Hemorrhage Control and Shock Flashcards
6 cards from real ITLS practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 Hemorrhage Control and Shock flashcards as text
A patient with multiple stab wounds to the abdomen is hypotensive with a distended abdomen. Estimated time to the trauma center is 45 minutes. What is the appropriate fluid management strategy?
Answer: Use permissive hypotension with 250 mL crystalloid boluses, targeting a systolic BP of 80-90 mmHg while prioritizing rapid transport
For penetrating abdominal trauma with uncontrolled hemorrhage, permissive hypotension limits crystalloid to maintain minimal acceptable perfusion while avoiding clot disruption and hemodilution until surgical hemorrhage control.
What are the early, subtle signs of hemorrhagic shock that may precede changes in blood pressure?
Answer: Anxiety, tachycardia, narrowed pulse pressure, pallor, and delayed capillary refill
Early shock signs reflect sympathetic activation and peripheral vasoconstriction occurring while blood pressure is still maintained: anxiety, mild tachycardia, slight narrowing of pulse pressure, skin pallor, and delayed capillary refill (>2 seconds).
A patient with a massive scalp laceration has lost approximately 800 mL of blood at the scene. Why are scalp wounds particularly prone to significant hemorrhage?
Answer: The scalp has a rich, interconnected vascular network with vessels that do not vasoconstrict effectively because they are held open by the dense connective tissue of the galea aponeurotica
The scalp's dense vascular network has vessels tethered within the galea aponeurotica, preventing them from retracting and constricting when lacerated, which leads to persistent and often underestimated blood loss.
What is the difference between whole blood and component therapy (packed red blood cells, plasma, platelets) in trauma resuscitation?
Answer: Whole blood provides all components in physiologic ratios, while component therapy separates products and may require balanced ratios (1:1:1) to approximate the benefits of whole blood
Whole blood contains red cells, plasma, platelets, and clotting factors in natural ratios. Component therapy separates these, requiring balanced transfusion (1:1:1 ratio of RBCs:plasma:platelets) to approximate whole blood's hemostatic and oxygen-carrying benefits.
A trauma patient develops shock during air transport at altitude. How does altitude affect hemorrhagic shock physiology?
Answer: Reduced atmospheric pressure at altitude decreases oxygen partial pressure, worsening tissue hypoxia in a patient already compromised by hemorrhage-related reduced oxygen delivery
At altitude, reduced atmospheric pressure decreases the partial pressure of inspired oxygen (PiO2), compounding the already reduced oxygen delivery caused by hemorrhagic anemia. This accelerates tissue hypoxia and shock progression.
Why should ITLS providers avoid using the Trendelenburg position (legs elevated, head down) for treating hemorrhagic shock?
Answer: Evidence shows it does not sustainably improve blood pressure, may increase ICP, compromise respirations from abdominal viscera pressure on the diaphragm, and is potentially harmful in head-injured patients
The Trendelenburg position provides only transient blood pressure improvement, can increase intracranial pressure (harmful in TBI), impairs diaphragmatic excursion from abdominal contents pressing on it, and may increase aspiration risk.