ITLS Hemorrhage Control and Shock 2

Question 1

A patient has a gunshot wound to the groin crease with arterial bleeding. A tourniquet cannot be applied at this junctional location. What is the most appropriate hemorrhage control technique?

Accepted Answer

Pack the wound with hemostatic gauze and apply direct pressure

Answer

Apply a tourniquet to the upper thigh

Answer

Apply pressure with a standard gauze pad only

Answer

Clamp the vessel with hemostats

Question 2

What is the lethal triad of trauma, and why does it create a vicious cycle?

Accepted Answer

Hypothermia, acidosis, and coagulopathy—each worsens the other two, creating a self-reinforcing downward spiral toward death

Answer

Pain, anxiety, and confusion

Answer

Tachycardia, hypotension, and altered mental status

Answer

Hemorrhage, infection, and organ failure

Question 3

When is it appropriate to apply a tourniquet in the prehospital setting according to current ITLS guidelines?

Accepted Answer

For life-threatening extremity hemorrhage that cannot be controlled by direct pressure, applied as early as needed

Answer

Only after all other methods have failed for at least 10 minutes

Answer

Only for amputations

Answer

Tourniquets are no longer recommended in civilian EMS

Question 4

A trauma patient presents with cool, mottled extremities, delayed capillary refill, and thready radial pulses but has a blood pressure of 118/90. What stage of shock is this patient in?

Accepted Answer

Compensated shock—the body is maintaining blood pressure through vasoconstriction despite significant volume loss

Answer

No shock—blood pressure is normal

Answer

Decompensated shock

Answer

Irreversible shock

Question 5

What is the role of tranexamic acid (TXA) in trauma hemorrhage management?

Accepted Answer

It is an antifibrinolytic that prevents clot breakdown and improves survival when given within 3 hours of injury

Answer

It replaces lost blood volume

Answer

It increases blood pressure through vasoconstriction

Answer

It provides pain relief that reduces hemorrhage-associated tachycardia

Question 6

How do you differentiate obstructive shock from hypovolemic shock in a trauma patient?

Accepted Answer

Obstructive shock (tension pneumothorax, cardiac tamponade) presents with JVD and often unilateral breath sounds changes, while hypovolemic shock presents with flat neck veins and clear lungs

Answer

They cannot be differentiated in the prehospital setting

Answer

Obstructive shock only occurs in blunt trauma

Answer

Hypovolemic shock always causes bradycardia