EMT Ch 25: Bleeding and Shock
Which of the following is NOT indicated in the management of a patient in shock? A. High-speed ambulance transportation B. On-scene spinal precautions, if indicated C. Minimizing on-scene time D. Delaying a detailed exam until en route to the hospital
A. High-speed ambulance transportation
Your patient is a 6-year-old child who has fallen down while running on a sidewalk. She has abrasions on both knees and the palms of both hands, which are oozing blood. This is an example of bleeding from which of the following types of vessels? A. Lymphatic vessels B. Capillaries C. Veins D. Arteries
B. Capillaries
You suspect that your patient has a GI bleed. She presents with tachycardia, hypotension, and pale skin. What stage of shock is she MOST likely in? A. Hypovolemic shock B. Decompensated shock C. Early shock D. Compensated shock
B. Decompensated shock
Which of the following must be kept in mind when considering the severity of external bleeding? A. The amount of blood loss is easily estimated by the amount of blood visible on the ground. B. A younger person can tolerate more blood loss than an adult. C. Signs of shock do not appear until a large amount of blood has been lost. D. All of the above
C. Signs of shock do not appear until a large amount of blood has been lost.
Which of the following is a characteristic of arterial bleeding? A. Steady flow B. Dark red color C. Spurting under pressure D. Both B and C
C. Spurting under pressure
It is characteristic of arterial bleeding to be: A. constant. B. inconsistent. C. abundant. D. gradual.
C. abundant.
Hypoperfusion is: A. inadequate oxygen delivery to the tissue. B. reduced oxygen saturation of the blood. C. inadequate blood flow to the tissue. D. reduced blood volume.
C. inadequate blood flow to the tissue.
As an EMT, your BEST clue indicating the possibility of internal bleeding may be the presence of: A. painful, swollen, or deformed extremities. B. the absence of a tender, rigid, or distended abdomen. C. mechanism of injury. D. bruising, swelling, or pain over vital organs.
C. mechanism of injury.
Waste can build up in the body when: A. the heart rate decreases. B. the blood volume reduces. C. perfusion decreases. D. excretion increases.
C. perfusion decreases.
Which of the following is the leading cause of internal bleeding? A. Penetrating trauma B. Blunt trauma C. Crush injury D. Aortic aneurysm
B. Blunt trauma
Which of the following is the most important reason for controlling external bleeding? A. To prevent hypoperfusion B. To prevent the spread of infectious diseases C. To prevent the patient from becoming upset at the sight of blood D. To make clean-up of the ambulance and your equipment easier after the call
A. To prevent hypoperfusion
You are caring for a 62-year-old male patient who complains of chest pain, shortness of breath, and nausea. His heart rate is more than 120, and his blood pressure is 90/60. You notice some pallor and peripheral cyanosis on his cool, clammy skin. He is MOST likely suffering from: A. cardiogenic shock. B. anaphylactic shock. C. septic shock. D. neurogenic shock.
A. cardiogenic shock.
Cold is sometimes used to help control bleeding. When using cold, the following guidelines and statements are true except: A. it should be applied directly to the skin; it will not be effective if anything is between the cold agent and the wound. B. it should not be used alone but rather in conjunction with other manual techniques. C. it should not be left in place for more than 20 minutes. D. it will reduce pain.
A. it should be applied directly to the skin; it will not be effective if anything is between the cold agent and the wound.
The problem of blood vessels dilating in compensation for trauma is primarily related to: A. vascular capacity that is too great. B. inadequate gas exchange. C. heart failure. D. lost blood volume.
A. vascular capacity that is too great.
Internal bleeding may result from a variety of causes. If you suspect that your patient has internal bleeding, you should remember that: A. your suspicion of internal bleeding may be based only on the mechanism of injury. B. head injury is more likely to cause unexplained shock than internal bleeding is. C. the two most common causes of internal bleeding are ruptured aortic aneurysm and bleeding stomach ulcers. D. internal bleeding is usually very obvious and should be identified quickly.
A. your suspicion of internal bleeding may be based only on the mechanism of injury.
Which of the following is MOST likely to cause cardiogenic shock? A. A massive MI that impairs the pump function of the heart B. A massive pulmonary embolus C. Taking too much nitroglycerin for chest pain D. A drug that induces widespread vascular dilation
A. A massive MI that impairs the pump function of the heart
During severe external bleeding, the brain MAY suffer a lack of oxygen. Which of the following contributes most to that lack of oxygen? A. A reduction in the number of red blood cells and blood pressure B. The vasodilation that occurs during shock C. A reduction in the rate of breathing from shock D. A redirection of blood flow to the site of the injury
A. A reduction in the number of red blood cells and blood pressure
Which of the following patients at the scene of an accident is most likely developing shock? A. An elderly female is vomiting on her hands and knees B. A middle-aged male is leaning against a paramedic for support C. A male child is crying in an adult female's arms D. A young adult female is gesturing for your attention
A. An elderly female is vomiting on her hands and knees
For a patient at what stage of shock are the efforts of EMTs likely to be MOST successful and have the GREATEST impact on a positive outcome? A. Compensated shock B. Refractory shock C. Irreversible shock D. Decompensated shock
A. Compensated shock
Which of the following is the major cause of shock that the EMT will encounter? A. Hemorrhage B. High blood pressure C. Vomiting D. Excessive sweating
A. Hemorrhage
In trauma patients, which form of shock is the most common? A. Hypovolemic shock B. Cardiogenic shock C. Septic shock D. Neurogenic shock
A. Hypovolemic shock
You are managing a 27-year-old female with severe hemorrhage from her right ankle after a motor vehicle collision. You are unable to stop the hemorrhage with direct pressure. What intervention should you do next? A. Immediately apply a tourniquet proximal to the wound on the patient's femur. B. Apply a bulky sterile dressing. C. Apply a pressure dressing. D. Place the patient on high-flow oxygen.
A. Immediately apply a tourniquet proximal to the wound on the patient's femur.
Which of the following is NOT the purpose of making airway management the highest priority of patient care when managing the patient in shock? A. It allows the bronchoconstriction of the smaller airways to be reversed. B. It minimizes the chances of aspiration of blood or vomit. C. It allows for improved elimination of carbon dioxide. D. It allows for oxygenation of the lungs.
A. It allows the bronchoconstriction of the smaller airways to be reversed.
Which of the following types of bleeding is most serious? A. Massive bleeding of any type B. Arterial bleeding C. Internal bleeding D. External bleeding
A. Massive bleeding of any type
Which of the following statements is true when talking about neurogenic shock? A. Neurogenic shock is sometimes caused by spinal injuries. B. Neurogenic shock is caused by the blood vessels overfilling with blood, causing leaking into the nerves. C. Neurogenic shock is very common in the field. D. Neurogenic shock is the result of the blood vessels decreasing in size.
A. Neurogenic shock is sometimes caused by spinal injuries.
Which of the following would be the BEST approach for a patient who is in shock secondary to internal bleeding? A. Provide necessary care while transporting the patient to a hospital that can provide surgical intervention. B. Provide necessary care and transport the patient to the closest hospital even though it is a community hospital. C. Provide necessary care and transport the patient to the local surgery clinic. D. Provide necessary care while awaiting the arrival of paramedics.
A. Provide necessary care while transporting the patient to a hospital that can provide surgical intervention.
Your patient is a 28-year-old male who cut his thigh with a chain saw. Bleeding is significant and difficult to control. Which of the following is NOT part of the proper management of this patient? A. Replacement of fluid level by giving the patient adequate amounts of water B. Use of a tourniquet C. Using direct pressure to control the bleeding D. Administering oxygen
A. Replacement of fluid level by giving the patient adequate amounts of water
Which of the following is an indication of altered mental status in a patient in shock? A. Restlessness B. Dilated pupils C. Nausea D. Thirst
A. Restlessness
Which of the following BEST explains the reason for minimizing on-scene time for the trauma patient with significant hemorrhage or the potential for significant hemorrhage? A. Studies have indicated that trauma patients who receive surgery within one hour of injury have better chances of survival. B. The clock for the "golden hour" of trauma begins at the time of your arrival. C. There is nothing the EMT can do for a patient in shock. D. It gives the EMT less opportunity to make mistakes in the patient's care.
A. Studies have indicated that trauma patients who receive surgery within one hour of injury have better chances of survival.
Which of the following is responsible for most of the signs and symptoms of early shock? A. The body's attempts at compensation for blood loss B. Increased respirations of the patient C. Constriction of the peripheral blood vessels D. Dilation of the peripheral blood vessels
A. The body's attempts at compensation for blood loss
Your patient is a 33-year-old man who has a gunshot wound to his right leg and has active, steady, dark red bleeding. He is awake, pale, and diaphoretic. He has a strong radial pulse of 112 per minute, a respiratory rate of 24 breaths per minute, and a blood pressure of 122/82 mmHg. He has no other injuries or complaints. Which of the following is the BEST sequence of steps in the management of this patient? A. High-concentration oxygen, tourniquet, PASG, and elevation of the extremity B. Direct pressure, high-concentration oxygen, and splinting the leg C. High-concentration oxygen, elevation of the extremity, and application of ice D. Cervical spine immobilization, high-concentration oxygen, direct pressure, and pressure point compression
B. Direct pressure, high-concentration oxygen, and splinting the leg
Which of the following is NOT recommended when controlling epistaxis? A. Keeping the patient calm and quiet B. Having the patient tilt the head backward to elevate the nose C. Placing the unconscious patient in the recovery position D. Pinching the nostrils together
B. Having the patient tilt the head backward to elevate the nose
Which one of the following is incorrect in the application of a tourniquet? A. The tourniquet should be two to four inches wide. B. If possible, the tourniquet should be placed on a joint. C. A blood pressure cuff can be used as a tourniquet. D. The tourniquet should be placed approximately two inches above the bleeding.
B. If possible, the tourniquet should be placed on a joint.
In all forms of shock, what is the greatest consequence to the body? A. Decreased blood flow to the tissue B. Inadequate delivery of oxygen to the cells C. Decreased removal of waste from the tissue D. Inadequate delivery of nutrients to the tissue
B. Inadequate delivery of oxygen to the cells
Limiting time spent at a scene can be especially important if the mechanism of injury suggests that the patient could go into shock. In order to keep the time at the scene to a minimum, which of the following assessments or treatments should not be performed on the scene? A. Immobilization B. Splinting swollen extremities C. Rapid trauma exam D. ABCs with spinal precautions
B. Splinting swollen extremities
Why does a patient in shock secondary to blood loss develop pale, cool, and clammy skin? A. The patient's body is using all available energy to combat the blood loss, so sweating is to expected. B. The sympathetic nervous system limits peripheral circulation. C. The blood has lost some of its red blood cells, which give the blood (and skin) the red color. D. Blood flow is being redirected to the periphery of the body to combat the heat load.
B. The sympathetic nervous system limits peripheral circulation.
Shock is the circulatory system's failure to provide sufficient blood and oxygen to all the body's tissues, and it is: A. typically related to heart failure. B. a life-threatening condition. C. a consequence of blood or fluid loss D. caused by severe hemorrhage.
B. a life-threatening condition.
The signs and symptoms of internal bleeding include: A. dropping blood pressure as an early sign. B. poor peripheral perfusion. C. constricted pupils that are sluggish to respond. D. slow, deep respirations.
B. poor peripheral perfusion.
You have been called to a nursing home where you find an 88-year-old female patient who is confused and combative. The staff states that this is not her normal behavior but that she has been bedridden from a previous stroke. They also report that she has had a recent urinary tract infection from an indwelling catheter. You note that her skin is flushed and warm, her pulse is 108, and her blood pressure is 80/44. You should suspect: A. anaphylactic shock. B. septic shock. C. hypovolemic shock. D. neurogenic shock.
B. septic shock.
Which of the following vessels has the thickest muscular walls that allow constriction and dilation? A. Lymphatic vessels B. Capillaries C. Arteries D. Veins
C. Arteries
In neurogenic shock, what mechanism causes hypoperfusion? A. Injury to the neurological system causes the blood vessels to leak extensively. B. Loss of nervous regulation results in the blood vessels contracting completely, not allowing blood to flow. C. Arteries that are under continuous nervous control lose their ability to maintain contraction and dilate fully, causing a drop in blood pressure. D. Nervous control necessary for the heart to continue to beat effectively is lost.
C. Arteries that are under continuous nervous control lose their ability to maintain contraction and dilate fully, causing a drop in blood pressure.
What causes a patient in shock to exhibit cool, pale, and clammy skin? A. An increased respiratory rate B. An increased pulse rate C. Blood directed away from the skin D. Blood directed away from the digestive system
C. Blood directed away from the skin
Which of the following blood vessels cannot stop bleeding by constricting? A. Arterioles B. Vena cava C. Capillaries D. Arteries
C. Capillaries
Your patient is a 12-year-old boy who ran his arm through a glass window and has an eight-inch laceration on his anterior forearm. You have applied a pressure dressing and bandage, but these have become saturated due to continued bleeding. Which of the following should you do now? A. Remove the pressure dressing and bandage, apply direct pressure with your gloved hand, and elevate the arm. B. Apply additional dressing material, bandage it in place, and apply pressure to the brachial artery. C. Elevate that arm and prepare to apply a tourniquet or consider administering a hemostatic agent. D. Remove the pressure dressing and bandage, apply an ice pack to the wound, and bandage it in place with an elastic bandage.
C. Elevate that arm and prepare to apply a tourniquet or consider administering a hemostatic agent.
When deciding where to transport a patient who is in hypovolemic shock or who has the potential for developing hypovolemic shock, which of the following is the MOST important service to be provided by the receiving hospital? A. Availability of a chaplain B. Rehabilitation services C. Immediate surgical capabilities D. Critical-care nursing
C. Immediate surgical capabilities
Which of the following is a characteristic of venous bleeding? A. It cannot lead to life-threatening amounts of blood loss. B. It often requires the use of a tourniquet. C. It can be profuse but is generally easily controlled. D. It commonly requires the use of pressure point compression.
C. It can be profuse but is generally easily controlled.
You are treating a 29-year-old motorcycle crash victim who appears pale, cool, and diaphoretic. You suspect he sustained a traumatic brain injury based on decreased pupillary response. Based on these findings and the mechanism of injury, which of the following is the MOST appropriate method to manage this patient? A. Assess and catalog all major and minor injuries prior to transporting the patient to the hospital. B. Splint all orthopedic injuries found prior to transporting the patient to the hospital. C. Limit on-scene time and promptly transport the patient to the hospital. D. Perform a detailed secondary assessment on the patient prior to transportation.
C. Limit on-scene time and promptly transport the patient to the hospital.
Which of the following is the BEST indicator of perfusion in the adult? A. Capillary refill B. Pulse C. Mental state and alertness D. Blood pressure
C. Mental state and alertness
In shock states, what general principle can be observed regarding perfusion? A. Perfusion is increased in all regions of the body. B. Perfusion is enhanced in shock by increased heart rate and an expansion of blood vessels to reduce resistance. C. Perfusion in some areas is inadequate because the circulatory system malfunctions. D. Increased perfusion to the core circulation is accomplished by vasodilation in the periphery.
C. Perfusion in some areas is inadequate because the circulatory system malfunctions.
When a patient has significant blood loss, which of the following clinical findings would you expect to find that signifies the presence of shock? A. Calm and relaxed demeanor with mental alertness and verbal responsiveness B. Flushed, warm, dry skin C. Rapid heart rate D. Slowed breathing and a bounding pulse
C. Rapid heart rate
Which of the following principles may help the MOST in ensuring the survival of a patient who is suffering from shock due to massive trauma? A. Starting oxygen administration at a low concentration and increasing it gradually to the desired levels to avoid hyperoxia B. Facilitating immediate transport to the local community hospital C. Rapid transport to an appropriate facility D. Waiting for the arrival of paramedics so that they can administer IV fluids
C. Rapid transport to an appropriate facility
Which of the following is part of the body's compensatory response to shock? A. Decreasing heart rate B. Shutting down of vital organs C. Redirection of blood circulation D. Decreasing pulse rate
C. Redirection of blood circulation
Which patient would you assess as requiring a tourniquet? A. A patient with a laceration of the neck B. A patient with capillary bleeding along the forearm C. A patient with a puncture wound in the chest D. A patient with a long arterial wound on the lower leg
D. A patient with a long arterial wound on the lower leg
Which of the following should increase the EMT's suspicion of internal bleeding? A. Fall from a height two or more times the patient's height B. High-speed motor vehicle collision C. Penetrating trauma to the chest or abdomen D. All of the above
D. All of the above
Your patient presents with signs and symptoms of shock after a motor vehicle crash. Which of the following would be one such sign? A. Heightened alertness B. Increased docility C. Measured speech D. Apparent agitation
D. Apparent agitation
Which of the following blood vessels do you believe will cause the most significant hemorrhage if injured? A. Radial artery B. Saphenous vein C. Brachial artery D. Femoral artery
D. Femoral artery
A 49-year-old male patient was injured with a chain saw while cutting down a tree. He sustained a deep, jagged laceration to his left thigh. On arrival, you find him to be conscious but breathing rapidly, with a rapid pulse and cold, clammy skin. What type of shock would you suspect that he is in? A. Anaphylactic shock B. Neurogenic shock C. Cardiogenic shock D. Hypovolemic shock
D. Hypovolemic shock
Which of the following is recommended in situations in which a tourniquet must be used? A. Apply the tourniquet over the elbow or knee. B. Remove the tourniquet as soon as bleeding is controlled to minimize further damage to the limb. C. Apply a bulky dressing and bandage over the tourniquet. D. Use a piece of material that is wide and thick.
D. Use a piece of material that is wide and thick.
Once a pressure dressing has been applied, the EMT should NEXT: A. place the patient on high-flow oxygen. B. obtain a baseline set of vital signs. C. immediately check for a distal pulse. D. ensure that bleeding is controlled.
D. ensure that bleeding is controlled.
