Chapter 29 | Bleeding and Shock

Question 1

Define:

shock

Answer 1

body’s inability to circulate blood adequately to the body’s cells to supply them with oxygen and nutrients

aka hypoperfusion (oh and it’s life-threatening)

Question 2

Define:

capillaries

Answer 2

any of the fine branching blood vessels that form a network between the arterioles and venules

Question 3

List:

functions of blood

5 points

Answer 3

• transportation of gasses: does the air-liquid dance at the alveoli and stuff
• nutrition: transportation of nutrients from digestive system (like glucose)
• excretion: removing waste from cells (like CO₂)
• protection: protecting against pathogens and clotting
• regulation: hormones/enzymes/chemicals carried in blood to control body functions

Question 4

Define:

hemorrhage

Answer 4

bleeding

(especially severe bleeding)

Question 5

Define:

hypoperfusion

(physiological term)

Answer 5

inability of the body to adequately circulate blood to the body’s cells to supply them with oxygen and nutrients

literally synonymous with shock

Question 6

Define:

hypovolemic shock

Answer 6

hypoperfusion caused by low blood/fluid volume

Question 7

Define:

distributive shock

Answer 7

hypoperfusion caused by low blood vessel tone

Question 8

Define:

cardiogenic shock

Answer 8

hypoperfusion caused by failure of heart to pump blood

Question 9

Define:

obstructive shock

Answer 9

hypoperfusion caused by inability of blood to flow

Question 10

Define:

hemorrhagic shock

Answer 10

hypoperfusion caused by uncontrolled bleeding

the patient is hemorrhaging (bleeding dumbass)

Question 11

Define:

neurogenic shock

Answer 11

hypoperfusion caused by spinal cord injury that results in systemic vasodilation

Question 12

List:

pathophysiologies of shock

4 points

Answer 12

• volume problems: hypovolemia/hemorrhage
• pump problems: cardiogenic shock
• blood vessel tone problems: distributive shock
• obstruction of blood to flow: obstructive shock

Question 13

List:

signs/symptoms of compensated shock

5 points

Answer 13

• slight mental status changes (AMS)
• increased HR
• increased RR
• pale/cool/diaphoretic skin
• delayed capillary refill time

(compensation usually includes normal BP)

Question 14

List:

body’s means of responding to shock

3 points (how does it compensate)

Answer 14

• regulation of volume: kidneys retain fluid and excretion is reduced
• vasoconstriction: (most useful method) narrowing blood vessels to try to increase BP
• cardiopulmonary response: epinephrine/norepinephrine released to speed up heart

Question 15

Define:

decompensated shock

Answer 15

period when body can no longer compensate for hypoperfusion

(late signs like decreasing BP become evident)

Question 16

List:

signs/symptoms of decompensated shock

3 points

Answer 16

• low BP
• weak/thready pulse (with abnormal rate)
• cool, pale, diaphoretic skin

Question 17

Define:

irreversible shock

Answer 17

hypoperfusion to the point of failure of organ systems

Question 18

Fill in the blank:

Irreversible shock is called irreversible because [BLANK].

Answer 18

Irreversible shock is called irreversible because at this point, even if the patient survives, the underlying problem of organ damage is likely uncorrectable.

Question 19

Describe:

key interventions for hypovolemic shock

2 points

Answer 19

bleeding control and rapid transport

Question 20

Describe:

key intervention for cardiogenic shock

(Dude is in cardiogenic shock. What do you do? Go.)

Answer 20

request ALS because certain meds/interventions to support BP may be critical

Question 21

Describe:

key intervention for anaphylactic distributive shock

Answer 21

epinephrine administration

Question 22

Describe:

key intervention for septic distributive shock

2 points

Answer 22

sepsis alert (to notify receiving facility) and rapid transport

(very time sensitive)

Question 23

Explain:

ways to recognize arterial bleeding

3 points

Answer 23

• bright red color
• often spurting
• profuse bleeding (and difficult to control)

Question 24

List:

ways to identify veinous bleeding

3 points

Answer 24

• dark red or maroon color
• steady flow
• easier to control

Question 25

# List: ways to identify **capillary bleeding** | 2 points

Answer 25

* slow rate * oozing flow of blood

Question 26

# List: primary *methods* of controlling massive **external bleeding** | 5 points

Answer 26

* direct pressure * hemostatic agents * elevation * wound packing * tourniquet use on extremeties

Question 27

# List: procedure for applying **direct pressure** to *external bleeding* | 5 points

Answer 27

1. **[apply firm pressure](https://youtu.be/vCadcBR95oU?si=ZIs8ICOlYHRmAIVF)** with palm of hand 2. **hold pressure firmly** until bleeding is controlled 3. **resist temptation** to apply layers of absorbent dressings 4. (once controlled) bandage a dressing firmly in place with **pressure dressing** 5. **do not remove dressing**

Question 28

# List: procedure for **wound packing** for *external bleeding* | 3 points

Answer 28

* apply **direct pressure** to wound * feed **gauze into wound cavity** until full * resume **direct pressure** once cavity is full (consider pressure dressing)

Question 29

# Define: pressure dressing

Answer 29

bulky dressing held in position with tightly wrapped bandage | applies pressure to help control bleeding

Question 30

# Define: tourniquet

Answer 30

device used to constrict extremity blood flow to stop bleeding

Question 31

# Identify:

Answer 31

tourniquet | (device used to constrict extremity blood flow to stop bleeding)

Question 32

# List: procedure for **applying a tourniquet** for *external bleeding* | 5 points

Answer 32

1. select **appropriate site** (proximal to extremity wound) 2. place the **strap around the limb**, pull the free end through the buckle, and **tighten as much as possible** 3. **warn patient** of immense pain 4. **tighen using mechanism** until arterial occlusion (evidenced by distal pulse) 5. **annotate** when applied on patient

Question 33

# List: *types* of **shock** | 6 points

Answer 33

* **hypovolemic** shock * **cardiogenic** shock * **neurogenic** shock * **anaphylactic** shock * **septic** shock * **obstructive** shock

Question 34

# List: primary treatments for *shock* | 4 points

Answer 34

* high-flow oxygen * laying supine * warm blanket * rapid transport

Question 35

# List: stages of shock severity | 3 points

Answer 35

* compensated * decompensated * irreversible

Question 36

# Fill in the blank: A victim who is bleeding from an artery can die in **[BLANK]** minutes.

Answer 36

A victim who is bleeding from an artery can die in **3** minutes.

Question 37

# Fill in the blank: A victim who is bleeding from an artery can **[BLANK]** in 3 minutes.

Answer 37

A victim who is bleeding from an artery can **die** in 3 minutes.

Question 38

# Choose: If blood is not circulated adequately through the body's capillaries, cells become starved for oxygen and nutrients, and overloaded with carbon dioxide and waste products. **This condition is known as:** ## Footnote **A.** cardiac compromise. **B.** hypoperfusion. **C.** circulatory depression. **D.** hypotension.

Answer 38

**B** ## Footnote *under some conditions, blood does not circulate adequately through all the body’s capillaries* chief result of inadequate circulation is a state of profound depression of cell perfusion, called shock (or hypoperfusion) cells become starved for oxygen (hypoxia) and nutrients, and become overloaded with carbon dioxide and other waste products

Question 39

# Answer: How does the vascular system control temperature regulation?

Answer 39

The body’s mechanism to conserve heat is to **expand (dilate) or narrow (constrict) the blood vessels**. ## Footnote *dilation of the blood vessels contributes to heat dissipation, whereas constriction of the blood vessels preserves core temperature by decreasing heat dissipation*

Question 40

# Choose: Gas exchange of oxygen for carbon dioxide occurs at the cellular level of the body between: ## Footnote **A.** capillaries and veins. **B.** capillaries and body cells. **C.** arteries and body cells. **D.** arteries and capillaries.

Answer 40

**B**

Question 41

# Choose: Of the following adjustments to the vascular system, which will contribute the *most* to increased perfusion to the core? ## Footnote **A.** Decreased vascular diameter **B.** Increased blood volume **C.** Decreased heart rate **D.** Increased oxygen consumption

Answer 41

**A** ## Footnote laws of hemodynamics demonstrate that a reduction in vascular diameter has the greatest influence on perfusion conversely, increasing the diameter would cause a reduction in perfusion, as is seen with septic and anaphylactic shock

Question 42

# Choose: Which of the following is a defense mechanism that the body uses to defend against shock? ## Footnote **A.** Increased heart rate **B.** Vasodilation **C.** Decreased respirations **D.** Decreased heart rate

Answer 42

**A**

Question 43

# Choose: When the body responds to shock, what physiological effects would you expect to occur? ## Footnote **A.** Bradypnea **B.** Peripheral vasoconstriction **C.** Peripheral vasodilation **D.** Bradycardia

Answer 43

**B** ## Footnote The body starts to “shunt” the blood from the extremities to the core of the body to protect the main organs of life (lungs, heart, brain, liver, spleen, etc.)

Question 44

# Choose: Which patient is in the *initial stages of shock*? ## Footnote **A.** 45-year-old motor vehicle crash victim with pale, cool, skin and tachycardia **B.** 16-year-old female with a possible traumatic brain injury presenting with altered mental status and low blood pressure **C.** 36-year-old fall victim with absent peripheral pulses **D.** 52-year-old assault victim with bilaterally dilated pupils and cyanosis

Answer 44

**A** ## Footnote initial presentation of shock symptoms include pale/cool/clammy skin, tachycardia, and tachypnea vital signs will deteriorate, with low blood pressure, thirst, dilated pupils, and cyanosis as shock progresses to late signs

Question 45

# Choose: Your patient is a 49-year-old female with complaints of shortness of breath and generalized weakness. On examination, you note that she has extensive crackles in her lungs, swelling of her feet and ankles, and difficulty in breathing when lying down. This is troublesome for her because she gets lightheaded when sitting up, because of her low blood pressure. **You would classify her shock as:** ## Footnote **A.** neurogenic shock. **B.** anaphylactic shock. **C.** septic shock. **D.** cardiogenic shock.

Answer 45

**D** ## Footnote the patient’s signs and symptoms suggest *congestive heart failure*, indicating cardiogenic shock, because the pumping mechanism has been compromised

Question 46

# Choose: Which of the following would *most likely* lead to hypovolemic shock? ## Footnote **A.** Open fracture of the hand **B.** Subdural hematoma **C.** Crush injury to the foot **D.** Crush injury to the abdomen

Answer 46

**D** ## Footnote hypovolemic shock is most often caused by significant blood loss due to trauma or internal hemorrhage from a medical cause (such as an AAA, GI bleed, or crush injuries to major body cavities, such as the chest or abdomen) hypovolemic shock may also result from third-space losses such as fluid shifts into various body compartments, as in severe pancreatitis, or fluid loss from protracted vomiting

Question 47

# Choose: Your 55-year-old female patient is suffering from a rupturing abdominal aortic aneurysm, and is entering into the decompensating stage of shock. **What finding would *not* be an indicator of decompensated shock in this patient?** ## Footnote **A.** Cyanosis **B.** Dilated pupils **C.** Increased heart rate **D.** Falling blood pressure

Answer 47

**C** ## Footnote increased heart rate would be a sign of early, compensating shock (not an indicator of decompensated shock)

Question 48

# Choose: You are assessing a 53-year-old male with severe blood loss from a wound that is covered with a pressure bandage. Bleeding appears to have stopped. The patient's pulse and respiration are elevated, but blood pressure is falling. The patient's skin around the lips shows signs of cyanosis, and the patient's pupils are dilated. **What is a sign that the patient has entered decompensated shock?** ## Footnote **A.** Cyanotic skin **B.** Severe blood loss **C.** Elevated pulse **D.** Elevated respiration

Answer 48

**A** ## Footnote *cyanosis around the lips and nail beds is one of the signs of late shock (which would indicate the onset of decompensated shock)* *B is wrong because* severe blood loss alone does not indicate decompensated shock *C and D are wrong because* an elevated pulse and respiration would be consistent with compensated shock

Question 49

# Choose: You are caring for a 28-year-old male patient who was involved in a motor vehicle crash. He has sustained a closed head injury and blunt-force trauma to his chest and abdomen, and is unconscious and in shock. **In what position should you transport him?** ## Footnote **A.** In a sitting position, because of his closed head trauma **B.** In a reverse Trendelenburg position, because of the patient’s head trauma and pulmonary injury **C.** In a left lateral position, to allow for vomiting and to prevent aspiration **D.** In a supine position with sufficient spinal immobilization

Answer 49

**D** | shock position... also consider the MVC and need for immobilization

Question 50

# Choose: You are treating a 64-year-old female patient complaining of weakness and abdominal pain. You find the patient pale, cool, and diaphoretic, leaning against the wall adjacent to her toilet. You note the presence of bright, red blood in the toilet. Based on these findings, **what treatment option will improve the body’s ability to clot?** ## Footnote **A.** Cover the patient in a blanket to prevent hypothermia. **B.** Request advanced life support assistance, so that intravenous fluids can be infused to replace lost blood volume. **C.** Place the patient on high-flow oxygen via nonrebreather. **D.** Transport the patient to the most appropriate facility as soon as possible.

Answer 50

**A** ## Footnote *(in addition to depleting the body’s energy stores) hypothermia may reduce the body’s ability to clot* keeping the patient warm may prevent heat loss (which contributes to hypothermia)

Question 51

# Fill in the blank: A bulky dressing that is held in place by a tightly wrapped bandage and is used to control bleeding is called a **[BLANK]**.

Answer 51

A bulky dressing that is held in place by a tightly wrapped bandage and is used to control bleeding is called a **pressure dressing**.

Question 52

# Choose: You arrive on scene to an 8-year-old male patient who fell while skating. He is responsive but is lying down on the pavement. As you assess the patient, you notice abrasions with self-controlled bleeding located on both his knees. **Based on your assessment, what type of external bleeding is this?** ## Footnote **A.** Arterial **B.** Non-significant **C.** Venous **D.** Capillary

Answer 52

**D** ## Footnote *Slowly oozing blood that is a dark or intermediate color of red usually indicates damaged capillaries. In most cases, capillary bleeding is easily controlled. This type of bleeding often clots spontaneously.*

Question 53

# Choose: Your 14-year-old male patient has fallen off his bike and scraped his arm. The bleeding is dark red and oozing slowly. This type of bleeding is usually from damaged: ## Footnote **A.** arteries. **B.** veins. **C.** capillaries. **D.** venules.

Answer 53

**C** ## Footnote *Slowly oozing blood that is a dark or intermediate color of red usually indicates damaged capillaries. In most cases, capillary bleeding is easily controlled. This type of bleeding often clots spontaneously. However, if a large body surface is involved, bleeding may be profuse, and the threat of infection is great.*

Question 54

# Choose: You are treating a 43-year-old female who was hunting with a pistol. When she sat down in the outhouse, her gun went off and created a large hole in her right femur, which is now severely spurting blood. **What is the *most appropriate* method of bleeding control for this injury if direct pressure fails?** ## Footnote **A.** Direct pressure and elevation **B.** Looking for a pressure point to apply **C.** Application of ice on the wound **D.** Application of a tourniquet

Answer 54

**D** ## Footnote *when a patient has a severe extremity injury (as in this case in which the blood is spurting from an artery), the most effective bleeding control method will be a tourniquet.*

Question 55

# Choose: If you find a major bleed during your initial assessment of the patient, you should immediately **[BLANK]**.

Answer 55

If you find a major bleed during your initial assessment of the patient, you should immediately **apply direct pressure to the site with your gloved hand**. | major bleeds must be stopped ASAP before continuing primary assessment

Question 56

# Answer: *You are on scene for a 31-year-old female with bleeding from the medial aspect of her right upper arm. Emergency medical responders on scene applied a tourniquet. As you inspect the wound, you decide that a tourniquet is unnecessary.* **What are the proper steps for removing the tourniquet?**

Answer 56

once a tourniquet has been placed, **you should not remove it** unless approved by medical direction

Question 57

# Choose: In applying a tourniquet, which of the following is the proper technique? ## Footnote **A.** Place the tourniquet at least 2 inches above the bleeding wound. **B.** If no commercial tourniquet device is​ available, the EMT can use ropes or wires to create an improvised tourniquet. **C.** Cover the injury and the tourniquet site to prevent overexposure to the environment. **D.** Ensure that the patient has a pulse and sensory and motor function distal to the site after application of the tourniquet.

Answer 57

**A**

Question 58

# Choose: Emergency medical care for internal bleeding includes: ## Footnote **A.** placing the patient with head and torso elevated, to better perfuse the brain. **B.** rapid transport for patients with signs and symptoms of shock. **C.** applying supplemental oxygen by nasal cannula only, so that the circulatory system is not overwhelmed. **D.** applying direct manual pressure to the areas of internal bleeding.

Answer 58

**B** ## Footnote *The goal of all emergency medical care for internal bleeding is to recognize its presence quickly, maintain the body’s perfusion, treat for shock, and provide rapid transport to an appropriate medical facility.*

Question 59

# Choose: 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?** ## Footnote **A.** Limit on-scene time and promptly transport the patient to the hospital. **B.** Perform a detailed secondary assessment on the patient prior to transportation. **C.** Assess and catalog all major and minor injuries prior to transporting the patient to the hospital. **D.** Splint all orthopedic injuries found prior to transporting the patient to the hospital.

Answer 59

**A**

Question 60

# Choose: 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:** ## Footnote **A.** hypovolemic shock. **B.** septic shock. **C.** anaphylactic shock. **D.** neurogenic shock.

Answer 60

**B**

Question 61

# Choose: What could be a sign that a patient is experiencing internal bleeding into the abdomen? ## Footnote **A.** Tenderness **B.** Contraction **C.** Erythema **D.** Cyanosis

Answer 61

**A**

Question 62

# Choose: 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?** ## Footnote **A.** Compensated shock **B.** Decompensated shock **C.** Early shock **D.** Hypovolemic shock

Answer 62

**B** ## Footnote *On the basis of the patient's vital signs and skin condition, in particular her abnormally low blood pressure, she is in decompensated shock.*

Question 63

# Choose: You are treating a patient who was dizzy and fell, sustaining a laceration to the forehead. Aside from determining the cause of the dizziness and dealing with the bleeding with direct pressure and bandaging, **should you assess the patient for internal bleeding? Why?** ## Footnote **A.** Yes, because of the fall **B.** No, because the fall only inflicted a laceration **C.** No, because there are no signs of shock **D.** Yes, because of the laceration

Answer 63

**A**

Question 64

# Choose: 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 try next?** ## Footnote **A.** Apply a tourniquet proximal to the wound on the patient’s femur. **B.** Place the patient on high-flow oxygen. **C.** Apply a bulky sterile dressing. **D.** Apply a pressure dressing.

Answer 64

**A**

Question 65

# Choose: Waste can build up in the body when: ## Footnote **A.** excretion increases. **B.** the blood volume reduces. **C.** perfusion decreases. **D.** the heart rate decreases.

Answer 65

**C**

Question 66

# Choose: *In all forms of shock,* what is the greatest consequence to the body? ## Footnote **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

Answer 66

**B**

Question 67

# Choose: You respond to the scene of a 27-year-old female who was working on her car when she "snagged her hand on a sharp edge." She has napkins around her hand covering the wound. You uncover it and note that the bleeding is slow and dark red in color. Direct pressure easily stops the bleeding. **Based on this information, what is the source of her bleeding?** ## Footnote **A.** Radial artery **B.** Capillary bleed **C.** Brachial artery **D.** Cephalic vein

Answer 67

**D**

Question 68

# Choose: Your patient has been severely injured in a fight. He is now lying supine, with gurgling respirations and visible blood in the throat. **Which of the following should you do first?** ## Footnote **A.** Suction the airway **B.** Apply oxygen **C.** Initiate PPV with oxygen **D.** Fully immobilize the patient

Answer 68

**A**

Question 69

# Choose: *You respond to the scene of a 34-year-old male whose left lower arm is bleeding profusely after an accidental amputation at the wrist while cutting planks with a circular saw. Direct pressure does not stop the bleeding, so you decide to place a tourniquet on the patient’s limb.* **Which of the following statements is the most accurate?** ## Footnote **A.** Apply the tourniquet over the elbow joint to stop the bleeding. **B.** The tourniquet should be applied proximal to the wound, but not over a joint. **C.** Apply the tourniquet distal to the wound. **D.** Twist the rod or windlass until the bleeding is not spurting, just flowing.

Answer 69

**B**

Question 70

# Choose: You are treating a 42-year-old male complaining of chest pain and shortness of breath. You notice that he appears pale, cool, and sweaty. **What is the *most likely* reason for these findings?** ## Footnote **A.** The patient’s pain receptors are causing his vessels to expand and dilate. **B.** Blood vessels are dilating, causing inadequate gas exchange. **C.** Blood vessels constrict in response to sympathetic stimulation, causing a decrease in blood flow to the skin. **D.** The body is attempting to rid waste products through the skin as well as the kidneys.

Answer 70

**C** | this is definitely correct answer according to everywhere online ## Footnote my *best guess* in explaining this answer is that *patient is having AMI* which apparently *causes sympathetic stimulation* according to Wikipedia snippet from Google, sympathetic stimulation "causes *vasoconstriction* of most blood vessels, including many of those *in the skin*, the digestive tract, and the kidneys"

Question 71

# Choose: During severe external bleeding, the brain may suffer a lack of oxygen. Which of the following contributes most to that lack of oxygen? ## Footnote **A.** A reduction in the rate of breathing, from shock **B.** A reduction in the number of red blood cells and blood pressure **C.** The vasodilation that occurs during shock **D.** A redirection of blood flow to the site of the injury

Answer 71

**B**

Question 72

# Choose: Which of the following would be the best approach for a patient who was in shock secondary to internal bleeding? ## Footnote **A.** Provide necessary care while transporting the patient to a hospital that can provide surgical intervention. **B.** Provide necessary care while awaiting the arrival of paramedics. **C.** Provide necessary care and transport the patient to the local surgery clinic. **D.** Provide necessary care and transport the patient to the closest hospital, even though it is a community hospital.

Answer 72

**A**

Question 73

# Choose: Which of the following patients at the scene of an accident is *most likely developing shock*? ## Footnote **A.** A middle-aged male is leaning against a paramedic for support. **B.** A young adult female is gesturing for your attention. **C.** A male child is crying in an adult female’s arms. **D.** An elderly female is vomiting on her hands and knees.

Answer 73

**D**

Question 74

# Choose: As you approach a patient with severe hemorrhaging from one arm, **what should you do *first*?** ## Footnote **A.** Immediately elevate the arm and apply direct pressure **B.** Don standard precautions before touching the patient **C.** Place the patient on high-flow oxygen to manage the patient’s hypoperfusion **D.** Check the patient’s airway

Answer 74

**B**

Question 75

# Choose: In your care of a patient suffering from shock due to a motor vehicle crash, **which of the following is most critical?** ## Footnote **A.** Closely examining the vehicles that were involved to determine the mechanisms of injury **B.** Conducting a detailed secondary assessment at the scene **C.** Gathering information from the bystanders, family, or police officers before leaving the scene **D.** Minimizing your scene time

Answer 75

**D**

Question 76

# Choose: You have a patient with a long laceration to his thigh after falling through a roof on which he was working. The bleeding is bright red and spurting, and the patient is becoming increasingly pale and disoriented. **How would you characterize this bleeding?** ## Footnote **A.** Capillary **B.** Venous **C.** Arterial **D.** Noncritical

Answer 76

**C**

Question 77

# Choose: Which of the following is the least effective method of controlling bleeding? ## Footnote **A.** Hemostatic agent **B.** Tourniquet **C.** Elevation **D.** Direct pressure

Answer 77

**C**

Question 78

# Choose: 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?** ## Footnote **A.** Remove the pressure dressing and bandage, apply direct pressure with your gloved hand, and elevate the arm. **B.** Remove the pressure dressing and bandage, apply an ice pack to the wound, and bandage it in place with an elastic bandage. **C.** Apply additional dressing material, bandage it in place, and apply pressure to the brachial artery. **D.** Elevate the arm and prepare to apply a tourniquet or consider administering a hemostatic agent.

Answer 78

**D**

Question 79

# Choose: When deciding where to transport a patient who has internal bleeding or who has the potential for internal bleeding, **which of the following is the *most important* service to be provided by the receiving hospital?** ## Footnote **A.** Rehabilitation services **B.** Immediate surgical capabilities **C.** Availability of a chaplain **D.** Critical-care nursing

Answer 79

**B**

Question 80

# Choose: 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?** ## Footnote **A.** High-concentration oxygen, elevation of the extremity, and application of ice **B.** High-concentration oxygen, tourniquet, PASG, and elevation of the extremity **C.** Direct pressure, high-concentration oxygen, and splinting the leg **D.** Cervical spine immobilization, high-concentration oxygen, direct pressure, and pressure point compression

Answer 80

**C**

Question 81

# Fill in the blank: **[BLANK]** can be used in lieu of a tourniquet for junctional bleeding.

Answer 81

**Specialized compression devices** can be used in lieu of a tourniquet for junctional bleeding.

Question 82

# Fill in the blank: Specialized compression devices can be used in lieu of a tourniquet for **[BLANK]**.

Answer 82

Specialized compression devices can be used in lieu of a tourniquet for **junctional bleeding**.

Question 83

# Choose: Your 26-year-old male patient was stabbed multiple times in a bar fight. Police are on the scene, and it is now safe for you to begin your assessment and treatment. The use of **[BLANK]** is essential whenever bleeding is discovered or simply anticipated. ## Footnote **A.** full protective gear **B.** Standard Precautions **C.** universal isolation precautions **D.** Tyvek overalls

Answer 83

**B**

Question 84

# Choose: *Finding arterial bleeding quickly is very important in assessing a patient.* **Which statement about arterial bleeding is correct?** ## Footnote **A.** Clot formation takes place rapidly. **B.** Arterial bleeding is often rapid and profuse. **C.** Arterial bleeding is the least difficult type of bleeding to control. **D.** Arterial bleeding causes the blood pressure to rise.

Answer 84

**B** ## Footnote *Arterial bleeding is often rapid and profuse. Blood in the arteries is maintained under high pressure by thick, muscular walls. Therefore, arterial hemorrhage is more difficult to control. Clot formation is also difficult because of this pressure.*

Question 85

# Choose: *You are treating a 58-year-old male whose throat was slashed by an attacker standing behind him during a street hold-up.* **When a large bleeding vein in the neck sucks in an air bubble, or embolism, this can cause:** ## Footnote **A.** an evisceration. **B.** heart stoppage. **C.** infection. **D.** severe bleeding.

Answer 85

**B** ## Footnote air bubble (embolism) sucked in by a large bleeding vein in the neck can cause heart stoppage or damage to the brain or lungs — the EMT should cover it immediately with an occlusive dressing an evisceration occurs when an organ or part of an organ protrudes through a wound opening

Question 86

# Fill in the blank: The sudden loss of **[BLANK]** of blood in a 33-year-old adult is considered serious. | (how much)

Answer 86

The sudden loss of **1,000 cc** of blood in a 33-year-old adult is considered serious. | double the amount that a blood donor gives

Question 87

# Fill in the blank: A sudden loss of **[BLANK]** of blood in a 7-year-old child is considered serious. | (how much)

Answer 87

A sudden loss of **500 cc** of blood in a 7-year-old child is considered serious.

Question 88

# Fill in the blank: A sudden loss of **[BLANK]** of blood in a 1-year-old infant is considered serious.

Answer 88

A sudden loss of **150 cc** of blood in a 1-year-old infant is considered serious.

Question 89

# Choose: *When a patient cuts a blood vessel, the body attempts to protect the patient even before a bandage is applied.* **The body's natural responses to bleeding are constriction of the injured blood vessel and:** ## Footnote **A:** perfusion. **B:** hypoperfusion. **C:** compensation. **D:** clotting.

Answer 89

**D** ## Footnote *The body's natural responses to bleeding are constriction of the injured blood vessel(s) and clotting. However, a serious injury may prevent effective clotting and thus allow continued bleeding.*

Question 90

# Choose: You are treating a 19-year-old female who experienced a series of lacerations. **Your assessment of external bleeding includes all of the following *except*:** ## Footnote **A.** estimating the amount of blood lost to predict potential shock. **B.** waiting for signs and symptoms of shock to appear before beginning treatment. **C.** prioritizing bleeding patients properly. **D.** identifying during the primary assessment any bleeding that must be treated.

Answer 90

**B** ## Footnote *Do not wait for signs and symptoms of shock to appear before beginning treatment. Any patient with a significant amount of blood loss should be treated to prevent the development of shock. Many signs and symptoms of shock appear late in the process.*

Question 91

# Fill in the blank: The most common and effective way to control severe external bleeding is by using a **[BLANK]**.

Answer 91

The most common and effective way to control severe external bleeding is by using a **tourniquet**.

Question 92

# Fill in the blank: The initial dressing should not be removed from a bleeding wound because **[BLANK]**.

Answer 92

The initial dressing should not be removed from a bleeding wound because **it is a necessary part of clot formation**. | removing dressing may destroy developing clots or cause further injury

Question 93

# Choose: Elevation is used to assist in minor/moderate bleeding control for all of the following reasons *except* that it: ## Footnote **A.** slows bleeding. **B.** raises the limb above the heart. **C.** helps to reduce blood pressure in the limb. **D.** speeds up the pulse rate.

Answer 93

**D** | *shock* speeds up pulse

Question 94

# Choose: When is it *inappropriate* to use elevation to assist in bleeding control? ## Footnote **A.** as you apply direct pressure **B.** while trying to bandage an extremity **C.** if you suspect musculoskeletal injuries **D.** when a patient is found lying down

Answer 94

**C** | you could further injure the patient

Question 95

# Fill in the blank: A bleeding injury on the head should be controlled with **[BLANK]** and not **[BLANK]**.

Answer 95

A bleeding injury on the head should be controlled with **direct pressure** and not **a tourniquet**.

Question 96

# Choose: A 39-year-old female, who was dressing the mannequins in a clothing store display, fell through the store window and has sustained a large cut. Blood is flowing from her forehead. **What method of bleeding control should you use?** ## Footnote **A.** A tourniquet will need to be applied to control the bleeding. **B.** Direct pressure with a dressing and bandage should work. **C.** Apply cold directly to the wound right away. **D.** Lower the patient's head below her heart, and the bleeding will stop.

Answer 96

**B**

Question 97

# Choose: *You are treating a 22-year-old male who has a deep laceration that is continuing to bleed.* **Use of direct pressure may not be effective if the wound:** ## Footnote **A.** was caused by an impaled object. **B.** was accompanied by spinal injury. **C.** is at the distal end of a limb. **D.** involves a profusely bleeding artery.

Answer 97

**D**

Question 98

When applying cold to a bleeding area, wrap the ice pack or cold pack in **[BLANK]**.

Answer 98

When applying cold to a bleeding area, wrap the ice pack or cold pack in **a cloth or towel**.

Question 99

**[DO/DON'T]** insert the ice directly into a wound.

Answer 99

**Do not** insert the ice directly into a wound. | ice may help but not by packing the wound with ice

Question 100

# Fill in the blank: In treating a wound, **[DO/DON'T]** apply an ice pack or cold pack directly onto the skin.

Answer 100

In treating a wound, **do not** apply an ice pack or cold pack directly onto the skin.

Question 101

# Fill in the blank: When applying cold to a bleeding wound, do not leave it in place for more than **[BLANK]**.

Answer 101

When applying cold to a bleeding wound, do not leave it in place for more than **20 minutes**.

Question 102

# Choose: When attempting to control a deep laceration across the entire right buttock of a 22-year-old ski racer, you note that the cut goes down to the bone and will not stop bleeding. The best treatment would be to utilize **[BLANK]** while beginning to transport the patient by MEDEVAC to the regional trauma center. ## Footnote **A.** elevation of the wound **B.** hemostatic gauze into the wound **C.** ice packs into the wound **D.** a commercial tourniquet

Answer 102

**B** ## Footnote the key is to stuff hemostatic gauze directly into the bleeding wound, apply a pressure bandage, and take the patient to the regional trauma center you will not be able to use a tourniquet because the wound is on the buttocks you would not stuff cold packs directly into the wound or elevate it

Question 103

# Choose: Your patient was cutting trees on his property with a manual bow saw when it slipped from its track and lacerated his right upper thigh. He is conscious, alert, and oriented with a 6-inch long laceration visible with moderate to severe dark red flowing blood present. His family is applying pressure to the femoral artery without successfully controlling the hemorrhage. **What type of bleeding do you suspect and how should you attempt to control it?** ## Footnote **A.** Arterial bleeding; direct pressure and pressure points **B.** Venous bleeding; direct pressure with bulky trauma dressing **C.** Capillary bleeding; tourniquet above the wound **D.** Arterial bleeding; tourniquet over the wound

Answer 103

**B** ## Footnote *Venous bleeding presents as dark red due to the waste products that are contained within the blood from the lungs. It can be life-threatening if it remains uncontrolled. Direct pressure should be attempted first followed by a tourniquet if it is unsuccessful.*

Question 104

# Choose: Which of the following body cavities is *not* spacious enough to allow for an internal bleed to progress to the point of causing hypotensive shock? ## Footnote **A.** The thorax **B.** The proximal leg **C.** The skull **D.** The abdomen

Answer 104

**C** ## Footnote *The skull is the only cavity in the body that is encased entirely by immovable bone. In addition, it is (ideally) filled with brain matter, making infiltration by large amounts of fluid impossible. Another way to look at it is by considering that since the other cavities (the incorrect answers) can expand while the skull cannot, the biggest problem with intracranial bleeding is increased intracranial pressure causing disturbances in homeostasis, not the actual amount of blood lost into it.*

Question 105

# Choose: You arrive on the scene of a reported shooting after the police have cleared the scene. A victim's mental status has been declining at a rapid rate. Police report that he has become pale, confused, and seems to be breathing rapidly. You note an entrance wound on the left abdomen that is oozing a significant quantity of blood. **Which of the following would you also anticipate finding during the primary survey?** ## Footnote **A.** Shallow respirations **B.** Bradycardia **C.** Weak or absent peripheral pulses **D.** Abdominal distention from internal bleeding

Answer 105

**C** ## Footnote *Severe blood loss presents with cold and pale skin, rapid breathing, tachycardia/bradycardia, confusion, weakness, cyanosis, loss of consciousness, and diminished peripheral pulses. THE MOST RELIABLE SIGN OF SEVERE BLOOD LOSS IS DIMINISHED OR ABSENT PULSES IN THE ANKLES AND WRISTS. The lack of these pulses implies the patient's systolic BP is below 80. A carotid pulse is palpable until systolic goes below 60.*