Hemorrhage Control and Shock Flashcards

A 28-year-old male has a deep, actively bleeding laceration to his right upper arm after an industrial accident. Direct pressure has failed to control the severe arterial bleeding. What is the most appropriate next step according to ITLS guidelines?

Answer: Immediately apply a tourniquet proximal to the wound.

For life-threatening extremity hemorrhage that is not controlled by direct pressure, the immediate application of a tourniquet is the next critical intervention to stop the blood loss. ITLS emphasizes a 'C-ABC' approach, prioritizing catastrophic hemorrhage control before airway and breathing.

Which of the following is the primary goal of permissive hypotension in the prehospital management of a patient with suspected non-compressible torso hemorrhage?

Answer: To prevent clot disruption and re-bleeding before surgical control.

Permissive hypotension is a strategy of restricting fluid resuscitation to maintain a lower-than-normal blood pressure (e.g., SBP of 80-90 mmHg) in patients with suspected non-compressible hemorrhage. The goal is to avoid dislodging newly formed clots by excessive intravascular pressure, which could worsen bleeding before the patient reaches definitive surgical care.

According to ITLS guidelines, what is the recommended time frame for administering Tranexamic Acid (TXA) to a trauma patient with significant hemorrhage for maximum effectiveness?

Answer: As soon as possible, but no later than 3 hours after injury.

ITLS guidelines, supported by major trauma studies like CRASH-2, recommend administering TXA as early as possible to patients with significant hemorrhage. The evidence shows that its effectiveness in reducing mortality diminishes over time and it may be harmful if given more than 3 hours after the injury occurs.

You are treating a patient with signs of compensated hemorrhagic shock. Which of the following findings would you most likely expect to see first?

Answer: Tachycardia and cool, clammy skin.

In the early (compensated) stage of hemorrhagic shock, the body attempts to maintain blood pressure and vital organ perfusion. The initial response involves the sympathetic nervous system, leading to an increased heart rate (tachycardia) and peripheral vasoconstriction, which causes the skin to become cool and clammy. A drop in blood pressure is a sign of decompensated shock.

A patient has a severe bleeding wound in the left axilla (armpit) region that cannot be controlled with direct pressure. Which hemorrhage control technique is most appropriate for this junctional injury?

Answer: Wound packing with a hemostatic agent.

Junctional hemorrhage occurs where limbs or the head join the torso (e.g., axilla, groin, neck). Standard tourniquets are ineffective in these areas. The appropriate ITLS-recommended technique is to pack the wound tightly with a hemostatic dressing, followed by direct pressure.

When managing a trauma patient with both a severe traumatic brain injury (TBI) and hemorrhagic shock, the ITLS fluid resuscitation strategy differs from that of isolated hemorrhagic shock. What is the target systolic blood pressure for this specific patient population?

Answer: At least 110 mmHg

In a patient with both hemorrhagic shock and a severe TBI, it is critical to maintain adequate cerebral perfusion pressure (CPP). Hypotension can be devastating to the injured brain. Therefore, the standard permissive hypotension target is abandoned, and fluid is administered to maintain a higher systolic blood pressure, typically at or above 110 mmHg, to ensure the brain remains adequately perfused.