Page 41 - JSOM Fall 2025

D) aPTT/INR level
E) X-ray of the extremity distal to the access site
13. Which is the best method to rapidly obtain arterial access of the common femoral artery?
A) Fluoroscopic guidance of a hollow-tip needle
B) Ultrasound guidance of a hollow-tip needle
C) Puncture with a hollow-tip needle above the inguinal canal
D) Open groin cut-down
E) Both B and D
14. A trauma patient with pelvic crush injury is hypotensive and a non-responder to fluid and blood product resuscitation. A pelvic binder is
placed with no improvement in blood pressure despite ongoing resuscitation. No other injuries are present. You decide to place an ER-
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REBOA catheter, but the pelvic binder appropriately obscures the arterial access site. What is the best option to facilitate obtaining arterial
access in this patient?
A) Remove the pelvic binder to improve exposure
B) Brachial artery access
C) Open cut-down on the superficial femoral artery
D) Ultrasound guided access of the superficial femoral artery with a hollow-tip needle
E) Cut a window in the pelvic binder to access the common femoral artery
15. In which of the following would REBOA have a role in hemorrhage control?
A) Penetrating cardiac trauma
B) Exsanguinating upper extremity injury
C) Penetrating neck trauma with uncontrolled bleeding
D) Penetrating right upper quadrant wound with hypotension
16. In placing an ER-REBOA catheter, what is the external landmark that should be used for placement of the p-tip to approximate Zone 1
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aortic balloon position?
A) Tip of the xiphoid process
B) Umbilicus
C) Mid-sternum
D) Sternal notch
17. What is the best external anatomic landmark to locate the common femoral artery for insertion of a femoral arterial line or arterial sheath?
A) Arterial pulse immediately caudal to the inguinal skin crease
B) Palpable pulse in proximal thigh
C) Arterial pulse immediately caudal to an imaginary line connecting the anterior superior iliac spine and pubic tubercle
D) Immediately medial to the site where venous blood was aspirated caudal to the level of the inguinal ligament
18. A patient with an open pelvic fracture had a REBOA catheter placed and inflated in Zone 3. He was then brought to the operating room
and had preperitoneal packing performed. He was resuscitated with blood products and is now normotensive. All of the following are
appropriate considerations regarding balloon deflation EXCEPT:
A) Pre-notification of anesthesia
B) Pre-emptive administration of bicarbonate and calcium
C) Minimize ischemia time by rapid balloon deflation
D) Use of partial balloon deflation with progression guided by hemodynamic parameters
E) Pre-emptive administration of pressors prior to balloon deflation
19. The phrase “3 and 8, don’t overinflate” refers to:
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A) The expected external diameter (in cm) of the inflated ER-REBOA balloon in aortic Zones 3 and 1, respectively
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B) The expected volume of fluid injected (in mL) into the ER-REBOA balloon typically required to achieve aortic occlusion in aortic Zones
3 and 1, respectively
C) The maximal aortic occlusion time (in hours) for Zones 1 and 3, respectively
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D) The two recommended sheath sizes for ER-REBOA and Coda balloon placement
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20. In placing an ER-REBOA catheter, what is the external landmark that should be used for placement of the p-tip to approximate Zone 3
aortic balloon position?
A) Tip of the xiphoid
B) Umbilicus
C) Mid-sternum
D) Suprasternal notch
21. A soldier has a REBOA placed by an austere surgical team for exsanguinating hemorrhage following an IED blast. He undergoes damage
control laparotomy with packing of a major liver injury. Following this procedure there are no signs of ongoing bleeding, but the patient is
acidotic and has an INR of 2. He is now being prepared for helicopter transport to a Forward Surgical Team that is 20 minutes away. The
optimal management for the REBOA catheter and sheath will be which of the following:
A) Transport with femoral sheath in place and REBOA in place and inflated
B) Remove REBOA catheter and remove the femoral sheath prior to transport
C) Transport with femoral sheath in place and REBOA in place but deflated
D) Remove REBOA catheter and leave the femoral sheath in place
22. A patient arrives at your Forward Surgical Team with penetrating wounds to the abdomen and an initial SBP of 60 mmHg. He has a positive
FAST and a normal CXR, but then progresses to PEA arrest 10 minutes after arrival. Which of the following statements is correct regarding
the role for REBOA in traumatic arrest?
A) REBOA is associated with similar time to achieve aortic occlusion compared to ER thoracotomy
B) REBOA is contra-indicated in traumatic arrest due to penetrating mechanisms
C) Placement of the 7 French sheath is best performed using palpation and landmarks in this scenario
D) Blood product resuscitation should not be initiated until the REBOA is in place and inflated

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