ATLS Hemorrhage Control and Damage Control Surgery 1 — Questions and Answers
Question 1: What is the maximum estimated blood loss in Class I hemorrhage according to ATLS classification?
- Up to 750 mL (up to 15% blood volume) (Correct answer)
- Up to 1,500 mL (up to 30% blood volume)
- Up to 2,000 mL (up to 40% blood volume)
- Up to 500 mL (up to 10% blood volume)
Correct answer: Up to 750 mL (up to 15% blood volume)
Class I hemorrhage involves up to 750 mL of blood loss (up to 15% of total blood volume) with minimal physiologic changes.
Question 2: Which best defines damage control surgery (DCS) in the context of trauma care?
- Definitive repair of all injuries in a single prolonged operation
- Abbreviated surgery to control hemorrhage and contamination, followed by ICU resuscitation and planned reoperation (Correct answer)
- Surgery performed exclusively in the emergency department
- Minimally invasive laparoscopic techniques for all trauma patients
Correct answer: Abbreviated surgery to control hemorrhage and contamination, followed by ICU resuscitation and planned reoperation
DCS is an abbreviated initial operation focused on controlling hemorrhage and contamination, deferring definitive repair until physiology is restored in the ICU.
Question 3: Which triad of physiologic derangements is known as the 'lethal triad' in trauma patients?
- Hypertension, hyperkalemia, and alkalosis
- Hypothermia, acidosis, and coagulopathy (Correct answer)
- Tachycardia, hypotension, and oliguria
- Anemia, thrombocytosis, and hypoxia
Correct answer: Hypothermia, acidosis, and coagulopathy
The lethal triad of hypothermia, acidosis, and coagulopathy is a self-perpetuating cycle that greatly increases mortality in trauma patients.
Question 4: In penetrating torso trauma without suspected traumatic brain injury, permissive hypotension targets a systolic blood pressure of approximately:
- 90–100 mmHg until surgical hemorrhage control is achieved (Correct answer)
- 120–130 mmHg maintained with aggressive crystalloid infusion
- Below 70 mmHg in all trauma patients until OR arrival
- Normal blood pressure using vasopressors if needed
Correct answer: 90–100 mmHg until surgical hemorrhage control is achieved
Permissive hypotension targets SBP of 90–100 mmHg to avoid clot disruption without causing ischemia, used until surgical hemorrhage control is achieved.
Question 5: What blood product ratio is recommended during damage control resuscitation for massive hemorrhage?
- 1:1:1 ratio of packed red blood cells, fresh frozen plasma, and platelets (Correct answer)
- 4:1:1 ratio of packed red blood cells, fresh frozen plasma, and platelets
- 2:4:1 ratio of packed red blood cells, fresh frozen plasma, and platelets
- Packed red blood cells only until coagulopathy is confirmed by labs
Correct answer: 1:1:1 ratio of packed red blood cells, fresh frozen plasma, and platelets
A 1:1:1 ratio of PRBCs:FFP:platelets approximates whole blood and has been shown to improve outcomes in massive hemorrhage.
Question 6: Resuscitative thoracotomy performed in the emergency department for blunt trauma is most appropriate when the patient:
- Had signs of life on arrival and then loses vital signs in the ED (Correct answer)
- Arrives with no signs of life after more than 10 minutes of blunt traumatic arrest
- Is hemodynamically stable with suspected cardiac tamponade
- Has penetrating cardiac injury with pulseless electrical activity for more than 15 minutes
Correct answer: Had signs of life on arrival and then loses vital signs in the ED
ED resuscitative thoracotomy has the best outcome in blunt trauma patients who had signs of life on arrival and then deteriorated, as meaningful neurological survival is rare with prolonged absent signs of life.
Question 7: The primary goal of the first stage of a damage control laparotomy is:
- Complete bowel anastomosis and reconstruction
- Control of life-threatening hemorrhage and gross contamination (Correct answer)
- Definitive vascular repair of all injured vessels
- Fasciotomy closure and wound debridement
Correct answer: Control of life-threatening hemorrhage and gross contamination
The first stage of DCS focuses solely on hemorrhage control (packing, vessel ligation) and contamination control (bowel stapling), deferring reconstruction.
ATLS Hemorrhage Control and Damage Control Surgery 1
What is the maximum estimated blood loss in Class I hemorrhage according to ATLS classification?