Chapter 26 Bleeding

Question 1

What is the significance of recognizing bleeding and understanding how it affects the body?

Answer 1

It is an important skill

Bleeding can be external and obvious or internal and hidden, both of which are potentially dangerous.

Question 2

What are the potential consequences of bleeding?

Answer 2

• Weakness
• Shock
• Death

Uncontrolled bleeding is the most common cause of hypoperfusion following a traumatic injury.

Question 3

What are the components of the cardiovascular system?

Answer 3

• Pump (heart)
• Container (blood vessels)
• Fluid (blood and body fluids)

The cardiovascular system circulates blood to all the body’s cells and tissues.

Question 4

What are the types of blood vessels?

Answer 4

• Arteries
• Arterioles
• Capillaries
• Venules
• Veins

Oxygen and nutrients easily pass from the capillaries into the cells.

Question 5

What does perfusion refer to?

Answer 5

The circulation of blood within an organ or tissue in adequate amounts

Adequate perfusion is necessary to meet the cells’ current needs for oxygen, nutrients, and waste removal.

Question 6

What are the characteristics of external bleeding?

Answer 6

• Poor general appearance
• Signs of shock
• Significant blood loss
• Rapid blood loss
• Uncontrolled bleeding
• Significant MOI

Arterial bleeding is typically brighter red and spurts in time with the pulse.

Question 7

What is the maximum acute blood loss the body can tolerate?

Answer 7

Greater than 20% of blood volume (about 2 pints)

Adverse changes in vital signs may occur with significant blood loss.

Question 8

What are the signs and symptoms of internal bleeding?

Answer 8

• Pain
• Swelling
• Distention
• Dyspnea
• Tachycardia
• Hypotension
• Hematoma
• Bruising
• Bleeding from any body opening

Internal bleeding can be very serious and is not easy to detect immediately.

Question 9

What does DCAP-BTLS stand for?

Answer 9

• Deformities
• Contusions
• Abrasions
• Punctures/penetrations
• Burns
• Tenderness
• Lacerations
• Swelling

This mnemonic is used to assess for signs of injury.

Question 10

True or false: Hemophilia means the patient lacks one or more of the blood’s clotting factors.

Answer 10

TRUE

Patients with hemophilia may experience spontaneous bleeding.

Question 11

What are the methods to control external bleeding?

Answer 11

• Direct, even pressure
• Pressure dressings and/or splints
• Tourniquets
• Hemostatic dressing
• Wound packing

Direct pressure is the most common and effective way to control external bleeding.

Question 12

What should you do if obvious, life-threatening bleeding is present?

Answer 12

Control it as quickly as possible

Ensure the patient has an open airway and is breathing adequately.

Question 13

What is the role of tourniquets in bleeding control?

Answer 13

Used if direct pressure does not control extremity bleeding

A tourniquet is only useful if a patient has substantial bleeding from an extremity injury.

Question 14

What are junctional tourniquets used for?

Answer 14

Proximal compression of life-threatening bleeding in areas where standard tourniquet application is not possible

They may be indicated for severe hemorrhage at the junction of the torso with the arms or legs.

Question 15

What are the signs of hypoperfusion?

Answer 15

• Change in mental status
• Weakness or dizziness
• Changes in skin color
• Tachycardia
• Cold, moist skin
• Altered level of consciousness

These signs suggest internal bleeding and require prompt transport.

Question 16

What is the primary assessment in patient assessment for bleeding?

Answer 16

• Identify life threats
• Form a general impression
• Perform a rapid exam
• Assess skin color
• Determine level of consciousness

Address obvious, life-threatening external bleeding first.

Question 17

What should you do if a patient has substantial bleeding from an extremity injury?

Answer 17

Follow the steps in Skill Drill 26-3 to demonstrate applying commercial tourniquet

This is critical for managing severe bleeding effectively.

Question 18

What are junctional tourniquets used for?

Answer 18

• Proximal compression of life-threatening bleeding
• Areas where standard tourniquet application is not possible
• Severe hemorrhage at the junction of the torso with the arms or legs

Some junctional tourniquets may be used as a pelvic binder.

Question 19

What are the functions of air splints?

Answer 19

• Control internal or external bleeding associated with severe extremity injuries
• Immobilize fractures
• Act like a pressure dressing applied to an entire extremity

They provide broader support compared to localized dressings.

Question 20

What is a pelvic binder used for?

Answer 20

Indicated for a suspected closed unstable pelvic fracture

Helps control internal bleeding, especially with life-threatening open-book pelvic fractures.

Question 21

What conditions can result in bleeding from the nose, ears, and mouth?

Answer 21

• Skull fracture
• Facial injuries
• Sinusitis
• High blood pressure
• Coagulation disorders
• Digital trauma
• Cancer

These conditions can indicate serious underlying issues.

Question 22

What is epistaxis?

Answer 22

Common emergency that can occasionally cause enough blood loss to lead to shock

The visible blood may be only a small part of the total blood loss.

Question 23

How can you effectively handle a nontraumatic nosebleed?

Answer 23

Pinching the nostrils together

Follow the steps in Skill Drill 26-4 to control epistaxis.

Question 24

What does bleeding from the nose or ears following a head injury indicate?

Answer 24

May indicate a skull fracture

Do not attempt to stop blood flow; apply light compression and cover the site with a sterile gauze pad.

Question 25

What is the first step in **emergency medical care for internal bleeding**?

Answer 25

Keep the patient calm, reassured, and as still and quiet as possible ## Footnote This helps minimize further injury and complications.

Question 26

What should you never use to control bleeding from **closed, internal, soft-tissue injuries**?

Answer 26

A tourniquet ## Footnote This could exacerbate the injury and lead to further complications.