Hemorrhage Control and Damage Control Surgery Flashcards

To maximize benefit in traumatic hemorrhage, tranexamic acid (TXA) should be administered:

Answer: Within 3 hours of injury, with the first dose given as early as possible

Evidence from the CRASH-2 trial shows TXA is most effective within 3 hours of injury; benefit decreases with time and may be harmful if given after 3 hours.

Which hemostatic dressing is recommended by ATLS guidelines for uncontrolled external extremity hemorrhage not amenable to tourniquet?

Answer: Combat gauze (kaolin-impregnated) or similar zeolite/chitosan-based hemostatic agent

ATLS recommends hemostatic dressings such as kaolin-impregnated combat gauze or chitosan-based products packed firmly into wounds that cannot be controlled with a tourniquet.

A patient with an unstable pelvic ring fracture and hemodynamic instability should initially receive:

Answer: Pelvic binder or circumferential sheet wrap for provisional stabilization

A pelvic binder or sheet wrap reduces pelvic volume, tamponades venous bleeding, and stabilizes the fracture as the critical first step before imaging or surgery.

When REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) is placed in Zone 1, it is used to address hemorrhage from:

Answer: Intra-abdominal and thoracoabdominal hemorrhage above the celiac axis

Zone 1 REBOA placement (descending thoracic aorta) controls hemorrhage from abdominal solid organs and major vessels by occluding aortic flow above the bleeding site.

A tourniquet applied to control extremity hemorrhage should be positioned:

Answer: 2–3 inches proximal to the wound with sufficient pressure to obliterate the distal pulse

Tourniquets must be placed proximal to the injury and tightened enough to eliminate the distal pulse, ensuring arterial hemorrhage is controlled.

Which temporary abdominal closure technique is most commonly used after damage control laparotomy?

Answer: Negative pressure wound therapy (vacuum-assisted closure device)

Negative pressure wound therapy (VAC) is the preferred temporary abdominal closure after DCS as it manages fluid, prevents fascial retraction, and facilitates reoperation.

Class III hemorrhage (30–40% blood volume loss) is most characteristically associated with which clinical findings?

Answer: Tachycardia, decreased pulse pressure, altered mental status, and decreased urine output

Class III hemorrhage (1,500–2,000 mL) produces marked tachycardia, narrow pulse pressure, anxiety or confusion, and decreased urine output reflecting organ hypoperfusion.