Hemorrhage Control and Shock in Trauma - NREMT AEMT Level

1. What is the correct next step if direct pressure does not control external bleeding?

   Apply a tourniquet proximal to the wound. Tourniquets occlude arterial flow when direct pressure fails to stop life-threatening hemorrhage in extremities.

2. Where should an extremity tourniquet be placed relative to the bleeding site?

   2–3 inches proximal to the wound, not over a joint. Placement ensures optimal arterial compression without slippage or interference from joint movement.

3. Which assessment finding is an early indicator of shock in an adult trauma patient?

   Tachycardia. Compensatory mechanisms increase heart rate to maintain cardiac output before blood pressure drops.

4. What is the standard method to control severe bleeding from a scalp laceration?

   Direct pressure and a pressure dressing. Scalp wounds bleed profusely due to vascularity, requiring compression to achieve hemostasis effectively.

5. Which shock type should you suspect when hypotension follows penetrating chest trauma with JVD?

   Obstructive shock (cardiac tamponade). Penetrating injury can cause pericardial effusion, obstructing cardiac filling and output with venous distension.

6. What IV/IO access strategy is most appropriate for an adult trauma patient in shock?

   Two large-bore IVs or IO if IV access fails. Multiple access points enable rapid fluid administration; intraosseous is backup for difficult venous access.

7. What is shock, in physiologic terms, in the trauma patient?

   Inadequate tissue perfusion and oxygen delivery. Shock results from insufficient oxygen delivery to tissues, compromising cellular function in injured patients.

8. Which three measures help prevent or treat the lethal triad in hemorrhagic trauma?

   Control bleeding, prevent hypothermia, limit acidosis. These interventions disrupt the cycle of hypothermia, acidosis, and coagulopathy in massive hemorrhage.

9. Which mental status change is concerning for inadequate cerebral perfusion in shock?

   Altered mental status (confusion, agitation, lethargy). Brain hypoperfusion from shock manifests as these changes, signaling urgent need for intervention.

10. What is the correct endpoint for tightening a tourniquet on an extremity?

    Bleeding stops and distal pulse is absent. Tightening achieves complete occlusion of blood flow, preventing further hemorrhage while monitoring for complications.

11. What is the correct technique after placing hemostatic gauze into a wound?

    Pack firmly, then hold direct pressure per protocol. Firm packing ensures contact with bleeding sources, while pressure maintains hemostasis per guidelines.

12. Which fluid strategy helps limit worsening hemorrhage in suspected uncontrolled bleeding?

    Permissive hypotension per protocol (avoid over-resuscitation). Maintaining lower pressures reduces clot disruption and further bleeding in non-compressible hemorrhage.

13. What should you do if bleeding continues after the first tourniquet is tightened properly?

    Apply a second tourniquet proximal to the first. A second device provides additional occlusion when the first is insufficient due to wound severity or anatomy.

14. Which assessment finding is a late sign of decompensated hemorrhagic shock?

    Hypotension. Blood pressure falls only after compensatory mechanisms fail in advanced hypovolemic states.

15. Which skin finding most strongly supports poor perfusion from shock in trauma?

    Cool, pale, diaphoretic skin. Vasoconstriction and sympathetic response cause these signs, indicating reduced peripheral perfusion.

16. What is the most common type of shock in major trauma?

    Hemorrhagic (hypovolemic) shock. Trauma often causes significant blood loss, leading to hypovolemia as the primary shock mechanism.

17. Which bleeding sites are appropriate for hemostatic gauze use in trauma?

    Junctional/non-tourniquet sites (groin, axilla, neck). These areas are not amenable to tourniquets, allowing hemostatic agents to promote clotting in compressible sites.

18. What should you do with a tourniquet once applied and bleeding is controlled?

    Do not remove; leave in place and reassess. Removal risks re-bleeding, so ongoing assessment ensures continued control without adjustment unless directed.

19. Which shock type is suggested by hypotension, muffled heart sounds, and JVD after trauma?

    Obstructive shock from cardiac tamponade. Beck's triad indicates pericardial tamponade, obstructing cardiac function in trauma patients.

20. Which intervention is indicated for suspected pelvic fracture with hemodynamic instability?

    Apply a pelvic binder/sheet at the greater trochanters. Binding stabilizes fractures, reduces pelvic volume, and minimizes internal bleeding in unstable patients.

21. Which shock type is most consistent with hypotension plus absent breath sounds on one side after trauma?

    Obstructive shock from tension pneumothorax. Air accumulation compresses the mediastinum, obstructing venous return and cardiac output unilaterally.

22. Which transport decision is most appropriate for a trauma patient with uncontrolled hemorrhage?

    Rapid transport to a trauma center after immediate control measures. Definitive care requires surgical intervention, so expedited transport improves outcomes in unstable patients.

23. Which hemorrhage control action should you perform first for severe external bleeding?

    Direct pressure with a sterile dressing. This initial step mechanically compresses the bleeding vessel to promote clot formation and stabilize the patient.

24. What must you document after tourniquet application for trauma hemorrhage control?

    Time of application and effectiveness. Documentation supports continuity of care, tracking potential complications like ischemia or compartment syndrome.

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