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PHTLS Study Guide/Notes

The document provides an overview of key topics covered in the PHTLS (Prehospital Trauma Life Support) study guide and exam, including the primary and secondary assessments, bleeding control, shock, pneumothorax and flail chest, brain injuries, fluid resuscitation, burn care, airway management, use of ETCO2, spinal immobilization principles, trauma arrests, and golden principles of trauma care. It also lists some topics that commonly cause confusion on the PHTLS final exam, such as the prevalence of geriatric falls, scoop stretcher use, tension pneumothorax management, epidural hematoma patterns, dermatome anatomy, non-viable trauma patients, breathing assessments, he

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1K views

PHTLS Study Guide/Notes

The document provides an overview of key topics covered in the PHTLS (Prehospital Trauma Life Support) study guide and exam, including the primary and secondary assessments, bleeding control, shock, pneumothorax and flail chest, brain injuries, fluid resuscitation, burn care, airway management, use of ETCO2, spinal immobilization principles, trauma arrests, and golden principles of trauma care. It also lists some topics that commonly cause confusion on the PHTLS final exam, such as the prevalence of geriatric falls, scoop stretcher use, tension pneumothorax management, epidural hematoma patterns, dermatome anatomy, non-viable trauma patients, breathing assessments, he

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PHTLS Study Guide/Notes

“Priority of care in the critical multi-system trauma patient is rapid identification and
management of life-threatening injuries.”

“The most common basis of life-threatening injuries is lack of adequate tissue


oxygenation, which leads to anaerobic metabolism.”

▪ Primary Assessment
o “ABCDE” – know and understand what constitutes each part of the
primary assessment

▪ Secondary Assessment – AKA - the “head-to-toe” assessment


o Objective: “identify injuries or problems that were not identified during
the primary assessment”.
o These injuries should be minor and not life-threatening.

▪ Bleeding Control
o Steps of bleeding control
o Use of a tourniquet
o Place of hemostatic agents in bleeding control.

▪ Types of shock:
o Know the types of shock and characteristics of each.
▪ Example: Neurogenic shock vs. Hemorrhagic shock
o Know what system initially response to compensate for blood loss

▪ Pneumothorax and Flail Chest - Signs/symptoms and treatment

▪ Brain injuries:
o Types and characteristics of each type
o Understand secondary brain injury
o Understand “controlled hyperventilation” and risks of hyperventilation

▪ Fluid resuscitation in Trauma:


o Why don’t we do excessive fluid resuscitation anymore?
o What should guide our fluid resuscitation?
o What should be our target blood pressure be in a trauma patient?

▪ Burn care and treatment


o Wet vs. dry dressing
▪ Airway management of the trauma patient
o Suctioning
o What is the main goal?

▪ ETCO2 – it’s place in airway care of the trauma patient

▪ Understand the new standards of “Selective Spinal Immobilization”

▪ Trauma arrest – when to work vs. when to call without working

▪ What are the PHTLS “Golden Principles of Trauma Care”?


Things we found on the PHTLS Final Exam that seem confusing or weird:

• More geriatric trauma patients die from falls than ANY other mechanism even if there
are other mechanisms that seem more dangerous. Read the question—it wants to
know a statistic and so realize that there are LOTS of geriatric falls.

• The scoop stretcher is a favorite of the PHTLS people for moving patients quickly to a
backboard even though you don’t see that much in our area.

• Remember to remove the occlusive chest seal when your patient develops a tension
pneumo BEFORE you needle the chest. A miracle might happen and the removal of
that seal might actually lead to a venting of the built up pressure. Chucks and clots
and dirt and shirt pieces might actually move out of the way and allow that air bubble
to escape. Miracles happen in PHTLS just like they do in ACLS (everyone lives!!!).

• A patient with an epidural hematoma tends to have a loss of consciousness and then a
lucid interval and then deterioration according to PHTLS legend.

• Dermatomes matter if you want to get #39 correct. Know the nipple line and belly
button line and where the corresponding injury is for those. Know that C3-4-5 keep the
diaphragm alive.

• Blunt trauma patient who is pulseless and apneic on your initial assessment is non-
viable according to PHTLS.

• Breathing should not be noticeable—not labored, not noisy. If you notice it, deal with it.

• Hemostatic agents help control bleeding and they are cool per PHTLS.

• Usually we make fun of people that use weird (although correct) medical terminology
like bradypnea but PHTLS has weird people writing questions.

• When suctioning your PHTLS patient, don’t be stuck in the ridiculous Irrational
Registry rules—suction it out even if that takes longer than some magical and fictitious
time limit.

• When your patient is herniating, you should use controlled hyperventilation at a rate of
___ for adults and ___ for kids even though you know that you may cause some
cerebral vasoconstriction—the guy is going to croak if you don’t do something even if it
has a horrendous side effect.

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