Hemorrhage and Shock-Table 1 Flashcards
Mod7 Checkpoint 1 Exam
In a previously healthy individual, which of the following types of shock may NOT result in the typical signs of cool, pale, moist skin; tachycardia; and narrowed pulse pressure?
Neurogenic
Which of the following guidelines applies to the prehospital administration of IV fluids in the patient with hemorrhagic shock?
Administer isotonic crystalloid fluids only as necessary to maintain perfusion.
Your patient is a 23-year-old male with a gunshot wound to the abdomen and an exit wound in the right flank. He responds to verbal stimuli; has pale, cool, diaphoretic skin; and has a heart rate of 128, respirations at 24, and a blood pressure of 82/60. These findings indicate which of the following kind of shock?
Decompensated
Your patient is a 42-year-old male with multiple lacerations on his arms, head, and torso after falling through a plate-glass window. On your arrival he appears to be unresponsive, lying prone on the sidewalk. Which of the following is the correct sequence of actions in caring for this patient?
- Control major hemorrhage.
- Take body-substance-isolation precautions.
- Check the area for broken glass before kneeling next to the patient.
- Turn him to a supine position.
- Open his airway.
3, 2, 4, 1, 5
Which of the following results from anaerobic metabolism in shock?
Metabolic Acidosis
Which of the following, located in the aortic arch, monitor blood pressure and send feedback to the medulla oblongata to maintain homeostasis?
Baroreceptors
Managing a laceration with arterial bleeding most often requires:
Direct Pressure
In which of the following patients with hemorrhagic shock can you employ aggressive fluid resuscitation?
A 26 year old male with a GSW involving popliteal artery
Which of the following results from the beta 1 actions of epinephrine in response to shock?
- Positive inotropy
- Positive chronotropy
- Positive dromotrophy
- Bronchiolar smooth muscle relaxation
- Increased peripheral vascular resistance
1, 2, 3
In anaphylactic shock, a massive _______ release causes general vasodilation, precapillary sphincter dilation, capillary engoregement, and fluid movement into the interstitial compartment.
histamine
Which of the following results from relaxation of the postcapillary sphincters in shock?
“Washout” of microemboli and lactic acid
Which of the following is defined as the volume of blood ejected from the heart with each beat?
Stroke Volume
A fracture of the femur may result in a hematoma that contains enough blood to make it a Class ________ hemorrhage.
III
Your patient is a 45-year-old male who has received several stab wounds to the chest and abdomen. Although bleeding was significant at first, the rate of bleeding had slowed considerably before your arrival. The patient is agitated and confused, pale, diaphoretic, and cool to the touch. He lacks a radial pulse, and his carotid pulse is weak and rapid. Respirations are 28 and shallow. Which of the following is certain with this patient?
He is in decompensated shock
Your patient has a possible pelvic fracture from a frontal motor vehicle collision. She has a blood pressure of 78 by palpation, has a heart rate of 130, and responds only to painful stimuli. Before you arrived BLS providers immobilized the patient to a long backboard. Which of the following should you do next?
Initiate rapid transport
Peripheral vascular resistance (afterload) is measured as which of the following?
Mean arterial pressure
Which of the following substances has the most rapid effect when compensating for hemorrhage?
Catecholamines
Which of the following is the preferred in-hospital fluid for resuscitation in hemorrhagic shock?
Whole Blood
Which of the following best describes the importance of oxygen in cellular metabolism?
It prevents pyruvic acid from being converted to lactic acid
When cells become hypoxic and the amount of carbon dioxide in them increases, reducing tissue pH, which of the following occurs to restore homeostasis?
Mast cells release histamine, resulting in dilation of capillary sphincters and an increase in tissue perfusion.
The phase of blood clotting in which the smooth muscle of an injured blood vessel contracts is known as the ________ phase.
Vascular
Which of the following findings indicates a progression from compensated shock to decompensated shock?
Altered Mental Status
When assessing the chest during rapid trauma survey, what is most likely to indicate major internal hemorrhage?
Dullness to percussion
Which of the following types of wound facilitates the effectiveness of normal blood-clotting mechanisms?
Transverse laceration of the vessel
Which of the following mechanisms is responsible for accumulating lactic acid in shock?
Anerobic Metabolism
A hematoma resulting from a fracture of the humerus may contain enough blood to make it a Class ________ hemorrhage.
I
Which of the following does NOT indicate compensated shock?
Altered Mental Status
Which of the following is NOT a benefit of PASG?
An autotransfusion of up to 2,000 ml of blood from the lower extremities
Even with intervention, survival is unlikely with blood loss over ________ percent of the total blood volume.
35
Which of the following indicates that a patient has transitioned from compensated to decompensated shock?
Hypotension
Red blood cells make up approximately ________ percent of whole blood volume.
45
Which of the following is a manifestation of orthostatic hypotension?
Your patient’s blood pressure is 142/90 when she is supine but 116/88 when she sits up.
Assuming all of the following patients have experienced significant blood loss and are hypotensive, in which would the use of PASG be absolutely contraindicated?
A 31-year-old man with a stab wound between his thoracic vertebral column and right scapula
The blood flowing to the heart best describes:
Preload
Under normal circumstances, at any given moment most of the blood is in the ________ system.
Venous
Which of the following best describes definitive care for the trauma patient with ongoing, significant hemorrhage?
Immediate Surgery
Which of the following impairs blood clotting?
A. Hypothermia, B. Administration of IV Fluids, C. Use of Non-steroidal Anti-inflamatories, D. ALL OF THE AVBOVE
For which of the following mechanisms of injury should you maintain the highest index of suspicion for hemorrhagic shock?
Frontal-impact motor vehicle collision at 45 miles per hour
The rapid trauma exam focuses on finding injuries that may cause shock by quickly assessing which of the following body areas?
- Head
- Neck
- Chest
- Abdomen
- Pelvis
- Proximal extremities
- Distal extremities
1, 2, 3, 4, and 5
Which of the following measures effectively controls bleeding in body cavities?
Surgery
Septic shock results from massive infection releasing what substances into the vascular system?
Toxins
Which of the following statements about the patient in neurogenic shock is NOT true?
Unopposed sympathetic nervous stimulation results in generalized pallor and diaphoresis.
Your patient is an obese 39-year-old woman involved in a lateral-impact motor vehicle collision. Which of the following should you remember when assessing and treating this patient?
Relative to body weight, a smaller amount of hemorrhage may result in shock.
Which of the following fluids is appropriate for the prehospital management of hypovolemic shock?
Lactated Ringer’s
Which of the following would be the most likely cause of neurogenic shock?
Spinal Cord injury
Rapid volume replacement is best achieved under which of the following conditions?
Use a short catheter with a large diameter
Which of the following vessels has the greatest ability to change diameter?
Arterioles
Your patient is a 29-year-old male who works in a meat-processing plant. He received a knife wound in the proximal anteromedial thigh, which is continuing to bleed on your arrival. He is restless and thirsty and has pale, cool skin. He has a weak radial pulse of 130 and a blood pressure of 118/88. This patient is exhibiting signs and symptoms consistent with a Class ________ hemorrhage.
II
Which of the following early signs of shock is easily missed?
Tacycardia
Which of the following is TRUE of the elderly trauma patient?
The elderly trauma patient is more likely to experience myocardial ischemia as a result of hemorrhage.; Medications like beta-blockers may interfere with normal compensatory mechanisms.; Hemorrhage may not result in tachycardia as expected.; ALL OF THE ABOVE.
Your patient is a 24-year-old male who was struck just below the left scapula with a 3-inch diameter metal pipe. He is awake but having difficulty breathing. His pulse is 112 at the radial artery, and his respiratory rate is 28 per minute and shallow. His breath sounds are present bilaterally but diminished on the left. He has a blood pressure of 108/68. The patient is coughing up some bloody sputum. He has no other complaints, and a rapid trauma survey reveals no additional life-threatening injuries. Which of the following represents the best sequence of intervention for this patient?
Oxygen 10–12 lpm by nonrebreathing mask, begin transport, 16-gauge IV at a keep-open rate
Which of the following is NOT a characteristic of arterial bleeding?
Clots quickly on its own
In responding to a trauma patient at the scene of a motor vehicle crash, which of the following is an early sign or signs of shock you might encounter during the primary assessment?
Rapid heart rate and anxiety
Which of the following represents the correct sequence for controlling hemorrhage from an extremity?
Direct pressure on the dressing and wound, finger pressure through the dressing to the leaking vessel, and, if pressure fails, application of a tourniquet
Which of the following terms is best described as the loss of blood from the vascular space?
Hemorrhage
