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

For pelvic fracture hemorrhage unresponsive to binder, preperitoneal pelvic packing or angioembolization are the next interventions, chosen based on available resources and injury pattern.

Question 2

The correct sequence of the damage control surgery phases is:

Accepted Answer

Abbreviated surgery → ICU resuscitation → planned reoperation for definitive repair

Answer

DCS proceeds as: abbreviated operation (hemorrhage/contamination control) → ICU correction of the lethal triad → planned reoperation for definitive repair.

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

Citrate in stored blood products binds ionized calcium; during massive transfusion, hepatic metabolism cannot clear citrate fast enough, causing clinically significant hypocalcemia.

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

Eviscerated bowel should be covered with a moist sterile dressing to prevent desiccation and contamination; reduction and repair are surgical procedures performed in the OR.

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

The presence of the lethal triad (coagulopathy, acidosis, hypothermia) with ongoing hemorrhage is the classic indication for DCS, as prolonged definitive surgery will worsen physiology and increase mortality.

ATLS - Advanced Trauma Life Support Practice Test

ATLS - Advanced Trauma Life Support Practice Test

ATLS Hemorrhage Control and Damage Control Surgery 3