CFA Hemorrhage & Emergency Response 3 — Questions and Answers
Question 1: During a laparotomy, the surgeon inadvertently nicks the inferior vena cava (IVC). The FIRST response by the first assistant should be to:
- Immediately clamp the aorta above the diaphragm
- Apply direct finger pressure over the injury site (Correct answer)
- Pack the abdomen and close the fascia emergently
- Suction the field aggressively to improve visualization
Correct answer: Apply direct finger pressure over the injury site
Direct finger or sponge pressure on an IVC injury is the immediate priority to control massive venous hemorrhage while the surgical team prepares definitive repair.
Question 2: Damage control surgery (DCS) for hemorrhage primarily aims to:
- Complete all definitive repairs in a single prolonged operation
- Control hemorrhage and contamination while deferring complex repairs (Correct answer)
- Maximize the use of advanced laparoscopic techniques
- Avoid the use of blood products by using crystalloid resuscitation
Correct answer: Control hemorrhage and contamination while deferring complex repairs
Damage control surgery focuses on rapid hemorrhage control and contamination prevention, leaving complex reconstructions for a later operation after physiologic stabilization.
Question 3: Which electrolyte abnormality is MOST commonly associated with massive blood transfusion and can worsen coagulopathy?
- Hyperkalemia
- Hypocalcemia (Correct answer)
- Hyponatremia
- Hypomagnesemia
Correct answer: Hypocalcemia
Stored blood contains citrate which chelates ionized calcium; massive transfusion depletes calcium needed for coagulation factor activation, worsening coagulopathy.
Question 4: A patient undergoing an emergent splenectomy begins showing a prolonged PT/INR, low fibrinogen, and thrombocytopenia. This constellation MOST likely represents:
- Heparin-induced thrombocytopenia (HIT)
- Disseminated intravascular coagulation (DIC) (Correct answer)
- Thrombotic thrombocytopenic purpura (TTP)
- Von Willebrand disease exacerbation
Correct answer: Disseminated intravascular coagulation (DIC)
DIC presents with simultaneous consumption of clotting factors and platelets, producing elevated PT, low fibrinogen, and thrombocytopenia in a massively bleeding patient.
Question 5: The 'lethal triad' of trauma refers to the combination of:
- Hypoxia, acidosis, and coagulopathy
- Hypothermia, acidosis, and coagulopathy (Correct answer)
- Hypotension, tachycardia, and coagulopathy
- Hypothermia, hyperkalemia, and metabolic alkalosis
Correct answer: Hypothermia, acidosis, and coagulopathy
The lethal triad — hypothermia, acidosis, and coagulopathy — creates a self-perpetuating cycle that dramatically increases mortality in severely injured patients.
Question 6: Permissive hypotension during hemorrhagic shock resuscitation is generally targeted at a systolic blood pressure of:
- 60–70 mmHg
- 80–90 mmHg (Correct answer)
- 100–110 mmHg
- 120–130 mmHg
Correct answer: 80–90 mmHg
Permissive hypotension targets SBP of 80–90 mmHg to maintain end-organ perfusion while avoiding hydrostatic disruption of forming clots before surgical hemorrhage control.
Question 7: Which suture technique is preferred for rapid temporary control of a bleeding vessel during emergent hemorrhage?
- Running mattress suture
- Figure-of-eight suture (Correct answer)
- Horizontal mattress suture
- Pledgeted suture repair
Correct answer: Figure-of-eight suture
A figure-of-eight suture provides rapid, secure ligation of a bleeding vessel by encircling and compressing the tissue on both sides of the vessel.
CFA Hemorrhage & Emergency Response 3
During a laparotomy, the surgeon inadvertently nicks the inferior vena cava (IVC).
The FIRST response by the first assistant should be to: