ATLS Hemorrhage Control and Damage Control Surgery 2

Question 1

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

Accepted Answer

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

Answer

Only after 24 hours when coagulopathy is confirmed by laboratory values

Answer

Exclusively in penetrating trauma patients with TBI

Answer

As a slow continuous infusion without an initial loading dose

Question 2

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

Accepted Answer

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

Answer

Standard dry gauze with firm direct pressure alone

Answer

Petroleum-impregnated gauze to keep the wound moist

Answer

Silver-impregnated antimicrobial dressings

Question 3

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

Accepted Answer

Pelvic binder or circumferential sheet wrap for provisional stabilization

Answer

Immediate surgical exploration of the retroperitoneum

Answer

Greater than 2 liters of crystalloid to restore blood pressure before any intervention

Answer

CT pelvis with contrast prior to any mechanical intervention

Question 4

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

Accepted Answer

Intra-abdominal and thoracoabdominal hemorrhage above the celiac axis

Answer

Isolated pelvic venous bleeding below the aortic bifurcation

Answer

Extremity arterial injuries distal to the femoral vessels

Answer

Carotid and subclavian artery injuries in the neck

Question 5

A tourniquet applied to control extremity hemorrhage should be positioned:

Accepted Answer

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

Answer

As close to the wound as possible to minimize ischemic tissue

Answer

At the most distal point of the limb for greatest mechanical advantage

Answer

Removed and re-applied every 30 minutes to prevent limb ischemia

Question 6

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

Accepted Answer

Negative pressure wound therapy (vacuum-assisted closure device)

Answer

Primary fascial closure with running PDS suture

Answer

Simple skin stapling without fascial approximation

Answer

No closure at all — the abdomen is left open without coverage

Question 7

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

Accepted Answer

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

Answer

Normal heart rate and blood pressure with mild anxiety

Answer

Bradycardia, hypertension, and respiratory depression (Cushing's response)

Answer

Loss of consciousness with otherwise normal vital signs