ATLS Hemorrhage Control and Damage Control Surgery 3

Question 1

A patient with a pelvic fracture and refractory hemorrhagic shock after pelvic binder application should next undergo:

Accepted Answer

Preperitoneal pelvic packing or angiographic embolization depending on institutional protocol

Answer

Immediate exploratory laparotomy as the first surgical procedure

Answer

External fixation alone as definitive hemorrhage control

Answer

Continued IV crystalloid resuscitation targeting normal blood pressure

Question 2

The correct sequence of the damage control surgery phases is:

Accepted Answer

Abbreviated surgery → ICU resuscitation → planned reoperation for definitive repair

Answer

ICU resuscitation → abbreviated surgery → planned reoperation

Answer

Definitive surgery → ICU monitoring → reoperation if needed

Answer

Resuscitation → ICU → abbreviated surgery → definitive surgery

Question 3

Hypocalcemia is a common complication during massive transfusion because:

Accepted Answer

Citrate preservative in stored blood products chelates and lowers ionized calcium

Answer

Red blood cells directly consume circulating ionized calcium

Answer

Platelets release calcium-binding proteins during transfusion

Answer

Hypothermia reduces gastrointestinal calcium absorption acutely

Question 4

In penetrating abdominal trauma with evisceration, the appropriate emergency management is:

Accepted Answer

Cover the eviscerated bowel with a moist sterile dressing and prepare for urgent surgery

Answer

Manually replace all eviscerated bowel and apply an abdominal binder

Answer

Clamp the eviscerated bowel loop to prevent further contamination

Answer

Reduce and repair the wound at the scene before transport

Question 5

Which clinical scenario most clearly indicates a patient requires damage control surgery rather than definitive repair?

Accepted Answer

Severe coagulopathy, metabolic acidosis, and hypothermia with ongoing hemorrhage requiring packing

Answer

Isolated penetrating wound with stable vital signs and no peritonitis

Answer

Blunt splenic laceration grade II with hemodynamic stability

Answer

Isolated extremity fracture with neurovascular compromise

Question 6

After damage control laparotomy, the primary goals of ICU resuscitation before planned reoperation include:

Accepted Answer

Correcting hypothermia, metabolic acidosis, and coagulopathy to prepare for safe reoperation

Answer

Normalizing all laboratory values within the first 60 minutes of ICU arrival

Answer

Returning the patient to the OR within 2 hours regardless of physiologic status

Answer

Avoiding blood product administration to prevent transfusion-related complications

Question 7

In damage control vascular surgery, a temporary intravascular shunt is used to:

Accepted Answer

Restore distal perfusion to the extremity while deferring definitive vascular repair

Answer

Permanently bypass the injured vessel segment without future repair

Answer

Control proximal arterial hemorrhage by occluding inflow

Answer

Monitor distal arterial pressure in a non-invasive manner