External Hemorrhage: Types and Assessment Practice Questions

25 multiple-choice questions on External hemorrhage: types and assessment 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. Arterial bleeding is characterized by blood that is:

   1. A. Bright red and spurting with each heartbeat
   2. B. Dark red and flowing in a steady stream
   3. C. Dark red and slowly oozing from the edges
   4. D. Bright red and seeping evenly from the wound
   Show answer

   Answer: A. Bright red and spurting with each heartbeat

   Arterial blood is oxygen rich and under high pressure, so it spurts in time with the pulse. A steady dark-red flow is venous; it can still be heavy but lacks the pulsatile pattern.

2. Capillary bleeding typically:

   1. A. Spurts with each beat of the heart
   2. B. Flows steadily as a dark red stream
   3. C. Oozes slowly and clots on its own
   4. D. Requires a tourniquet to control
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   Answer: C. Oozes slowly and clots on its own

   Capillary bleeding, as from an abrasion, is slow and low pressure, and it usually stops with light pressure. Even so, a large abraded area can add up to meaningful loss.

3. A 79-year-old woman calls because a varicose vein on her lower leg ruptured. Dark red blood is flowing steadily and has soaked the floor. Your best initial action is to:

   1. A. Reassure her that venous bleeding is minor
   2. B. Apply firm direct pressure to the site
   3. C. Place a cold pack and recheck in 10 minutes
   4. D. Wrap the leg loosely and position it down
   Show answer

   Answer: B. Apply firm direct pressure to the site

   Venous bleeding lacks arterial pressure but can be heavy enough to kill, and ruptured varicose veins have caused fatal hemorrhage in older adults. Firm direct pressure usually controls it; lowering the leg would raise venous pressure and increase the flow.

4. In the XABCDE approach to the primary survey, the X stands for:

   1. A. Exposure of the entire body surface
   2. B. Examination of the cervical spine
   3. C. Exsanguinating external hemorrhage
   4. D. Extrication from the vehicle
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   Answer: C. Exsanguinating external hemorrhage

   XABCDE moves control of severe external bleeding ahead of the airway, because a patient can bleed to death from a major vessel in minutes. Exposure is the E at the end of the survey, not the X.

5. A 24-year-old man struck by a car has bright red blood spurting from his thigh and snoring respirations. Your first action should be to:

   1. A. Open the airway with a jaw-thrust
   2. B. Control the bleeding from the thigh
   3. C. Insert a nasopharyngeal airway
   4. D. Assess his breathing and lung sounds
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   Answer: B. Control the bleeding from the thigh

   Under XABCDE, massive external hemorrhage comes first; it takes seconds with a tourniquet, and the airway follows immediately. With a second provider both can be done at once, but airway work must not delay hemorrhage control.

6. In the TCCC MARCH sequence, the M stands for:

   1. A. Mental status
   2. B. Mechanism of injury
   3. C. Medication history
   4. D. Massive hemorrhage
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   Answer: D. Massive hemorrhage

   MARCH is massive hemorrhage, airway, respiration, circulation, and head injury/hypothermia. Like the X in XABCDE, it places stopping exsanguination before airway care.

7. A man has an arterial wound to the arm. Over several minutes the spurting becomes weaker, though you have not yet controlled it. This most likely means:

   1. A. His blood pressure is falling
   2. B. The artery has begun to heal
   3. C. He is regaining his compensation
   4. D. The wound has nearly clotted
   Show answer

   Answer: A. His blood pressure is falling

   Arterial spurting depends on pressure, so weakening flow without any intervention can mean the patient is decompensating. Do not mistake it for natural clotting; control the bleeding and treat for shock.

8. A man was assaulted and is lying supine on dark gravel in a heavy winter coat. He is pale and tachycardic, but you see no blood. You should next:

   1. A. Assume a medical cause of his tachycardia
   2. B. Expose him and sweep with gloved hands for blood
   3. C. Wait until the hospital staff can undress him fully
   4. D. Check a blood glucose before any exam
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   Answer: B. Expose him and sweep with gloved hands for blood

   Clothing, dark surfaces, and the ground under the patient can hide large blood losses. A blood sweep of the back, armpits, and groin with gloved hands, plus exposure, finds bleeding that a visual glance misses.

9. Visual estimates of external blood loss at a scene are:

   1. A. Accurate to within 100 mL for most providers
   2. B. More reliable than the heart rate and mental status
   3. C. Accurate when blood has pooled on a hard floor
   4. D. Often inaccurate, so judge by the patient's signs
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   Answer: D. Often inaccurate, so judge by the patient's signs

   Blood spread over a floor or soaked into clothing is easily over- or underestimated, and pooled blood on a hard floor is especially easy to misjudge. Mental status, pulse, skin, and blood pressure give a better picture of how much the patient has lost.

10. Which finding indicates life-threatening external bleeding, as taught in Stop the Bleed?

    1. A. Blood pooling on the ground
    2. B. A wound longer than 5 cm
    3. C. Bleeding that has stopped on its own
    4. D. Bruising around a closed wound
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    Answer: A. Blood pooling on the ground

    Stop the Bleed lists spurting blood, pooling, soaked clothing or bandages, amputation, and a confused or unresponsive victim as signs of life-threatening bleeding. Wound length alone does not determine how fast a wound bleeds.

11. A 70-kg man has lost about 1,000 mL of blood. This is roughly what percentage of his blood volume?

    1. A. 5%
    2. B. 10%
    3. C. 20%
    4. D. 40%
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    Answer: C. 20%

    At 70 mL/kg he has about 4,900 mL, so 1,000 mL is about 20%, enough for tachycardia and anxiety. 40% would be about 2,000 mL, the range of class IV hemorrhage.

12. A 4-kg infant has lost about 100 mL of blood from a scalp wound. This represents roughly:

    1. A. 30% of her blood volume
    2. B. 3% of her blood volume
    3. C. 10% of her blood volume
    4. D. 60% of her blood volume
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    Answer: A. 30% of her blood volume

    An infant has roughly 80 to 90 mL/kg, or about 320 to 360 mL in total. A loss that would be trivial in an adult is roughly 30% of an infant's volume, at the border of class II and class III hemorrhage.

13. Before treating a patient with spurting arterial bleeding, the most appropriate PPE is:

    1. A. Gloves only
    2. B. An N95 respirator only
    3. C. A gown and shoe covers only
    4. D. Gloves and eye protection
    Show answer

    Answer: D. Gloves and eye protection

    Spurting blood can splash the face and eyes, so eye and face protection is added to gloves. An N95 protects against airborne particles, which is not the main route of exposure here.

14. Scalp lacerations can cause significant blood loss mainly because the scalp:

    1. A. Has thin, fragile skin
    2. B. Has a rich blood supply
    3. C. Lacks lymphatic drainage
    4. D. Lies directly over the sinuses
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    Answer: B. Has a rich blood supply

    The scalp is highly vascular, and dense connective tissue holds its vessels open so they do not constrict well. The skin is not especially thin; in children, a scalp wound alone can cause shock.

15. Capillary refill is least reliable as a perfusion sign in:

    1. A. An infant in a warm room
    2. B. A toddler with vomiting
    3. C. An adult in a cold environment
    4. D. A child with a closed leg fracture
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    Answer: C. An adult in a cold environment

    Cold causes peripheral vasoconstriction that delays refill regardless of volume status, and adult refill is also affected by age and medications. In children in a warm setting, delayed refill is a more useful early sign of shock.

16. A motorcyclist thrown from his bike has a possible neck injury and an arm wound spurting blood. You have one partner. The best plan is:

    1. A. Fully immobilize the spine, then treat the bleeding
    2. B. Control the airway first, then treat the arm
    3. C. Load quickly and control bleeding at the hospital
    4. D. Partner holds the head while you stop the bleeding
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    Answer: D. Partner holds the head while you stop the bleeding

    Massive bleeding is the most immediate threat and can be controlled in seconds, while manual stabilization protects the spine at the same time. Delaying hemorrhage control for full immobilization risks exsanguination.

17. During SALT triage at a mass-casualty incident, which lifesaving intervention may be done before assigning a category?

    1. A. Starting an IV line
    2. B. Splinting a fracture
    3. C. Applying a tourniquet
    4. D. Placing a cervical collar
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    Answer: C. Applying a tourniquet

    SALT allows quick lifesaving interventions such as hemorrhage control, opening the airway, chest decompression, and antidote autoinjectors. IV access, splinting, and spinal motion restriction take too long and wait for treatment areas.

18. A man has a deep groin laceration and blood is soaking through his jeans. A major arterial bleed like this can become fatal:

    1. A. Within about 3 to 5 minutes
    2. B. Within about 30 minutes
    3. C. Within about 1 hour
    4. D. Within about 2 to 3 hours of injury
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    Answer: A. Within about 3 to 5 minutes

    Bleeding from a major vessel such as the femoral artery can kill in minutes, which is why Stop the Bleed stresses immediate control by whoever is present. Waiting for transport to treat it is not an option.

19. Which mechanism should most raise your concern for hidden hemorrhage?

    1. A. A low-speed bicycle fall onto grass
    2. B. A fall of 6 m (20 ft) onto concrete
    3. C. A ground-level slip onto carpet
    4. D. A rear-end crash at 8 km/h (5 mph)
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    Answer: B. A fall of 6 m (20 ft) onto concrete

    High-energy mechanisms transfer enough force to injure solid organs, the pelvis, and large vessels without visible wounds. The 2021 field triage guideline lists falls from more than 3 m (10 ft) as a high-risk mechanism.

20. A patient's forearm laceration was controlled with a dressing. On reassessment, the most important thing to check first is:

    1. A. The patient's current pain score
    2. B. Whether the dressing is soaking through
    3. C. Whether the gauze has stuck to the wound
    4. D. The color of the wound edges
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    Answer: B. Whether the dressing is soaking through

    Reassessment of bleeding control comes first; a soaked dressing means bleeding has resumed and needs more pressure, packing, or a tourniquet. Pain, stuck gauze, and wound edge color matter for comfort and later wound care but do not tell you whether hemorrhage is controlled.

21. A stabbing victim is awake but increasingly restless, anxious, and combative. He is tachycardic with a normal blood pressure. You should suspect:

    1. A. Early shock from blood loss
    2. B. Alcohol or drug intoxication
    3. C. A primary psychiatric illness
    4. D. An acute stress reaction
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    Answer: A. Early shock from blood loss

    Restlessness and anxiety are early signs of reduced brain perfusion and sympathetic activity. Assuming intoxication, a stress reaction, or emotion is a classic way to miss compensated hemorrhagic shock.

22. After exposing a trauma patient to look for bleeding, you should next:

    1. A. Leave the patient uncovered for reassessment
    2. B. Apply cold packs to slow the bleeding
    3. C. Cover the patient to preserve body heat
    4. D. Remove only the blood-soaked clothing
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    Answer: C. Cover the patient to preserve body heat

    Exposure is needed to find wounds, but heat loss quickly worsens coagulopathy. Cover the patient as soon as the exam is done and keep the ambulance warm; reassessment can be done under the blanket.

23. When documenting external bleeding, the most useful information to report to the receiving facility includes:

    1. A. The estimated volume of blood left on the scene
    2. B. The length of the wound in centimeters
    3. C. Only the patient's lowest blood pressure
    4. D. The type of bleeding and how it was controlled
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    Answer: D. The type of bleeding and how it was controlled

    The receiving team needs the bleeding pattern, interventions (including tourniquet time), and response to treatment. A volume estimate is unreliable, and wound length or a single pressure reading leaves out what the team must act on.

24. Which patient has the highest risk of an underappreciated external hemorrhage?

    1. A. A woman with a bleeding finger she is holding
    2. B. A child with a scraped knee crying for his mother
    3. C. A man lying supine with a stab wound to the back
    4. D. A man with a cut lip who is spitting blood
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    Answer: C. A man lying supine with a stab wound to the back

    Posterior wounds bleed into the ground or mattress and are missed unless the patient is logrolled and swept. Wounds the patient or the provider can see are far less likely to be underestimated.

25. You arrive to find a man with a deep arm laceration and a bystander holding pressure. Bleeding appears controlled. Your best action is to:

    1. A. Remove the bystander's hand to inspect the wound
    2. B. Have the bystander keep pressing while you assess
    3. C. Replace the bystander's dressing with a clean one
    4. D. Thank the bystander and release all pressure
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    Answer: B. Have the bystander keep pressing while you assess

    Releasing pressure to look can restart bleeding that has just begun to clot. Keep pressure on until you are ready to apply a pressure dressing, packing, or a tourniquet, and assess the rest of the patient meanwhile.