Chapter 25: Bleeding and Shock
The use of PASG is NOT advised for which of the following injuries? Answer External bleeding of the lower extremities Pelvic fracture Gunshot wound to the chest Internal bleeding to the lower extremities
Gunshot wound to the chest
Which of the following is NOT recommended when controlling epistaxis? Answer Pinching the nostrils together Keeping the patient calm and quiet Having the patient tilt the head backward to elevate the nose Placing the unconscious patient in the recovery position
Having the patient tilt the head backward to elevate the nose
Which of the following is the major cause of shock that the EMT will encounter? Answer Vomiting High blood pressure Hemorrhage Excessive sweating
Hemorrhage
Your patient is a 12-year-old boy who ran his arm through a glass window and has an 8-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? Answer Remove the pressure dressing and bandage, apply an ice pack to the wound, and bandage it in place with an elastic bandage. Elevate that arm and prepare to apply a tourniquet or consider administering a hemostatic agent. Apply additional dressing material, bandage it in place, and apply pressure to the brachial artery. Remove the pressure dressing and bandage, apply direct pressure with your gloved hand, and elevate the arm.
Elevate that arm and prepare to apply a tourniquet or consider administering a hemostatic agent.
In the average adult, the sudden loss of ___________ cc of blood is considered serious. Answer 150 500 1,000 750
1,000
For which of the following shock patients would the use of PASG be contraindicated? Answer A 50-year-old man whose pelvis has been crushed by a forklift A 7-year-old male with massive soft-tissue loss of the left thigh from a shark bite A 70-year-old female who is vomiting blood and has crackles in her lungs A 23-year-old pregnant woman with obvious fractures of both femurs
A 70-year-old female who is vomiting blood and has crackles in her lungs
Which of the following circumstances may result in hypoperfusion? Answer There is external bleeding. Blood vessels are dilated. The heart is damaged. All of the above
All of the above
Which of the following is a consequence of hypoperfusion? Answer Cellular waste products are not removed. Cells are not supplied with nutrients. Cells are not supplied with oxygen. All of the above
All of the above
Which of the following is the purpose of making airway management the highest priority of patient care when managing the patient in shock? Answer It allows for oxygenation of the lungs. It allows for improved elimination of carbon dioxide. It minimizes the chances of aspiration of blood or vomit. All of the above
All of the above
Which of the following may occur when there is bleeding from a large vein? Answer Transmission of bloodborne illnesses Air embolism Hypoperfusion All of the above
All of the above
Which of the following should increase the EMT's suspicion of internal bleeding? Answer Penetrating trauma to the chest or abdomen High-speed motor vehicle collision Fall from a height two or more times the patient's height All of the above
All of the above
Which of the following is the most sensitive indicator of hypoperfusion? Answer Delayed capillary refill Dilation of the pupils Increased heart rate Altered mental status
Altered mental status
Which of the following vessels contain blood under the highest amount of pressure? Answer Veins Arteries Venules Capillaries
Arteries
Which of the following vessels has the thickest muscular walls that allow constriction and dilation? Answer Arteries Capillaries Veins Lymphatic vessels
Arteries
If you do not have a commercial tourniquet available, what common device found on the ambulance can be used as a substitute? Answer Air or vacuum splint Blood pressure cuff Ice packs tied in place with triangle bandage Use a rope tie-down to make a tourniquet
Blood pressure cuff
Which of the following is part of the body's compensatory response to blood loss? Answer Blood vessels constrict and the heart rate increases. Blood vessels dilate and the heart rate increases. Blood vessels dilate and the heart rate decreases. Blood vessels constrict and the heart rate decreases.
Blood vessels constrict and the heart rate increases.
In which of the following vessels does the vital exchange take place and also has the thinnest walls through which oxygen, nutrients, and wastes can pass? Answer Capillaries Microvenules Arterioles Veins
Capillaries
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? Answer Veins Arteries Lymphatic vessels Capillaries
Capillaries
Which of the following distinguishes irreversible shock from other stages of shock? Answer Cell damage and death in the vital organs Altered mental status Delayed capillary refill time Low blood pressure
Cell damage and death in the vital organs
Which of the following will worsen the condition of the patient in shock? Answer Applying high-concentration oxygen when it is not needed Elevating the patient's legs 8 to 10 inches Conducting oneself in a manner that increases the patient's fear and anxiety Transporting without first splinting all extremity fractures
Conducting oneself in a manner that increases the patient's fear and anxiety
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? Answer High-concentration oxygen, elevation of the extremity, and application of ice Cervical spine immobilization, high-concentration oxygen, direct pressure, and pressure point compression High-concentration oxygen, tourniquet, PASG, and elevation of the extremity Direct pressure, high-concentration oxygen, and splinting the leg
Direct pressure, high-concentration oxygen, and splinting the leg
Which of the following is NOT indicated in the management of a patient in shock? Answer Minimizing on-scene time Delaying a detailed exam until en route to the hospital High-speed ambulance transportation On-scene spinal precautions, if indicated
High-speed ambulance transportation
Which of the following is another way of describing the condition of shock? Answer Internal bleeding Hypotension Hypoperfusion Hemorrhage .
Hypoperfusion
Which of the following signifies a failure in the patient's compensatory response to blood loss? Answer Hypotension Tachycardia Tachypnea Pale, cool skin
Hypotension
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? Answer Critical-care nursing Immediate surgical capabilities Availability of a chaplain Rehabilitation services
Immediate surgical capabilities
Which of the following is a characteristic of venous bleeding? Answer It commonly requires the use of pressure point compression. It can be profuse, but is generally easily controlled. It cannot lead to life-threatening amounts of blood loss. It often requires the use of a tourniquet.
It can be profuse, but is generally easily controlled.
Which of the following BEST describes the function of blood? Answer It is a life-giving liquid that supports all the body's functions to maintain hypoperfusion. It clots, flows, transports, protects, and excretes to fight disease and life. It transports gases along with nutrients, aids in excretion, and provides protection and regulation. It flows from the heart with the vital gases and nutrients to maintain lack of perfusion.
It transports gases along with nutrients, aids in excretion, and provides protection and regulation.
In which of the following instances would PASG be an appropriate choice to control bleeding? Answer Multiple lacerations to the lower extremities A knife impaled in the abdomen A laceration of the large veins of the neck A gunshot wound to the chest
Multiple lacerations to the lower extremities
Which of the following BEST describes the delivery of oxygen and nutrients at the body's cellular level? Answer Hydrostatic pressure Perfusion Osmosis Circulation
Perfusion
Your patient is a 28-year-old male who cut his thigh with a chain saw. It appears that he has lost about 600 cc of blood. Which of the following is NOT part of the proper management of this patient? Answer Use of a tourniquet Replacement of fluid level by giving the patient adequate amounts of water Using direct pressure to control the bleeding Administering oxygen
Replacement of fluid level by giving the patient adequate amounts of water
Which of the following must be kept in mind when considering the severity of external bleeding? Answer Signs of shock do not appear until a large amount of blood has been lost. The amount of blood loss is easily estimated by the amount of blood visible on the ground. A younger person can tolerate more blood loss than an older one. All of the above
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? Answer Steady flow Dark red color Spurting under pressure Both B and C
Spurting under pressure
Which of the following BEST explains the reason for minimizing scene-time for the trauma patient with significant hemorrhage or the potential for significant hemorrhage? Answer There is nothing the EMT can do for a patient in shock. It gives the EMT less opportunity to make mistakes in the patient's care. Studies have indicated that trauma patients who receive surgery within 1 hour of injury have better chances of survival. All of the above
Studies have indicated that trauma patients who receive surgery within 1 hour of injury have better chances of survival.
Which of the following is responsible for most of the signs and symptoms of early shock? Answer External bleeding Internal bleeding Dilation of the peripheral blood vessels The body's attempts at compensation for blood loss
The body's attempts at compensation for blood loss
Your patient is a 19-year-old motorcyclist who has crashed into a parked car and was ejected from his motorcycle. He was wearing a helmet; he is awake, shivering, and anxious. The patient is pale, with slight cyanosis of his lips, a slightly increased respiratory rate, and a rapid, thready radial pulse. Bystanders state that there was no loss of consciousness. The patient has abrasions to his hands and face, and blood is saturating the thigh area of both legs of his jeans. A rapid trauma assessment reveals that the patient has swelling and deformity of both thighs. Which of the following is NOT appropriate in the on-scene management of this patient? Answer The use of a long backboard The use of traction splinting for the lower extremity injuries The use of PASG The use of high-concentration oxygen by nonrebreather mask
The use of traction splinting for the lower extremity injuries
Which of the following is the most important reason for controlling external bleeding? Answer To prevent hypoperfusion To prevent the spread of infectious diseases To make clean up of the ambulance and your equipment easier after the call To prevent the patient from becoming upset at the sight of blood
To prevent hypoperfusion
Which of the following is recommended in situations in which a tourniquet must be used? Answer Apply a bulky dressing and bandage over the tourniquet. Apply the tourniquet over the elbow or knee. Use a material that is wide and thick. Remove the tourniquet as soon as bleeding is controlled to minimize further damage to the limb.
Use a material that is wide and thick.
Which of the following is the most effective way of controlling external bleeding? Answer Running cold water over the wound Using direct pressure with a dressing Elevating the affected part Using an ice pack
Using direct pressure with a dressing
Which of the following types of vessels have valves to maintain one-way blood flow? Answer Arteries Capillaries Veins Arterioles
Veins
The most common form of a hemostatic agent is: Answer hemostatic granular. hemostatic dressings. hemostatic tourniquet. hemostatic powder.
hemostatic dressings.