Chapter 27 - Bleeding and Shock

Blood that has been depleted of oxygen and loaded with carbon dioxide empties into the ___, which carry I back to the heart.

A. arteries

B. veins

C. capillaries

D. tissues

B

Cells and tissues of the brain, spinal cord, and ___ are the most sensitive to inadequate perfusion.

A. kidneys

B. lungs

C. stomach

D. heart

A

Your 22 year old male patient was stabbed multiple times in a bar fight. Police are on the scene and it is safe to being your assessment and treatment. The use of ____ is essential whenever bleeding is discovered or simply anticipated.

A. full protective gear

B. standard precautions

C. universal isolation precaution

D. tyvek overalls

B

You will be doing a complete body scan search of the 22 year old male patient was stabbed multiple times in a bar fight to look for bleeding. Bleeding is classified as all o the following except:

A. arterial

B. venous

C. cellular

D. capillary

C

Finding arterial bleeding quickly is very important when assessing the 22 year old male that was in a bar fight. Which statement about arterial bleeding is correct?

A. clot formation takes place rapidly

B. it is often rapid and profuse

C. it is the least difficult to control

D. it causes the blood pressure to rise

B

A steady flow of dark red or maroon blood is a result of ____ bleeding.

A. arterial

B. venous

C. capillary

D. pulmonary

B

Your patient has sustained a large road rash from sliding along the highway when he laid down his motorcycle. Bleeding described as oozing usually is a result of ____ bleeding.

A. arterial

B. venous

C. capillary

D. bronchiole

C

You are treating a 52 year old male whose throat was slashed in a robbery. When a large bleeding vein in the neck sucks in debris or an air bubble, this can cause:

A. an evisceration

B. heart stoppage

C. infection

D. severe bleeding

B

Sudden blood loss of ____ in an adult is considered serious.

A. 250 cc

B. 500 cc

C. 600 cc

D. 500 cc

D

Sudden blood loss of ____ in a child is considered serious.

A. 200 cc

B. 300 cc

C. 400 cc

D. 500 cc

D

Sudden blood loss of ____ in a 1 year old infant is considered serious.

A. 25 cc

B. 50 cc

C. 100 cc

D. 150 cc

D

When a patient cuts a blood vessel, the body attempts to protect the patient even prior to the first bandage being applied by an EMT. The body's natural responses to bleeding are constriction of the injured blood vessel and:

A. perfusion

B. hypoperfusion

C. compensation

D. clotting

D

You are treating a 19 year old who experienced a series of lacerations. Your assessment of external bleeding includes all of the following items except:

A. estimating the amount of blood lost in order to predict potential shock

B. waiting for signs and symptoms of shock to appear before beginning treatment

C. triaging, or prioritizing, bleeding patient properly

D. identifying bleeding that must be treated during the primary assessment

B

the major methods used to control external extremity bleeding include all of the following except:

A. direct pressure

B. elevation

C. tourniquet

D. vessel clamps

D

Why is administration of supplemental oxygen an important treatment for any trauma patient?

A. it enhances blood clotting

B. it improves oxygenation of the tissues

C. it constricts the blood vessel

D. it is important for all of these reasons

B

You are treating a 28 year old female who sustained several deep lacerations when she fell off her bike and then fell onto a guardrail. The most common and effective way to control severe external extremity bleeding is by:

A. cold application

B. elevation

C. tourniquet

D. direct pressure

C

The patient has already bled through a small pile of gauze pads. You will be applying some additional sterile pads to the injury. The initial layer of dressing should not be removed from a bleeding wound because it:

A. can become a biohazard

B. takes too long to remove

C. is a necessary part of clot formation

D. may increase the change of infection

C

After controlling bleeding from an extremity using a pressure dressing, be sure to:

A. loosen the tourniquet

B. check the distal pulse

C. apply a PASG

D. administer oxygen by nasal cannula

B

Elevation is used to assist in bleeding control for all of the following reasons except:

A. it slows bleeding

B. it raises the limb above the heart

C. it helps to reduce blood pressure in the limb

D. it speeds up the pulse rate

D

When is it inappropriate to use elevation to assist in bleeding control?

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 laying down

C

A patient fell through a store window and has sustained a large cut, which is flowing blood from his forehead. What is the method of bleeding control that should be utilized?

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 head below the heart and the bleeding will stop

B

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:

A. was caused by an impaled object

B. was accompanied by spinal injury

C. is at the distal end of a limb

D. is a profusely bleeding artery

D

You are going to use an air sling to manage the bleeding on the lower leg of a 22 year old male patient. Which of the following is true about the use of an air splint?

A. it is effective for controlling venous and capillary bleeding

B. it should be used only if there is no suspected bone injury

C. it is most effective for controlling arterial bleeding

D. it should be used before other manual methods of bleeding control

A

Which of the following is not a guideline for supplementing bleeding control wit ha cold application?

A. wrap the ice pack in a cloth or towel

B. do not apply the cold application directly onto the skin

C. do not leave the cold pack in place for more than 20 minutes

D. insert the ice directly into the wound

D

use of the pneumatic antishock garment (PASG) is controversial, and its use should be defined by your services Medical Director. Some "experts" agree that the PASG is useful for:

A. controlling bleeding from head trauma

B. controlling bleeding from the areas the garment covers

C. penetrating chest trauma

D. the patient in cardiogenic shock

B

You are treating a 29 year old female factory worker who was involved in an accident where a machine has amputated her right forearm. Bleeding from a clean-edged amputation is usually cared for initially with:

A. a pressure dressing

B. cold application

C. a tourniquet

D. a pneumatic antishock garment

A

Rough-edged amputations, usually produced by crushing or tearing injuries:

A. are easily controlled by a pressure bandage

B. tend to stop bleeding on their own

C. often bleed very heavily

D. constrict quickly to control bleeding

C

You have decided that the most appropriate method of bleeding control for your patient is to apply a tourniquet. Once a tourniquet is in place, it must:

A. not be removed or loosened unless ordered by medical direction

B. be covered immediately to prevent accidental removal

C. be loosened every 15 minutes to dislodge clots

D. be used under the pneumatic antishock garment

A

Your 35 year old male patient has severe bleeding form a large laceration on his right forearm. You tried direct pressure and it obviously did not work. A blood pressure cuff:

A. can be used as a tourniquet if it is inflated to 70mmHg

B. should never be used for bleeding control

C. can be used as a temporary tourniquet if it is inflated to 150 mmHg

D. should always be used to control arterial bleeding

C

If your 20 year old female patient, who fell off her bike, has a head injury, and you note bleeding or loss of cerebrospinal fluid (CSF) from the patient's ears of nose, you should:

A. apply direct pressure to the skull

B. apply direct pressure to the ears and nose

C. apply cold packs to the ears and nose

D. allow the drainage to flow freely

D

You are treating a 58 year old woman who has had a nosebleed for the last hour. The medical term for a nosebleed is:

A. hemorrhage

B. epistaxis

C. epihemorrhage

D. nostrium

B

You are treating a 50 year old female patient who called the ambulance because her nose has been bleeding for quite a while. To stop a nosebleed, try each of the following except:

A. place the patient in a sitting position, leaning forward

B. apply direct pressure by pinching the nostrils

C. keep the patient calm

D. apply cold packs to the bridge of the nose

D

The leading cause of internal injuries and bleeding is:

A. blunt trauma

B. penetrating trauma

C. auto collisions

D. large lacerations

A

Which is not an example of a penetrating trauma?

A. blast injury

B. gunshot wound

C. knife wound

D. ice-pick wound

A

You suspect that your 52 year old male patient may have internal bleeding. Signs of internal bleeding include all of the following except:

A. vomiting a coffee ground like substance

B. bradycardia and a flushed face

C. dark, tarry stools

D. tender, rigid or distended abdomen

B

A 28 year old male patient fell and you suspect he has sustained internal bleeding. He may have all of the following except:

A. painful, swollen, or deformed extremities

B. signs and symptoms of shock

C. bright red blood in the stool

D. a laceration to the forearm

D

Because of internal bleeding, the patient is developing inadequate tissue perfusion. This condition is referred to as:

A. hyperperfusion

B. hypoxia

C. hypoperfusion

D. hypotension

C

You suspect that your patient may be going into shock. Shock may develop as a result of all of the following except:

A. pump failure

B. lost blood volume

C. dilated blood vessels

D. injury to the head

D

The type of shock most commonly seen by EMT's is ____ shock.

A. cardiogenic

B. irreversible

C. neurogenic

D. hypovolemic

D

The most common mechanism of shock for a heart attack patient is:

A. vasoconstriction

B. fluid loss

C. pump failure

D. vasodilation

C

Your patient was involved in a car crash and it took all night to find his car. He is unable to move his lower extremities and you suspect he is in shock. Shock caused by the failure of the nervous system to control the diameter of blood vessels is called ____ shock.

A. hypovolemic

B. cardiogenic

C. neurogenic

D. reversible

C

Your 46 year old male patient is in shock, yet his body is still able to maintain perfusion to his vital organs. This is often referred to as _____ shock.

A. compensated

B. decompensated

C. delayed

D. irreversible

A

Early signs of shock that are actually the body's compensating mechanisms include all of the following except:

A. increased heart rate

B. increased respirations

C. pale, cool skin

D. decreased capillary refill time

D

Your patient with severe internal bleeding is struggling to deal with the blood loss. When the body has lost the battle to maintain perfusion to the organ systems, the patient is experiencing _____ shock.

A. delayed

B. compensated

C. decompensated

D. irreversible

D

You are treating a 45 year old female patient who has sustained considerable blood loss after slicing her hand while preparing food. She states that she feels nauseated. What is causing this symptom of feeling nauseated.

A. blood is diverted from the digestive system

B. blood rushes rapidly to the digestive system

C. shock increases the production of digestive juices

D. the patient has swallowed a great amount of blood

A

You are treating a 45 year old female patient who has sustained considerable blood loss after slicing her hand while preparing food. She states that she feels nauseated. The pulse of this patient will:

A. decrease

B. be absent

C. increase

D. be irregular

C

You are treating a 45 year old female patient who has sustained considerable blood loss after slicing her hand while preparing food. She states that she feels nauseated. She has a drop in her blood pressure and this is:

A. an early sign of shock

B. an early sign of shock in a child

C. always present in shock

D. a late sign of shock

D

When observing the patient who you suspect may be in shock, additional signs may include any of the following except:

A. thirst

B. dilated pupils

C. cyanosis around the lips and nail beds

D. flushed, warm skin

D

Your patient is a 6 year old male who fell off his skateboard and has numerous injuries to both of his legs. You should be especially careful when evaluating pediatric patient for shock because they:

A. cannot be administered oxygen at low flow rates

B. may display few signs and/or symptoms until a large percentage of blood volume is lost

C. can decompensate for blood loss very quickly

D. may exhibit erratic capillary refill times

B

Which of the following is the best description of the concept of a " platinum 10 minutes?"

A. the maximum on-scene time when caring fro a trauma or shock patient

B. the optimum time limit from the time of injury until surgery

C. the maximum time limit for controlling arterial bleeding before shock occurs

D. the optimum time limit for applying PASG to the shock pateint

A