Bleeding & Shock

Question 1

Arteries

Answer 1

Systemic
• Carry oxygen-rich blood away from the heart
• Comprised of thick, muscular walls that enable dilation and constriction
Pulmonary
• Pulmonary artery

Question 2

Veins

Answer 2

• Carry oxygen-depleted blood rich in carbon dioxide back to the heart
• Contain one-way valves to prevent back flow of blood

Question 3

Capillaries

Answer 3

• Microscopic blood vessels
• Vital exchange site: oxygen, nutrients passed through
capillary walls in exchange for
carbon dioxide from cells - occurs in the alveoli - circulatory system rich in CO2 (during exchange)

Question 4

Functions of Blood

Answer 4

• Transportation of gases
• Nutrition
• Excretion
• Protection
• Regulation

Question 5

Perfusion

Answer 5

Adequate circulations of blood throughout body

Question 6

Hypoperfusion (Shock)

Answer 6

Inadequate circulations of blood to tissues and organs

Pump Problem - cardiogenic
Content - hypovolemic, dehydration, bleeding
Container Problem - Sepis, Anaphylaxis, neurogenic

Question 7

Two Types of Bleeding

Answer 7

• External
• Internal -

main area you can loose enough blood to die in thorax, abdomen, pelvis, femur fracture

how much blood do I have to loose to have a problem

20% rule (circulating blood volume)

1200ml (6000ml x 20%)

Question 8

External Bleeding What does it look like:
Arteries:
Veins:
Capillaries:

Answer 8

Arteries: Spurting Blood, Pulsating Flow, Bright Red Color

Veins: Steady, slow flow, Dark Red Color

Capillaries: Steady Even Flow

Question 9

Arterial External Bleeding is?

Answer 9

Oxygen Rich
Rapid and profuse
Spurting with heartbeat
Most difficult to control

Question 10

Venous External Bleeding is?

Answer 10

Rich in carbon dioxide & waste
Steady flow
Easier to control
low pressure system

Question 11

Capillary External bleeding is?

Answer 11

Slow and Oozing
Easily controlled
Stops Spontaneously

Question 12

Think About It: Bleeding

Answer 12

• How severe is the bleeding? Is it exsanguinating hemorrhage? If so, how does that affect the priorities of treatment?

Question 13

Patient Assessment - Primary Assessment

Answer 13

Standard Precautions
Open Airway
Monitor Respirations
Ventilate if Necessary
Control Bleeding
Skin: Color, Temp, Condition, Check Pulses

Question 14

Methods to Control External Bleeding

Answer 14

Direct Pressure
Elevate
Pressure Dressing
Tourniquet

Question 15

Direct Pressure - How to

Answer 15

• Apply firm pressure to wound with gloved hand and gauze bandage
• Hold pressure until bleeding is controlled
• If necessary, add dressings when lower ones are saturated
• Never remove bandages—even when bleeding is controlled
• When controlled, check for pulse distal to wound - PMS

Question 16

Elevate

Answer 16

• Elevate injured extremity above level of the heart while applying direct pressure
• Do not elevate if musculoskeletal injury is suspected

Question 17

Pressure Dressing

Answer 17

• Place several gauze pads on wound
• Hold dressings in place with self-adhering roller bandage wrapped tightly over
dressings and above and below wound site
• Create enough pressure to control bleeding

Question 18

Hemostatic Agents

Answer 18

• Commonly, dressing containing substance that absorbs and traps red blood cells
• Can be wadded up and inserted into wound
• May be a powder poured directly into the wound
• Manual pressure is always necessary

Question 19

Tourniquet

Answer 19

• Use if bleeding is uncontrollable via direct pressure
• Use only on extremity injuries
• Once applied, do not remove or loosen
• Attach notation to patient alerting other providers tourniquet has been applied

Question 20

Think About It: Bleeding

Answer 20

• Is the current method of bleeding control working? Do you need to move on to a more aggressive step? How would you
evaluate this?

Question 21

Other Ways to Stop Bleeding

Answer 21

• Splinting
• Cold application
• Pneumatic anti-shock garment (PASG)

Question 22

Special Bleeding Situations Head Injury

Answer 22

• Head injury
– From increased intracranial pressure, not direct trauma
– Stopping bleeding only increases intracranial pressure

Question 23

Special Bleeding Situations Nose Bleeds (Epistaxis)

Answer 23

– Have patient sit and lean forward
– Apply direct pressure to fleshy
portion of nostrils
– Keep patient calm and quiet
– Do not let patient lean back
– If patient becomes unconscious, place patient in recovery position and be prepared to suction

Question 24

Internal Bleeding

Answer 24

• Damage to internal organs and large blood vessels can result in loss of a large quantity of blood in short time
• Blood loss commonly cannot be seen
• Severe blood loss can even result from injuries to extremities

Question 25

Blunt Trauma is..

Answer 25

``` • Leading cause of internal bleeding – Falls – Motor vehicle crashes – Automobile–pedestrian collisions – Blast injuries ```

Question 26

Penetrating Trauma

Answer 26

• Common penetrating injuries – Gunshot wounds – Stab wounds – Impaled objects

Question 27

Signs of Internal Bleeding

Answer 27

* Injuries to surface of body * Bruising, swelling, or pain over vital organs * Painful, swollen, or deformed extremities * Bleeding from mouth, rectum, or vagina * Tender, rigid, or distended abdomen * Vomiting coffee-ground or bright-red material

Question 28

Pediatric Considerations Bleeding

Answer 28

• Infants and children—efficient compensating mechanisms maintain blood pressure until half of volume is depleted • Potential for shock must be recognized and treated before tell-tale signs appear

Question 29

Cultural Considerations: Bleeding

Answer 29

• Places on body to look to assess circulation via skin color – Fingernails and lips – Conjunctiva in eyes – Palms of hands; soles of feet

Question 30

Treatment of Internal Bleeding

Answer 30

Administer Oxygen Maintain ABC'c Control External Bleeding Rapid Transport to Appropriate Medical Facility

Question 31

Shock

Answer 31

Inability to supply cells with oxygen | Inadquate removal of waster products from cells

Question 32

Causes of Shock

Answer 32

• Failure of any component of circulatory system – Heart: loses ability to pump – Blood vessels: dilate, making too large a “container” to fill – Blood: loses volume from bleeding Pump Content Container

Question 33

Severity of Shock Compensated

Answer 33

Compensated - Body shunts blood where needed

Question 34

Severity of Shock Decompensated

Answer 34

Decompensated - Blood pressure falls as body can't handle loss of blood

Question 35

Severity of Shock Irreversible

Answer 35

Cell damage occurring, causing rapid death

Question 36

During Shock

Answer 36

- Pulse increases to maintain cardiac output - Blood vessels constrict, causing pale, clammy skin - Respiration rate increases - Blood is shunted away from the GI organs causing nausea - Decreasing blood pressure is a late sign of shock

Question 37

Types of Shock

Answer 37

* Hypovolemic * Cardiogenic * Neurogenic

Question 38

Hypovolemic Shock

Answer 38

* Results from a decreased volume of circulating blood and plasma * Called hemorrhagic shock if caused by uncontrolled bleeding (internal or external) * Can be caused by burns or crush injuries

Question 39

Cardiogenic Shock

Answer 39

* Seen in patients suffering myocardial infarction * Results from inadequate perfusion to heart, decreasing strength of contractions * Heart’s electrical system may malfunction causing heartbeat that is too slow, too fast, or irregular

Question 40

Neurogenic Shock

Answer 40

* Results from inability to control dilation of blood vessels because of nerve paralysis * No blood loss, but vessels dilated so much that blood volume can’t fill them * Rarely seen in the field

Question 41

Signs and Symptoms of Shock

Answer 41

* Altered mental status * Pale, cool, clammy skin * Nausea and vomiting * Vital sign changes

Question 42

Care for Shock

Answer 42

* Aggressive airway maintenance * Administer high-concentration oxygen * Attempt to stop cause of shock * Apply and inflate PASG if approved * Splint any suspected bone or joint injuries * Prevent loss of body heat * Deliver patient to appropriate medical facility within “golden hour” * Speak calmly and reassure throughout assessment and care

Question 43

Bleeding & Shock Chapter Review

Answer 43

• Almost all external bleeding can be controlled by direct pressure and elevation. If these don’t work, apply tourniquet if bleeding is on an extremity. • Emergency care for internal bleeding is based on prevention and treatment of shock. • Early signs of shock: restlessness, anxiety, pale skin, rapid pulse and respirations. • If shock is uncontrolled, patient’s blood pressure falls (late sign of shock). • Signs and symptoms may not be evident early; treatment based on MOI may be lifesaving. • Treat shock by airway maintenance; administration of high-concentration oxygen; controlling bleeding; and keeping the patient warm. One of most important treatments is early recognition of shock and immediate transport.

Question 44

Remember: Bleeding & Shock

Answer 44

• The circulatory system is designed to ensure adequate perfusion of body tissues. • The classification of hemorrhage is directly related to the type of vessel ruptured and the pressure within that vessel. • Treatment of external hemorrhage includes progression through the following steps: direct pressure, elevation, tourniquet application, use of hemostatic agents. • Internal bleeding is impossible to evaluate. The most appropriate treatment must be rapid transport to an appropriate facility.

Question 45

Remember: Bleeding & Shock

Answer 45

* Shock develops if the heart fails, blood volume is lost, or blood vessels dilate, resulting in inadequate perfusion. * Signs of shock reflect the body’s attempts at compensating for inadequate perfusion. * The most significant treatment for the shock patient is early recognition and prompt transport to a hospital where the patient will receive definitive care.

Question 46

Questions to Consider: Bleeding & Shock

Answer 46

* What can I use for a tourniquet that will control bleeding but not damage tissue? * When treating a patient with shock, what should I do at the scene and what should I do en route to the hospital?

Question 47

Questions to Consider: Bleeding & Shock

Answer 47

• Is a patient with pale, cool skin, tachycardia, and rapid, shallow respirations in shock or just under stress? How will continuing assessment help in making that decision?

Question 48

Critical Thinking • A patient has been involved in a motor vehicle collision. There is considerable damage to the vehicle. The steering column and wheel are badly deformed. The patient complains of a “sore chest.” You note no external bleeding.

Answer 48

• The patient’s vital signs are pulse 116, respirations 20, blood pressure 106/70. How would you proceed to assess and care for this patient?

Question 49

Be Able to trace a drop of blood through the body including the valves of the heart

Answer 49

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Question 50

an adult patient with a blood volume of 7 will start to see symptoms of shock after how much blood loss

Answer 50

.

Question 51

test questions on what does blood loss look like bright red Dark red color steady even flow which type of blood loss is characterized by......

Answer 51

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Question 52

Always check the pulse distal to the injury, PMS

Answer 52

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Question 53

can use an BP cuff as a tourniquet

Answer 53

look this up in the book - pg 627

Question 54

Nosebleed

Answer 54

lean the patient back swallow blood they are going to vomit blood they get in the mouth spit it out

Question 55

recovery position

Answer 55

place pt on left side

Question 56

can loose a two liters of blood with bilateral femur fracture.

Answer 56

.

Question 57

blunt trauma pt in cardiac arrest don't survive penetrating trauma a little bit better lost circulating blood volume

Answer 57

.

Question 58

internal

Answer 58

look of for mechanism bruising over liver is it rigid or hurt

Question 59

kids compensate much better than adults - they maintain for a longer period of time - and then drop off a cliff

Answer 59

.

Question 60

Three phases of shock

Answer 60

compensated - increases HR, Blood vessels get smaller - HR 130, cool clammy skin, BP 120/80 decompensated - blood pressure starts to fall - not a good sign prehospital - HR, Skin, abdomen irreversible

Question 61

know symptoms of shock in kids | 633

Answer 61

.

Question 62

know compensated, decompensated, irreversible last vital sign to fail in shock in BP

Answer 62

.

Question 63

hypovolemic - content - blood vomiting, diarrhea, shot dehydration cardiogenic - pump nuerogenic - container septic anaypy psychogenic

Answer 63

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Question 64

care for shock

Answer 64

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