PHTLS Shock and Hemorrhage Control 2 — Questions and Answers
Question 1: 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?
- Class I
- Class II
- Class III (Correct answer)
- Class IV
Correct answer: Class III
Class III hemorrhagic shock involves 30–40% blood volume loss and presents with hypotension, tachycardia >120, and altered mental status.
Question 2: Which of the following is the MOST appropriate initial intervention for a suspected pelvic fracture causing hemodynamic instability in the prehospital setting?
- Apply a pelvic binder or sheet wrap (Correct answer)
- Perform external cardiac compression
- Initiate IV fluid bolus of 2L normal saline
- Place the patient in Trendelenburg position
Correct 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.
Question 3: When using a windlass tourniquet on a lower extremity, how far proximal to the wound should it be placed?
- Directly over the wound
- 1–2 inches proximal to the wound
- 2–3 inches proximal to the wound (Correct answer)
- At the groin crease regardless of wound location
Correct 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.
Question 4: 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:
- Nonresponder
- Responder
- Transient responder (Correct answer)
- Delayed responder
Correct answer: Transient responder
A transient responder improves initially but then deteriorates, suggesting ongoing hemorrhage that may require surgical control.
Question 5: Which acid-base disturbance is most commonly seen in severe hemorrhagic shock?
- Metabolic alkalosis
- Respiratory alkalosis
- Metabolic acidosis (Correct answer)
- Respiratory acidosis
Correct answer: Metabolic acidosis
Anaerobic metabolism from inadequate tissue perfusion produces lactic acid, causing metabolic acidosis in hemorrhagic shock.
Question 6: In the PHTLS model, 'permissive hypotension' targets a systolic BP of approximately how much in penetrating trauma without TBI?
- 60–70 mmHg
- 80–90 mmHg (Correct answer)
- 100–110 mmHg
- 120 mmHg
Correct 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.
Question 7: Which finding is the EARLIEST clinical indicator of hemorrhagic shock in an otherwise healthy adult?
- Hypotension
- Tachycardia (Correct answer)
- Altered mental status
- Decreased pulse pressure
Correct answer: Tachycardia
Tachycardia is the earliest compensatory response as the body attempts to maintain cardiac output despite falling blood volume.
PHTLS Shock and Hemorrhage Control 2
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?