Conflicting test question...

[DirtyBlackSocks]

You arrive on the scene with a patient screaming and squirting bright red blood from the femoral artery, what is your first step?

Answers were along the lines of check airway, control bleeding, take pulse and something silly.

Just about everyone missed it, according to the instructor it's check airway - I chose control bleeding. Obviously if the pt is screaming their airway is fine, and if they've got arterial bleeding that seems like a bigger issue.

Thoughts on this one? Bumped my test score from an A to a B.

Note that this is an older question from an EMT course I took in the military, I don't know why I thought of it now.

[DirtyBlackSocks]

So obviously it's a trick question designed to test critical thinking.

What would you do if you came upon a patient squirting blood from the femoral artery that was unconscious, though?

Would you tourniquet the leg and then check airway?

Wouldn't the act of compressions from CPR do nothing more than force blood out of the body until the artery was taken care of?

[animal1993]

If the pt was unconscious, I would think you would check the airway/breathing first. If the blood is squirting from the femoral artery, I would think that would indicate that the pt had a pulse, and would not need compressions at that time. (Never been in this situation--just looking at it as a test question.)

[simboka]

So walking on a scene of a pt screaming and you see bright red blood squirting from there femoral, I can knock off A, B, and C almost instantly all from >10'

So the question then becomes, did you have and know the "A-B-C" dogma back then; if so, then did you not realize what answer the question was looking for?

If the pt was laying unconscious and you say a femoral bleed squirting (wouldn't that mean they wouldn't be wearing pants?), which would you check first?

But what I feel is the deeper question was posed by GilaRN asking about the disconnect between "academia" and the "real world." I personally always liked the actively staffing lecturerers best :)

[Michaelxy]

A hemorrhaging femoral artery will bleed out in about two minutes. After that it won't matter. Choice seems clear to me. I hate the question.

[DirtyBlackSocks]

Well, there were three instructor's for this particular course - keep in mind this was a military course for training combat medics.

One was an active Special Forces Medic, one was a civilian flight Paramedic and one was a fresh out of school paramedic.

The flight medic was actually the main instructor for the course, and he's the one who said check airway was the correct answer.

The SF Medic (who was crazy) told us if you ever come across some one squirting blood you take care of that, period.

All in all, most of the medic instructors (there were around 30 of them) that were military all agreed that if you did not control arterial bleeding first, you pretty much condemn your patient to death.

I would assume, being a Special Forces medic, that the guy has experience with such things. Combat related injuries are a whole different ball game from standard civilian injuries.

The reason our lead instructor was so adamant about checking airway first, is because the actual NREMT is just as bad with it's questions. You always check airway first on paper.

In actual practice as a medic, I go by the most evident trauma. If some one has profuse hemorrhage, it will always take presidence for me. I would rather tourniquet a leg before starting any sort of compressions, because that's common sense.

There are only a handful of conditions that would make airway a secondary concern, but I'd say arterial bleeding is definitely one of them.

But then, that's why we work in teams. If you've got a pt. who's lost so much blood that they aren't breathing and are asystolic AND they have an open artery - you're pretty much SOL without two medics on hand. Unless you're really fast with a tourniquet.

Where I find issue with that sort of teaching, is that everyone deals with stressful situations differently - and training is what you're supposed to fall back on. Fresh medics who run into a bad situation run the risk of costing some one their life because of poorly worded questions.

[Music in My Heart]

What would you do if you came upon a patient squirting blood from the femoral artery that was unconscious, though?

...

Wouldn't the act of compressions from CPR do nothing more than force blood out of the body until the artery was taken care of?

You wouldn't need to do compressions. The fact that they're squirting blood tells me that the pump is working fine.

[Emergency RN]

He's screaming and squirting? ABC check was completed by the preceding statement.

Move to the next problem. Take care of the bleeder.

[Guest219794]

It's a test of test taking skills.

It's always airway.

If I am taking a test, and I see that the answer choices include airway, I won't even really read the question. I have taken a lot of tests, including NCLEX, ACLS, PALS, CPR, CCRN, TNCC, EMT, WEMT, WFR, OEC, AND OTHERS. I have yet to see a test question in which airway was not the priority.

Your instructor did a good job preparing you for future tests. I bet you now always put airway first on a test.

Would you rather be right, or get a good grade?

BTW- If you ever see me with a spurting arterial bleed, please apply well aimed direct pressure really quickly. And yes hearing me screaming will suffice for an airway check. The only way you will be able to do a more detailed airway assesment would be to stop the bleeding so I stop screaming.

[CT Pixie, BSN, RN]

Its always always, always, Airway, breathing, circulation. airway is always the 1st priority in real life and in the "test" world. What good is stopping the bleeding if the pt isn't breathing d/t a blocked airway??

When you see the pt is screaming and bleeding profusely, you've just assessed the airway without even thinking about it. You know that screaming means the person has an open airway and they are breathing. You assessed the airway and breathing without even knowing it but you did it in that order A&B..you then would move to stopping the bleeding. But you did AB and then C.

[PedsDrNurseTheo, ADN, BSN, MSN, DNP, RN, EMT-P, NP]

The only way you will be able to do a more detailed airway assesment would be to stop the bleeding so I stop screaming.

Or ...

Let the bleeding continue until the screaming/breathing stops, and then drop an ET tube to secure the airway.

Because, as we all know ... all bleeding stops - eventually.

Just like all arrhythmias stabilize, eventually. Asystole is a stable rhythm.

Whether that's a GOOD thing or not, well, that's a whole other question, isn't it?

But like hherrn said - it's a test-taking test question. Which I always hated.

IRL, you can act and assess at the same time - which tends to be nice for your patient. It doesn't work so well on paper.

[sunnycalifRN]

oh, it's just a test question and a silly one at that. But, since the patient is screaming . . . airway is intact. I'd go straight to holding pressure to stop the bleeding.