External Hemorrhage Control and Stop the Bleed Practice Questions

25 multiple-choice questions on External hemorrhage control and Stop the Bleed for paramedic and EMT students, from Chapter 31 (Bleeding). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. For most external bleeding, the first and most effective method of control is:

   1. A. Elevating the limb
   2. B. Pressure on a pressure point
   3. C. Applying a cold pack
   4. D. Firm direct pressure
   Show answer

   Answer: D. Firm direct pressure

   Direct pressure over the bleeding point controls most external bleeding. Elevation and pressure points are no longer recommended because they lack evidence and delay effective control.

2. The three steps taught to lay rescuers in the Stop the Bleed ABCs are:

   1. A. Alert, find the bleeding, and compress
   2. B. Airway, breathing, and circulation
   3. C. Assess, bandage, and carry them to safety
   4. D. Alert, bandage, and cover the wound
   Show answer

   Answer: A. Alert, find the bleeding, and compress

   A = alert (call 911), B = find the bleeding, C = compress with pressure, packing, or a tourniquet. Airway-breathing-circulation is the older resuscitation sequence and does not prioritize bleeding.

3. A man has a stab wound to the left chest wall. Blood is oozing steadily from it and it bubbles with each breath. The best treatment for the wound itself is to:

   1. A. Pack hemostatic gauze deep into the chest wound
   2. B. Hold firm pressure with a bulky gauze dressing
   3. C. Leave it open so the blood can drain freely
   4. D. Cover it with a vented chest seal and monitor
   Show answer

   Answer: D. Cover it with a vented chest seal and monitor

   A wound that bubbles with breathing is an open pneumothorax, so the wound needs an airtight seal; TCCC prefers a vented chest seal, and the patient is then watched for tension pneumothorax (burp the seal or decompress if it develops). Bleeding from inside the chest is noncompressible and needs rapid transport to surgery. Hemostatic gauze and packing are for compressible extremity and junctional wounds; gauze pushed into the chest cannot compress intrathoracic bleeding. A bulky gauze dressing is not airtight, so air keeps entering the pleural space. Leaving the wound open allows continued air entry and does nothing for the bleeding. (TCCC Guidelines, Respiration: open/sucking chest wound; PHTLS 10th ed.)

4. A thigh laceration has soaked through the dressing despite your pressure. You should:

   1. A. Remove the dressing and replace it with a new one
   2. B. Lift the dressing every minute to check the wound
   3. C. Leave the dressing and escalate to a tourniquet
   4. D. Elevate the leg above the heart and wait
   Show answer

   Answer: C. Leave the dressing and escalate to a tourniquet

   Removing a soaked dressing disrupts the forming clot. If pressure fails on an extremity, move to a tourniquet; piling more gauze on top without effective pressure only hides continued bleeding.

5. A man has a deep stab wound to the groin with heavy bleeding. A tourniquet cannot be placed above it. The best treatment is:

   1. A. Wound packing with hemostatic gauze and pressure
   2. B. A tourniquet on the lower thigh, below the wound
   3. C. A loose dressing and rapid transport
   4. D. Elevating both legs and applying a cold pack
   Show answer

   Answer: A. Wound packing with hemostatic gauze and pressure

   Junctional wounds of the groin, axilla, and neck cannot take a limb tourniquet, so the wound is packed tightly and firm pressure is held. A tourniquet below the wound would not stop flow coming from above.

6. When packing a deep wound, you should:

   1. A. Lay gauze loosely over the top of the wound
   2. B. Pack tightly to the base, over the bleeding source
   3. C. Pack only the outer edge of the wound
   4. D. Fill the wound loosely with gauze soaked in saline
   Show answer

   Answer: B. Pack tightly to the base, over the bleeding source

   Packing works by putting pressure directly on the bleeding vessel deep in the wound, so gauze is pushed to the source and packed firmly until the cavity is full. Gauze laid on top does not reach the vessel.

7. After packing a wound with hemostatic gauze such as QuikClot Combat Gauze, firm pressure should be held for at least:

   1. A. 30 seconds
   2. B. 3 minutes
   3. C. 1 minute
   4. D. 30 minutes
   Show answer

   Answer: B. 3 minutes

   The manufacturer and TCCC call for at least 3 minutes of direct pressure after packing with hemostatic gauze. Holding for less often fails because the clot has not yet formed.

8. No hemostatic gauze is available, so you pack a deep thigh wound tightly with plain gauze. How should you hold pressure on it?

   1. A. Lightly, lifting it each minute to check the wound
   2. B. Firmly for 30 seconds, then release it to look
   3. C. Firmly and without letup for about 10 minutes
   4. D. Firmly until the gauze soaks, then pull it out
   Show answer

   Answer: C. Firmly and without letup for about 10 minutes

   Plain gauze relies on the body's own clotting, so pressure must be firm and uninterrupted until a clot forms; many courses teach about 10 minutes for plain gauze (versus at least 3 minutes for hemostatic gauze), and pressure is kept on until a pressure bandage replaces your hands. Light pressure and repeated lifting to check disrupt the forming clot. Thirty seconds is far too short for any clot to form. Pulling out soaked packing removes the clot that has begun to form; instead add firm pressure and escalate (repack or tourniquet if on a limb) per protocol. (Stop the Bleed; PHTLS 10th ed.)

9. Kaolin-impregnated hemostatic gauze controls bleeding mainly by:

   1. A. Activating the body's clotting cascade
   2. B. Sticking to tissue like an adhesive
   3. C. Constricting the injured vessel
   4. D. Producing heat that seals the torn vessel
   Show answer

   Answer: A. Activating the body's clotting cascade

   Kaolin activates factor XII and the intrinsic pathway, speeding clot formation. Chitosan products work differently, by adhering to tissue and red cells to seal the wound.

10. Chitosan-based hemostatic dressings work mainly by:

    1. A. Activating factor XII in the blood
    2. B. Releasing extra calcium into the wound bed
    3. C. Producing an exothermic reaction
    4. D. Adhering to tissue and sealing the wound
    Show answer

    Answer: D. Adhering to tissue and sealing the wound

    Chitosan, derived from shellfish shells, is mucoadhesive and attracts red cells, forming a seal over the vessel. Activating factor XII is the mechanism of kaolin.

11. Early granular zeolite hemostatic agents were largely abandoned because they:

    1. A. Lost their potency after brief storage
    2. B. Caused burns from the heat they produced
    3. C. Required refrigeration to stay effective
    4. D. Worked only on venous bleeding
    Show answer

    Answer: B. Caused burns from the heat they produced

    The original zeolite powders released heat as they absorbed water, causing tissue burns. Current products use gauze impregnated with agents such as kaolin or chitosan.

12. Hemostatic dressings are of little use for:

    1. A. Bleeding inside the abdominal cavity
    2. B. Deep wounds of the groin
    3. C. Deep wounds of the axilla
    4. D. Scalp wounds with heavy, steady bleeding
    Show answer

    Answer: A. Bleeding inside the abdominal cavity

    These dressings must contact the bleeding vessel with pressure behind them, so they cannot treat noncompressible bleeding in the chest or abdomen. Those patients need rapid transport to surgery.

13. Junctional tourniquets are designed for use over the:

    1. A. Forearm and lower leg
    2. B. Neck and face
    3. C. Groin and axilla
    4. D. Chest and abdomen
    Show answer

    Answer: C. Groin and axilla

    Junctional devices such as the SAM Junctional Tourniquet apply focused pressure over the femoral or axillary vessels where limb tourniquets cannot be placed. Forearm and lower-leg wounds take an ordinary limb tourniquet.

14. After a blast, a man has a traumatic amputation high on the thigh with no room for a tourniquet. Packing and pressure have not stopped the bleeding. The next step is:

    1. A. A second layer of gauze on the wound
    2. B. Elevating the stump above the heart level
    3. C. Pressure on the popliteal artery
    4. D. A junctional tourniquet over the groin
    Show answer

    Answer: D. A junctional tourniquet over the groin

    A junctional tourniquet compresses the femoral vessels proximal to the wound when a limb tourniquet will not fit. The popliteal artery is below the wound, so pressing on it cannot stop inflow.

15. A man has a knife wound to the side of the neck with dark blood flowing and a faint sucking sound. You should first:

    1. A. Cover it with an occlusive dressing and press
    2. B. Apply a circumferential pressure bandage
    3. C. Leave the wound open to drain freely
    4. D. Pack the wound and wrap tape around the neck
    Show answer

    Answer: A. Cover it with an occlusive dressing and press

    An open neck vein can draw in air and cause a fatal air embolism, so an occlusive dressing with direct pressure is needed. Circumferential wraps can compress the airway and the opposite carotid.

16. After applying a pressure bandage to an extremity, you should check:

    1. A. Only that the bandage is tight
    2. B. The patient's pupils and glucose
    3. C. Distal pulse, movement, and sensation
    4. D. Capillary refill at the edge of the wound
    Show answer

    Answer: C. Distal pulse, movement, and sensation

    A pressure bandage should stop bleeding without acting as an unintended tourniquet, so distal circulation, motor function, and sensation are rechecked. A bandage that is merely tight may still let bleeding continue underneath.

17. A bystander without any supplies finds a man with heavy bleeding from a thigh wound. Stop the Bleed teaches the bystander to:

    1. A. Find a stick to make a tourniquet first
    2. B. Wait for EMS to bring proper equipment
    3. C. Lay a shirt loosely over the wound
    4. D. Press hard on the wound with both hands
    Show answer

    Answer: D. Press hard on the wound with both hands

    With no equipment, steady, firm pressure with both hands or a knee is the fastest effective option. Hunting for materials to improvise a tourniquet delays control of a bleed that can kill in minutes.

18. A worker has a metal rod impaled in his forearm with moderate bleeding around it. You should:

    1. A. Remove the rod and then pack the wound tightly
    2. B. Stabilize the rod and apply pressure around it
    3. C. Apply a tourniquet before direct pressure
    4. D. Press down firmly on the rod itself
    Show answer

    Answer: B. Stabilize the rod and apply pressure around it

    Removing an impaled object can release its tamponade and cause severe bleeding. Stabilize it with bulky dressings and press around it; only an object blocking the airway or CPR is removed in the field. Moderate bleeding around a rod does not call for a tourniquet first, and pressing on the rod drives it deeper and adds injury.

19. An amputated finger should be prepared for transport by:

    1. A. Placing it directly into a cup of ice
    2. B. Soaking it in a container of saline
    3. C. Wrapping in moist gauze in a bag on ice
    4. D. Wrapping it in dry gauze at room temperature
    Show answer

    Answer: C. Wrapping in moist gauze in a bag on ice

    The part is wrapped in sterile gauze moistened with saline, sealed in a plastic bag, and kept cool by setting that bag on ice. Direct contact with ice freezes the tissue and ruins the chance of reattachment.

20. A patient has a partial amputation of the hand held on by a skin bridge. You should:

    1. A. Control bleeding and splint the part in position
    2. B. Complete the amputation to simplify the transport
    3. C. Pack ice directly against the injured part
    4. D. Cover the wound but leave the part unsplinted
    Show answer

    Answer: A. Control bleeding and splint the part in position

    Leave a partial amputation attached, control the bleeding, and splint it in a functional position. The skin bridge may contain vessels and nerves that improve the chance of repair. Ice in direct contact can freeze the tissue, and an unsplinted part can twist and tear the remaining bridge.

21. A public-access bleeding control kit typically contains:

    1. A. An airway, oxygen mask, and a stethoscope
    2. B. A cervical collar, splint, and cold packs
    3. C. IV catheters, saline, and a pressure bag
    4. D. A tourniquet, hemostatic gauze, and gloves
    Show answer

    Answer: D. A tourniquet, hemostatic gauze, and gloves

    Public kits are built around tools a lay rescuer can use: gloves, a commercial tourniquet, hemostatic or plain packing gauze, and a pressure bandage. IV supplies require training laypeople do not have.

22. Direct pressure most often fails because the pressure is:

    1. A. Applied with a gloved hand rather than gauze
    2. B. Not firm enough or not held long enough
    3. C. Placed directly over the bleeding point
    4. D. Combined with a pressure bandage
    Show answer

    Answer: B. Not firm enough or not held long enough

    Effective pressure is firm, focused on the bleeding point, and uninterrupted. Peeking at the wound or using light pressure lets the clot break down; a gloved hand alone is acceptable when no gauze is available.

23. You have controlled a calf laceration with direct pressure and need your hands free. You should next:

    1. A. Remove the dressing to apply a new one
    2. B. Release pressure and recheck in 10 minutes
    3. C. Apply a pressure bandage over the dressing
    4. D. Tighten a tourniquet on the thigh as a backup
    Show answer

    Answer: C. Apply a pressure bandage over the dressing

    A pressure bandage maintains the pressure your hands were providing so you can move on. A tightened tourniquet is for bleeding that pressure cannot control, not a routine precaution once bleeding has stopped.

24. The Stop the Bleed campaign was launched to:

    1. A. Teach bystanders to perform chest compressions
    2. B. Teach bystanders to control severe bleeding
    3. C. Train EMS crews in surgical airway skills
    4. D. Stock ambulances with prehospital whole blood
    Show answer

    Answer: B. Teach bystanders to control severe bleeding

    Launched after the Sandy Hook shooting and the Hartford Consensus, the campaign teaches the public pressure, packing, and tourniquet use. Bystanders are often the only ones present in the minutes when a bleed is survivable.

25. A man has a heavily bleeding scalp laceration over a palpably depressed area of skull. You should:

    1. A. Apply gentle pressure around the wound edges
    2. B. Press firmly in the center of the wound
    3. C. Pack the wound tightly with hemostatic gauze
    4. D. Leave it uncovered to allow drainage
    Show answer

    Answer: A. Apply gentle pressure around the wound edges

    Firm central pressure or packing can push bone fragments into the brain. Gentle pressure around the edges with a bulky dressing controls bleeding while protecting the injury.