Emsonline (January 2015 - B)

1. Your main priority in the focused assessment of a conscious patient with visibly blood-soaked clothing should be geared towards:

Obtaining a complete medical history, including current medications

Rapidly locating and managing any and all sites of ongoing/active bleeding

Preparing for aggressive airway management in case patient becomes unresponsive

None of the above

The main priority in the focused assessment of a conscious patient with visibly blood-soaked clothing should be geared towards rapidly locating and managing any and all sites of ongoing/active bleeding. This is important as it helps to control and stop the bleeding, preventing further blood loss and potential complications. Obtaining a complete medical history and preparing for aggressive airway management are also important aspects of patient care, but in this specific scenario, the immediate focus should be on identifying and managing the source of bleeding.

Explanation

The main priority in the focused assessment of a conscious patient with visibly blood-soaked clothing should be geared towards rapidly locating and managing any and all sites of ongoing/active bleeding. This is important as it helps to control and stop the bleeding, preventing further blood loss and potential complications. Obtaining a complete medical history and preparing for aggressive airway management are also important aspects of patient care, but in this specific scenario, the immediate focus should be on identifying and managing the source of bleeding.

2. Tourniquets (of any type) are an appropriate intervention for use in:

Extremity hemorrhage not controllable by other means

Groin or neck wounds requiring high sustained pressure to control

Patients on chronic anticoagulation with mild oozing of blood, since it might worsen unexpectedly

None of the above

Tourniquets are an appropriate intervention for extremity hemorrhage not controllable by other means. This means that when other methods of controlling bleeding, such as direct pressure or elevation, are ineffective, a tourniquet can be used to apply pressure to the bleeding extremity. Tourniquets are not recommended for groin or neck wounds requiring high sustained pressure to control, as these areas are more sensitive and may be injured further by the application of a tourniquet. Additionally, tourniquets should not be used on patients on chronic anticoagulation with mild oozing of blood, as it may unexpectedly worsen the bleeding.

Explanation

Tourniquets are an appropriate intervention for extremity hemorrhage not controllable by other means. This means that when other methods of controlling bleeding, such as direct pressure or elevation, are ineffective, a tourniquet can be used to apply pressure to the bleeding extremity. Tourniquets are not recommended for groin or neck wounds requiring high sustained pressure to control, as these areas are more sensitive and may be injured further by the application of a tourniquet. Additionally, tourniquets should not be used on patients on chronic anticoagulation with mild oozing of blood, as it may unexpectedly worsen the bleeding.

3. "Direct pressure" to control bleeding is BEST provided:

With multiple bulky dressings able to “soak up” ongoing bleeding

With a small area (finger) as close as possible to the identified origin of bleeding

By having the patient hold a dressing themselves to keep the pressure from being uncomfortable

None of the above

Direct pressure is the most effective method to control bleeding. By applying pressure directly to the bleeding site, it helps to close off the blood vessels and reduce blood flow. The answer suggests that providing direct pressure with a small area (such as a finger) as close as possible to the identified origin of bleeding is the best approach. This allows for targeted pressure on the source of bleeding, increasing the chances of stopping it effectively.

Explanation

Direct pressure is the most effective method to control bleeding. By applying pressure directly to the bleeding site, it helps to close off the blood vessels and reduce blood flow. The answer suggests that providing direct pressure with a small area (such as a finger) as close as possible to the identified origin of bleeding is the best approach. This allows for targeted pressure on the source of bleeding, increasing the chances of stopping it effectively.

4. Which of the statements regarding fistulas used for hemodialysis is true?

They are generally under low pressure due to the venous structures involved

They are easy for a surgeon to create and don’t require much maintenance or protection

They should generally not be accessed by non-dialysis personnel, although may be considered in a resuscitation emergency

None of the above

Fistulas used for hemodialysis should generally not be accessed by non-dialysis personnel because they require specialized knowledge and skills to handle. However, in a resuscitation emergency, accessing the fistula may be considered as a last resort to save the patient's life. This is because the fistula provides direct access to the bloodstream and can be used for rapid administration of fluids or medications in emergency situations.

Explanation

Fistulas used for hemodialysis should generally not be accessed by non-dialysis personnel because they require specialized knowledge and skills to handle. However, in a resuscitation emergency, accessing the fistula may be considered as a last resort to save the patient's life. This is because the fistula provides direct access to the bloodstream and can be used for rapid administration of fluids or medications in emergency situations.

5. Concerning general vital sign findings in patients reporting bleeding might include:

Persistent hypotension

Initial tachycardia in a visibly anxious patient, resolved after bleeding is controlled

Strong peripheral pulses

All of the above

Persistent hypotension is a possible vital sign finding in patients reporting bleeding. This means that the patient's blood pressure remains low over time, which can be a sign of ongoing blood loss. It is an important finding to monitor as it indicates the need for immediate medical intervention to control the bleeding and stabilize the patient's condition.

Explanation

Persistent hypotension is a possible vital sign finding in patients reporting bleeding. This means that the patient's blood pressure remains low over time, which can be a sign of ongoing blood loss. It is an important finding to monitor as it indicates the need for immediate medical intervention to control the bleeding and stabilize the patient's condition.