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

Junctional hemorrhage (groin, axilla, neck) cannot be controlled by tourniquet. Wound packing with hemostatic gauze (such as Combat Gauze or Celox) followed by sustained direct pressure is the recommended technique.

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

The lethal triad (hypothermia, acidosis, coagulopathy) creates a self-perpetuating cycle: hemorrhage causes hypothermia and acidosis, both impair clotting, worsened coagulopathy increases hemorrhage, which deepens hypothermia and acidosis.

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

Current ITLS guidelines support early tourniquet application for life-threatening extremity hemorrhage when direct pressure is ineffective or impractical, reflecting evidence from military and civilian trauma that early tourniquet use saves lives.

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

This patient is in compensated shock. Despite maintaining a near-normal systolic pressure through intense vasoconstriction, the clinical signs (cool skin, mottling, delayed capillary refill, narrowed pulse pressure) reveal inadequate tissue perfusion.

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

Tranexamic acid (TXA) inhibits fibrinolysis (the breakdown of blood clots), helping the body maintain clots that have formed at injury sites. The CRASH-2 trial showed significant mortality reduction when administered within 3 hours of injury.

ITLS - International Trauma Life Support Practice Test

ITLS - International Trauma Life Support Practice Test

ITLS Hemorrhage Control and Shock 2