Shock and Hemorrhage Control Flashcards

A trauma patient has a BP of 80/60 mmHg, HR of 128 bpm, and cool, clammy skin. Which class of hemorrhagic shock does this best represent?

Answer: Class III

Class III hemorrhagic shock involves 30–40% blood volume loss and presents with hypotension, tachycardia >120, and altered mental status.

Which of the following is the MOST appropriate initial intervention for a suspected pelvic fracture causing hemodynamic instability in the prehospital setting?

Answer: Apply a pelvic binder or sheet wrap

A pelvic binder or sheet wrap reduces pelvic volume and tamponades internal hemorrhage in unstable pelvic fractures.

When using a windlass tourniquet on a lower extremity, how far proximal to the wound should it be placed?

Answer: 2–3 inches proximal to the wound

PHTLS guidelines recommend placing a tourniquet 2–3 inches proximal to the wound to ensure adequate compression of the vessel.

A patient in hemorrhagic shock has received 1L of blood products en route. On reassessment, BP is 88/60 and HR is 110. This response is best described as:

Answer: Transient responder

A transient responder improves initially but then deteriorates, suggesting ongoing hemorrhage that may require surgical control.

Which acid-base disturbance is most commonly seen in severe hemorrhagic shock?

Answer: Metabolic acidosis

Anaerobic metabolism from inadequate tissue perfusion produces lactic acid, causing metabolic acidosis in hemorrhagic shock.

In the PHTLS model, 'permissive hypotension' targets a systolic BP of approximately how much in penetrating trauma without TBI?

Answer: 80–90 mmHg

Permissive hypotension targets a systolic BP of 80–90 mmHg to maintain cerebral perfusion while avoiding dilution of clotting factors and clot disruption.

Which finding is the EARLIEST clinical indicator of hemorrhagic shock in an otherwise healthy adult?

Answer: Tachycardia

Tachycardia is the earliest compensatory response as the body attempts to maintain cardiac output despite falling blood volume.

Tranexamic acid (TXA) is most effective when administered within what time frame after traumatic injury?

Answer: Within 3 hours

The CRASH-2 trial demonstrated TXA is most effective when given within 3 hours of injury; after this window it may increase mortality.

A patient has an arterial bleed from the axilla that cannot be controlled with a standard tourniquet. What is the BEST hemorrhage control option?

Answer: Pack the wound with hemostatic gauze and apply direct pressure

Junctional wounds like the axilla cannot be controlled with a standard tourniquet, so wound packing with hemostatic gauze and sustained direct pressure is the appropriate technique.

What is the primary mechanism by which hypothermia worsens hemorrhagic shock?

Answer: It impairs coagulation enzyme function

Clotting enzymes are temperature-dependent; hypothermia slows their activity, impairing coagulation and worsening the lethal triad.

Which component of Damage Control Resuscitation (DCR) directly addresses dilutional coagulopathy?

Answer: High-ratio packed red blood cells to FFP

DCR uses a balanced 1:1:1 ratio of PRBCs to FFP to platelets to replace all lost blood components and prevent dilutional coagulopathy.

A motorcyclist ejected at high speed has distended neck veins, absent breath sounds on the left, and hypotension. After needle decompression fails to improve vitals, what condition should you consider?

Answer: Cardiac tamponade

Persistent hypotension with distended neck veins after ruling out tension pneumothorax suggests cardiac tamponade (Beck's triad), which requires pericardiocentesis or thoracotomy.

In the context of PHTLS, the term 'lethal triad' refers to which combination of conditions?

Answer: Hypothermia, acidosis, and coagulopathy

The lethal triad of hypothermia, acidosis, and coagulopathy creates a vicious cycle that dramatically increases mortality in trauma patients.

When packing a wound for junctional hemorrhage control, approximately how long should direct pressure be maintained after packing?

Answer: 3 minutes

PHTLS and TCCC guidelines recommend at least 3 minutes of direct pressure after wound packing to allow clot formation with hemostatic agents.

A 45-year-old patient with blunt abdominal trauma presents with rigidity, guarding, and a BP of 90/70. Estimated blood loss is 1.5L. What is the PRIORITY prehospital action?

Answer: Rapid transport to a trauma center with hemostatic resuscitation

Internal abdominal hemorrhage cannot be controlled prehospitally; rapid transport and hemostatic resuscitation are the priorities to minimize time to definitive surgical care.

Which physiologic parameter is MOST reliable for detecting early compensated shock in a young, fit trauma patient?

Answer: Shock index (HR/SBP)

The shock index (HR divided by SBP) is more sensitive than either parameter alone in detecting early compensated shock, with values >1.0 indicating significant hemodynamic compromise.

A patient has a tourniquet applied to the right thigh. How should time of application be documented?

Answer: Written directly on the tourniquet or patient's skin with the time

The time of tourniquet application must be written directly on the tourniquet or patient's forehead/skin to prevent accidental removal and inform definitive care providers of ischemia duration.

Which type of shock results from a mismatch between oxygen supply and demand due to cellular inability to utilize oxygen, despite adequate delivery?

Answer: Cellular/metabolic shock

Cellular or metabolic shock (e.g., from cyanide poisoning) occurs when cells cannot use delivered oxygen, leading to anaerobic metabolism despite normal or high oxygen supply.

In neurogenic shock following spinal cord injury, which hemodynamic profile is MOST characteristic?

Answer: Low BP, bradycardia, warm extremities

Neurogenic shock from sympathetic disruption causes vasodilation (warm extremities) and loss of cardiac acceleration (bradycardia) alongside hypotension.

A PHTLS provider applies a Combat Application Tourniquet (CAT) to a bleeding arm. Upon reassessment 5 minutes later, the wound is still oozing significantly. What is the MOST appropriate next step?

Answer: Tighten the windlass until bleeding stops and recheck distal pulse

If a tourniquet is not controlling hemorrhage, it should be tightened further until bleeding stops, as an undertightened tourniquet provides inadequate occlusion and may worsen venous engorgement.