Hemorrhage & Emergency Response Flashcards

A patient is hemorrhaging from a posterior hepatic vein injury. The surgeon performs a Pringle maneuver without effect. This finding indicates:

Answer: Bleeding from a vessel that does not depend on portal inflow

The Pringle maneuver occludes the portal triad; if bleeding continues, it originates from the hepatic veins or IVC which are not controlled by this maneuver.

In a trauma patient with suspected tension pneumothorax presenting with hemorrhagic shock, immediate management includes:

Answer: Needle decompression at the second intercostal space, midclavicular line

Tension pneumothorax is a clinical diagnosis requiring immediate needle decompression without waiting for imaging, as cardiac output can arrest within minutes.

Which topical hemostatic agent is CONTRAINDICATED for use inside a body cavity or near neural tissue due to swelling and compression risk?

Answer: Oxidized regenerated cellulose (Surgicel) in large quantities

Oxidized regenerated cellulose can swell significantly when saturated with blood, making large quantities dangerous near enclosed spaces or neural structures due to compression risk.

During a right colectomy, the first assistant observes inadvertent entry into the right ureter with active bleeding. The PRIORITY action is:

Answer: Apply hemostatic clips to visible bleeding vessels and alert the surgeon

Applying hemostatic clips under direct visualization to control active bleeding while notifying the surgeon allows for controlled repair and avoids further ureteral damage.

Which blood product is MOST effective for correcting isolated fibrinogen deficiency in a bleeding surgical patient?

Answer: Cryoprecipitate

Cryoprecipitate is the concentrated source of fibrinogen, factor VIII, vWF, and factor XIII, making it the first-line product for correcting fibrinogen deficiency.

A scrub technician hands the first assistant a pledget. In the context of hemorrhage control, a pledget is used to:

Answer: Reinforce suture lines on fragile or friable vascular tissue

Pledgets are small felt or Teflon pads used to back sutures on friable vessels, distributing suture tension and preventing the suture from tearing through the tissue.

Which intraoperative sign BEST indicates that hemorrhagic shock has been adequately resuscitated during damage control surgery?

Answer: Normalization of serum lactate and base deficit

Normalization of lactate and base deficit reflects resolution of tissue hypoperfusion and anaerobic metabolism, confirming adequate cellular resuscitation beyond just hemodynamic parameters.