PHTLS Shock and Hemorrhage Control 4 — Questions and Answers
Question 1: 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?
- Establish two large-bore IV lines and infuse 2L of NS
- Rapid transport to a trauma center with hemostatic resuscitation (Correct answer)
- Apply an abdominal binder and administer morphine for pain
- Place a Foley catheter to monitor urine output
Correct 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.
Question 2: Which physiologic parameter is MOST reliable for detecting early compensated shock in a young, fit trauma patient?
- Systolic blood pressure
- Heart rate
- Shock index (HR/SBP) (Correct answer)
- Mean arterial pressure
Correct 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.
Question 3: A patient has a tourniquet applied to the right thigh. How should time of application be documented?
- Verbally communicated to receiving hospital only
- Written directly on the tourniquet or patient's skin with the time (Correct answer)
- Entered in the patient care report at the end of transport
- Estimated based on arrival time at the ED
Correct 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.
Question 4: Which type of shock results from a mismatch between oxygen supply and demand due to cellular inability to utilize oxygen, despite adequate delivery?
- Hypovolemic shock
- Distributive shock
- Obstructive shock
- Cellular/metabolic shock (Correct answer)
Correct 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.
Question 5: In neurogenic shock following spinal cord injury, which hemodynamic profile is MOST characteristic?
- High BP, low HR, cold extremities
- Low BP, tachycardia, diaphoresis
- Low BP, bradycardia, warm extremities (Correct answer)
- Low BP, bradycardia, cool extremities
Correct answer: Low BP, bradycardia, warm extremities
Neurogenic shock from sympathetic disruption causes vasodilation (warm extremities) and loss of cardiac acceleration (bradycardia) alongside hypotension.
Question 6: 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?
- Remove the tourniquet and apply direct pressure instead
- Tighten the windlass until bleeding stops and recheck distal pulse (Correct answer)
- Apply a second tourniquet proximal to the first
- Pack the wound above the tourniquet with hemostatic gauze
Correct 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.
Question 7: What is the primary goal of administering blood products rather than crystalloids in hemorrhagic shock resuscitation?
- Lower the viscosity of blood to improve flow
- Restore oxygen-carrying capacity and coagulation factors simultaneously (Correct answer)
- Rapidly expand intravascular volume with minimal cost
- Prevent electrolyte imbalances from large-volume resuscitation
Correct answer: Restore oxygen-carrying capacity and coagulation factors simultaneously
Blood products restore both oxygen-carrying capacity (via RBCs) and coagulation factors (via FFP/platelets), addressing the root causes of hemorrhagic shock without the dilutional effects of crystalloids.
PHTLS Shock and Hemorrhage Control 4
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?