be on maintaing vital functions through resuscitation,
and only limited measures should be taken to address the extremity injuries.
Analgesics should not be administered when...
1. the PT presents with or develops signs and symptoms of shock.
2. pain is significantly relieved with stabilization and splinting.
3. the PT appears under the influence of drugs or alcohol.
Morphine
-for use in PTs with moderate to severe pain.
-dosage should be titrated to the PT's response to pain and physiological status.
, -can be given IV, IM, SQ
-Adult dosage: 2.5 to 15 mg, administered slowly over several minutes while
monitoring PT for relief.
Fentanyl
-has rapid onset and does not cause increase in release of histamine (as morphine
does), which can exacerbate hypotension in hypovolemic PTs.
-adult dosage: 50 to 100 mcg
-child dosage: 1 to 2 mcg/kg
As analgesics manage pain, sedatives address the anxiety. Sedatives include...
Sedatives include diazepam (Valium), midazolam (Versed), Iorazepam (Ativan),
and alprazolam (Xanax) are the best known and have benefit of ante grade
amnesia.
Management of amputated part
1. clean amputated part with lactated Ringer's (LR) solution.
2. wrap part in sterile gauze moistened with LR and place in plastic bag or
container.
3. label bag or container, and place it in outer container filled with crushed ice.
4. DO NOT place directly on ice.
5. transport along with PT to closest facility possible.
FINAL EXAM QUESTIONS AND CORRECT ANSWERS
What is the most common cause of shock in the trauma patient?
blood loss/ hypovolemia
What is used prehospital isotonic, hypertonic or hypotonic?
isotonic
When oxygen does not reach the cell, what happens to the cell?
hypoxia
Internal Blood Loss: rib, radius or ulna, humerus, tibia or fubula, femur, pelvis
rib: 125, radius or ulna: 250-500, humerus: 500-750, tibia or fubula: 500-1000,
femur: 1000-2000, pelvis: 1000-massive
osteomyelitis
In an open fracture, a bone punctures the skin and the end can be contaminated
with bacteria from the skin or environment.
Contraindications to use of traction splint
-suspected pelvic fracture
-suspected femoral neck (hip) fracture
,-avulsion or amputation of the ankle and foot
-suspected fractures adjacent to the knee
Rami fracture
Isolated fracture of the inferior or superior rami which are generally minor and
do not require surgical stabilization.
Acetabular fracture
These fractures occur when the head of the femur is driven into the acetabulum
of the pelvis.
Pelvic ring fractures
Fractures of the pelvic ring are typically classified into three categories. Life-
threatening hemorrhage is probably most common with vertical shear fractures,
but it may be associated with each type of pelvic ring fracture.
3 categories of pelvic ring fractures:
1. Lateral compression fractures
2. anterior-posterior compression fractures
3. vertical shear fractures
1. Lateral compression fractures- occur when forces are applied to the lateral
aspects.
,2. anterior-posterior compression fractures- occur when forces are applied in an
anterior or posterior direction.
3. vertical shear fractures- (worst of all) occur when a vertical force is applied to
the hemi-pelvis. Blood vessels are often torn resulting in severe hemorrhage.
How do you splint dislocations?
Splint dislocations in "position found." However, when pulse is absent or weak,
gentle manipulation of the joint can be done to try to return blood flow.
Life takes precedence over limb
When faced with a critically injured trauma PT with extremity injuries that are not
bleeding, the focus should be on maintaing vital functions through resuscitation,
and only limited measures should be taken to address the extremity injuries.
Analgesics should not be administered when...
1. the PT presents with or develops signs and symptoms of shock.
2. pain is significantly relieved with stabilization and splinting.
3. the PT appears under the influence of drugs or alcohol.
Morphine
-for use in PTs with moderate to severe pain.
-dosage should be titrated to the PT's response to pain and physiological status.
, -can be given IV, IM, SQ
-Adult dosage: 2.5 to 15 mg, administered slowly over several minutes while
monitoring PT for relief.
Fentanyl
-has rapid onset and does not cause increase in release of histamine (as morphine
does), which can exacerbate hypotension in hypovolemic PTs.
-adult dosage: 50 to 100 mcg
-child dosage: 1 to 2 mcg/kg
As analgesics manage pain, sedatives address the anxiety. Sedatives include...
Sedatives include diazepam (Valium), midazolam (Versed), Iorazepam (Ativan),
and alprazolam (Xanax) are the best known and have benefit of ante grade
amnesia.
Management of amputated part
1. clean amputated part with lactated Ringer's (LR) solution.
2. wrap part in sterile gauze moistened with LR and place in plastic bag or
container.
3. label bag or container, and place it in outer container filled with crushed ice.
4. DO NOT place directly on ice.
5. transport along with PT to closest facility possible.
