PHTLS Study Guide/Notes
PHTLS Study Guide/Notes
PHTLS Study Guide/Notes
“Priority of care in the critical multi-system trauma patient is rapid identification and
management of life-threatening injuries.”
▪ Primary Assessment
o “ABCDE” – know and understand what constitutes each part of the
primary assessment
▪ 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
▪ Brain injuries:
o Types and characteristics of each type
o Understand secondary brain injury
o Understand “controlled hyperventilation” and risks of hyperventilation
• 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.