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 the​MOI?

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. You​suspect:

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 secondary​assessment?

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, her​t-shirt is stained over the stomach. She complains of cold. What should you do in response to this​complaint?

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 clotting​process, 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 trauma​victim?

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 to​exsanguination, 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 form​of:

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, controlled​by:

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 a​semi-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