- Prehospital Trauma Life Support Shock and Hemorrhage Control Flashcards

What is the definition of shock according to PHTLS?

Answer: Inadequate tissue perfusion and oxygenation

PHTLS defines shock as inadequate tissue perfusion, when oxygen delivery fails to meet metabolic demands.

Which class of hemorrhagic shock typically presents with the first measurable drop in systolic blood pressure?

Answer: Class III

Class III hemorrhage (30-40% blood volume loss) is typically when systolic blood pressure measurably drops, as compensatory mechanisms become overwhelmed.

What is the PHTLS-recommended first-line treatment for life-threatening extremity hemorrhage?

Answer: Tourniquet application

PHTLS now recommends early tourniquet application as the first-line treatment for life-threatening extremity hemorrhage.

How does PHTLS recommend managing junctional hemorrhage (neck, axilla, groin)?

Answer: Wound packing with hemostatic gauze and sustained direct pressure

Junctional hemorrhage is managed with wound packing using hemostatic agents and sustained direct pressure.

What is the concept of permissive hypotension in trauma resuscitation?

Answer: Targeting a lower-than-normal blood pressure to prevent disruption of clots while maintaining organ perfusion

Permissive hypotension involves accepting a systolic blood pressure of 80-90 mmHg to maintain basic perfusion while avoiding elevated pressures that might dislodge clots.

Which physical finding helps differentiate neurogenic shock from hemorrhagic shock?

Answer: Warm dry skin and bradycardia in neurogenic versus cool clammy skin and tachycardia in hemorrhagic

Neurogenic shock causes vasodilation (warm dry skin) and loss of sympathetic cardiac stimulation (bradycardia), while hemorrhagic shock causes vasoconstriction (cool skin) and tachycardia.

According to PHTLS, what role do hemostatic agents play in hemorrhage control?

Answer: They enhance clot formation when packed into wounds, working best with sustained direct pressure

Hemostatic agents contain substances that accelerate the clotting cascade and are packed into wounds in combination with direct pressure.

What is the 'lethal diamond' concept that expands on the traditional trauma triad of death?

Answer: Hypothermia, acidosis, coagulopathy, and hypocalcemia from massive transfusion

The lethal diamond adds hypocalcemia to the traditional triad, recognizing that calcium depletion from citrated blood products further impairs coagulation and cardiac function.

How does PHTLS recommend assessing perfusion status in a trauma patient?

Answer: Integrating mental status, skin signs, heart rate, blood pressure, and capillary refill

PHTLS teaches assessment of multiple perfusion indicators because no single vital sign reliably indicates shock.

What is the concept of damage control resuscitation in PHTLS?

Answer: A strategy combining permissive hypotension, hemorrhage control, and avoiding the lethal triad

Damage control resuscitation combines permissive hypotension, aggressive hemorrhage control, hypothermia prevention, and limited crystalloid use.

According to PHTLS, what is the significance of lactate levels in trauma patients?

Answer: Elevated lactate indicates anaerobic metabolism from inadequate tissue perfusion, serving as a marker of shock severity

When cells receive inadequate oxygen, they switch to anaerobic metabolism producing lactate. Rising lactate levels indicate worsening tissue hypoperfusion.

How should a prehospital provider manage a patient in hemorrhagic shock when IV access cannot be obtained?

Answer: Establish intraosseous access as an alternative for fluid and medication administration

Intraosseous access provides a rapid, reliable vascular access route when IV access fails.