Volume 4 Chapter 3
You arrive at the scene of a single car accident to find that a bystander has placed a makeshift but effective tourniquet on the victim's leg to stem bleeding from an open femur fracture. There are no other apparent injuries. What should be included in treatment of this fracture?
Dress the wound, immobilize, and rapidly transport to the ED.
When treating a victim at a trauma scene following an MVC, when should you begin to establish theMOI?
During scene size-up
What causes the spurting of blood in arterial bleeding?
Arterial blood pressure
You arrive at the scene of a female victim complaining of a severe laceration of the left forearm she received when a glass slipped from her hand and broke while she was placing it in the cupboard. You note as you approach the woman that she is sitting in a chair holding her hand over a wound that is freely hemorrhaging dark red blood between her fingers. She appears to be alert and well oriented. What method of bleeding control would you immediately attempt?
Direct pressure over a dressing
Capillary hemorrhage generally oozes from the wound and is:
bright red.
The transition between decompensated and irreversible shock is:
impossible to differentiate using signs and symptoms.
Your auto accident victim is alert and oriented, has no obvious injuries other than a tender abdomen, and displays vital signs of pulse 100, respirations 24/deep, and blood pressure 110/84; her skin is cool, slightly pale, and clammy. She appears anxious and restless, and she complains of being thirsty. Yoususpect:
internal bleeding.
Blood loss in the chest, abdomen, and pelvis can continue until:
it clots or is surgically repaired.
Drugs that prevent thrombosis or emboli in patients with heart or vascular disease:
may prolong active external hemorrhage.
Approximately what percent of the blood volume can be added to arterial circulation by constriction of the venous system?
20 percent
At what point does a trauma victim begin losing his ability to compensate for blood loss, placing his survival at risk?
30 to 40 percent of volume
As it pertains to trauma, which definition of coagulopathy is most accurate?
A condition in which the blood's ability to clot is impaired
For which trauma patient should you not perform a trauma assessment during the secondaryassessment?
A critical patient with uncontrolled airway, breathing, or circulation problems
The ability of the body to maintain blood pressure in the face of hypovolemia by reduction of the venous compartment is a form of:
compensation.
Capillary fluids are pushed into the interstitial spaces by:
hydrostatic pressure.
Given the same injury and rate of blood loss, which patient would likely progress most slowly through the classes of hemorrhage?
A pregnant female in her third trimester
You arrive at the scene of an altercation after the scene has been cleared by law enforcement. There you are faced with a 27-year-old female lying on the sidewalk who is bleeding from multiple lacerations to the left right hands and forearms and one cut to her face. Although you cannot see any other wounds, hert-shirt is stained over the stomach. She complains of cold. What should you do in response to thiscomplaint?
As soon as possible after assessing her injuries and addressing life threats, cover her with a warm blanket.
Where do clotting factors provided by the extrinsic pathway come from?
Blood vessel walls
A patient who has lost 25 percent of his circulating blood volume would be displaying signs and symptoms associated with which class of hemorrhage?
Class II hemorrhage
You are dispatched to meet and assist a basic unit treating a 28-year-old male victim of a gunshot wound to the abdomen. Upon entering the BLS unit, you note that the victim is pale, cool, and diaphoretic with a distended abdomen; the EMT informs you that the victim is also anxious and becoming confused with a radial pulse of 128 and thready, a blood pressure of 92/82, and respirations of 22. What class hemorrhage is the patient displaying signs and symptoms of?
Class III
As blood loss continues for the patient in compensated shock, what is the clinical result of blood being redirected to critical organs from the peripheral circulation?
Cool and pale skin
Which medical term is defined as the complex three-step process that the body uses to control localized hemorrhage?
Hemostasis
Which condition do all forms of shock share?
Inadequate tissue perfusion
Why must treatment of blood loss in infants and small children be more aggressive than in adults?
Infant and child compensatory mechanisms are neither as well developed nor as effective as those of adults.
Which type of blood loss is most likely to continue unabated until it is halted by the normal clottingprocess, a significant drop in blood pressure, exsanguination, or surgical intervention?
Internal blood loss into the abdomen
Which of the following does not result in hypovolemic shock?
Introduction of a foregin substance into the body that causes a massive histamine release
What condition exists when aggressive resuscitation restores blood pressure and pulse but organ failure continues unabated?
Irreversible shock
Hemorrhagic shock is typically initiated by what event?
Loss of blood from the vascular compartment
What physiological differences most likely adversely affect an elderly patient's response to hemorrhage?
Lower fluid reserves and less-responsive compensatory mechanisms
What is the first sign that can reliably be attributed to a state of hypovolemic shock?
Narrowing pulse pressure
If a patient was to display some signs and symptoms of a Class I hemorrhage, what would they include?
Nervousness and marginally cool skin with a slight pallor
Which statement is accurate regarding external blood loss?
Serious blood loss can be hidden from view due to clothing.
Which of the following can result in hemorrhagic shock?
Significant blood loss
What could be an early indicator of internal bleeding requiring intervention as part of your treatment plan?
Signs of poor peripheral perfusion
When observing the patient's respiratory effort and chest excursion, what are late signs of shock?
Tachypnea and air hunger
How does the progression of shock for a woman in the late stages of pregnancy differ from the general population?
The mother can lose a greater blood volume prior to progressing through the stages of shock.
For what reason would an obese patient fare worse than the general population when progressing through the stages of shock due to blood loss?
The volume of circulating blood is based on a patient's ideal weight, not actual weight.
Why is a list of medications important to gather, if available, during the assessment of a critically injured trauma patient?
To determine whether there are any medications that may affect coagulation
You arrive at the scene of an altercation after the scene has been cleared by law enforcement. There you are faced with a 22-year-old female, unconscious on the sidewalk, with a bat nearby. The victim is without response to pain and has a large contusion in the area of the left zygomatic arch. Additionally, you note that her radial pulse is 68 and thready, her skin is warm and dry, and her right pupil is dilated. Based on her findings, do you believe there is significant internal bleeding?
Unlikely
How would the quality of the clot be described that is formed during the platelet phase of hemostasis?
Unstable
What determines whether you utilize the CAB or ABC approach to the primary assessment of the traumavictim?
Whether or not the patient is in cardiac arrest
A patient's jugular veins are flat, suggesting hypovolemic shock, and you can see signs of hemorrhaging. Serious hemorrhaging from the neck should be addressed aggressively because, in addition toexsanguination, the victim of a neck injury may be subject to:
an air emboli.
During the absence of perfusion that occurs distally from the application of a tourniquet, the body forms lactic acid with potassium liberation. The chemicals formed are known as:
anaerobic metabolites.
Potential significant internal hemorrhage may first reveal itself during the primary assessment in the formof:
a rapid, thready pulse.
Hematemesis, an indicator of internal bleeding, may present with the appearance of:
coffee grounds.
Virtually all external bleeding encountered in the field can be controlled by:
direct pressure.
If severe hemorrhage continues and hypotension occurs, the reduced blood pressure at the hemorrhage site subsequently limits blood flow and the rate of hemorrhage, and:
enhances clot development.
External venous hemorrhage from small vessels can almost always be, and is preferred to be, controlledby:
firmly bandaging a dressing in place
Cool and pale skin in the victim of hypovolemic shock is the result of:
peripheral vasoconstriction.
The most important step in any treatment plan for victims suspected of internal hemorrhage is:
rapid transport with monitoring for signs and symptoms of shock.
The ultimate killer of all trauma and medical patients is:
shock.
The majority of the body's blood volume is located in the:
venous system.
You are completing a rapid trauma assessment of a fall victim and suspect a pelvic fracture. What amount of blood loss would you estimate to be involved?
2,000 mL
You are dispatched to the scene of an industrial accident for a 42-year-old dockworker pinned between asemi-trailer wall and a forklift. As you pull up to the dock, you note that the victim has been extricated by his coworkers and placed in a supine position with his legs drawn up. He is alert, well oriented, pale, and diaphoretic with a thready radial pulse of 120 and clear respirations of 26; his abdomen is distended but he does not appear to be in severe pain as long as his knees are bent. What would you include in your initial treatment plan for this victim?
High-flow oxygen, rapid spinal immobilization, rapid transport to the highest-level trauma center available, initiate large-bore IVs en route, and reassess at 5-minute intervals.
What are the signs of the release of epinephrine and norepinephrine in a patient?
Nervousness, marginally cool skin, and slight pallor
Which set of vital signs MOST indicates that your patient is beginning to enter hemorrhagic shock?
P-98; BP-102/86; R-16
