Tourniquets Practice Questions

25 multiple-choice questions on Tourniquets 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. A forklift crushed a 30-year-old man's leg. Bright red blood is spurting from his mangled calf. Your first treatment should be:

   1. A. Direct pressure for 10 minutes
   2. B. Elevation of the leg
   3. C. A bulky pressure dressing
   4. D. A tourniquet above the wound
   Show answer

   Answer: D. A tourniquet above the wound

   Life-threatening limb hemorrhage, especially from a mangled extremity or amputation, calls for an immediate tourniquet. Current guidance does not require direct pressure to fail first when the bleeding is clearly life threatening.

2. When the wound is visible, a limb tourniquet should be placed:

   1. A. 5 to 7.5 cm (2 to 3 in) above the wound
   2. B. Directly over the wound itself
   3. C. Just below the wound edge
   4. D. Over the nearest joint just above the wound
   Show answer

   Answer: A. 5 to 7.5 cm (2 to 3 in) above the wound

   Placing it a few inches above the wound compresses the artery proximal to the injury. A joint has little soft tissue to compress the vessel against, and tourniquets over joints often fail.

3. A high and tight tourniquet placement is appropriate when:

   1. A. The bleeding comes from the hand or fingers
   2. B. The patient is a child under age 8
   3. C. Direct pressure has already controlled it
   4. D. The wound cannot be seen or reached quickly
   Show answer

   Answer: D. The wound cannot be seen or reached quickly

   When the area is unsafe or dark, or the wound cannot be exposed, placing the tourniquet as high on the limb as possible ensures it is above the injury. Once conditions allow, it can be replaced 2 to 3 inches above the wound.

4. A tourniquet is tight enough when:

   1. A. The skin below it turns slightly pink and warm
   2. B. Bleeding stops and the distal pulse is absent
   3. C. The patient reports mild tightness
   4. D. The windlass has turned two times
   Show answer

   Answer: B. Bleeding stops and the distal pulse is absent

   The endpoint is cessation of bleeding and loss of the distal pulse. Stopping at a set number of turns or at mild discomfort risks a venous tourniquet that increases bleeding.

5. After you tighten a tourniquet on a thigh, bleeding slows but continues, and the windlass will not turn further. You should:

   1. A. Loosen the first and reapply it lower
   2. B. Pack gauze around the tourniquet's band
   3. C. Add a second tourniquet above the first
   4. D. Leave it and accept partial control
   Show answer

   Answer: C. Add a second tourniquet above the first

   Large thighs often need a second tourniquet placed side by side and just proximal to the first. Loosening the first to reposition it would restart full arterial bleeding.

6. Once a tourniquet has controlled bleeding, it should be:

   1. A. Left tight without periodic loosening
   2. B. Loosened every 15 minutes
   3. C. Loosened every hour for 1 to 2 minutes
   4. D. Removed once the bleeding stops
   Show answer

   Answer: A. Left tight without periodic loosening

   Periodic loosening lets more blood out and was abandoned. A tourniquet stays tight until a provider decides to convert it under controlled conditions.

7. The time a tourniquet was applied should be:

   1. A. Estimated at the hospital from the wound
   2. B. Recorded only after the call is complete
   3. C. Written on the tourniquet or the patient
   4. D. Relayed verbally without being written
   Show answer

   Answer: C. Written on the tourniquet or the patient

   Writing the time on the tourniquet tag or the patient's forehead ensures every provider knows the ischemia time, which guides conversion and surgical decisions. Verbal reports alone are easily lost in handoffs.

8. A conscious patient is screaming in pain after you tighten a tourniquet that has stopped his arm bleeding. You should:

   1. A. Loosen it until the pain is tolerable
   2. B. Leave it in place and give analgesia
   3. C. Remove it and switch to elevation
   4. D. Loosen it for 2 minutes, then retighten
   Show answer

   Answer: B. Leave it in place and give analgesia

   Pain is expected from an effective tourniquet and does not mean it is wrong. Loosening it to relieve pain restarts bleeding; treat the pain with an opioid or ketamine per protocol.

9. After a tourniquet is applied, the leg becomes dusky and swollen and the bleeding increases. The most likely problem is that the tourniquet:

   1. A. Is too tight and has crushed the artery
   2. B. Was placed too far from the wound
   3. C. Has caused a severe allergic reaction
   4. D. Is blocking veins but not arterial flow
   Show answer

   Answer: D. Is blocking veins but not arterial flow

   A loose tourniquet occludes low-pressure veins but lets arterial blood in, so the limb engorges and bleeds more. Tighten it until bleeding stops and the distal pulse is gone.

10. An improvised tourniquet should be at least:

    1. A. 0.5 cm (0.25 in) wide
    2. B. 1 cm (0.5 in) wide
    3. C. 15 cm (6 in) wide
    4. D. 5 cm (2 in) wide
    Show answer

    Answer: D. 5 cm (2 in) wide

    A band about 5 cm (2 in) wide, such as a folded cravat, spreads pressure enough to occlude the artery with a windlass. Cords, wire, and shoelaces (0.5 to 1 cm) concentrate pressure, cut into tissue, cause nerve damage, and often fail to stop arterial flow. Wider bands occlude at lower pressure, but a 15-cm minimum is not required and would rule out most cravats and belts. Improvised tourniquets fail often, so a commercial windlass tourniquet is preferred whenever one is available. (Stop the Bleed; PHTLS 10th ed.; Wall et al., JSOM, strap width and occlusion pressure.)

11. Compared with improvised tourniquets, commercial windlass tourniquets such as the CAT:

    1. A. Stop arterial flow more reliably
    2. B. Can be loosened every 10 minutes
    3. C. Do not require a time to be recorded
    4. D. Cause no pain when they are tightened
    Show answer

    Answer: A. Stop arterial flow more reliably

    Devices recommended by the CoTCCC are tested to occlude arterial flow and are faster to apply. They still hurt, still need the time recorded, and are not loosened periodically.

12. If a blood pressure cuff is used as a tourniquet, you should:

    1. A. Inflate it to 20 mmHg below the systolic pressure
    2. B. Inflate it and release it every 10 minutes
    3. C. Inflate it until bleeding stops and clamp the tubing
    4. D. Leave it at the pressure used for a BP reading
    Show answer

    Answer: C. Inflate it until bleeding stops and clamp the tubing

    The cuff must be inflated until bleeding stops and the tubing clamped to prevent slow leaks, then watched closely. Pressure below systolic acts as a venous tourniquet and increases bleeding.

13. Permanent limb damage from a tourniquet is uncommon if it is in place for less than about:

    1. A. 10 minutes
    2. B. 2 hours
    3. C. 30 minutes
    4. D. 24 hours
    Show answer

    Answer: B. 2 hours

    Nerve and muscle injury are uncommon when ischemia time is under about 2 hours and rise after that. Fear of a short time limit such as 30 minutes should never delay a lifesaving tourniquet.

14. Tourniquet conversion should not be attempted when the patient:

    1. A. Has stable vital signs
    2. B. Was injured less than 2 hours ago
    3. C. Can be watched closely
    4. D. Has a traumatic amputation
    Show answer

    Answer: D. Has a traumatic amputation

    TCCC advises against conversion for amputations, patients in shock, wounds that cannot be watched closely, or tourniquets on more than 6 hours. Stable vitals, early timing, and close monitoring are conditions that favor conversion.

15. When converting a tourniquet to a pressure dressing, you should:

    1. A. Remove the tourniquet before packing
    2. B. Pack the wound, then slowly loosen it
    3. C. Loosen it rapidly to restore perfusion
    4. D. Cut the tourniquet off and discard it
    Show answer

    Answer: B. Pack the wound, then slowly loosen it

    The wound is packed or a pressure dressing applied first, then the tourniquet is loosened slowly and left loose in place so it can be retightened if bleeding returns. Removing it first risks uncontrolled bleeding.

16. For a civilian patient with a 20-minute transport to a trauma center, a tourniquet that controls bleeding should usually be:

    1. A. Left in place until hospital care
    2. B. Converted on scene before transport
    3. C. Loosened at the midpoint of transport
    4. D. Removed once the patient is loaded
    Show answer

    Answer: A. Left in place until hospital care

    With short civilian transport times, the risk of ischemic injury is low and the risk of rebleeding during conversion is real. Conversion is mainly for prolonged field care or delayed evacuation.

17. After applying a tourniquet, you should:

    1. A. Cover it with the patient's clothing
    2. B. Wrap it under a bulky dressing
    3. C. Leave it exposed and clearly visible
    4. D. Cover it with a blanket for warmth
    Show answer

    Answer: C. Leave it exposed and clearly visible

    A covered tourniquet can be missed at handoff and left on far too long. Keep it visible and marked, while keeping the rest of the patient warm.

18. A tourniquet placed on the forearm or lower leg:

    1. A. Cannot work because of the two bones
    2. B. Can control bleeding if tightened enough
    3. C. Is harmful and must be moved to the upper arm
    4. D. Should be loosened every 30 minutes
    Show answer

    Answer: B. Can control bleeding if tightened enough

    Older teaching held that two-bone segments could not be compressed, but current guidance places the tourniquet 2 to 3 inches above the wound even on the forearm or leg. If it fails, a second one goes above the elbow or knee.

19. A thigh tourniquet stopped the bleeding, but after you move the patient into the ambulance the wound starts bleeding again. You should:

    1. A. Remove it and apply firm direct pressure
    2. B. Leave it and pack gauze on top
    3. C. Tighten it further or add a second one
    4. D. Elevate the leg and recheck later
    Show answer

    Answer: C. Tighten it further or add a second one

    Tourniquets can loosen with movement, and muscle relaxation or swelling changes the pressure needed. Reassess after every move and tighten it or add a proximal tourniquet.

20. Military studies of tourniquet use found survival was greatest when tourniquets were applied:

    1. A. After fluids had been started
    2. B. Only after pressure had failed
    3. C. At the field hospital
    4. D. Before the onset of shock
    Show answer

    Answer: D. Before the onset of shock

    Studies from Iraq showed much higher survival when tourniquets went on before shock developed. Waiting for direct pressure to fail costs blood the patient cannot spare.

21. A woman has a deep laceration 2 cm (1 in) below the knee with spurting blood. Where should the tourniquet go?

    1. A. On the distal thigh above the knee
    2. B. Directly over the knee joint
    3. C. On the calf just below the laceration
    4. D. On the wound itself
    Show answer

    Answer: A. On the distal thigh above the knee

    The tourniquet must be proximal to the wound and not on a joint. When the wound is too close to the joint to fit a tourniquet between them, it goes on the thigh just above the knee.

22. Releasing a tourniquet that has been in place for several hours may cause:

    1. A. Hypoglycemia and seizures
    2. B. Hypercalcemia and confusion
    3. C. Hypernatremia and edema
    4. D. Hyperkalemia and acidosis
    Show answer

    Answer: D. Hyperkalemia and acidosis

    Ischemic muscle accumulates potassium, lactic acid, and myoglobin; reperfusion washes them into the circulation and can cause dysrhythmias. Release after long ischemia is done in the hospital with monitoring.

23. A soldier with a leg wound applies his own tourniquet. Self-application of a windlass tourniquet:

    1. A. Is unsafe because it cannot get tight enough
    2. B. Is taught so casualties can treat themselves
    3. C. Should be done only by a trained medic
    4. D. Works only on the upper extremity
    Show answer

    Answer: B. Is taught so casualties can treat themselves

    Self-aid with a one-handed tourniquet is a core TCCC skill, because the casualty may be the only one able to act. Commercial tourniquets are designed to be applied one-handed to an arm or a leg.

24. A thigh tourniquet stopped the bleeding when the SBP was 70 mmHg. After a unit of whole blood the SBP is 105 and the wound is still dry, but you can now feel a pedal pulse. You should:

    1. A. Leave it, since the wound is not bleeding
    2. B. Loosen it, since perfusion has returned
    3. C. Tighten it until the distal pulse is gone
    4. D. Convert it to a pressure dressing now
    Show answer

    Answer: C. Tighten it until the distal pulse is gone

    A tourniquet tight enough at a low blood pressure may stop occluding arterial inflow once resuscitation raises the pressure. A returning distal pulse means incomplete occlusion, which risks rebleeding and venous congestion; TCCC calls for tightening it further or adding a second tourniquet side by side above it to eliminate the distal pulse. A dry wound right now does not make a partially occluding tourniquet safe. Loosening it restarts arterial bleeding. Conversion is not attempted in a patient who has just been in shock. (TCCC Guidelines, Massive hemorrhage: reassess tourniquets and check distal pulse.)

25. A bystander stopped a leg bleed with a belt tourniquet. You should:

    1. A. Place a commercial one above it, then remove the belt
    2. B. Remove the belt and observe the wound for rebleeding
    3. C. Leave only the belt in place for the entire transport
    4. D. Loosen the belt to check whether bleeding has stopped
    Show answer

    Answer: A. Place a commercial one above it, then remove the belt

    Improvised tourniquets often loosen or fail, so a commercial tourniquet is applied proximal to the belt and tightened before the belt is removed. Removing or loosening the belt first restarts bleeding.