CFA Hemorrhage & Emergency Response 2 — Questions and Answers
Question 1: When managing a patient with suspected internal hemorrhage after blunt abdominal trauma, which finding is MOST indicative of significant blood loss?
- Bradycardia with hypertension
- Tachycardia with hypotension (Correct answer)
- Normal pulse with decreased respiratory rate
- Hypertension with decreased urinary output
Correct answer: Tachycardia with hypotension
Tachycardia combined with hypotension is a classic sign of significant internal blood loss indicating compensatory shock.
Question 2: A patient sustains a femoral artery laceration. After applying direct pressure for 3 minutes, bleeding continues. What is the NEXT appropriate step?
- Remove the dressing to reassess the wound
- Apply a tourniquet proximal to the wound (Correct answer)
- Elevate the limb and apply ice packs
- Apply a distal tourniquet below the wound
Correct answer: Apply a tourniquet proximal to the wound
A tourniquet placed proximal to an arterial laceration that fails to respond to direct pressure is the correct escalation to control life-threatening extremity hemorrhage.
Question 3: Which class of hemorrhagic shock corresponds to a blood loss of 750–1500 mL in a 70 kg adult?
- Class I
- Class II (Correct answer)
- Class III
- Class IV
Correct answer: Class II
Class II hemorrhage represents 15–30% of blood volume loss (approximately 750–1500 mL), typically showing tachycardia but near-normal blood pressure.
Question 4: During a surgical case, the first assistant notices persistent oozing from a small vessel in the wound bed. The MOST appropriate immediate action is to:
- Irrigate the wound and observe for 5 minutes
- Apply bipolar electrocautery to the bleeding vessel (Correct answer)
- Pack the wound tightly with laparotomy sponges
- Request a blood transfusion immediately
Correct answer: Apply bipolar electrocautery to the bleeding vessel
Bipolar electrocautery precisely coagulates small vessels with minimal collateral thermal damage, making it the preferred tool for persistent intraoperative oozing.
Question 5: Which hemostatic agent works by providing a physical scaffold that activates the clotting cascade when applied to a bleeding wound?
- Tranexamic acid
- Oxidized regenerated cellulose (Correct answer)
- Fresh frozen plasma
- Protamine sulfate
Correct answer: Oxidized regenerated cellulose
Oxidized regenerated cellulose (e.g., Surgicel) acts as a physical matrix that promotes platelet aggregation and activates clotting factors at the wound site.
Question 6: A tourniquet has been applied to a patient's arm for hemorrhage control. The first assistant notes the time of application is critical because prolonged use beyond how long may cause irreversible limb damage?
- 30 minutes
- 1 hour
- 2 hours (Correct answer)
- 4 hours
Correct answer: 2 hours
Tourniquet application beyond 2 hours significantly increases the risk of nerve damage, ischemia, and irreversible tissue necrosis.
Question 7: A 58-year-old patient on warfarin therapy presents with uncontrolled surgical bleeding. Which intervention MOST rapidly reverses anticoagulation?
- Administer vitamin K orally
- Administer 4-factor prothrombin complex concentrate (PCC) (Correct answer)
- Infuse 2 units of packed red blood cells
- Apply topical thrombin to the wound
Correct answer: Administer 4-factor prothrombin complex concentrate (PCC)
4-factor PCC rapidly replaces vitamin K-dependent clotting factors (II, VII, IX, X) and reverses warfarin anticoagulation within minutes.
CFA Hemorrhage & Emergency Response 2
When managing a patient with suspected internal hemorrhage after blunt abdominal trauma, which finding is MOST indicative of significant blood loss?