CPR First Aid: Wounds, Burns and Shock 1 — Questions and Answers

Question 1: What is the primary first aid treatment for a minor laceration (cut) with active bleeding?

Apply a tourniquet above the wound immediately
Apply direct pressure with a clean cloth or bandage for at least 5-10 minutes without lifting to check (Correct answer)
Clean the wound with hydrogen peroxide and cover loosely
Elevate the wound only, without applying pressure

Correct answer: Apply direct pressure with a clean cloth or bandage for at least 5-10 minutes without lifting to check

Direct pressure is the most effective first-line method to control bleeding; sustained pressure allows clotting to occur.

Direct pressure is the cornerstone of wound hemorrhage control. Place a clean cloth, sterile gauze, or bandage directly over the wound and apply firm, continuous pressure for at least 5-10 minutes. Do not lift the dressing to check the wound—lifting disrupts forming clots. If blood soaks through, add more material on top without removing the original dressing. For extremity wounds with severe hemorrhage not controlled by pressure, elevation of the limb above heart level can reduce blood flow. Wound packing (pressing gauze deeply into the wound) is appropriate for deep, gaping wounds. Most minor lacerations controlled with pressure can be monitored at home; those requiring sutures, deep wounds, and wounds with continued bleeding require medical evaluation.

Question 2: What is the 'Rule of Nines' used for in burn assessment?

To determine how many days of antibiotic treatment are needed
To estimate the total body surface area (TBSA) affected by burns for fluid resuscitation calculations (Correct answer)
To classify the depth of burn injury
To identify which burns require immediate surgery

Correct answer: To estimate the total body surface area (TBSA) affected by burns for fluid resuscitation calculations

The Rule of Nines divides the adult body into areas of 9% or 18% TBSA to quickly estimate total burned surface area for guiding treatment.

The Rule of Nines is a rapid tool for estimating total body surface area (TBSA) burned in adults: head and neck = 9%, each arm = 9% (18% total), chest = 9%, abdomen = 9%, upper back = 9%, lower back = 9%, each thigh = 9%, each lower leg = 9%, and genitals = 1% (total = 100%). TBSA percentage is used to calculate fluid resuscitation needs (Parkland formula: 4 mL × weight kg × %TBSA burned of second-degree or deeper, given over 24 hours, half in first 8 hours). The Lund-Browder chart is more accurate, especially in children (adjusting for the head being proportionally larger). The Rule of Nines is not appropriate for children under 10.

Question 3: How are burn injuries classified by depth, and what characterizes each degree?

Grade 1 (surface), Grade 2 (deep), Grade 3 (all layers), Grade 4 (bone)
First-degree (superficial, redness only), Second-degree (partial thickness, blisters), Third-degree (full thickness, white/charred, painless), Fourth-degree (charred to bone/muscle) (Correct answer)
Mild, Moderate, Severe, Critical based on patient pain level
Thermal, Chemical, Electrical, Radiation based on causative agent

Correct answer: First-degree (superficial, redness only), Second-degree (partial thickness, blisters), Third-degree (full thickness, white/charred, painless), Fourth-degree (charred to bone/muscle)

Burns are classified by depth: first-degree (superficial), second-degree (partial thickness with blisters), third-degree (full thickness, painless), fourth-degree (extending to muscle/bone).

Burns are classified by tissue depth: (1) First-degree (superficial): involves only the epidermis; presents as redness (erythema), pain, and no blistering—e.g., mild sunburn. Heals in 3-5 days. (2) Second-degree (partial thickness): involves epidermis and part of dermis; presents with blisters, wet pink/red appearance, and significant pain—e.g., scalds, brief flame contact. Superficial partial thickness heals in 10-14 days; deep partial thickness may need skin grafting. (3) Third-degree (full thickness): destroys entire dermis; white, leathery, or charred appearance; typically painless due to nerve destruction—requires skin grafting. (4) Fourth-degree: extends through skin into underlying fat, muscle, or bone; devastating injuries requiring extensive surgical management.

Question 4: What is the correct first aid treatment for a chemical burn to the skin?

Apply neutralizing agents (e.g., vinegar for alkali burns)
Immediately flush with large amounts of cool running water for at least 20 minutes, while removing contaminated clothing and jewelry (Correct answer)
Cover the burn with a dry dressing and seek care later
Apply butter or oil to soothe the skin

Correct answer: Immediately flush with large amounts of cool running water for at least 20 minutes, while removing contaminated clothing and jewelry

Continuous water irrigation for at least 20 minutes is the most effective treatment for chemical burns—neutralizers can generate heat and worsen injury.

Chemical burns require immediate and copious water irrigation—the goal is to dilute and physically remove the chemical from the skin. Remove all contaminated clothing and jewelry (taking care not to contaminate the responder—wear gloves if available). Flush continuously with cool running water for at least 20 minutes (some guidelines say 30-60 minutes for strong acids or alkalis). Do NOT use neutralizing agents: attempting to neutralize acid with a base or vice versa generates an exothermic reaction that can worsen burns. Hydrofluoric acid burns are a special exception requiring calcium gluconate gel application in addition to irrigation. Dry chemical burns (e.g., lime) should have excess powder brushed off BEFORE water irrigation, as water activates some dry chemicals.

Question 5: What are the three stages of burn shock, and when does it typically begin?

Inflammation, repair, remodeling—starting at 12 hours
Fluid shift/hypovolemic phase (0-48 hours), diuretic phase (48-72 hours), recovery—shock begins within minutes to hours of significant burn (Correct answer)
Neurogenic, cardiogenic, distributive—starting at 24 hours
Burn shock only occurs with 100% TBSA burns

Correct answer: Fluid shift/hypovolemic phase (0-48 hours), diuretic phase (48-72 hours), recovery—shock begins within minutes to hours of significant burn

Major burns cause massive fluid shift into the wound and surrounding tissue (capillary leak), leading to hypovolemic shock within hours.

Major burn shock follows a predictable progression: (1) Acute (fluid shift) phase (0-48 hours): Massive release of inflammatory mediators causes systemic capillary leak syndrome—fluid, protein, and electrolytes shift from intravascular space into the wound and surrounding tissue. This causes hypovolemia (decreased circulating blood volume), leading to distributive and hypovolemic shock. Fluid resuscitation (Parkland formula) is critical to prevent organ failure. (2) Diuretic phase (48-72 hours): Capillary permeability normalizes, resorption begins, and patients diurese the fluid. Careful monitoring prevents fluid overload. (3) Recovery: Continues over weeks-months. Burns >20% TBSA in adults (>15% in children) typically require IV fluid resuscitation. Inadequate resuscitation leads to multi-organ failure and death.

Question 6: What are the key signs and symptoms of hypovolemic shock?

Bradycardia, hypertension, flushed skin, and increased urine output
Tachycardia, hypotension, pale/cold/clammy skin, altered mental status, decreased urine output, and rapid weak pulse (Correct answer)
Only low blood pressure without other symptoms
Fever, chest pain, and distended neck veins

Correct answer: Tachycardia, hypotension, pale/cold/clammy skin, altered mental status, decreased urine output, and rapid weak pulse

Hypovolemic shock manifests as compensatory tachycardia, then hypotension, poor perfusion signs (pale, clammy skin), decreased consciousness, and oliguria.

Hypovolemic shock progresses through stages as blood volume decreases: (1) Compensated shock (<30% volume loss): heart rate increases (tachycardia), blood pressure maintained through vasoconstriction, anxiety, cool/pale skin, reduced pulse pressure, normal to reduced urine output. (2) Uncompensated shock (30-40% loss): hypotension develops, significant tachycardia (>120 bpm), very pale/clammy skin, confusion/altered mental status, oliguria. (3) Irreversible shock (>40% loss): severe hypotension, very rapid weak ('thready') pulse, mental obtundation, anuria, impending cardiac arrest. First aid focuses on controlling the source of bleeding (direct pressure, tourniquets) and positioning (supine, legs elevated if no spinal injury), while calling 911 for severe presentations.

Question 7: When is a tourniquet the appropriate first aid treatment for a wound?

For any cut that is bleeding
For life-threatening extremity hemorrhage that cannot be controlled with direct pressure (Correct answer)
Only in military settings, never in civilian first aid
For head and neck wounds with heavy bleeding

Correct answer: For life-threatening extremity hemorrhage that cannot be controlled with direct pressure

Tourniquets are life-saving for severe extremity hemorrhage that doesn't stop with direct pressure—they are now recommended in public first aid.

Current guidelines (Stop the Bleed campaign, AHA, TCCC) recommend tourniquet use for life-threatening extremity (arm or leg) hemorrhage when direct pressure is insufficient or impractical. Modern evidence from combat medicine has demonstrated that early tourniquet application significantly saves lives with minimal complications. Proper technique: apply 2-3 inches above the wound (never over a joint), tighten until bleeding stops, note the time of application, and do not remove. Commercial tourniquets (CAT, SOFTT-W) are preferred. Improvised tourniquets (belt, clothing) are less effective but acceptable in emergencies. Tourniquets should NOT be used on the neck, chest, or abdomen. Previous reluctance to use tourniquets due to limb loss concerns has been significantly revised—properly applied tourniquets for 2-4 hours carry very low amputation risk.

Question 8: What is the proper first aid treatment for a suspected open (sucking) chest wound?

Apply direct pressure with a cloth and tape on all four sides
Seal the wound with a vented chest seal or improvised non-occlusive dressing taped on three sides to allow air to escape during exhalation (Correct answer)
Leave the wound uncovered to allow air to move freely
Apply the tourniquet above the wound

Correct answer: Seal the wound with a vented chest seal or improvised non-occlusive dressing taped on three sides to allow air to escape during exhalation

A vented chest seal (or three-sided dressing) prevents tension pneumothorax by sealing the wound while allowing air to escape during exhalation.

An open chest wound (sucking chest wound) allows air to enter the pleural space through the chest wall during inspiration, potentially causing tension pneumothorax (a life-threatening emergency where air accumulates under pressure, collapsing the lung and shifting the mediastinum). First aid treatment uses a vented chest seal (a commercial device with one-way valve) or improvised three-sided dressing: tape three sides of a clean dressing over the wound, leaving the fourth side open. During inhalation, the dressing seals against the chest to prevent air entry; during exhalation, the free side allows trapped air to escape. If the patient deteriorates with a seal in place (suggesting tension pneumothorax), temporarily remove the seal to allow air to escape. Call 911 immediately for any penetrating chest wound.

Question 9: What is the appropriate first aid response for a minor burn (first-degree or small second-degree)?

Apply butter, oil, or toothpaste to soothe the burn
Cool the burn with cool (not ice cold) running water for 10-20 minutes, cover loosely with a sterile bandage, and avoid breaking blisters (Correct answer)
Apply ice directly to the burn to reduce pain
Pop blisters to reduce pressure and infection risk

Correct answer: Cool the burn with cool (not ice cold) running water for 10-20 minutes, cover loosely with a sterile bandage, and avoid breaking blisters

Cool (not ice) water for 10-20 minutes reduces heat damage; avoid ice (causes frostbite), butter (traps heat, promotes infection), or popping blisters.

For minor burns (first-degree or small second-degree burns <2-3 inches/5-7 cm not on face/hands/feet/genitals/major joints): (1) Cool the burn with cool running water for 10-20 minutes—this reduces residual heat in the tissue and pain. (2) Do NOT use ice or ice water—this causes vasoconstriction and can cause frostbite on damaged skin. (3) Do NOT apply butter, oil, toothpaste, or other home remedies—these trap heat, promote bacterial growth, and interfere with wound assessment. (4) Cover loosely with a sterile non-stick bandage or clean cloth. (5) Do NOT break blisters—they provide a sterile barrier over the wound; broken blisters increase infection risk. (6) Take over-the-counter pain relievers (ibuprofen, acetaminophen) as needed. (7) Seek medical care for burns involving face, hands, feet, genitals, major joints, or circumferential burns.

Question 10: How should an impaled object in a wound be managed in the field?

Remove the object immediately to allow the wound to be inspected and cleaned
Leave the object in place, stabilize it with bulky dressings, and control bleeding around the object without applying pressure on it (Correct answer)
Push the object deeper if it's protruding to prevent it from moving
Apply a tourniquet directly over the impaled object

Correct answer: Leave the object in place, stabilize it with bulky dressings, and control bleeding around the object without applying pressure on it

Impaled objects should never be removed in the field—they may be sealing damaged vessels; stabilize in place and transport for surgical removal.

Impaled (embedded) objects should never be removed from wounds in the pre-hospital setting (with the sole exception of objects impaling the cheek that threaten airway). The object may be passing through a major vessel and its removal could cause rapid, uncontrollable hemorrhage. Management: (1) Leave the object in place—do not remove, shorten (unless necessary for transport), or adjust its position, (2) Control bleeding around the object using bulky dressings placed on either side without pressing down on the object itself, (3) Stabilize the object by building up dressings around it to prevent movement during transport, (4) Keep the patient as still as possible, (5) Call 911 for all impalement injuries. Definitive removal is performed in the operating room with surgical control of potential hemorrhage. Special case: impaled objects in the eye should be covered with a rigid shield (not removed).

Question 11: What is neurogenic shock, and what makes it different from hypovolemic shock?

Neurogenic shock is caused by excess fluid in the blood vessels
Neurogenic shock results from spinal cord injury causing loss of sympathetic tone, leading to vasodilation and bradycardia rather than the typical compensatory tachycardia seen in hypovolemic shock (Correct answer)
Neurogenic shock only occurs in head injuries
Neurogenic shock and hypovolemic shock are identical conditions with the same treatment

Correct answer: Neurogenic shock results from spinal cord injury causing loss of sympathetic tone, leading to vasodilation and bradycardia rather than the typical compensatory tachycardia seen in hypovolemic shock

Neurogenic shock from spinal injury causes vasodilation + bradycardia (unlike hypovolemic shock's vasoconstriction + tachycardia) due to loss of sympathetic nervous system control.

Neurogenic shock is distributive shock caused by spinal cord injury at or above T6, which disrupts the descending sympathetic nervous system pathways. Loss of sympathetic tone causes: (1) Widespread vasodilation (hypotension without compensatory vasoconstriction), (2) Bradycardia (unlike compensatory tachycardia in hypovolemic shock)—because parasympathetic tone to the heart is unopposed, (3) Warm, flushed, dry skin (unlike the pale, cold, clammy skin of hypovolemic shock). Treatment focuses on IV fluid to fill the expanded vascular space, vasopressors (norepinephrine or phenylephrine) to restore vascular tone, and atropine for symptomatic bradycardia. Importantly, spinal injury patients may also have hemorrhagic hypovolemic shock concurrently, which complicates the presentation and requires active hemorrhage control.

Question 12: What is the RICE protocol for soft tissue injuries such as sprains and strains?

Rest, Ice, Compression, Elevation — the standard initial treatment for musculoskeletal injuries (Correct answer)
Rinse, Immobilize, Cast, Evaluate
Reposition, Inject, Compress, Exercise
Radiology, Immobilization, Consultation, Elevation

Correct answer: Rest, Ice, Compression, Elevation — the standard initial treatment for musculoskeletal injuries

RICE: Rest (avoid stressing the injury), Ice (reduce swelling and pain for 20 min every 2-3 hours), Compression (elastic bandage), Elevation (above heart level to reduce swelling).

The RICE protocol is the traditional first aid approach for soft tissue injuries: R = Rest—avoid activity that stresses the injury; use crutches or a sling if needed. I = Ice—apply ice wrapped in a cloth for 20 minutes every 2-3 hours for the first 24-72 hours to reduce pain and swelling. Never apply ice directly to skin (frostbite risk). C = Compression—apply an elastic bandage (Ace wrap) to reduce swelling; wrap from distal to proximal and check regularly for circulation impairment. E = Elevation—elevate the injured limb above heart level to reduce swelling by promoting lymphatic and venous drainage. Note: More recent evidence has prompted some practitioners to move to the PEACE & LOVE or POLICE protocols, emphasizing that complete rest may impair healing—but RICE remains the widely taught first aid standard.

Question 13: When is it appropriate to apply a wound dressing for a major wound before definitive medical care?

Only after the wound has been fully cleaned with disinfectant
Immediately, after controlling major bleeding with direct pressure—clean the wound only with clean water if available, apply dressing, and seek immediate medical care (Correct answer)
Only if EMS is more than 30 minutes away
Dressings should never be applied before medical care

Correct answer: Immediately, after controlling major bleeding with direct pressure—clean the wound only with clean water if available, apply dressing, and seek immediate medical care

For major wounds, control bleeding first, then apply a dressing and seek immediate care—do not delay dressing application to clean the wound thoroughly.

For major wounds requiring immediate care, the priority is hemorrhage control followed by wound coverage: (1) Control bleeding with direct pressure (or tourniquet for extremity hemorrhage), (2) If available, briefly rinse with clean water to remove gross contamination—do not attempt to clean the wound with antiseptics (can damage tissue and delay healing), (3) Apply a sterile or clean dressing over the wound while maintaining pressure, (4) Do not remove dressings to inspect—add more material if blood soaks through, (5) Seek immediate medical care. For minor wounds not requiring emergency care: clean gently with soap and water, apply antiseptic if desired, cover with adhesive bandage. Major wounds are best cleaned definitively in a controlled medical environment where proper wound irrigation, debridement, and closure can occur.

Question 14: What are the warning signs of wound infection that should prompt medical evaluation?

Normal redness that disappears within 24 hours
Increasing redness, warmth, and swelling beyond 48-72 hours, purulent (pus) discharge, fever, red streaks extending from the wound, or severe pain (Correct answer)
A scab forming over the wound
Wound edges sticking together

Correct answer: Increasing redness, warmth, and swelling beyond 48-72 hours, purulent (pus) discharge, fever, red streaks extending from the wound, or severe pain

Signs of wound infection include worsening redness, increasing swelling, pus, fever, red streaks (lymphangitis), and escalating pain—all require medical evaluation.

Normal wound healing involves some initial redness and swelling that should improve after 48-72 hours. Warning signs of wound infection requiring medical evaluation include: (1) Increasing rather than decreasing redness, warmth, and swelling after 48-72 hours, (2) Purulent discharge (pus)—yellow, green, or cloudy fluid, (3) Fever >38°C (100.4°F), (4) Red streaks extending from the wound toward the trunk (lymphangitis—suggests bacterial spread through lymphatic system), (5) Severe or increasing pain after the first few days, (6) Wound edges pulling apart or failing to close. Risk factors for infection include: animal or human bites, contaminated wounds (soil, feces), delayed cleaning, immunocompromised patients, and wounds not debrided of foreign material. Diabetic patients are at particularly high risk and should seek early medical evaluation.

Question 15: What is the appropriate first aid for a suspected fracture, and what assessment helps distinguish fracture from sprain?

Only apply ice; splints are contraindicated until X-ray confirms fracture
Immobilize the injury in the position found using a splint (rigid or soft) extending above and below the injury, check circulation/sensation/movement (CSM) before and after splinting (Correct answer)
Manually realign the fracture to prevent neurovascular damage before splinting
Elevate only and wait for spontaneous healing

Correct answer: Immobilize the injury in the position found using a splint (rigid or soft) extending above and below the injury, check circulation/sensation/movement (CSM) before and after splinting

Splint in the position found, check CSM before and after, and seek medical care—the only reliable way to distinguish fracture from sprain is X-ray.

Suspected fracture first aid: (1) Immobilize the injury in the position found using a splint—improvised (boards, sticks, cardboard) or commercial. The splint should extend one joint above and one joint below the injury. Do NOT attempt to straighten or realign the fracture (exceptions exist for providers with advanced training). (2) Check CSM (Circulation, Sensation, Movement) distally before and after splinting—assess pulse, capillary refill, sensation, and ability to move fingers/toes. Report any changes immediately. (3) Apply padding between the limb and splint for comfort. (4) For open fractures (bone protruding), cover the wound with a sterile dressing—do not push bone back. (5) Seek X-ray confirmation. Clinical signs suggesting fracture over sprain include: deformity, point tenderness directly over bone, bone crepitus, significant swelling, and mechanism of injury.

Question 16: What is the correct first aid approach for electrical burns and shock injuries?

Immediately grab the victim to pull them from the electrical source
Ensure the scene is safe (power off or victim away from source) before approaching; assess for cardiac arrest, entry/exit wounds, internal burns, and spinal injury (Correct answer)
Apply water immediately to extinguish electrical burns
Focus only on the visible surface burns, as internal injuries are not common

Correct answer: Ensure the scene is safe (power off or victim away from source) before approaching; assess for cardiac arrest, entry/exit wounds, internal burns, and spinal injury

Scene safety is the absolute priority in electrical injuries; the victim may still be in contact with live current, making rescuer approach potentially fatal.

Electrical injuries require special first aid considerations: (1) Scene safety FIRST—do not touch the victim if they may still be in contact with the electrical source. Turn off the power or have trained personnel remove the victim from contact using non-conductive materials (dry wood, rubber). EMS should be called immediately. (2) Electrical injuries are often far worse than they appear—the small entry/exit wounds may hide extensive internal tissue destruction along the current pathway (muscles, nerves, blood vessels). (3) Cardiac arrest is a major risk—VF can be induced by electrical current crossing the heart. Begin CPR immediately if the victim is pulseless. (4) Spinal injury must be suspected, especially if the victim was thrown or fell. (5) All electrical injury patients require hospital evaluation for cardiac monitoring (arrhythmia risk), renal monitoring (myoglobinuria from muscle destruction), and vascular assessment.

Question 17: What is the recommended first aid position for a conscious patient in hypovolemic shock without suspected spinal injury?

Sitting upright with legs dangling
Supine (flat on back) with legs elevated 8-12 inches (Trendelenburg-like position) (Correct answer)
Left lateral recovery position
Prone (face down)

Correct answer: Supine (flat on back) with legs elevated 8-12 inches (Trendelenburg-like position)

Laying flat with legs elevated uses gravity to increase venous return to the heart, improving cardiac output in hypovolemic shock.

For conscious patients in hypovolemic shock without suspected spinal injury or breathing difficulty: lay the patient flat on their back and elevate the legs 8-12 inches. This position (sometimes called the modified Trendelenburg or 'shock position') increases venous return to the heart by using gravity to move blood from the lower extremities to the central circulation, improving cardiac preload and output. This is a temporary supportive measure while controlling bleeding and awaiting EMS. Do NOT use this position if: (1) The patient is having difficulty breathing (keep semi-upright), (2) Spinal injury is suspected (maintain neutral alignment), (3) The patient has head, chest, or abdominal trauma (individual assessment needed). The classic full Trendelenburg position (entire body tilted head down) is no longer recommended as it worsens respiratory mechanics and cerebral edema risk.

Question 18: What is the proper first aid treatment for a thermal burn covering more than 10% TBSA in an adult?

Apply ice packs over the entire burn area and wrap tightly
Call 911 immediately; cool the burn briefly (20 min max for small areas), do not overcool (risk of hypothermia), cover loosely with clean dressings, and keep the patient warm (Correct answer)
Apply antibiotic cream and cover with plastic wrap
Have the patient soak in cold water until EMS arrives

Correct answer: Call 911 immediately; cool the burn briefly (20 min max for small areas), do not overcool (risk of hypothermia), cover loosely with clean dressings, and keep the patient warm

Major burns >10% TBSA require immediate EMS activation; excessive cooling risks hypothermia—cool briefly, cover, keep warm, and call for help.

For major burns (>10% TBSA adults, >5% TBSA children, or any third-degree burn): (1) Call 911 immediately, (2) Remove the patient from the burning source and ensure safety, (3) Remove clothing and jewelry from the burn area (unless stuck to the skin), (4) For large burns, limit water cooling to 20 minutes maximum and only cool the burn area (not the whole body)—full-body cooling risks life-threatening hypothermia, (5) Cover loosely with clean, dry, non-fluffy bandages or burn dressings, (6) Keep the patient warm (blanket over unburned areas), (7) Do NOT apply ice, butter, oil, or any home remedies, (8) Do NOT break blisters, (9) Do NOT remove stuck clothing. Transport to a burn center is ideal for major burns—burn centers provide specialized fluid resuscitation, wound care, and rehabilitation.

Question 19: What is 'septic shock,' and how does it differ from hypovolemic shock?

Septic shock is shock caused by blood loss from infection-related hemorrhage
Septic shock is a form of distributive shock where overwhelming systemic infection causes massive vasodilation, hypotension, and organ dysfunction despite adequate fluid resuscitation (Correct answer)
Septic shock only occurs in immunocompromised patients
Septic shock is identical to hypovolemic shock except it occurs faster

Correct answer: Septic shock is a form of distributive shock where overwhelming systemic infection causes massive vasodilation, hypotension, and organ dysfunction despite adequate fluid resuscitation

Septic shock is distributive—infection causes vasodilation and increased vascular permeability, leading to refractory hypotension despite fluid administration.

Septic shock is the most common and deadly form of distributive shock. Overwhelming systemic infection triggers massive immune activation (SIRS response), causing release of cytokines (TNF-α, IL-1, IL-6) that produce: (1) Severe vasodilation (lowering systemic vascular resistance), (2) Increased capillary permeability (fluid leaks into tissue), (3) Myocardial depression, (4) Activation of coagulation (DIC risk). Unlike hypovolemic shock where blood volume is depleted, the vascular space is pathologically enlarged in septic shock—there's relative hypovolemia. Skin may be warm/flushed early ('warm shock') before progressing to cold extremities. Treatment requires IV fluids (usually 30 mL/kg bolus), vasopressors (norepinephrine), antibiotics, and source control. Diagnosis: persistent hypotension requiring vasopressors + lactate ≥2 mmol/L after fluid resuscitation.

Question 20: When assessing a wound, what does 'DCAP-BTLS' stand for?

Depth, Color, Age, Pain — Burns, Trauma, Lacerations, Skin condition
Deformities, Contusions, Abrasions, Penetrations — Burns, Tenderness, Lacerations, Swelling (Correct answer)
Discharge, Clotting, Alignment, Position — Bruising, Tearing, Loss of function, Sensitivity
Drainage, Crepitus, Avulsion, Puncture — Bleeding, Tissue loss, Length, Shape

Correct answer: Deformities, Contusions, Abrasions, Penetrations — Burns, Tenderness, Lacerations, Swelling

DCAP-BTLS is an EMS trauma assessment mnemonic: Deformities, Contusions, Abrasions, Penetrations, Burns, Tenderness, Lacerations, Swelling.

DCAP-BTLS is a standardized trauma assessment mnemonic used by EMS and first aid providers to systematically evaluate injuries during the physical examination: D = Deformities (abnormal shape or alignment suggesting fracture/dislocation), C = Contusions (bruising indicating blunt trauma), A = Abrasions (scrapes or road rash), P = Penetrations (puncture wounds or impaled objects), B = Burns (thermal, chemical, electrical), T = Tenderness (pain on palpation), L = Lacerations (cuts or tears in skin), S = Swelling (edema suggesting injury). This systematic head-to-toe evaluation helps ensure no injuries are missed, particularly in trauma patients where obvious injuries may distract from less apparent but potentially life-threatening ones. DCAP-BTLS is assessed for each body region during the rapid trauma assessment.

Question 21: What is the appropriate first aid for a suspected spinal injury in an unconscious trauma victim?

Flex the neck to open the airway as in standard head-tilt chin-lift
Maintain manual in-line spinal stabilization, use jaw-thrust for airway, and minimize movement until EMS arrives with immobilization equipment (Correct answer)
Rapidly move the patient to the recovery position
Avoid any airway interventions to prevent moving the spine

Correct answer: Maintain manual in-line spinal stabilization, use jaw-thrust for airway, and minimize movement until EMS arrives with immobilization equipment

Suspected spinal injury requires in-line stabilization and jaw-thrust airway technique; airway management takes priority over spinal concerns if the victim isn't breathing.

For an unconscious trauma victim with suspected spinal injury: (1) Maintain manual in-line cervical spine stabilization—hold the head in a neutral position aligned with the body without traction or compression, (2) Use the jaw-thrust maneuver (not head-tilt chin-lift) to open the airway while maintaining neutral alignment, (3) Minimize all movement—log-roll en bloc if the patient must be moved, (4) Do NOT remove a helmet unless airway cannot be managed with it in place, (5) If the patient is not breathing, airway management takes absolute priority over spinal precautions—the AHA states that if jaw-thrust fails to open the airway, use head-tilt chin-lift even in suspected spinal injury. EMS provides spinal immobilization with cervical collar and long backboard. Note: modern trauma protocols are reconsidering the utility of full spinal immobilization in many settings.

Question 22: What is anaphylactic shock, and what first aid treatment is provided for a known severe allergic reaction?

Anaphylactic shock is caused by blood loss; treat with IV fluids
Anaphylactic shock is a severe, systemic allergic reaction causing vasodilation, bronchospasm, and potential cardiovascular collapse; treat with epinephrine auto-injector (EpiPen) in the outer thigh immediately (Correct answer)
Anaphylactic shock requires antihistamines only (diphenhydramine)
Anaphylactic shock is managed with corticosteroids as the first-line treatment

Correct answer: Anaphylactic shock is a severe, systemic allergic reaction causing vasodilation, bronchospasm, and potential cardiovascular collapse; treat with epinephrine auto-injector (EpiPen) in the outer thigh immediately

Anaphylaxis is a life-threatening allergic emergency treated immediately with epinephrine (EpiPen), which reverses vasodilation, bronchospasm, and prevents cardiovascular collapse.

Anaphylaxis is a severe, systemic, potentially life-threatening hypersensitivity reaction triggered by allergens (foods, insect stings, medications, latex). Mechanisms include massive IgE-mediated mast cell degranulation releasing histamine, tryptase, and leukotrienes, causing: systemic vasodilation (hypotension), bronchospasm (respiratory distress/wheezing), laryngeal edema (stridor, risk of airway obstruction), urticaria and angioedema. First aid: (1) Administer epinephrine auto-injector (EpiPen, Auvi-Q) immediately in the outer thigh—epinephrine is the ONLY first-line treatment that reverses all components of anaphylaxis, (2) Call 911 immediately, (3) Lay the person flat with legs elevated unless dyspneic, (4) Begin CPR if cardiac arrest occurs. Antihistamines and corticosteroids are adjunct treatments (not first-line) and should never replace epinephrine—they do not treat the life-threatening components of anaphylaxis.

Question 23: What is the 'golden hour' concept in trauma management, and how does it influence first aid?

Trauma patients have exactly 60 minutes before they always die
The first hour after major trauma is when definitive hemorrhage control and surgical intervention have the greatest impact on survival; this drives rapid identification, first aid, and transport (Correct answer)
The golden hour refers to the time to administer the first antibiotic in trauma
It means rescuers have one hour to perform CPR before stopping

Correct answer: The first hour after major trauma is when definitive hemorrhage control and surgical intervention have the greatest impact on survival; this drives rapid identification, first aid, and transport

The golden hour concept emphasizes that definitive surgical intervention within 60 minutes of major trauma dramatically improves survival from hemorrhagic and traumatic injuries.

The 'Golden Hour' concept (attributed to R. Adams Cowley) reflects the observation that trauma patients who receive definitive surgical care within 60 minutes of injury have significantly better survival outcomes. The underlying physiology is that major trauma causes shock (primarily hemorrhagic), which triggers a cascade of coagulopathy, hypothermia, and acidosis ('lethal triad') that becomes increasingly difficult to reverse with time. This concept drives modern trauma systems: (1) Bystander first aid focuses on hemorrhage control (direct pressure, tourniquet) and airway management to stabilize the patient, (2) EMS focuses on rapid transport to the appropriate facility (trauma center), not prolonged scene treatment, (3) Trauma centers maintain 24/7 surgical teams for immediate hemorrhage control. The golden hour is a guideline concept rather than a strict 60-minute rule—outcomes improve with faster care at any point.

Question 24: For a patient in shock with multiple trauma and suspected internal hemorrhage, what is the most important first aid principle?

Aggressively administer fluids by mouth to replace lost blood volume
Control any external bleeding, maintain airway, keep the patient warm, call 911, and ensure rapid transport to trauma care—you cannot control internal bleeding with first aid (Correct answer)
Elevate all four extremities simultaneously
Perform abdominal compressions to tamponade internal bleeding

Correct answer: Control any external bleeding, maintain airway, keep the patient warm, call 911, and ensure rapid transport to trauma care—you cannot control internal bleeding with first aid

Internal bleeding cannot be controlled with first aid—rapid transport to surgical trauma care while managing airways and external wounds is the only effective approach.

Internal hemorrhage (from solid organ injury, major vessel injury, pelvic fractures) cannot be controlled by first aid—it requires emergency surgery (exploratory laparotomy, angioembolization, pelvic packing). First aid priorities: (1) Control any external bleeding with direct pressure or tourniquet, (2) Maintain airway and provide rescue breathing if needed, (3) Call 911 and ensure the most rapid possible transport to a trauma center, (4) Maintain body temperature (prevent hypothermia, which worsens coagulopathy), (5) Do NOT give fluids by mouth (aspiration risk in altered consciousness, delays surgery), (6) Position the patient appropriately. Modern trauma resuscitation uses 'damage control resuscitation'—balanced transfusion of blood products (packed red cells, plasma, platelets in 1:1:1 ratio) and avoidance of large volumes of crystalloids that worsen coagulopathy. Permissive hypotension (target SBP ~80-90 mmHg) is used until surgical hemorrhage control is achieved.

Question 25: What is the difference between a 'closed' and 'open' wound?

Closed wounds are deeper than open wounds
Closed wounds have intact skin (contusions, hematomas); open wounds have broken skin (lacerations, abrasions, punctures, avulsions) (Correct answer)
Only open wounds can cause infection
Closed wounds always require surgery

Correct answer: Closed wounds have intact skin (contusions, hematomas); open wounds have broken skin (lacerations, abrasions, punctures, avulsions)

Wound classification: closed wounds (intact skin with internal bleeding/damage) versus open wounds (skin integrity broken, higher infection risk).

Wounds are classified primarily by whether skin integrity is maintained: Closed wounds—skin is intact but underlying tissue is damaged: (1) Contusion (bruise): blood vessels damaged within tissue without skin break; (2) Hematoma: larger blood collection under the skin; (3) Internal crush injuries. Open wounds—skin barrier is broken, creating infection risk: (1) Abrasion: superficial skin scraped away (road rash); (2) Laceration: irregular tear in skin from blunt force or sharp object; (3) Incision: clean, linear cut from sharp edge; (4) Puncture: deep, narrow wound from pointed object (nail, knife, bullet); (5) Avulsion: skin/tissue forcibly torn away; (6) Amputation: body part severed. Open wounds generally require more aggressive first aid, cleaning, and medical evaluation due to contamination and infection risk.

Question 26: What is the purpose of a pressure dressing versus a simple gauze dressing for wound care?

A pressure dressing prevents infection; a simple dressing only absorbs blood
A pressure dressing applies continuous mechanical pressure to control hemorrhage; a simple gauze dressing primarily absorbs exudate and protects the wound surface (Correct answer)
Pressure dressings are only used on arterial bleeds
Simple dressings apply more pressure than pressure dressings

Correct answer: A pressure dressing applies continuous mechanical pressure to control hemorrhage; a simple gauze dressing primarily absorbs exudate and protects the wound surface

Pressure dressings maintain continuous pressure to control bleeding; simple dressings absorb exudate and provide wound protection without significant hemostatic pressure.

Different dressing types serve different purposes: Pressure dressings (also called compression bandages): applied firmly over a wound to maintain continuous mechanical pressure that controls hemorrhage. They typically use multiple layers (sterile gauze over the wound + elastic or conforming bandage wrapped snugly) to create a pressure gradient that helps clotting. Used for actively bleeding wounds, post-procedural sites, or venous stasis wounds. Simple gauze dressings: absorb wound exudate, protect the wound from contamination, maintain a moist healing environment (for non-hemorrhaging wounds), and allow gas exchange. Used for clean wounds that have stopped bleeding, abrasions, and post-operative incisions. Non-adherent (silicone or petroleum-impregnated) dressings prevent gauze fibers from adhering to the wound bed—important for partial-thickness burns, skin grafts, and wounds with granulation tissue.

Question 27: What is 'wound packing' and when is it used in hemorrhage control?

Placing a wet cloth loosely in a wound for drainage
Tightly filling a deep wound cavity with gauze to apply direct pressure to internal bleeding that cannot be controlled with surface pressure alone (Correct answer)
Inserting a tube into a wound to monitor bleeding rate
Applying packing only for infected wounds

Correct answer: Tightly filling a deep wound cavity with gauze to apply direct pressure to internal bleeding that cannot be controlled with surface pressure alone

Wound packing is used for deep, cavitary wounds (junctional injuries, deep lacerations) where surface pressure is insufficient to reach the bleeding source.

Wound packing (cavity packing) is a hemorrhage control technique for wounds where the bleeding source is too deep for surface pressure to be effective. Technique: (1) Use plain gauze or hemostatic gauze (impregnated with kaolin, chitosan, or zeolite), (2) Pack the gauze tightly into the wound cavity using fingers or a gloved hand, applying firm continuous pressure, (3) Continue packing until no more gauze can be inserted, (4) Apply direct pressure over the packed wound for 3-5 minutes (or per hemostatic gauze instructions—typically 3 minutes), (5) Do not remove packing in the field. Common applications: deep junctional wounds (groin, axilla, neck—where tourniquets cannot be applied), gunshot wounds, stab wounds, blast injuries. Hemostatic dressings (QuikClot, Combat Gauze, Celox) significantly improve packing effectiveness by accelerating clot formation.

Question 28: What is the appropriate first aid response to a partial amputation (incomplete severing of a body part)?

Complete the amputation to make hemorrhage control easier
Control bleeding with direct pressure or tourniquet, gently realign if possible, wrap in moist sterile dressing, and transport rapidly without completing the amputation (Correct answer)
Leave the patient and retrieve surgical instruments first
Only apply a tourniquet if the part is completely severed

Correct answer: Control bleeding with direct pressure or tourniquet, gently realign if possible, wrap in moist sterile dressing, and transport rapidly without completing the amputation

Never complete a partial amputation—control bleeding, preserve the tissue, and transport rapidly for possible surgical replantation.

Partial amputations retain soft tissue connections that may still contain blood vessels, nerves, and lymphatics potentially amenable to surgical replantation. First aid for partial amputation: (1) Control hemorrhage: apply direct pressure, and if an extremity with life-threatening bleeding, apply a tourniquet above the injury, (2) Do NOT complete the amputation—even small remaining connections preserve replantation potential and reduce blood loss, (3) Gently align the part in as anatomical a position as possible if severely angulated, (4) Cover with moist sterile dressings, (5) Immobilize, (6) Rapid transport to a facility with plastic/orthopedic surgery capability for replantation evaluation. Replantation success depends on: warm ischemia time (the severed/devascularized tissue should reach surgery within 4-6 hours), patient age, mechanism of injury (clean cuts vs. crush/avulsion), and which body part is involved.

Question 29: What are the signs of adequate circulation after applying a pressure bandage or splint to an injured extremity?

No change is needed as long as the patient is comfortable
Normal skin color, temperature, capillary refill <2 seconds, ability to feel sensation, ability to move fingers/toes distal to the injury, and presence of pulse (Correct answer)
Complete absence of pain indicates good circulation
Bandages should always be tight enough to feel pulsation

Correct answer: Normal skin color, temperature, capillary refill <2 seconds, ability to feel sensation, ability to move fingers/toes distal to the injury, and presence of pulse

CSM (Circulation, Sensation, Movement) checks assess normal skin color, warmth, rapid capillary refill, intact sensation, and movement distal to injury/dressing.

After applying any bandage, splint, or cast to an injured extremity, circulation assessment (CSM check) should be performed immediately and every 15-30 minutes: (1) Circulation: normal skin color (not pale, white, blue, or mottled), warm skin temperature, capillary refill <2 seconds (press nail bed, release, color returns within 2 seconds), presence of distal pulse, (2) Sensation: ability to feel light touch, pinprick, or pressure distal to the dressing, (3) Movement: ability to move fingers or toes distal to the injury/dressing. If any of these are abnormal after dressing application, the dressing is too tight and must be loosened immediately to prevent compartment syndrome, nerve damage, or limb ischemia. Document CSM findings before and after any intervention.

Question 30: What is 'cardiogenic shock' and how does it differ from hypovolemic shock?

Cardiogenic shock results from heart failure as the pump, causing hypoperfusion despite normal blood volume; hypovolemic shock results from insufficient circulating blood volume (Correct answer)
They are the same condition with different names
Cardiogenic shock only occurs after myocardial infarction in elderly patients
Hypovolemic shock always presents with distended neck veins

Correct answer: Cardiogenic shock results from heart failure as the pump, causing hypoperfusion despite normal blood volume; hypovolemic shock results from insufficient circulating blood volume

Cardiogenic shock is pump failure (heart cannot generate adequate cardiac output) despite normal or excess volume; hypovolemic shock is inadequate preload from volume loss.

Cardiogenic shock occurs when the heart fails as a pump and cannot generate sufficient cardiac output to meet the body's metabolic needs, despite adequate or excessive intravascular volume. Common causes include: massive myocardial infarction (>40% LV muscle loss), severe myocarditis, end-stage cardiomyopathy, acute valve failure (papillary muscle rupture), and cardiac tamponade (technically obstructive shock). Clinical features differ from hypovolemic shock: tachycardia + hypotension (similar to hypovolemic) but ALSO elevated central venous pressure (distended neck veins, peripheral edema), cool/pale/clammy skin (from intense vasoconstriction), pulmonary edema (from elevated left-sided pressures), and low cardiac output despite high filling pressures. Treatment focuses on reducing afterload (vasodilators), supporting contractility (inotropes), and treating the underlying cause—not fluid administration, which may worsen pulmonary edema.

Question 31: What is the appropriate first aid for ingestion of caustic or corrosive substances (e.g., drain cleaner)?

Induce vomiting immediately to remove the substance
Call poison control or 911 immediately; give small sips of water if the person can swallow; do NOT induce vomiting, which can cause further esophageal damage (Correct answer)
Administer milk to neutralize the acid or base
Give large amounts of water to dilute the substance

Correct answer: Call poison control or 911 immediately; give small sips of water if the person can swallow; do NOT induce vomiting, which can cause further esophageal damage

Never induce vomiting for caustic ingestion—regurgitation causes re-exposure of the esophagus to the corrosive substance, worsening injury.

Caustic substance ingestion (strong acids like toilet bowl cleaner, strong alkalis like drain cleaner/lye, bleach, etc.) causes chemical burns to the mouth, pharynx, esophagus, and stomach. First aid: (1) Call poison control (1-800-222-1222 in US) or 911 immediately, (2) Do NOT induce vomiting—bringing the caustic substance back up re-exposes the esophagus and can cause additional burns, aspiration into the lungs, and perforation, (3) Do NOT administer neutralizing agents—the exothermic reaction of acid+base generates heat and may worsen burns, (4) Small sips of water may help dilute the substance if the person is conscious and able to swallow—large amounts are not recommended, (5) Do not give milk (common misconception), (6) Remove any contaminated clothing, (7) Transport immediately. Medical management includes endoscopy, airway management, and surgical consultation for perforation.

Question 32: What is 'distributive shock' and what are its main causes?

Shock caused by loss of blood volume
A type of shock where maldistribution of blood flow occurs due to pathological vasodilation, including septic, anaphylactic, and neurogenic shock (Correct answer)
Shock caused by heart pump failure
Shock caused by blocked blood vessels

Correct answer: A type of shock where maldistribution of blood flow occurs due to pathological vasodilation, including septic, anaphylactic, and neurogenic shock

Distributive shock involves abnormal vasodilation causing blood to pool in the periphery, reducing effective circulating volume despite normal or elevated total blood volume.

Distributive shock is characterized by pathological systemic vasodilation that reduces systemic vascular resistance (SVR), causing blood to distribute abnormally—typically pooling in the periphery—despite normal or increased total blood volume. Unlike hypovolemic shock (where blood is lost) or cardiogenic shock (where the pump fails), in distributive shock the vascular compartment is pathologically enlarged. Types: (1) Septic shock: most common—cytokine-mediated vasodilation from systemic infection, (2) Anaphylactic shock: IgE-mediated massive mast cell degranulation releasing histamine and other mediators, (3) Neurogenic shock: loss of sympathetic vasomotor tone from spinal cord injury, (4) Adrenal crisis: cortisol deficiency impairing vasopressor response. Shared features: warm (early) or cool (late) skin, hypotension despite normal/high heart rate, high cardiac output in early sepsis, low SVR. Treatment targets the underlying cause while supporting blood pressure.

Question 33: When should a wound require a tetanus booster as part of its management?

All open wounds require immediate tetanus vaccination regardless of immunization history
Patients with wounds who have not been vaccinated in the last 5 years (for deep/dirty wounds) or 10 years (for clean, minor wounds) should receive a booster or complete tetanus prophylaxis (Correct answer)
Tetanus vaccination is only needed if the wound is contaminated with soil
No wounds require tetanus prophylaxis in the modern era

Correct answer: Patients with wounds who have not been vaccinated in the last 5 years (for deep/dirty wounds) or 10 years (for clean, minor wounds) should receive a booster or complete tetanus prophylaxis

Tetanus prophylaxis guidelines: clean minor wounds—booster if >10 years since last dose; dirty/deep wounds—booster if >5 years; unvaccinated patients receive TIG + vaccine.

Tetanus prophylaxis recommendations based on wound type and immunization history: Clean, minor wounds: Td booster if last dose >10 years ago. No tetanus immune globulin (TIG). Tetanus-prone wounds (punctures, crush injuries, burns, wounds contaminated with soil/feces/saliva, wounds with devitalized tissue, animal bites, frostbite): Td booster if last dose >5 years ago. TIG (250 units IM) plus Td vaccine if immunization history unknown or <3 prior doses. For immunocompromised patients: consider TIG for all significant wounds. High-risk wounds: soil contamination, deep punctures, animal bites, crush wounds with devitalized tissue, wounds in patients who use IV drugs. Tdap (tetanus + pertussis) is preferred over Td for adults needing a booster if they haven't previously received Tdap.

Question 34: What is 'hemostatic dressing' and how does it work differently from regular gauze?

Hemostatic dressings contain steroids to reduce inflammation
Hemostatic dressings are impregnated with substances (kaolin, chitosan, zeolite) that accelerate the blood clotting cascade, enabling faster hemorrhage control in severe wounds (Correct answer)
Hemostatic dressings cool the wound to slow bleeding
They work by absorbing blood more quickly than regular gauze

Correct answer: Hemostatic dressings are impregnated with substances (kaolin, chitosan, zeolite) that accelerate the blood clotting cascade, enabling faster hemorrhage control in severe wounds

Hemostatic dressings contain clot-promoting agents that actively accelerate the coagulation cascade, providing hemorrhage control significantly faster than standard gauze.

Hemostatic dressings (Combat Gauze, QuikClot, Celox, HemCon) are wound dressings impregnated with substances that accelerate the normal coagulation cascade: (1) Kaolin (Combat Gauze—military standard): activates Factor XII and the intrinsic coagulation pathway, achieving hemostasis in 3 minutes with appropriate pressure, (2) Chitosan (HemCon, Celox): a positively-charged polysaccharide derived from crustacean shells that electrostatically attracts negatively-charged red blood cells, forming a physical plug independent of the normal coagulation cascade—effective even in coagulopathic patients, (3) Zeolite (older QuikClot)—now mostly replaced. Technique: pack deeply into the wound, apply firm pressure for 3-5 minutes (per manufacturer). Hemostatic dressings should NOT be used in the thoracic or abdominal cavity (can damage internal organs). They are particularly valuable for junctional wounds, neck wounds, and wounds in coagulopathic patients where standard gauze is insufficient.

Question 35: What is 'secondary survey' in trauma first aid and when is it performed?

The initial assessment for life-threatening conditions
A systematic head-to-toe assessment performed after life-threatening conditions are addressed in the primary survey, to identify all injuries including less obvious ones (Correct answer)
It is only performed by emergency physicians
Secondary survey means waiting for the second ambulance to arrive

Correct answer: A systematic head-to-toe assessment performed after life-threatening conditions are addressed in the primary survey, to identify all injuries including less obvious ones

The secondary survey is a systematic head-to-toe examination performed after the primary ABCDE survey stabilizes life threats, to identify all injuries and guide definitive care.

Trauma assessment follows a structured two-stage approach: Primary survey (ABCDE): Airway (clear/maintain), Breathing (assess/support), Circulation (hemorrhage control), Disability (neurological status), Exposure (undress/hypothermia prevention). Life-threatening conditions are identified and treated immediately. Secondary survey (performed after primary survey stabilizes life threats): A systematic head-to-toe physical examination and history (SAMPLE: Symptoms, Allergies, Medications, Past medical history, Last meal, Events/mechanism). Assessment of every body region: head, face, neck, chest, abdomen, pelvis, extremities, posterior. Purpose: identify all injuries including those that are not immediately life-threatening but will need treatment—fractures, lacerations, contusions, abdominal tenderness, spinal tenderness. First aid providers may perform a limited secondary survey during extended response times or when preparing a patient for transport. A missed injury in the secondary survey can become life-threatening if untreated.

Question 36: What is 'blast injury' classification and what unique injuries does an explosion cause?

Blast injuries only cause external burns and hearing loss
Blast injuries are classified into four types: primary (pressure wave), secondary (fragmentation), tertiary (being thrown), quaternary (burns, crush, toxic inhalation) (Correct answer)
All blast injuries are identical to gunshot wounds
Blast injuries are only dangerous within 10 meters of the explosion

Correct answer: Blast injuries are classified into four types: primary (pressure wave), secondary (fragmentation), tertiary (being thrown), quaternary (burns, crush, toxic inhalation)

The four blast injury types reflect different mechanisms: pressure wave barotrauma, fragmentation, being thrown by the blast, and burns/toxic gas inhalation from the explosion.

Explosion injuries are classified by mechanism: Primary blast injury: caused by the high-pressure blast wave (overpressure wave) interacting with gas-filled body cavities. Most susceptible organs: ears (tympanic membrane rupture—most common), lungs (blast lung—hemorrhage, pneumothorax, air emboli), GI tract (perforation), sinuses. Often no external marks. Secondary blast injury: caused by fragmentation—projectiles (shrapnel, glass, debris) driven by the explosion, causing penetrating wounds. Most common blast injury. Tertiary blast injury: the victim is physically displaced and impacts surfaces—causing blunt traumatic injuries (fractures, TBI). Quaternary blast injury: all other explosion-related injuries including: burns (thermal, flash, chemical), crush injuries from structural collapse, toxic inhalation (CO, cyanide, smoke), and radiation (nuclear devices). Quinary blast injury (recently proposed): biological contamination from 'dirty' bombs.

CPR First Aid: Wounds, Burns and Shock 1

What is the primary first aid treatment for a minor laceration (cut) with active bleeding?

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