PHTLS Shock and Hemorrhage Control 5

Question 1

A 22-year-old stab victim has a wound to the right groin with pulsatile bright red bleeding. After failed tourniquet placement, what is the best hemorrhage control technique?

Accepted Answer

Use a junctional tourniquet device (e.g., SAM-JT or JETT) or deep wound packing

Answer

Apply ice packs to slow bleeding

Answer

Wrap the entire pelvis with an elastic bandage

Answer

Elevate both legs and apply circumferential pressure dressings

Question 2

Which of the following BEST describes 'obstructive shock' in the trauma setting?

Accepted Answer

Shock caused by a physical impediment to cardiac output

Answer

Shock from massive fluid loss into the interstitial space

Answer

Shock from systemic vasodilation reducing SVR

Answer

Shock from left ventricular pump failure

Question 3

During reassessment of a trauma patient, you note the original tourniquet site has been on for 90 minutes. The patient is now at the hospital. What is the CORRECT action?

Accepted Answer

Notify the receiving team of the application time and leave removal to the surgical team

Answer

Remove the tourniquet immediately to restore perfusion

Answer

Loosen the tourniquet slightly to allow intermittent perfusion

Answer

Replace the tourniquet with a pressure dressing during handoff

Question 4

In hemorrhagic shock, which organ is MOST vulnerable to ischemic injury due to its high metabolic demand and limited tolerance for hypoperfusion?

Accepted Answer

Cardiac myocytes

Answer

Skin

Answer

Skeletal muscle

Answer

Kidney tubular cells

Question 5

A patient with a penetrating chest wound develops worsening respiratory distress, tracheal deviation, and absent breath sounds on the right. After needle decompression at the 2nd intercostal space, midclavicular line, symptoms persist. What is the next step?

Accepted Answer

Perform needle decompression at the 4th/5th ICS, anterior axillary line

Answer

Repeat needle decompression at the same site

Answer

Apply an occlusive dressing and reassess

Answer

Administer high-flow oxygen and transport rapidly

Question 6

Which of the following BEST explains why large-volume crystalloid resuscitation is now discouraged in hemorrhagic shock management?

Accepted Answer

They cause dilutional coagulopathy, hypothermia, and worsen acidosis

Answer

Crystalloids are too expensive for routine prehospital use

Answer

They cannot be administered through a peripheral IV

Answer

They increase intracranial pressure more than blood products

Question 7

When is it appropriate to convert a field-applied tourniquet to a pressure dressing during prolonged transport?

Accepted Answer

Only under direct medical oversight when hemorrhage is confirmed controlled and total tourniquet time is less than 2 hours

Answer

After 30 minutes in all cases to prevent limb loss

Answer

Whenever the patient's blood pressure normalizes

Answer

Never — tourniquets should remain in place until surgical removal