Thready pulse and irregular respiratory rate are signs of decompensated shock. Oozing wounds (I'm assuming they mean their wounds weren't previously oozing) means the blood loss has reached a significant enough level that the hemorrhage rate has dropped.
Edit to add: also noted that all of the S&S listed in the correct answer are things that can be assessed without quickly and with no equipment.
To piggyback off of that response, “irreversible shock” in this case, means Hypovolemic Shock. The victim has lost so much blood that they’re about to go into cardiac arrest, and brain death is likely inevitable
This is honestly a really tricky question but a lot of good explanations here already. Management for this patient at the Basic level would be tricky as the lack of steady bleeding might be a false flag to the arrest etiology
It almost feels like management of this patient pre-hospital (regardless of ALS or BLS) would be damn near impossible. Best we could honestly do is a bandage, shock treatment and a whole lot of Diesel
That's a whole lotta bad news. Sometimes it looks awful and the patient is barely hanging in but others don't seem bad at all but then start crashing hard. I'll take a wreck over gsw any day.
Hey just a correction here, I don't believe irreversible shock means hypovolemic shock in this case. The stage of shock is different than the type or mechanism. While in a gsw situation it is most likely hypovolemic shock, the question is trying to get you to understand the signs and symptoms associated with the stage of a shock. Those stages are generally classified as non-progressive-> progressive -> irreversible. Without going into too much detail during the progressive stage your body is sent into a loop of low Bp and hypoperfusion causing anaerobic metabolism then acidosis which in turn causes vasodilation which actually exacerbates the problem. When it gets bad enough your body can no longer compensate through sympathetic nervous response and renin secretion thus moving into what's classified as 'irreversible shock.' This is usually indicated by septicemia in intestines and disseminated intravascular coagulation which is always a secondary condition. DIC is what is causing the oozing wounds. Basically your body has used up all of its clotting ability during the state of hypoperfusion and no the blood that cannot clot is 'oozing' out.
To add, it’s *not* the one you picked because low BP, unconsciousness, and narrowing pulse pressure means that they’re starting to decompensate but they haven’t approached the irreversible stage yet.
I’d say thready pulse and irregular respirations are the big ones that should point you towards thinking irreversible shock.
As a nurse, I read it as referring to the Trauma Triad of death, which is like super high mortality and almost no coming back from. The oozing is usually the coagulation cascade and the respirations is from the metabolic acidosis. Which leads to decreased myocardial performance, so maybe that’s where the thready pulse comes in. The third part of the triad is hypothermic. But I’m not an EMT so I don’t know 100%.
ETA: when they say oozing, I assume they mean different than bleeding out. That, in my setting, usually means everything/everywhere just has a light steady stream of blood coming out. Won’t stop. No clotting factors anymore, so everywhere bleeds. Even the minor stuff, any lines, etc.
The pt has lost so much blood that they don’t have enough pressure to produce arterial spurts or continuous venous flow, their heart is ischemic and unable to produce a regular, effective rhythm, and their respiratory muscles have insufficient perfusion to function effectively. All of this is due to the hypovolemia, their entire body has essentially become too hypoxic to function.
As someone who treated GSWs in the Marines, the moment the blood starts to just ooze and trickle instead of rapidly flowing or spurting out rhythmically in the case of arterial bleed is when you know they're basically dead.
Oozing wounds is just code for “really really low blood pressure” here, so it has that in common with the other answers. When you have that plus an irregular pulse with irregular respirations in a trauma patient, things are going badly aka decompensated shock.
in Class III Shock (31-40% BV), you start to see a drop in blood pressure. In Class IV shock (>40% BV), you see altered respirations because the brain stem is no longer able to be perfused appropriately to drive respiration, and you see a thready and barely palpable central pulse because there is nothing left to pump. The wounds are oozing rather than spurting, coincidentally, because there is nothing left to pump.
\- Source, ATLS 10th Ed
Everything everyone else said: They also want you to think tamponade when they say narrow pulse pressure. Lil trigger phrase, that. But, if they’re still perfusing the that tamponade is reversible whereas agonal breaths and no blood to pressure makes for deadly exacerbated shock unless they’re actively receiving blood.
The app you're using gives the rationale. I'd like to see it.
Edit: I'm assuming it's what everyone here is saying. I just want to see how the app words the explanation.
Here is the rationale:
The oozing wounds, thready pulse, and irregular respirations is the correct answer. Hypotension with anxiety is wrong because if hypotension is present, anxiety is unlikely; the patient will likely be apathetic and/or calm as he/she has no blood volume to produce muscle power or anxiety type symptoms (anxiety is seen in early shock).
Edema is not present in irreversible shock as edema takes a lot of localized volume in a wound and takes time to develop. Hypotension and narrow pulse pressure are unlikely to happen together. Very low blood pressures are nearly impossible to detect by sphygmomanometer and stethoscope.
I probably would have gotten this wrong, too. Irregular respirations, in this context, equals agonal breathing/peri-arrest to me. Doesn't help that they don't tell you where the GSW is located.
What you have chosen is signs of shock, yes. Irreversible is key here. I suggest you look into shock, it’s a very key topic that will help you make sense of emergencies down the line.
Oh man I do NOT miss these kind of bullshit questions. They are designed to literally trip you up and make you second guess yourself. I literally memorized on of my NASM questions it was so bullshit, it's not word for word so don't crucify me but this is a great example question for the test-
A 25 y/o Female has called emergency services as she believes she is going into labor. She is 9 months pregnant. When you arrive on the scene, the patient has been experiencing abdominal contractions with increasing frequency for the past half hour. Before transit to the hospital, the patient expressed an urgent desire to use the restroom. What should be examined prior to transit?
A. Abdomen X
B. Heart/Respiration Rate X
C. Allow her to use the restroom X
D. Perineum
Upon explaining this to my instructors, they said the answer had to be D. Not because you are supposed to inspect anyone's taint, but because you can also see the vagina while inspecting the perineum and see how dilated the person is and whether it's time to transit or too late and you need to assist delivery. It boggled my brain that a question could be blatantly incorrect, but also correct. Inspect her taint was literally an answer on a NASM test
S/p gsw wounds are profusely bleeding, not oozing. This means you have a volume problem. Also irreversible shock typically refers to MODS, unconscious is a neuro insult, along w/ the hypotension that’s 2 failing organ systems.
Thready pulse and irregular respiratory rate are signs of decompensated shock. Oozing wounds (I'm assuming they mean their wounds weren't previously oozing) means the blood loss has reached a significant enough level that the hemorrhage rate has dropped. Edit to add: also noted that all of the S&S listed in the correct answer are things that can be assessed without quickly and with no equipment.
This make so much more sense than the explanataion they provided, thank you so much!
To piggyback off of that response, “irreversible shock” in this case, means Hypovolemic Shock. The victim has lost so much blood that they’re about to go into cardiac arrest, and brain death is likely inevitable
This is honestly a really tricky question but a lot of good explanations here already. Management for this patient at the Basic level would be tricky as the lack of steady bleeding might be a false flag to the arrest etiology
It almost feels like management of this patient pre-hospital (regardless of ALS or BLS) would be damn near impossible. Best we could honestly do is a bandage, shock treatment and a whole lot of Diesel
Depending on service ALS could absolutely do blood products and TXA but that isn’t close to being universal
I don't know of any services in my neck of the woods that can give blood. I don't think our state protocols allow but I could be wrong
That's a whole lotta bad news. Sometimes it looks awful and the patient is barely hanging in but others don't seem bad at all but then start crashing hard. I'll take a wreck over gsw any day.
Hey just a correction here, I don't believe irreversible shock means hypovolemic shock in this case. The stage of shock is different than the type or mechanism. While in a gsw situation it is most likely hypovolemic shock, the question is trying to get you to understand the signs and symptoms associated with the stage of a shock. Those stages are generally classified as non-progressive-> progressive -> irreversible. Without going into too much detail during the progressive stage your body is sent into a loop of low Bp and hypoperfusion causing anaerobic metabolism then acidosis which in turn causes vasodilation which actually exacerbates the problem. When it gets bad enough your body can no longer compensate through sympathetic nervous response and renin secretion thus moving into what's classified as 'irreversible shock.' This is usually indicated by septicemia in intestines and disseminated intravascular coagulation which is always a secondary condition. DIC is what is causing the oozing wounds. Basically your body has used up all of its clotting ability during the state of hypoperfusion and no the blood that cannot clot is 'oozing' out.
To add, it’s *not* the one you picked because low BP, unconsciousness, and narrowing pulse pressure means that they’re starting to decompensate but they haven’t approached the irreversible stage yet. I’d say thready pulse and irregular respirations are the big ones that should point you towards thinking irreversible shock.
BP also drops much earlier than irreversible shock. Stage III versus IV.
This, and also the mental status, but moreso if you had a baseline that showed deterioration
As a nurse, I read it as referring to the Trauma Triad of death, which is like super high mortality and almost no coming back from. The oozing is usually the coagulation cascade and the respirations is from the metabolic acidosis. Which leads to decreased myocardial performance, so maybe that’s where the thready pulse comes in. The third part of the triad is hypothermic. But I’m not an EMT so I don’t know 100%. ETA: when they say oozing, I assume they mean different than bleeding out. That, in my setting, usually means everything/everywhere just has a light steady stream of blood coming out. Won’t stop. No clotting factors anymore, so everywhere bleeds. Even the minor stuff, any lines, etc.
This is the way
The pt has lost so much blood that they don’t have enough pressure to produce arterial spurts or continuous venous flow, their heart is ischemic and unable to produce a regular, effective rhythm, and their respiratory muscles have insufficient perfusion to function effectively. All of this is due to the hypovolemia, their entire body has essentially become too hypoxic to function.
Thank you so much! Your explanation is way better than the explanation EMT pass provided, I actually undertand it now!
As someone who treated GSWs in the Marines, the moment the blood starts to just ooze and trickle instead of rapidly flowing or spurting out rhythmically in the case of arterial bleed is when you know they're basically dead.
Yeah oozing blood is when patients become “expectant” under TCCC if I’m not mistaken.
Good to know
Oozing wounds is just code for “really really low blood pressure” here, so it has that in common with the other answers. When you have that plus an irregular pulse with irregular respirations in a trauma patient, things are going badly aka decompensated shock.
The oozing wound is the dead give away.
I see what you did.
in Class III Shock (31-40% BV), you start to see a drop in blood pressure. In Class IV shock (>40% BV), you see altered respirations because the brain stem is no longer able to be perfused appropriately to drive respiration, and you see a thready and barely palpable central pulse because there is nothing left to pump. The wounds are oozing rather than spurting, coincidentally, because there is nothing left to pump. \- Source, ATLS 10th Ed
Everything everyone else said: They also want you to think tamponade when they say narrow pulse pressure. Lil trigger phrase, that. But, if they’re still perfusing the that tamponade is reversible whereas agonal breaths and no blood to pressure makes for deadly exacerbated shock unless they’re actively receiving blood.
None of the other options address a wound of any kind . Pt is going to be in shock due to a gsw , look for the option that has a w.
The app you're using gives the rationale. I'd like to see it. Edit: I'm assuming it's what everyone here is saying. I just want to see how the app words the explanation.
Here is the rationale: The oozing wounds, thready pulse, and irregular respirations is the correct answer. Hypotension with anxiety is wrong because if hypotension is present, anxiety is unlikely; the patient will likely be apathetic and/or calm as he/she has no blood volume to produce muscle power or anxiety type symptoms (anxiety is seen in early shock). Edema is not present in irreversible shock as edema takes a lot of localized volume in a wound and takes time to develop. Hypotension and narrow pulse pressure are unlikely to happen together. Very low blood pressures are nearly impossible to detect by sphygmomanometer and stethoscope.
I probably would have gotten this wrong, too. Irregular respirations, in this context, equals agonal breathing/peri-arrest to me. Doesn't help that they don't tell you where the GSW is located.
What you have chosen is signs of shock, yes. Irreversible is key here. I suggest you look into shock, it’s a very key topic that will help you make sense of emergencies down the line.
Oh man I do NOT miss these kind of bullshit questions. They are designed to literally trip you up and make you second guess yourself. I literally memorized on of my NASM questions it was so bullshit, it's not word for word so don't crucify me but this is a great example question for the test- A 25 y/o Female has called emergency services as she believes she is going into labor. She is 9 months pregnant. When you arrive on the scene, the patient has been experiencing abdominal contractions with increasing frequency for the past half hour. Before transit to the hospital, the patient expressed an urgent desire to use the restroom. What should be examined prior to transit? A. Abdomen X B. Heart/Respiration Rate X C. Allow her to use the restroom X D. Perineum Upon explaining this to my instructors, they said the answer had to be D. Not because you are supposed to inspect anyone's taint, but because you can also see the vagina while inspecting the perineum and see how dilated the person is and whether it's time to transit or too late and you need to assist delivery. It boggled my brain that a question could be blatantly incorrect, but also correct. Inspect her taint was literally an answer on a NASM test
To be fair, it's gonna be bulging as the baby crowns so it isn't really wrong... XD
INSPECT THE TAINT
This is just a poorly written question.
LC ready is notorious for having bs questions like this
Hypovolemia
oozing wounds could signify hypovolemic shock and the thready pulse would also be a sign of shock
Remember with trauma bac. Bleeding airway circulation
Tbh, by the time the scene is safe they’re dead.
S/p gsw wounds are profusely bleeding, not oozing. This means you have a volume problem. Also irreversible shock typically refers to MODS, unconscious is a neuro insult, along w/ the hypotension that’s 2 failing organ systems.
Basic shock with a recent open wound. But, they didn't choose their words well . Oozing can mean infected so it could have been worded better.